58th All India Congress of Obstetrics & Gynaecology

21st - 25th January, 2015 | Chennai, INDIA

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Comparative Study On Of Ultrsound And Ct In The Diagnosis Of Ovarian Tumours And Its Correlation With Surgical
Staging And Histopathology
Author: Dr. Anuragamayi Yelamanchili
Co Author: Rajyalakshmi.D1, Karunakumari.Ch2, Umadevi3,

Abstract
Comparative Study On Of Ultrsound And Ct In The Diagnosis Of Ovarian Tumours And Its Correlation With Surgical
Staging And Histopathology
Dr.Y.Anuragamayi,Asst. Professor, ,Dr.D.Rajya Lakshmi ,Professor, Dr. Ch.Karuna Kumari, Asst.Professor.Dr.K.Uma Devi
,Post Graduate.Department Of Obstetrics & Gynaecology, Rangaraya Medical College, Kakinada, A.P.
Aims And Objectives :
To Compare The Diagnostic Features Of Ovarian Tumours Through Ultrasound And Ct Preoperatively And Its Correlation
With Surgical Staging And Histopathology . To Calculate Sensitivity And Specificity Of Ct And Usg In Diagnosis Of Benign
And Malignant Ovarian Tumours.

Materials And Methodology:

The Study Was Carried On 100 Patients Over A Period Of 2 Years, Who Were Attending The Gynecology And
Radiology Departments,Government General Hospital Kakinada, With Strong Clinical Suspicion Of Ovarian Tumours
Were Studied,With Usg And Ct And Then They Were Followed Up With Intraoperative, Post Operative & Hpe Findings.
Inclusion Criteria: Aii Age Groups,Primary Ovarian Tumuors
Exclusioncriteria:Functionalovariancyst,Secondaryovarian Tumuors,Endometriomas
Results:Sensitivity And Specificity Rates Of Usg In Identification Of Benign Tumuors Are 87.8% And 61% Respectively,In
Malignant Tumuors Are 61% And 87.8% Respectively With Accuracy Rate Of 81%. Sensitivity And Specificity Rates Of Ct
In Identification Of Benign Ovarian Tumours Are 97.2% And 92% Respectively, In Malignant Tumuors 92% And 97.2%
Respectively ,With An Accuracy Rate Of 96%.
Conclusion: Ct Is Definitely Superior To Usg In Determining The Nature Of Ovarian Tumors.Sensitivity And Specificity Of
Ct In Detecting Ovarian Tumours Is More Compared To Usg.Overall Accuracy Rate Of Ct In Detecting Ovarian Tumuors Is
96% When Compared To 81% By Usg. Usg Should Be Initial Screening Procedure Because It Is Highly Sensitive Though Not
Specfic In Characterization Of Nature Of Benign Tumours.Due To The Cost Effectiveness, No Requirement Of Contrast
Material And Lack Of Ionizing Radition And Good Sensitivity Rates, Usg Is Efficient As A Good Initial Imaging Modality Of
Choice.

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An Unusual Case Of Choriocarcinoma With Tropical Spleenomegaly

Author: Dr. Navya Kottapalli
Co Author: Dr.G.C.Prabhakar1, Dr.Kavitha2,

Introduction:
Choriocarcinoma Is A Malignant Neoplasm Of Placental Trophoblasts.In Asia, Its Incidence Is 1:500 To 1:1000 Live Births.It
Manifests As A Persistent Gestational Trophoblastic Neoplasm Following Molar Evacuation Or More So After A Non Molar
Pregnancy. On The Other Hand ,Tropical Spleenomegaly Is Commonly Seen In Malaria Endemic Areas And May Manifest
As Massive Spleenomegaly With Pancytopenia. Here, We Present An Unusual Case Of Choricarcinoma With Tropical
Spleenomegaly.
Case Report: A 25 Year Old Lady Who Is P2L2A1,Presented With Persistent Molar Pregnancy Following Post Molar
Evacuation . Ultrasonography Findings Revealed Intra Uterine Heterogenous Hyperechoic Mass With Few Anechoic
Spaces Along With Massive Spleenomegaly.On Further Investigations, There Was No Evidence Of Metastasis.
Pancytopenia Due To Hypersplenism Was Attributed To Tropical Spleenomegaly. As The Patient Belonged To A Low
Socioeconomic Status, With Completed Family And Could Not Come For Regular Follow Up, Total Abdominal
Hysterectomy Was Done . Histopathologicalexamination Revealed Choriocarcinoma.Finally,She Was Diagnosed To Be A
Low Risk Case Of Stage 1 Choriocarcinoma.After Initiating Anti Malarial Therapy For Tropical Spleenomegaly And
Correcting Pancytopenia With Blood Transfusions, 1 Course Of Single Drug Chemotherapy Regimen Of Methotrexate
Was Given.Fortunately,There Was Remission Of The Disease With One Cycle And The Patient Is Still Under Follow Up.
Conclusion : Gestational Trophoblastic Tumors Are Among The Rare Human Tumors That Can Be Cured Even In The
Presence Wide Spread Dissemination.Choriocarcinoma In Women With Low Risk Has A Cure Rate Of 100%.It Can Be
Achieved By Early Diagnosis And Prompt Treatment With Multi Disciplinary Approach.

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Peripartum Hysterectomy - A Life Saving Procedure In Pph Which Is Still A Catastroph In Rural India
Author: Prof. Vijayasree Medarametla
Co Author:

Abstract
Aims And Objectives: To Determine The Frequency, Indications, Risk Factors, Maternal And Perinatal Out Come Of
Peripartum Hysterectomy.
Materials And Methods: It Is A Prospective Study Done In Mamata Medical College, Khammam In The Department Of
Obstetrics And Gynaecology From July 2009 To June 2014 Over A Five Years Period .All The Patients Who Delivered Either
Vaginally Or By Caesarean Section And Underwent Hysterectomy In The Immediate Post-Partum Period Were Included .
Their Outcome Was Noted And Results Were Analysed.
Results: During The Study Period, 25 Patients Underwent Peripartum Hysterectomy . The Most Common Indication Was
Pph Due To Uterine Rupture: 15 (60% ) Followed By Uterine Atony: 6 (24% ) And Adherent Placenta: 4 (16% ). Almost
Half Of Them: 12 (48%) Were Unbooked .The Mean Age Of The Patients Was 35 Years & Mean Parity Was 5. Out Of The
25 Hysterectomies Complications Occurred In 10 Patients (40% ): Hypovolemic Shock 6 (24%), Bladder Injury 3(12%) And
Dic 1(4%).Internal Iliac Artery Ligation Was Done In 3 (12%) Patients.B- Lynch Was Done In All The Patients With Uterine
Atony 6 (24%). All The Patients Received Blood Transfusion And Average Transfusions Were 5 Units. The Still Birth Rate
Was 8 (32% ) , Over All Perinatal Mortality Was 12 (48% ) And Maternal Mortality Was 3 (12% ). The Average Duration
Of Hospital Stay Was 15 Days.
Conclusion: Peripartum Hysterectomy Remains A Life Saving Procedure In Obstetrical Hemorrhage Refractory To Other
Measures. The Indication In Recent Years Has Changed From Uterine Atony To Abnormal Placentation. Anticipation Of
Risk Factors, Early Management By An Experienced Obstetrician Will Reduce Maternal Morbidity And Mortality.
Key Words: Peripartum Hysterectomy, Obstetric Hemorrhage, Ruptured Uterus, Maternal Morbidity And Mortality.

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Water Birth:Is It Implementable In India?

Author: Prof. Fatima Poonamwala
Co Author: Dr.Fatima Poonawala1,

Water Birth:Implementable In India?

Dr. Fatima Poonawala Mrcog
Alfa Clinic.Bangalore .
Introduction:
The Positive Physiological Effects Of Water Like Buoyancy , The Hydrostatic Pressure And The Associated Thermal
Changes Of Warm Water Is Used To Give Pain Relief To Laboring Patients.

Water Birth Is Not Traditionally Available In India, We Were Led Into This By Patients Demand And Started Offering
This Option Since November 2011.

Aims: To Study , The Maternal And Fetal Outcome Of Mums Immersed In Warm Water, For Analgesia, In India Where
We Are Culturally Different, Not Used To Tub Bathing, And Where Obstetrician Is The Lead Care Provider.
Methods:
Leaflets Explaining The Concept Of Water Labour Were Available At The Reception At Alfa Clinic, Introducing The Option
To Our Pregnant Mums.
They Were Counselled Individually Once They Expressed Interest .
Final Selection Was Made In Labour.
This Is A Retrospective Study Of A Small Number Of Patients [70],Who Chose To Labour In Water At Alfa Clinic Over Thirty
Months.
70 Water Labours
25 Underwater Deliveries.
45 Abandoned Water/6 Lscs

Results:

Maternal:
Waterbirth

Perineal Trauma:

All 25 Had Second Degree Tears

Intact Perineum:0
Third Degree Tears: 0

Post Partum Haemorrhage: 1

Additional Analgesia Requirement: 4 Required Entonox

.
Maternal Satisfaction: 2 Said No Difference

Waterlabour Only

Additional Analgesia Requirement: 1 Had Epidural Who Also Had Lscs

Fetal Outcome: Water Birth:

Cord Snapping:

Nicu Admission: 0
Waterlabour Only:
Nicu Admission: 3
Fetal Infection: 0
Perinatal Mortality: 0
Conclusion: Thus , With Close Vigilance, Water Birth Is A Safe Alternative To Land Birth , Attenuating Normalcy, In A
Selected Group Of Low Risk Women, Requiring Very Little Intervention, And Offering A Good Birthing Experience, In An
Obstetrician Led Unit, In India.

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Rare Case Of Severe Endometriosis In An Elderly Primi With Term Pregnancy

Author: Dr. Gomathy Rakkiyannan
Co Author: Dr.R.Thamil Kothai, M.D.,O.G.,1, Dr.Sheba Rosatte Victor, M.D.,O.G.,2, Dr.Meena, M.D.,D.G.O.,Dnb.,3,

Abstract
Background
Endometriosis Is A Chronic Inflammatory Condition Where Abnormal Growth Of Endometrial Tissue Takes Place
Outside The Uterus. Endometriosis And Pregnancy Are Like Two Opposite Poles. Most Women With Endometriosis Suffer
From Miscarriages And Infertility. Studies Showed That Spontaneous Conception Is Possible Only In 3% Of The Cases In
Severe Endometriosis With Unexplained Infertility. Endometriosis Is Prevalent In Subfertile Than Fertile Women.
Case
A 42 Year Old Elderly Primi Married For 22 Years, Investigated For Infertility On And Off Had Been Admitted For
Safe Confinement. Her Basic Blood Investigations Were Within Normal Limits And Was Planned For Elective Lscs With An
Indication Of Elderly Primi With Long Period Of Infertility. Intra Operative Finding Showed Distorted Uterus With Scarred
Puckered Posterior Surface With Partial Obliteration Of Pouch Of Douglas, Both Ovaries Were Elongated And Fixed To
Posterior Surface Of Uterus, Powder Burnt Areas Were Seen Over The Bowel And Mesentry. She Delivered An Alive Term
Girl Baby In Good Condition.
Conclusion
This Case Is Presented For Its Rarity Of Clinical Presentation Where Spontaneous Conception To Term Pregnancy
In Severe Endometriosis Is Possible At This Age.

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Maternal Mortality Rate

Author: Dr. Suneeya Pattabhi
Co Author:

Abstract
Introduction:
Maternal Mortality Remains One Of The Most Serious Public Health Problems In India. Even Today 20% Of Maternal
Deaths Occur In India. As Per Indian Statistics 178 Maternal Deaths Occur Out Of 1 Lack Live Births
Materials And Methods:
Retrospective Analysis Of Maternal Deaths Over A Period Of 1 Year From August 2013 To July 2014 In A Tertiary
Care Hospital Guntur Medical College Andhra Pradesh Was Done.
Results:
The Deaths Occur Mostly In The Age Group 20 To 24 Years.
Out Of 62 Cases
Ante Partum Eclampsia With Hellp 38%
Pph Followed By Dic 34%
Pulmonary Embolism 11.2%
Abruption With Page Iii 6.4%
Hepatic Encephalopathy With Hepato Renal Failure 11.2%
Acute Renal Failure 9.6%
Cardiac Failure With Peripartum Cardiomyopathy 6%

Conclusion:

In 62 Cases Most Of The Maternal Deaths Are Un Booked Cases Refereed From Nearby PhcS ChncS And
Nearby District Hospitals Have Been Avoided If They Have Registered Early And Received Proper Antenatal Care Early
Diagnosis Timely Intervention And Early Referral .

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A Randomised Controlled Trial Of Oral Nifedipine Vs Oral Labetalol In Management Of Hypertension In Pregnancy
Author: Dr. Shailaja Bidri
Co Author:

Paper Presentation
Dr .Shailaja.R.Bidri
Professor
Department Of Obstetrics And Gynaecology
BldeuS Shri.B.M.Patil Medical College, Bijapur (Karnataka).

Title A Randomised Controlled Trial Of Oral Nifedipine Vs Oral Labetalol In Management Of Hypertension In
Pregnancy

Abstract

Introduction - Hypertensive Disorders Complicating Pregnancy Are Common , Contributing

Greatly To Maternal Morbidity And Mortality. One In Ten Women Will Develop Hypertension
During Pregnancy And Preeclamsia Complicates 2% To 8% Of Pregnancy.
Aim : Compare The Efficacy Of Oral Nifedipine Vs Labetalol In Hypertension In Pregnancy And
To Assess The Adverse Effects Of The Drugs Along With Maternal And Perinatal Outcome.
Materials And Methods
102 Women , Divided As Two Groups With Gestation More Than 20 Weeks And Blood Pressure
Greater Than 140 Mmhg Systolic And / Or Greater Than 90Mmhg Diastolic Were Randomized To
Receive Either Oral Nifediine Or Oral Labetalol. The Time Required To Reduce The Blood Pressure To
Target Value , The Number Of Doses Required And The Adverse Effect Were Measured.
Results
Nifedipine Requires Short Time To Act Than Labetalol And Requires Fewer Doses Than Oral
Labetalol To Control Blood Pressure In Hypertension In Pregnancy. The Adverse Effects Were
Similar.
Conclusion
Thus The Present Study Concludes That Nifedipine Is The Preferred Drug To Control Blood Pressure
Than Labetalol In Pregnancy As It Is More Efficacious And Can Be Used In The Peripheral Centres

Due To Cost Effectiveness And Its Ease Of Administration And Storage.

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A Rare Case Of Post Hysterectomy Fibroid

Author: Dr. Gomathi Meignana Moorthy
Co Author: Dr.Sheba Rosatte Victor, M.D.,O.G.,1,

Abstract
Background
Extrauterine Fibroids Are Rare And Post Hysterectomy Round Ligament Fibroids Are Still Rarest. Extrauterine
Fibroids Are Difficult To Differentiate From Ovarian Mass, The Diagnosis Is Often Histological.
Case Report
A 45 Years Old Nulliparous Woman Presented To Our Department With Complaints Of Abdominal Pain For 3
Months Duration. She Had Already Undergone Total Abdominal Hysterectomy At The Age Of 16 Years Following Pelvic
Trauma. Speculum Examination Showed A Healthy Looking Vault And Vagina. Bimanual Examination Revealed A Firm
Mass Of 88 Cm Felt Through The Vault. Transvaginal Sonogram Revealed A Solid, Hypoehoic, Well Defined Mass Of
6.96.7Cm And Both Ovaries Could Not Be Imaged Separately. Computed Tomography Was Done Which Showed Post
Hysterectomy Status With 77 Cm Solid And Cystic Lesion In Right Adnexa. The Impression Was That Of Ovarian Mass.
Patient Was Posted For Exploratory Laparotomy. Intra Operative Findings Revealed A Pelvic Mass Of Size 87 Cm
Arising From The Remnant Of The Right Side Round Ligament With Both Ovaries Appearing Normal. Cut Section Of The
Mass Revealed A Whorled Pattern And Histopathological Report Was Consistent With The Diagnosis Of Fibroid. Post
Operative Period Was Uneventful.
Conclusion
Post Hysterectomy Fibroids Are Rare And Pose A Diagnostic Challenge. Although Imaging Modalities Can Diagnose
A Solid Mass It Seldom Gives The Correct Diagnosis. A High Level Of Suspicion Can Help In Making Such A Diagnosis.

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Tuboplasty Through Mini Lap Incision

Author: Dr. Uma Tripathi
Co Author:

Abstract

Title : : Tuboplasty Through Minilap Incision :Sharing Our Experience

Introduction : In View Of Permanent Sterilization Being Important Constituent Of National Family Planning Programme
,Sterilizations Are Nowadays Performed In Young Women Of Low Parity Thinking That Family Is Complete. However Due
To Unforeseen Circumstances, 1-3% Of These Women
Subsequently Demand Reversal Of Sterilization .With The Help Of Tuboplasty Through Minilap Incision Number Of People
Who Request For Tuboplasty Is Increasing ,
Objectives : To Study Tuboplasy Through Minilap Incision With Respect To The Following Parameters: 1.Intra-Operative
Time 2. Intra-Operative Blood Loss 3.Post-Operative Pain 4.Time Required To Start Orals Post-Op5.Day Of Achieving
Complete Ambulation 6.Post-Operative Febrile Illness7.Wound Healing 8.Hospital Stay 9.Experience Of Operating
Surgeon
Materials And Methods: It Is A Retrospective And Prospective Analytical Study Conducted In 38 Case Of
Tuboplasty Done In Sir J.J. Group Of Hospitals From 2009 To 2014 Through Minilap Incision.
Results: Results Were Calculated And Analysed After 3 Months After Histerosalpingography Done
Conclusion: As Per The Study Tuboplasty If Performed Through A Minilap
Incision By An Experienced Surgeon, Had An Overall Decreased Morbidity
Resulting In Better Patient Satisfaction And Redused Hospital Stay .

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First Trimester Detection Of Anemia Are We Too Late...?

Author: Dr. Varnika Rastogi
Co Author:

First Trimester Detection Ofanemia Are We Too Late?

Aim
To Study The Relationship Between First-Trimester Low Hemoglobin And Adverse Pregnancy Outcome.
Objectives

To Compare The Pregnancy Outcomes With Different Haemoglobin Levels Estimated In The First Trimester.

To Compare The Pregnancy Outcomes In Gravidas Whose Anemia Has Been Corrected Later In Pregnancy With
Those Whose Anemia Has Not Been Corrected.
Material And Methods
This Study Is Case Control Study Done In District Tertiary Referral Centre , Included267 Subjects ( Those Women Whose
First Trimester Heamoglobin Was Known And Was Done Before Any Episode Of Bleeding, And Had Single Term
Intrauterine Gestation, Without Preexisting Medical Disorder Or Molar Pregnancy) And Out Of These Those Who Had
Abortion Or Admitted Due To Some Complication And Delivered Were Cases And Those Who Were Admitted And
Delivered Had Normal Maternal And Neonatal Outcome Were Control. Pregnancy Outcomes Was Compared In Gravidas
Based On Icmr Classification Of Severity Of Anemia.
Result : Out Of 267 Pregnant Women Studied 96 Women Had Adverse Outcome (Cases) 171 Women Did Not Had
Adverse Outcome(Control).Out Of 96 Cases 42 Were Of Low Heamoglobin In Moderate Range And 54 Were Of Normal
Heamoglobin Range. Out Of Control 76 Were In Low Heamoglobin Of Moderate Range And 95 Were In Normal
Heamoglobin Range.
Analysis Showed That Low Heamoglobin In First Trimester Is Associated With Increased Chance Of Preterm Labour,
Uterus Inertia, Pph, Fetal Distress And Low Apgar Irrespective Of Correction .
Conclusion : Since Women Who Was Found To Have First Trimester Low Heamoglobin Got Their Anemia Corrected
Thereafter Still They Had Adverse Neonatal Outcome Indicating Importance Of Correcting Anemia Preconceptionally To
Prevent Adverse Effect.

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Case Report Of Interstitial Ectopic Pregnancy

Author: Dr. Deepika S
Co Author: Dr Halesha B1, Dr Sapna I S2, Dr Shivamurthy3, Dr Soubhagya Koujalagi4, Dr Bandamma5

Background: Interstitial Ectopic Pregnancy Accounts For Only 2-4 % Of Tubal Ectopic Pregnancies. It Has A Higher Rate Of
Morbidity And Mortality. The Use Of Injection Vasopressin Can Reduce The Morbidity By Achieving Haemostasis Early.

Case: A Case Of G2P1L1 Presented With History Of 2 Months Of Amenorrhea And Moderate Amount Of Bleeding Per
Vaginum 2 Days Prior To Admission. She Underwent Emergency Lscs For Fetal Distress 1 And Half Years Back In Our
Government District Hospital And Postoperative Period Was Uneventful.
On Examination: A 24 Year Old Lady, Moderately Built, Mildly Dehydrated And Severely Pale With Pulse Rate Of 130 Bpm
And Blood Pressure Of 100/60 Mmhg.
Systemic Examination Revealed Normal Respiratory System. Cvs Showed Tachycardia. Abdomen Was Soft And
Pfannensteil Scar Was Healthy. No Guarding Or Rigidity Was Present. Speculum Examination Showed Minimal Bleeding.
On Per Vaginal Examination Uterus Felt Bulky, Anteverted, Mobile, Soft And Nontender. Right Forniceal Tenderness Was
Present; Cervix Was Uneffaced , Os Was Closed.
Emergency Ultrasound Was Done Which Showed Right Tubal Ectopic Pregnancy Of 7 Weeks Size. Emergency Laparotomy
Was Done. Operative Findings: There Was An Unruptured Right Ectopic Interstitial Pregnancy. Uterus Was 8 Weeks Size;
Right Fallopian Tube & Ovary Were Normal; Left Adnexa Was Normal. No Haemoperitoneum Was Present. Laparotomy
Proceeded With Linear Incision On Right Cornuo-Tubal Junction With Cautery And Removal Of Products Of Conception
From The Right Interstitium. Incidentally Right Fallopian Tube Was Injured Hence Right Salphingectomy Was Done.
Haemostasis Could Not Be Achieved With Multiple Suturing. Hence Injection Vasopressin 20 Units In 20 Ml Of Normal
Saline Was Injected Around The Right Cornua. Then Haemostasis Was Achieved. Patient Was Discharged On 5Th Post
Operative Day.

Conclusion: Injection Vasopressin Can Be Successfully Used To Achieve Haemostasis And Reduce Morbidity In Surgery For
Interstitial Ectopic Pregnancy.

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Prospective Clinical Study Of Molar Pregnancies In Rmh Thanjavur Tertiary Care Centre
Author: Dr. Munira Veerapandi
Co Author:

Abstract
Dr. Munira.V Md (Pg)

Prof Dr. E. Kalarani Md Dgo

Backgrounds & Objectives:

Molar Pregnancy Represents A Significant Burden Of Disease. Asian Women Are At Increased Risk Of Having
Molar Pregnancy And India Is Underreported For This Disease.
Objectives:
1. To Determine The Total No Of Cases In Rmh Over A Period Of 9 Months
2. To Evaluate The Demographics , Clinical Presentation , Risk Factors, Complications
3. To Determine The Outcome Of Molar Pregnancy In A Period Of 6 Months Follow Up
Methods:
It Was A Prospective Study Of Gtd At Rmh A Tertiary Care Centre Over 9 Months From 2013 June To 2014 Feb.
The Cases Were Followed Up For 6 Months From The Day Of Surgical Evacuation
Results:
25 Cases Of Gtd Were Seen With 12816 Deliveries
Median Age Of Presentation Was 20 Yrs
Majority Belongs At 15 -20
Apart From Amenorrhoea Vaginal Bleeding Was The Most Common Presentation
Mean Gestational Age At Presentation Was 12- 16 Wks
Histopathalogy Revealed Partial Mole 53% & Complete Mole 44%
3 Of Them Developed Gtn ,2 Being Invasive Mole, 1 Choriocarcinoma
Interpretation & Conclusion:
Routine Use Of Antenatal Usg Leads To Diagnosis Molar Pregnancy In First Trimester Rather Than Late Second
Trimester. Appropriate Diagnosis & Treatment Leads To 100% Cure. Majority Of Cases Are Cured By Simple Surgical
Intervention.. Follow Up Remains Challenging Task
Keywords:
Hydatiform Mole , Gestational Trophoblastic Disease, Beta Hcg.
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Spontaneous Bilateral Ectopic Pregnancy

Author: Dr. Tasneem Shah
Co Author: Dr.Prameela Panday1, Dr.Shreedhar Venkatesh2,

Spontaneous Bilateral Ectopic Pregnancy

Authors: Dr.Tasneem Nishah Shah , Dr. Pramila Pandey , Dr. Shreedhar Venkatesh,
Vydehi Institute Of Medical Science And Research Centre; Bangalore
Introduction-Bilateral Tubal Pregnancies In Absence Of Preceding Induction Of Ovulation Are Extremely Unusual
Occurrence And Represent Rarest Form Of Extra Uterine Pregnancy. Management Of Bilateral Tubal Pregnancy In A Young
Lady Desirous Of Fertility Is A Challenging Task. This Rare Case Of Spontaneous Bilateral Ectopic Pregnancy Is Presented
With The Aim Of Highlighting The Presentation, Diagnostic Pitfalls And Treatment Options.
Case Report- 24 Year Old Primigravida, With 14 Weeks Period Of Gestation, Came To Opd With Complains Of Vaginal
Bleeding -1 Month, Intermittent Abdominal Pain. On Examination Patient Was Pale ,Pulse-108/Min ,Blood Pressure100/60 Mm Hg, Urine Pregnancy Test Weakly Positive, Per Abdomen Showed Palpable Mass In Right Iliac Fossa About
8*10 Cm Cystic In Consistency, Tenderness On Palpation, Per Vagina- Right Fornix Full, Mass Of 6*6 Cm, Cervical
Movement Tenderness Present. Emergency Scan Done Showed Empty Uterus, Et-6Mm, Right Adnexal Mass 6.9*5.8Cm
And Left Adnexal Mass 27*21*22Mm Pouch Of Douglas- Significant Amount Of Free Fluid . Culdocentesis Confirmed
Hemoperitoneum And Diagnosis Of Right Ruptured Ectopic Pregnancy Made. . Emergency Exploratory Laparotomy Was
Done Which Revealed Ruptured Right Tubal Ectopic Pregnancy In The Ampullary Region And Left-Sided Unruptured
Ectopic Pregnancy. Considering Possibilities Of Bilateral Ectopic Gestation Salphingostomy Was Done On The Left Side
And Salphingectomy On The Right Side. Histopathology Confirmed The Diagnosis Of Bilateral Tubal Ectopic Pregnancy
Conclusion
This Case Demonstrates The Importance Of Thoroughly Examining The Entire Pelvis At The Time Of Exploratory
Laparotomy. High Index Of Suspicion, Early And Accurate Diagnosis, Immediate And Skillful Surgery And Moral
Responsibility Remains The Cornerstone Of Management Of Ectopic Pregnancy.

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Role Of Hysterosalpingography In Evaluation Of Genital Tuberculosis

Author: Dr. Sindhu Tripathy
Co Author: Prof. S.N.Tripathy.1,

.
Prof.(Mrs) S.N. Tripathy, And Prof. S.N. Tripathy
Aim And Objectives.
Genital Tuberculosis Is A Very Elusive Disease. It Is Very Difficult To Diagnose As There Are No Specific Signs And
Symptoms Or Any Easy Diagnostic Procedure. Hence , The Aim Of The Study Is To Know The Definitive Signs Of
Tuberculosis In Hysterosalpingography.
Materials And Methods . A Retrospective Study Of 135 Cases Of Genital Tuberculosis Who Underwent
Hysterosalpingography To Investigate Infertility , Diagnosed Histopathologically Are Taken Into The Study. The Duration
Of The Study Is From 1970 To August 2014.
Results. Most Of The Patients Are In Their Third Decade Of Life, 110 Vs 25. Primary Infertility Was More Common Than
Secondary Infertility 99 Vs 36 Cases. The Duration Of Infertility Is More Than 5 Years In Majority. Tubal Occlusion Is
Present In 87 % Cases. Hydrosalpinx Which May Be Specific Or Nonspecific Is Found In 35 % Cases. Hydrosalpinx Is Usually
Moderate Or Slight .. The Other Tubes Are "Beaded Tube", (16% ) , "Pipestem Tube" (25 %), Cornual Block Is Present In
7 %. Other Types Of Tubes Are Present In Other Cases. Normal Uterine Cavity Is Observed In 59 % Of Women, An
Irregular Cavity In 23 %, A Shrunken Cavity In 3 %, And Synechiae In 15 % Of Women . Other Findings Of Uterus
Are"Dwarfed" Uterus , With Occluded Tubes, "T-Shaped" Uterus. "Pseudo Unicornuate" Uterus And "Collar-Stud
Abscess" Are Found Very Rarely . Cervical Findings Are Elongated Tubes (6 % ) And Sun Ray Appearances(4 % ).
Intravasation And Extravasation Of Dye Is Observed In 21 % Cases.
Conclusion. The Characteristic Radiographic Appearances On Hsg Are Reliable Indicators Of Genital Tuberculosis.
However , ,Hysterosalpingograpphy Should Never Be Done Once The Disease Is Diagnosed.

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Acute Inflammatory Demyelinating Polyneuropathy Complicating Pregnancy

Author: Dr. Rekha Velchamy
Co Author: Dr.Usha Rani M.D.Og1,

A 32 Year Old Second Gravida,Lmp :15/2/13 Edd :22/11/13 Previous Caesarean Section For Fetal Distress,Known Case Of
Epilepsy Complicating For Past 2 Years On Levitriacetam And Oxycarbamazepine Of 26 Weeks Of Gestation Was Admitted
With Complaints Of Inability To Use Both Lower Limbs For1 Day Before Which She Had An Episode Of Seizure 1 Day
Back(19/8).
Subsequently She Developed Weakness In All Four Limbs,Ptosis And Type 2 Respiratory Failure And Was Put On
Ventilator Support(24/8)(Simv Mode),Later Tracheostomy Done(5/9) . Her Nerve Conduction Studies Revealed As Severe
Demyelinating Sensory-Motor Radiculopathy With Secondary Axonal Changes. She Was Treated With 5 Doses Of
Intravenous Immunoglobulin @0.4G/Kg/Day. She Developed Left Lung Lower Lobe Collapse .Bronchial Washings Was
Found To Be Infected With Kleibsiella Species Sensitive To Piptaz And Was Treated. She Developed Hypertension And
Was Treated With Labetalol 100Mg Bd. Injection Heparin 5000Sc Bd Was Given As Dvt Prophylaxis
She Was Weaned From Ventilator On 18Th Day(11/9) And Discharged On 40Th Day.On Vdl Scopy She Developed
Left Vocal Cord Palsy. On Usg At Time Of Discharge Had An Afi 7-8.She Was Prescribed Plenty Of Oral Fluids , L-Arginine
Sachet And Capsule Astymine.She Was Readmitted In Regular An Check Up On 38Weeks Of Gestation And Delivered An
Alive Male Baby Of 2.6Kg By Caesarean Section For Fetal Distress.

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A Rare Case Of Wernicks Encephalopathy In Hyperemesis Gravidarum

Author: Dr. Musali Reddy
Co Author:

A
Rare
Case
Of
Wernicks
Encephalopathy
In
Pregnancy
A 20 Year Old Primi Gravida With 16 Weeks Pregnancy Presented With Uncontrollable Nausea , Vomiting , Dehydration
And Giddiness Since One Month. This Was Initially Controlled With Anti Emetics , But After 5 Days She Developed Ataxia
, Diplopia And Altered Sensorium . History Of Weight Loss Present. It Was A Non Consanguineous Marriage Of 4 Years,
And She Conceived After Treatment For Infertility. On Examination , She Was Thin Built , Normotensive [ 110/80Mmhg]
But Drowsy , There Was No Neck Stiffness . She Had A Ataxia Gait And A Corresponding Mild Lower Limb Peripheral
Neuropathy With Absent Deep Tendon Reflexes. She Had Bilateral Horizontal Nystagmus And Poor Visual Acuity [ Rt 6/36,
Lt 6/18] .Hematological And Biochemical Tests Results Were Normal. Ultrasound Shows Early Live Intrauterine Live Fetus
Of 12 Weeks 5 Days . Mri Revealed Acute Bilateral Thalamic Infacts . Based On Clinical Features And Her Mri Result , A
Diagnosis Of WernickeS Encephalopathy Was Made . Her Serum Thiamine Level Was Only Marginally Low At 64
Nmol/L . Therapy With Pyridoxine , Folic Acid And Intravenous Thiamine Replacement Was Given.She Made A Rapid
Clinical Recovery . Visual Acuity Returned To Normal Withi 3Days And Her Ataxic Gait Limitation And Neuropathy
Improved. Review Mri Imaging 7 Days Later Showed Moderate Resolution Of The Hyperintensities . Patient Is
Asymptomatic With Complete Disappearance Of The Thalamic Infacts .
Conclusion : As Thiamine Deficiency Has Severe Consequences . Vitamin B1 Regular Supplementation Should Be
Considered In All Pregnant Women With Hyperemesis Gravidarum .Mri Imaging May Play An Important Role In Early
Diagnosis .

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Geriatric Pelvic Organ Prolapse Surgery - Going The Extra Mile

Author: Dr. Seethalakshmi Krishnan
Co Author: Dr. K.Seethalakshmi1, Dr. N.Rajamaheswari2,

Geriatric Pelvic Organ Prolapse Surgery- Going The Extra Mile

Aim : Pelvic Floor Surgeries In Geriatric Women Are Associated With 13.6% Higher Risk Of Death Than Their Younger
Counterparts. This Study Reveals That Safe Surgery In Geriatric Patients Ameliorates Pelvic Floor Dysfunctions And
Consequently Improves Activities Like Micturition,Defecation And Sex. Thus Age Need Not Be A Barrier As Long As Safe
Procedures Are Adopted.
Objective: To Assess The Quality Of Life In Geriatric Women After Reconstructive And Obliterative Vaginal Surgery For
Advanced Pelvic Organ Prolapse (Pop).
Materials And Methods: Prospective Observational Study Was Conducted Between 2009 And 2013 At The Department
Of Urogynaecology. 217 Women In The Age Group Of 60 To 94 Years With Advanced Pop Underwent Vaginal
Hysterectomy Along With Apical Suspension Procedures Like MccallS Culdoplasty(35.02%), Sacrospinous Fixation
(8.3%), Highuterosacral Ligament Suspension (26.2%) And Iliococcygeus Fixation (4.6%) For Stage 3 /4 Pop. Abdominal
Sacrocolpopexy (3.2%) Was Performed For Stage 3/4 Vaginal Vault Prolapse. 10.1 % Of Patients With Medical
Comorbidities Underwent LeefortS Colpocleisis. Site Specific Repair (12.5%) Was Done For Stage 3/4 Cystocele &
Rectocele.
The Main Outcomes Measured Were Subjective Cure ( No Prolapse), Subjective Improvements In Pelvic Floor Symptoms
As Per The Pop Questionnaire, And Objective Cure ( No Prolapse Of Vaginal Segment )
Results:
Mean Age Of The Participants Is 64.29 Years . 85% Were Examined At 3 And 12 Months. Full Popq Evaluation Was Done.
The Subjective Cure Rate At 12 Months Is 92% And The Objective Cure Rate Is 94.5% . In 5.5% Of Patients, Prolapse
Recurred.
Conclusion: The Geriatric Patients Who Underwent Either Reconstructive Or Obliterative Procedures Showed Significant
Improvements In Pelvic Floor Symptoms Which Ultimately Saved Them From Social Embarrassment And Improved Their
Quality Of Life.
Key Words: Geriatric Women, Pelvic Organ Prolapse, Colpocleisis, Quality Of Life

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Mullerian Duct Anomaly

Author: Dr. Soruba Rani
Co Author:

Mullerian Duct Anomaly

Background:

Developmental Anomaly Of Mullerian Duct Represent Some Of Fascinating Disorders That Obstetrician
&Gynaecologist Encounter.

They Often Present After Onset Of Puberty As Menstrual Disorders

Late Presentation Include Infertility & Obstetric Complications

Surgical Development Improve Infertility& Obstetric Outcomes

Case

22 Yr Old Unmarried Girl Named Deepa

C/O: Pain During Menstruation For Past 2Yrs

H/O Dysmenorrhoea Starts On First Day,Present Throughout Cycle,Gradually Increasing During Every Cycle For
T Past 2 Yrs

Attained Menarche At 13 Yrs

Her Cycles Are Regular, 5/30,Moderate Flow

Her Secondary Sexual Characters Are Normal

P/A:Soft

L/E:Normal External Genitalia

Pubic Hair:Tanner Stage Iv

No Vaginal Septum

P/R:Cx Uterus Anteverted ,Irregularly Enlarged To 8 Week Size

Usg Abdomen&Pelvis

Uterus Appears Bicornuate With Rudimentary Right Horn

Right Horn Shows Blood Within Endometrial Cavity S/O Hematometra

Bilateral Ovaries Normal

Mri:Abdomen&Pelvis

E/O Two Uterine Horns Noted

Left Horn:Measures 5.22.2Cm

Cervix &Lower Uterine Segment Appears To Be Continuous With Left Horn Of Uterus

E/O Rudimentary Right Horn Measuring 3.52.2 Cm

Endometrial Cavity Of Right Horn Is Non Communicatingwith Blood Products

Bilateral Ovaries Normal

Both Kidneys Normal In Position & Size

Impression:Class Ii B Mullerian Duct Anomaly

Unicornuate Uterus With Non Communicating Right Rudimentary Horn

Excision Of Non Communicating Rudimentary Horn:

Under Spinal Anaesthesia,Abdomen Opened By Pfannensteil Incision
Per Op Finding: Unicornuate Uterus With Right Rudimentary Horn
Right Fallopian Tube: Rudimentary
Right Ovary:Normal
Left Fallopian &Ovary:Normal
Right Rudimentary Horn Was Excised By Clamping,Cutting,Ligating Fibromuscular Band &Round Ligament.
Postoperative Period Uneventful
Conclusion
Non Communicating Rudimentary Horn With Hematometra Should Be Excised Because Of Danger Of Pregnancy In
Rudimentary Horn From Trans Peritoneal Migration Of Sperm/Ovum From Opposite Side Resulting In Rupture Of
Horn,Sudden&Severe Intraperitoneal Hemorrhage,Shock,Death .

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A Rare Case Of Rupture Uterus With Placenta Acreta

Author: Prof. Chellamma Velleettickal Kunjukunju
Co Author: Dr. Sudhamani. C1, Dr Rekha Viswanath2,

Background:
Rupture Of Uterus Following Lscs Usually Occurs During Labour And The Incidence Is 0.5-2%. Placenta Acreta Increases
With The Number Of Caesarean Section. Both Rupture Uterus And Placenta Acreta Increases Not Only Maternal
Morbidity And Mortality And But Also Perinatal Complications.
Case:
A 29 Year Old G3P1L1A1 With Previous Caesarean Section Was Admitted At 36 Wks Of Gestation As A Case Of Previous
Cs With Type Iv Placenta Previa. Her Antenatal Period Was Unevenful. Usg In Second Trimester Showed Normal Fetus
With Placenta Completely Covering The Os. Usg With Doppler In Third Trimester Showed No Evidence Of Placenta
Acreta.
She Was Posted For Elective Lscs At 38 Weeks After Arranging 5 Pints Of Blood. At Laparotomy, It Was Surprising To
See That The Complete Uterine Scar Was Given Way And The Baby Was Lying In The Peritoneal Cavity With Intact Bag
Of Membranes. There Was No Blood In The Peritoneal Cavity. A Term Unasphyxiated Male Baby Of Weight 3.35 Kg Was
Delivered. The Uterus With The Placenta Was Found Separately And Was About 18 Weeks Size. The Placenta Was
Completely Adherent To The Lower Uterine Segment. The Bladder Wall Was Thinned Out With Big Vessels On The
Anterior Surface Of Peritoneum. Proceeded To Hysterectomy And Bladder Was Injured During The Procedure Which Was
Repaired By Urologist. 4 Pints Of Prbc And 2 Pints Of Ffp Were Transfused. Postoperative Period Was Uneventful. Mother
And Baby Were Discharged On 14 Th Postoperative Day.
Conclusion:
This Case Is A Very Rare Combination Of Scar Rupture With Another Catastrophic Condition Of Placenta Acreta
Which May Increase Maternal And Perinatal Complications. But Here The Baby Was Survived Inspite Of Scar Rupture
And Baby Lying In The Peritoneal Cavity, Probably Due To Non Separated Placenta Which Was Adherent.

***************

Study Of Rupture Uterus Over A One Year Period In Rims

Author: Dr. Darukhshan Anjum Anjum
Co Author:

Study Of Rupture Uterus Over A One Year Period In Rims

Dr. Darukhshan Anjum
Under Guidance Of Dr. Rita Lal
M.S. Obs And Gynae
Associate Professor,Rims, Ranchi
Abstract
Aims And Objectives Rupture Uterus Is A Catastrophic Complication Of Pregnant Women Which Throws Challenges To
The Obstetrician All Over The World. The Objective Of The Study Is To Analyse The Incidence, The Etiological Agent, To
Evaluate The Management And Post Operative Morbidity And Mortality.
Methods
Study Of Rupture Uterus Is A Prospective Study And Has Been Done Over A 1 Year Period From 1St August 2013 -31St July
2014 In Obstetrics And Gynaecology Department In Rims, Ranchi.
Results
There Were 56 Cases Of Rupture Uterus Over The Study Period, The Incidence Being 0.66%
,That Is 1 In 151.6
Deliveries. Women Mostly Belonged To 26-30 Years 39.2%. The Most Common Cause Of Rupture Uterus Was Obstructed
Labour 46.4% Followed By Scar Rupture. There Were 78.57% Unbooked Cases, 94.6% Were Multigravida Patients.
Patients Were Mostly Treated By Resuscitation And Laparotomy Followed By Hysterectomy (Subtotal And Total) 60.7%.
Most Common Morbidity Was Fever 32.1%, And Mortality Among Women Of Rupture Uterus Was 5.35%
Conclusion
Improving The Quality Of Health Care, Good Antenatal Care, Identification Of High Risk Cases And Timely Interference,
Prompt And Early Referral To Tertiary Centres, Improving The Educational Status, Good Intranatal Monitoring Can Prevent
Cases Of Rupture Uterus. Availability Of Blood And Blood Products, Good Ventilatory Support Can Improve The
Treatment Of Rupture Uterus.

***************

A Study Of Serum Magnesium Levels In Preterm Labour

Author: Dr. Vasavi Korupolu
Co Author: Dr Vasavi1, Dr Arunrao A2, Dr Akankshagupta3,

Serum Magnesium Levels In Preterm Labour

Dr Vasavi K, Dr Arun Rao A, Dr Akanksha Gupta
Kasturba Medical College Mangalore (A Constituent Of Manipal University).
Post Graduate1 , Professor & Hod2, Senior Resident3
Introduction- Magnesium Plays An Important Role In The Physiology Of Parturition. Decrease Of Magnesium In Plasma
May Be Responsible For Decrease Of The Same In Myometrium And This Might Have A Considerable Influence On The
Preterm Labour. Hypomagnesaemia Leads To Neuromuscular Irritability Leading To Uterine Hyperactivity Which Leads
To Cervical Dilatation .Normal Range Of Magnesium In Pregnant Women Is 1.8 To 4Mg/Dl.
Methods- It Is A Prospective Case Control Study Conducted In Government Hospital,Mangalore From December 2012 To
August 2014 After Approval From Iec.Blood Was Collected From Patients With Established Preterm Labour.
Results-The Serum Magnesium Level Of Preterm Patients Ranged From 0.9Mg/Dl To 3.00M/Dl With Mean Magnesium
Level Of 1.470.49 S.D. In Pregnant Women Of Same Period Of Gestation As That Of Cases Not In Labour Ranged From
1.2 To 3.8Mg/Dl With A Mean Magnesium Level Of 2.810.52 S.D. The Difference Between The Cases And Controls
(P<0.000) Was Found To Be Highly Significant. The Difference Of Serum Magnesium Levels Observed Between The Study
Population And Control Population Is Independent Of Factors Like Maternal Age, Parity & Gestational Age.
Conclusion-Preterm Labour Is Associated With Increased Mortality And Morbidity. Prevention Has To Be Considered
.Cases Can Be Avoided By Simple Supplementation Of Magnesium. Dietary Supplementation Of Magnesium Might
Provide An Easy And Inexpensive Means To Decrease The Problems Related To Preterm Labour.
Keywords: Preterm Labour , Serum Magnesium Levels.

***************

A Rare Case Of Bilateral Multiple Ectopic Pregnancies.

Author: Dr. Dr.Jyothsna Madan
Co Author:

Introduction: The Incidence Of Ectopic Pregnancy Is About 11/1000Pregnancy With 90% In Fallopian Tube. Simultaneous
Bilateral Tubal Ectopic Is Very Rare, Incidence Being 1 In 725 To 1In 1580 Ectopic & 1 In 200000 Iu Pregnancies.
Case Report: We Came Across A Rarest Form Of Bilateral Multiple Tubal Ectopic Pregnancy.. Mrs. N , 27 Years , Married
For 5 Years Was On Treatment For Infertility For 1 Year,& Undergone Iui On23/11/2013, Presented To Us On 19/12/2013
With H/O Pain Abdomen Of 1 Day Duration. Upt Positive On 11/12/2013.
The Diagnosis Of Ectopic Pregnancy Was Made On Clinical Suspicion & Ultrasonography Confirmed Bilateral Multiple
Tubal Ectopic Pregnancies {2 On The Left & 1 In The Right Tube}. Laparoscopic .Bilateral Salpingectomy Done & Hpe
Confirmed Gestational Sacs In Both Tubes..

***************

Health Education- Ensuring Change In Rural India And Achieving Mdg

Author: Dr. Neelam .
Co Author: Dr. Neelam, Md,Dgo, Ficog, Consultant1, Dr. Pramila Modi, Ms, Consultant2,

Women In Rural India Especially Bihar Are Very Different From Their Urban Counterparts. Still, They Are Less Educated,
Less Resourceful, And Less Privileged. Onus Of Decision Making Lies On Elderly Woman And Head (Usually Male) Of
Undivided Family. Telecommunication And Better Roads Have Made Things A Bit Easier.
Aims And Objectives- To Educate The Patients And Observe Changes In Practice Regarding
1 Regular Anc And Its Importance
2. Role Of Maternal Nutrition And Weight Gain During Pregnancy
3 Role Of Routine Laboratory Investigations And Usg In Antenatal Period
4. Preparing For Institutional Delivery E.G. Transport And Communication, Anc Records, Bag Preparation For Delivery
5. Role Of Contraception In Postnatal Period
Materials And Methods- The Study Was Conducted In A Private Nursing Home In Rural Patna District From Feb 2014- Oct
2014. Pregnant Women Coming To Opd Were Educated From 7Th Month Onwards At Each Antenatal Visit. In The 9Th
Month Their Mobile Numbers Were Recorded Together With Their Edd In A Separate Register. Patients Were Followed
Up/ Guided Even They Preferred To Deliver At Local Government Hospital (Fru) / Other Tertiary Care Hospitals At Patna.
Many Patients Came Back For Pnc Even After Delivering Elsewhere. Postnatal Contraceptive Choices Were Also Discussed
In Antenatal And Postnatal Period By Cafeteria Approach.
Results- Majority Of Patients Had Institutional Deliveries. Lack Of Transport At Odd Hours Was The Major Factor For
Home Delivery. Detail Analysis Is Being Done And Will Be Discussed.
Conclusion- Mdg-5 Can Be Achieved To A Large Extent If Every Obstetrician Working In Rural Setup Goes For It Whole
And Sole And Gives A Little Health Education To Their Patients. Information Regarding Post Natal Contraception Should
Be Provided In Antenatal As Well As Post Natal Period By A Special Nurse/ All Nursing Staff In These Setups.

***************

Study Of Postpartum Iucd (Ppiucd) Insertions In Tertiary Health Care Centre In Bihar
Author: Dr. Anita Verma
Co Author: Dr. Abha Rani Sinha1,

Objective : The Present Study Was Planned To Evaluate Efficacy, Safety And Complications Of Post Partum Iucd (Ppiucd)
Insertions In Tertiary Hospital In Bihar Where Total Fertility Rate (Tfr) As Well As Unmet Need For Contraception Is Very
High.
Method : This Is A Prospective Study Carried Out At Patna Medical College, Patna From July 2012 To June 2014. Women
Fulfilling The Inclusion And Exclusion Criteria Underwent Ppiucd Insertion After Delivery Either Vaginally Or During
Caesarean Section After Proper Counseling. They Were Followed Up In Rch Opd Before And After Six Weeks.
Results : A Total Of 2303 Ppiucd Insertions Were Done During This Period In The Labour Room And 1392 Patients Were
Followed Up Rch Opd, The Rest Being Lost. Of These 21.23% Were Post Placental, 11.38% Were Immediate Post Partum
While Majority (67.39%) Were Intra Caesarean. No Major Complication Was Observed. There Was No Case Of Perforation
In Our Series While Most Common Complaints Were That Of Irregular And Excessive Bleeding (20.6%) And Missing Thread
(19.8%). Spontaneous Expulsion Was Observed In 2.5% Percent Of Cases While 4.8% Reported Infection.
Conclusion : Ppiucd Is A Cost Effective And Safe Method Of Contraception Which If Properly Implemented Can Help Meet
The Unmet Meet For Contraception To A Great Extent

***************

Abdominal Obesity During The Menopausal Transition

Author: Dr. Kohila Kalimuthu
Co Author: Dr. N. Hepsibah Kirubamani1,

Prevalence Of Abdominal Obesity And Metabolic Syndrome Known To Increase

From Pre Menopause To
Post Menopause In Women . Whether Age Or Menopause Per Se Influences Fat Distribution Remains Controversial.
Objective: To Assess The Presence Of Abdominal Obesity And Metabolic Syndrome During The Menopausal Transition In
Women.
Materials & Method: It Is A Cross Sectional Prospective Study. We Evaluated The Presence Of Obesity In 50 Women
From 35 Years To 70 Years Attending Saveetha Medical College Obstetrics& Gynaecology Outpatient Department.
Mean Age Of Menopause In Our Study- 45.2 Yrs. Women Were Divided Into 4 Groups: Premenopausal 3539 Years
(N=7), Perimenopausal 4045 Years (N=21), Early Postmenopausal 4655 Years (N=15) And Late Postmenopausal
56 70 Years (N=7). Obesity Was Assessed According To Body Mass Index, Waist-Circumference And Waist-Hip-Ratio.
Blood Pressure, Blood Glucose, Were Recorded
Results : Bmi>25 Of Perimenopause Vs Post Menopause Women - 36%Vs 42%,Waist Circumference >80Cm Of
Perimenopuase Vs Postmenopause Women - 86% Vs 82%, Waist Hip Ratio >0.85 In Perimenopause Vs Post
Menopause Women- 84% Vs 81%. Waist Circumference (Wc) And Waist-Hip Ratio (Whr) Are Important Parameters For
The Assessment Of Abdominal Adiposity. In Our Study Compared To Bmi ,Waist Circumference, Waist Hip Ratio
That Is Abdominal Obesity Increased In Perimenopause Age Group And Among Them Diabetes & Hypertension Is
More. In Our Study The Existence Of Central Obesity Is Considerably Higher As Compared To Generalized Obesity In Both
Groups.
Diabetes And Hypertension Was Detected In 12% Of Perimenopause Women Who Had Central Obesity And 32% Of Post
Menopause Women.
Conclusion: In Our Study In Perimenopause Group {4045 Years} The Prevalence Of Abdominal Obesity Is Increased.
Hence Preventive Measures For Obesity, Diabetes And Cardiovascular Disease Should Be Undertaken In Perimenopause
Women.

***************

Primary Amenorrhoea Due To Isolated Distal Vaginal Agenesis-A Case Report

Author: Dr. Sailatha R
Co Author: Dr.Sailatha.R1, Dr.Manimaran2, Prof.Dr.Famida.A.M3, Dr.Vijayalakshmi4, Dr.Renuka.S5

Abstract-Vaginal Agenesis Is A Rare Condition Which Has An Incidence Ranging From 1 In 4,000 To 1 In 10,000
Females.MayerRokitansky Kuster Hauser Syndrome Or Mullerian Agenesis Is The Most Common Etiology Of
Vaginal Agenesis . But It Can Also Occur As An Isolated Abnormality, Incidence Of Which Is 1 In 70,000.
15 Year Old Girl Presented With H/O Lower Abdominal Pain Off And On For Past 4-5Months.She HadnT Attained
Menarche ,There Was No Other Significant History.Examination Revealed That She Had Normal Development Of
Secondary Sexual Characters. External Genitalia Was Normal.There Was A Blind Vaginal Pouch Measuring 1.5 To 2 Cms
In Depth.P/R Examination Revealed A Fibrous Band Of About 4-5 Cms In Length Felt In Place Of Vagina,Above Which A
Boggy Swelling Of 5X5 Cms Was Felt.Clinical Diagnosis Of Primary Amenorrhoea Due To Vaginal Agenesis Was
Made.Ultrasound And Mri Revealed Proximal Haematocolpos With Normal Uterus, Cervix And Ovaries.After Adequate
Pre- Op Preparation And Counselling,Vaginoplasty By Proximal Vaginal Pull Through Technique, By Trans Perineal
Approach Was Planned.Neovagina Created By Blunt Dissection Between Urethra And Bladder In Front And Rectum
Behind. Vaginoplasty Completed By Pull Through Technique Using The Mobilised Wall Of The Proximal Vagina.Vaginal
Mold Made Of Polymethyl Methacrylate Was Prepared And Placed Insitu.Procedure And Post-Op Period Was
Uneventful.Patient Was Discharged On 10Th Post-Op Day With Advice On Appropriate Usage Of The Vaginal Mold.

***************

A Prospective Study On Maternal Basal Body Mass Index And Obstetric Outcome
Author: Dr. Kaipu Swetha
Co Author:

Aim:
To Evaluate The Incidence Of Pregnant Women With Abnormal Body Mass Indices In Our Out Patient Population And
To Correlate Maternal Basal (Prepregnancy) Body Mass Index And Their Obstetric Outcome

Materials And Methods:

A Prospective Study Was Conducted Which Included 300 Antenatal Patients , Randomly Selected And Weight And Height
Recorded In Their First Visit In 1St Trimester. The Obstetric Outcome Variables Like Gestational Diabetes , Gestational
Hypertension , Preterm Delivery, Intrauterine Growth Restriction, Induction Failure, Mode Of Delivery, Postpartum
Infections Etc., Were Evaluated In The Last Trimester .

Result:
Chi-Square Test Was Used To Find The Association Between The Bmi Categories And The Outcome Variables.
Independent T Test , Anova Tests Were Used For Analysis Of Significance . Among 300 Women, 130 Were Normal
Bmi, 110 Had High Bmi [Above 23], 60 Were Under Weight. We Found A Linear Relationship Between Increasing Body
Mass Indices And The Risk Of Developing Following Obstetric Outcomes Like Pre Eclampsia N-3% High Bmi-14% [P<0.09],
Gestational Diabetes N-7.1% High Bmi-16.5% [P<0.001] , Failed Induction And Caesarean Section Rate N-14% High Bmi33% [P<0.001], Postpartum Infections High Bmi-4.8% [P<0.07] And Instrumental Deliveries High Bmi -7.8% [P<0.22].

Conclusion :
Maternal Bmi Shows Strong Association With Pregnancy Complications And Outcomes. Continuing Education Of
Health Care Workers On The Deleterious Effect Of Maternal Obesity Is Needed . A Care Plan Will Improve The Quality Of
Care Of Obese Women In Obstetrics.

Key Words : Body Mass Index, Obesity, Obstetric Outcomes.

***************

A Study On Immediate Post-Partum Insertion Of Copper T 380A To Evaluate Its Safety And Complications.
Author: Dr. Biswa Choudhury
Co Author: Bibek Mohan Rakshit1, Pradip Kumar Banerjee2, Kalyanshri Chaudhuri3, Raju Gopal Saha4, Swarupa5

Aims And Objectives:

To Assess The Acceptibility Of Immediate Post Partum Iucd Insertion Following Counselling In Terms Of Age, Parity,
Education And Socio-Economic Status. The Expulsion Rates And Compatibility Of The Women With The Iucd In The Follow
Up Period Were Also Studied.
Materials And Methods : The Study Was Carried At Burdwan Medical College And Hospital From 1.9.12 To 1.9.13 (One
Year). Parturients With Noneventful Delivery And After Exclusion Of Unresolved Pph Were Counselled For Post Placental
Iud Insertion. After Amtsl And Written Consent From The Parturients, The Cu T 380A Was Inserted In The Uterine Cavity
Following Vaginal Delivery And At Cesarean Section Through The Incision Site. They Were Followed Up At 6 Weeks And
6 Months.
Results : 370 Parturients Were Counselled Out Of Which Only 27.8 % Accepted. Acceptance Of Ppiud Was Higher In Age
Group Of 20-25 Years (52.4%), Para-1+( 60.1%), At Intracesarean Section (55.3%), With Primary Education (43.6%) And
Future Pregnancy Desire Of 3 To 5 Years ( 39%). The Reasons For Refusal Were Partners Refusal (20.6%) And Interest For
Other Contraceptives (31%).The Expulsion Rates At 6 Weeks And 6 Months Were 6.6% And 5.5% Respectively. About 10%
Had Complications At 6 Weeks And 6 Months.4.2% Wanted Removal Of Iucd At 6 Weeks And 6.6% At 6 Months. Most
Common Cause Being The Complications (6.3%). Continuation Rate At 6 Weeks Was 89.3% And 6 Months Was 87.7%.
Conclusion : Immediate Post Partum Insertion Of Iucd Appears Safe And Effective.It Has Low Expulsion Rates If Inserted
By Trained Personals. This Study Suggests That Immediate Post Placental Insertion Of Iucd Is An Opportunity Not Be
Missed In A Country Like Ours With High Rates Of Unplanned Pregnancy. The Government Should Take Steps To
Amalgamate Ppfp With Institutional Delivery.

***************

Size Does Matter

Author: Dr. Punit Bhojani
Co Author: Vinita S Salvi1, Sangeeta Raodeo2,

Authors: Dr Punit Bhojani, Dr Sangeeta Raodeo, Dr Vinita Salvi

Presenting Author: Dr Punit Bhojani
Theme: High Risk Pregnancy

Abstract

Aims & Objectives:

1) To Evaluate The Outcome Of Pregnancy In Women With Pre Pregnancy Bmi 30 Kg/M2 Or Greater
2) To Compare The Outcome Of Pregnancy In Women With Pre Pregnancy Bmi 30 Kg/M2 Or Greater With That Of
Women Normal Bmi.
Materials & Methods:
Prospective Randomised Case Control Study Of 50 Pregnant Women Attending A Private Opd & Delivering In A Tertiary
Care Hospital In Mumbai. Twenty Five Women With Bmi 30 Kg/M2 Formed The Study Group & Twenty Five
Women With Normal Bmi Formed The Control Group. Both The Groups Were Followed Up For Development Of Any
Complications.
Mode Of Delivery, Birth Weight & Perinatal Outcome Were Noted In Both The Groups.
Data Was Evaluated & Analysed Using Chi Square & Fisher Exact Test
Results:
1) The Average Bmi In The Study Group Was 35.6 Kg/M2 Compared To 22.3Kg/M2 In The Control Group
2) The Average Weight Gain Was 18 Kgs In The Study Group Compared To 12 Kg In Control Group
3) The Incidence Of Gdm Was 16% In Study Group
4)Caesarean Section Rate Was 80% In The Study Group Whereas It Was 12 % In The Control Group.
5) The Incidence Of Gestational Hypertension Was 48% Compared To 8 % In Control Group.
6) The Average Birth Weight In The Study Group Was 3.9 Kgs & 2.6Kgs In The Control Group
Conclusion:
1) Obese Women Are At Increased Risk Of Pregnancy Complications.
2) Obstetricians Should Provide Counselling And Should Encourage Obese Patients To Undertake A Weight-Reduction
Program, Including Diet, Exercise, And Behavior Modification, Before Attempting Pregnancy

***************

Why Women Seek Termination Of Pregnancy

Author: Dr. Tadisina Reddy
Co Author:

In This Study Why Women Seek Termination Of Pregnancy , At A Terrtiary Urban Hospital, 78 Women Were Given A
Questionairre To Find Out The Most Common Reason For Going For Termination Of Pregnancy , And To Know Their
Cotraceptive Knowledge , Usage , Preferences , Myths And Acceptance And Uptake Of Male Sterilization .
Preconceptional And Premarital Counselling Colums Were Also Included . Evaluation Of Questionnaire Showed The
Mean Age Was 24 Yrs , Mean Gestational Age Was 7 Wks , 70 % Were Socioeconomic Class 2, 70 % Stated Common
Reason As Not Prepared For Pregnancy , Contracetive Was Used Only By 50 % , Most Had Myths About Usage As Weight
Gain , Cancer Etc. And Male Sterilisation Was Just 0.3 %.. 80% Did Not Have Preconceptional Counselling And Premarital
Counselling Was Hardly Received By 10 % . Also Immediate Post Partum Education On Risk Of Pregnancy And The Need
For Effective Cotraception Was Not Given Or If Given Was Not Effective Enough.
As Termination Is Associated With Maternal Mortality And Morbidity- Physical And Psychological And Other Ethical ,
Economic And Social Dilemas , It Is One Of The Major Duties Of Health Care Provider To Ensure Effective Contraceptive
Advice Premaritally , Preconceptionally An Postpartum . Also It Should Be A Continous And Effective Education So Thet
Women Are Able To Make Infomed Decisions. This Will Reduce If Not Prevent Unwanted Pregnancies .
***************

litigations In Obstetric And Gynaecological Practice- Can It Be Prevented? A Probability To Possibility

Author: Dr. Surakshith Gowda
Co Author: Dr Ambarish Bhandiwad1,

Introduction - Litigations In Medical Practice Is Becoming A Global Problem. So ItS Necessary To Know What
Constitutes Negligence & What Is Required To Prove It & How Far It Is Preventable.
Objectives To Analyze The Prevalence & Reasons For Litigations In Obstetrics & Gynaecology For Medical Negligence
& Deficiency In Service. To Analyze On What Grounds Negligence Was Proved And To Know Whether It Was Preventable.
Methodology A Retrospective Analysis Of The Judgments Obtained From The Official Website Of Consumer Forum
In The Country On Obstetrics & Gynaecology From Jan 2008 Dec 2013 From All The District Consumer Courts Of South
India Were Studied Specifically For Reasons In Filing The Case, Nature Of Settlement & Factors Considered In Deciding
Negligence.
Results- Totally 1317 Cases Were Found On Medical Negligence & Deficiency In Service, With 347(26.34%) Cases On Obg,
Next Being Orthopedics-196(14.9%) Cases. 85 Cases From Karnataka(24.5%), 128 Cases From Tamilnadu(36.88%), 71
Cases From Kerala(20.47%) & 63 Cases From Andhrapradesh(18.15%) Were Filed On Obg. Out Of 347 Cases On Obg
312(89.91%) Cases Were Settled In The Courts. Negligence Was Proved In 98(31.41%) Cases And 214(68.59%) Cases Were
Dismissed Without Compensation. 77(24.68%) Cases On Gynaecology Were Filed With Common Reasons For Litigation
Being Post-Op Complications(Vvf)(57.14%), Intra-Op Complications(11.68%), Extension Of Surgery Beyond Consent(2.6%)
Whereas Out Of 235(75.32%) Cases On Obstetrics, Tubectomy Failure(23.82%), Birth Asphyxia(10.21%), Traumatic Injury
To New Born(5.96%) Were The Common Reasons For Litigations. Inadequate Documentation And Improper Consent
Were The Main Factors Considered In Deciding Negligence On Part Of The Doctors.
Conclusion- By Having A Good Rapport, Respect, Regards Towards The Patients, Relatives And Their Feelings; Rx For
Appropriate Indication With Rational Practice & Proper Maintenance Of Records, Avoiding Resipsa-Loquitur & By
Explaining Possible Risks And Results Of Proposed Treatment; It Is Not Probable But Possible To Prevent Litigations.

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Role Of 3D Endometrial Volume & Vascular Indices In Prediction Of Ivf/Icsi Outcome

Author: Dr. Padmashri Giridharan
Co Author: Dr.Asha .R.Rao1, Dr.Damodhar Rao2, Dr.S.R.Rao3,

Objective:
3D Us Is A New Imaging Modality Which Is Being Introduced Into Clinical Practice. Aim Is To Study The Role Of Three
Dimensional Endometrial Volume & Vascular Indices In Prediction Of Ivf/Icsi Outcome
Design: A Prospective Clinical Study.
Materials And Methods: Endometrial Volume And Endometrial Vascularity Indices Vi/Fi/Vfi Were Measured In Women
Undergoing Ivf/Icsi Cycle, On The Day Of Hcg In Ocr Cycles & On The Day Of Progesterone In Recipient Cycles, Using 3 D
Transvaginal Ultrasound Probe (Voluson E8, Ge Healthcare). Patients Were Divided According To Endometrial Volume ,
Into 3 Subgroups; < 2Ml, 2-4Ml, And >4Ml, As Well As According To Endometrial Vascular Indices Into 3 Groups; Vi/Fi/VfiMean Values. Pregnancy Rates Were Compared Between All Groups.
Results: The Study Included 162 Art Cycles Who Underwent Ivf/Icsi At Rao Hospital. The Pregnancy Rates Between Three
Groups Of Endometrial Volume; <2Ml, 2-4Ml, And >4 Ml Was; 47%, 44.1% And 40% Respectively & Miscarriage Rate Was
44.9%,10.5% 7&10.0 % In Ocr Cycles. In Recipient Cycles, The Pregnancy Rates Between Three Groups Of Endometrial
Volume; <2Ml, 2-4Ml, And >4 Ml Was; 55%, 61.5% And 85.7% Respectively & Miscarriage Rate Was 13.3%, 12.5% And
0.0 % .. In Ocr Cycles Vascular Indices - Vi/Fi/Vfi Were 4.6/26.9/1.4 Respectively In Pregnant Group & 4.3/26.7/1.6 In
Non Pregnant Group. In Recipient Cycles -Vi/Fi/Vfi Were 3.6/25.9/1.0 In Pregnant Group & 1.7/24.2/0.6 Respectively In
Non Pregnant Group.
Conclusion: 3D Us With Pd Angiography Is A Promising Tool In The Evaluation Of Endometrial Receptivity. In Our Study
,Miscarriage Rate Was Higher If Endometrial Volume Wsa <2Ml & Pregnant Group Had Higher Endometrial Vascularity
Compared To Non Pregnant Group In Art Cycles.

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Induction Of Labour At Term In Primigravida With Misoprostol A Rural Clinical Study

Author: Prof. Sheela S.R
Co Author:

Objectives: The Aim Of The Study Is To Evaluate The Obstetric Outcome Of Induced Labour With Misoprostol In Term
Primigravida And Its Significance In Practice In Rural Area.
Materials And Methods: It Is A Retrospective Analysis Of 100 Cases Of Term Primigravida, Conducted At R L Jalappa
Hospital, Tamaka, Kolar, Between May 01, 2013 To September 15, 2014. Data On The Demographic Characteristics Of
The Parturient, Indications For Induction, Dosage Required, Maternal And Perinatal Outcomes And Reasons For Failed
Induction Were Collected From The Parturition Register & Inpatients Records In The Hospital. All Patients Were Induced
By Intravaginal Misoprostol, 50 g And 6Thhourly And Augmented With Oxytocin If Required .The Data Were Analyzed
With Spss14.0 Window Version.
Results: Majority Of Patients Were Aged Between 21 25 Years, About 54%. Most Of The
Patients Were Booked
For Regular Anc, 90%, And Gestational Age Were Between 40 41 Weeks, Constituting About 65% In The Induced
Population Of Primigravida. The Pre-Induction Bishop Score Was 5 6 In About 40% Of The Cases, The Commonest
Indication For Induction Of Labour Was Postdate Pregnancy, In About 46%. Induction Was Successful In 84% Of Cases
And About 14% Of The Population Requiring Caesarean Delivery Mainly Done For Fetal Distress And 2% Had Instrumental
Delivery. Neonatal Intensive Care Was Required For 22% Of Babies. No Maternal Mortality Was Reported. Induction
Delivery Interval Was Usually Between 10 3.5 Hrs.
Conclusion: In This Study Induced Labour, Had Effective And Successful Vaginal Delivery. Induction Of Labour In Term
Primigravida Reduced Caesarean Section Rate. Therefore, Induction Of Labour Is Safe And Beneficial In Obstetric Practice.
Category: Other Topic- Miscellaneous

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autotransfusion

The Fastest Self-Help Art In Ruptured Ectopic Pregnancy

Author: Dr. Pratibha Singh
Co Author: Dr Pratibha Singh1,

Ruptured Ectopic Pregnancy Is The Commonest Cause Of Massive Intra-Peritoneal Haemorrhage In The Female. It Is An
Important Cause Of Maternal Death, Which Can Easily Be Prevented If Haemorrhage Is Arrested And Lost Blood Rapidly
Replaced. Blood From The Peritoneal Cavity Can Be Utilised And Life-Saving, Especially When It Comes From A Ruptured
Ectopic Pregnancy Or A Ruptured Spleen. Also, It Carries No Risk Of Mismatch, Hepatitis, Hiv Etc., And Is Fastest Self-Help
Replacement Method . Auto-Transfusion Is Thus A Very Useful Tool In Cases Of Ruptured Ectopic Pregnancy Specially
In Poor Replacement Facilities .
Aim & Objectives: Clinical Outcomes Following The Use Of Auto-Transfusion In The Management Of Ruptured Ectopic
Pregnancy Were Reviewed At Healing Touch Hospital, Bhagalpur, Between March 2004 To February 2014 .
Materials & Methods: The Soup Ladle Method Was Used Rather Than The Vacuum Bottle Method As It Was Not
Available.
Results: All The Cases Of Ruptured Ectopic Pregnancies, With Hypovolemic Shock And Significant Hemoperitoneum,
Were Reviewed.
Conclusion: Based On The Reviewed Information, Intra-Operative Blood Salvage And Auto-Transfusion Is A Simple,
Effective, Safe And Most Ecologically Friendly Method Of Blood Replacement. Its Use Should Be Of Primary Consideration
In The Management Of Ruptured Ectopic Pregnancy. Although It Has No Haemostatic Benefit, The Blood From The
Peritoneal Cavity Is Useful In Volume Replacement, Augmentation Of Oxygen Carrying Capacity And Correction Of Post
Haemorrhagic Anaemia. The Practical Advantage Of Intra-Operative Auto Transfusion Is The Ease And Speed With Which
It Can Be Carried Out Without The Time Consuming Grouping And Cross-Matching Of Blood And Indeed 'The Safest
Blood In Dire Emergency When There Is No Time To Arrange Blood . All Gynaecologists Should Learn This Art, Especially
Those Working In Remote & Rural Areas.

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A Study Of Determinants Of Success For External Cephalic Version

Author: Dr. Srinivas K
Co Author: Dr. K V Malini1,

The Commonest Of Abnormal Presentation Is Breech, About 3% At Term. Almost 90% Of Women In Developed Countries
With A Breech-Presentation At Term Are Delivered By Caesarean Section. This Exposes Women To Risks Such As Uterine
Rupture And Abnormal Placentation During Subsequent Deliveries. A Novel Intervention For A Pregnancy With Breech
Presentation Is External Cephalic Version (Ecv) There By Reducing The Dilemma About The Route Of Delivery.
Aims And Objectives
It Was Done To Study The Effectiveness, Success Rate And Determinants Of Success And Failure For Ecv
Materials And Methods
This Study Was Conducted At Vani Vilas Hospital Attached To Bangalore Medical College Between Jan 2010 To August
2014. All Pregnant Women > 34 Weeks Fitting Into Inclusion Criteria Underwent Ecv And The Influence Of Age, Parity,
Amount Of Liquor, Fetal Weight, Need For Tocolysis, Status Of Labour During Ecv, Number Of Attempts, PatientS
Comfort Level, Success, And Route Of Delivery And Complications Were Computed.
Results
A Total Of 53 Cases Were Included In The Study. None Had Any Complications. 56% Was The Success Rate. There Was
No Need For Tocolysis In 59% Cases. 57% Women Were At Term Pregnany. 57% Babies Weighed 2.6-3 Kgs. 36% Women
Were In Labour. 30% Were Primigravidae. 66% Of Them Tolerated The Procedure Well. About 44% Cases Success Was
Achieved In The First Attempt. 57% Had Vaginal Delivery With Vertex Presentation After Version.
Conclusion
Ecv Is A Novel Intervention For Pregnancy With Breech Presentation And In Carefully Selected Cases It Should Be
Considered As An Option For Management.

***************

Uterine Leiomyosarcoma - A Case Series

Author: Dr. Anusha H
Co Author: Dr Sumangala Devi1, Dr Santosh Kuriakose2,

Uterine Leiomyosarcoma A Case Series

Dr Anusha.H , Dr. Sumangala Devi, Dr Santosh Kuriakose

Category Fogsi- Mrs. Chandravathi Devi Jagannath Singh Prize

Best Paper On Oncology.

Aim
To Study The Trend Of Leiomyosracoma Uterus In Our Institute , Government Medical College , Calicut Over
A Period Of 5 Years From 2010 2014.
Materials & Methods
All Cases Of Leiomyosarcoma Confirmed With Histopathological Examination In Our Institution Over A
Period Of 5 Years Were Studied And Analysed. Variables Analysed Include Age , Parity , Menopausal Status ,
Presenting Complaints , Imaging Findings , The Preoperative Diagnosis , Intraoperative Findings , Postoperative
Follow Up And Adjuvant Treatment . All The Patients Were Reviewed And Rate Of Recurrence , Mortality Rate
And The Disease Free Survival Period Also Calculated.
Results
Total Number Of Leiomyosarcoma Cases In This 5 Year Period Was 20.

Age - 31% Patients Were < 40Yr Old. Youngest Being 32 Years. 56% In 40 50 Yrs And 13% Of Patients
Were >50 Yrs.

Parity - 31% Were Nulliparous .

Menopausal Status - 31% Were Post Menopausal And 69 % Were In Reproductive Age Group.

Abdominal Distension Was The Most Common Presenting Complaint ( 44% ) Followed By Bleeding Per
Vaginum ( 25% ).

Clinically 80% Of Patients Had Uterus > 16 Weeks.

62 % Of Patients Pre Operative Imaging Showed Heterogenous Mass With Irregular Borders.

The Preoperative Diagnosis Was Fibroid Uterus In 88% Of The Cases , Leiomyosarcoma In 6% Of Cases
And Ovarian Tumor In 6 % Of Cases .

In 12 % Of Patients Myomectomy With Tumor Spillage Had Occurred And All Had Disease Recuurence

25 % Of Patients Developed Recurrence . 12 % Of Patients Died Due To Disease .

***************

Maternal And Fetal Outcome In Eclampsia

Author: Dr. Upasana Saharia
Co Author: Prof Dr. Robin Medhi1,

Abstract
Objectives:
This Study Was Undertaken To Analyse The Cases Of Eclampsia And Find Out The Incidence With Special Focus On
Maternal And Fetal Outcome.
Methods:
A Retrospective Study Was Done In The Department Of Obstetrics And Gynaecology In Silchar Medical College And
Hospital From September 2009 To August 2014. Datas Of Eclampsia Patients Were Retrieved And Analyzed. Analysis Was
Done Regarding Incidence, Parity, Gestational Age, Type Of Eclampsia, Antenatal Care, Mode Of Delivery, Fetal Outcome,
Maternal Outcome.
Results:
Total Number Of Deliveries During This Period Was 41520. There Were 954 Cases Of Eclampsia Giving An Incidence
Of 2.3%. Majority (86%) Were Primipara. 89% Of The Cases Were Unbooked And 11% Were Booked .The Antepartum,
Intrapartum And Postpartum Incidence Of Eclampsia Were 60%, 12% And 28% Respectively. Of Antepartum Eclampsia,
6% Developed Eclampsia During 20-28 Weeks, 10% Developed During 28-32Weeks And 28% During 32-36Weeks And
56% During 36-40Weeks. 30% Patients Were Delivered By Caesarean Section, 40% By Assisted Deliveries And 30%
Spontaneous Vaginaly. 52% Mothers Showed Complications Of Eclampsia. Of Them Hellp Syndrome (11%), Neurologic
Deficit (9%), Aspiration Pneumonia (8%), Pulmonary Oedema (7%), Renal Failure (6.5%), Dic (6%) Were Common.
Maternal Mortality Was 9%. There Were 28% Stillbirth And 9% Early Neonatal Deaths. Causes Of Early Neonatal Death
Were Perinatal Asphyxia, Septicaemia And Prematurity. 80% Of Total Births Were Low Birth Weight.
Conclusion:
Eclampsia Is Still A Major Obstetrical Complication Contributing A Major Chunk Of Maternal Mortality In Assam.
Quality Antenatal Care, Female Education, Social Awareness, Identification And Timely Referral Of High Risk Patients
Coupled With Availability Of Emergency Obstetric And Neonatal Care Services Are Needed To Reduce The Incidence Of
This Dreaded Obstetrical Complication.

***************

Admission Test, Afi And Color Of Liquor In Term Pregnancies In Active Labour And Their Association With Labour And
Perinatal Outcome.
Author: Dr. Maheshwari Marisiddaiah
Co Author: Dr Maheshwari1,

Abstract

Aims And Objectives:

To Study The Admission Non Stress Test, Amniotic Fluid Index And Color Of Liquor At Term Gestation In Active Labour
In All Primi Gravida And Multi Gravida Irrespective Of Their Medical Condition.
To Assess The Mode Of Delivery And Its Association With Perinatal Outcome.
Methods:
An Observational Study Was Done From October 2010 To 2012 On 200 Pregnant Women Who Were Admitted For
Labour And Delivery. A Detailed Examination Was Done And Nst, Afi And Color Of Liquor Were Studied In Active Labour.
Details Of The Mode Of Delivery, Condition Of The Mother And The Neonate Was Assessed At The End Of Each
Delivery.
Results:
Out Of 200 Patients, 15(7.5%) Patients Had Non Reactive Admission With Oligohydramnios With Meconium Stained
Liquor.27(13.5%) Patients Had Meconium Stained Liquor With Non Reactive Admission Test. 18(9%) Patients Had
Meconium Stained Liquor With Oligohydramnios.9(4.5%) Patients Had Non Reactive Admission Test With
Oligohydramnios.131(65%) Had All The Three Parameters In Normal Range.

Interpretation:
The Sensitivity Of Studying All The Three Parameters Is 100% And Specificity Is 91.91%. The Positive Predictive Value
Is 85.33% , Negative Predictive Value Is 100% And Accuracy Is 94.58% With Significant P Value Of < 0.001.
Conclusion:
From This Study We Can Conclude That Studying All The Three Parameters I.E. Admission Test, Amniotic Fluid Index
And Color Of Liquor In Term Pregnancies Is A Reliable Method To Assess Perinatal Outcome.

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Intraoperative Complications Of Primary Versus Repeat Caesarean Sections

Author: Dr. Sheethal Joseph
Co Author: Dr.Sareena Gilvaz1,

Aims And Objective: To Study The Incidence And Type Of Intra-Operative Difficulties In Repeat Versus Primary Caesarean
Section And Their Intra Operative Management.
Material & Methods: This Is An Observational Prospective Study, Conducted In A Tertiary Care Hospital. The Study
Included 100 Consecutive Patients Who Underwent Primary Caesarean Section And 100 Consecutive Patients Requiring
Repeat Caesarean Section. All Patients Underwent Caesarean Section After Necessary Preoperative Evaluation
.Intraoperative Findings Were Noted In Proforma. The Data Was Analysed Using Chi Square Tests .
Results: Out Of The 200 Caesarean Sections 100 Were Primary Sections And 100 Were Repeat Sections. Out Of The 100
Repeat Caesarean Sections, 70 Had Previous Single Section, 26 Had Previous 2 Sections And 4 Had Three. 52 Cases Did
Not Show Any Complications(52%),And The Remaining 48 Cases Showed A Variety Of Complications Including A Variety
Of Adhesions (79%),Thinned Out Lower Uterine Segment (47%),Haemorrhage(10%) ,Two Cases Of Placenta Accreta
Requiring Obstetric Hysterectomy. In 26 Cases (26%) There Was Difficulty In Approaching Lower Uterine Segment. Only
Major Complication In Primi Section Was Haemorrhage(15%).
Conclusion: Women With Repeat Caesarean Section Are At Risk Of Having Multiple Intraoperative Complications, Which
May Increase The Rate Of Maternal And Fetal Morbidity. Parietal Layer And Intraperitoneal Adhesions Make Repeat
Caesarean A Difficult Procedure. Hence Repeat Sections Need To Be Conducted In A Tertiary Care Centre . Patients
Requiring Repeat Sections Should Be Educated About The Need Of Good Antenatal Care And The Need To Keep Cesarean
Sections In A Tertiary Care Centre. All Previous Records Should Be Maintained As It Will Help In Future For Decision
Making And Handling Of Intraoperative Complications In Subsequent Pregnancies. The Best Method To Reduce The
Various Complications Is To Reduce The Rate Of Primary Sections Whenever Possible.

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A Case Report Of Successful Mc Indoe Vaginoplasty For Mayer Rokitansky-Kuster-Hauser Syndrome

Author: Dr. Boddu Sirisha
Co Author: Dr.Sajana Gogineni1, Dr.Ushanag2, Dr.Prasanthi.V3,

Background
Mrkh Syndrome Is Characterized By Complete Or Partial Congenital Aplasia Of Uterus And Vagina With Normal Ovaries
And External Genitalia. It May Be Isolated Or Associated With Renal, Cardiac And Skeletal Abnormalities. The Condition
Occurs Typically In Women With Normal Karyotype 46Xx And Normal Phenotype-Normal Secondary Sexual
Characteristics.

Case Report
A 18 Yr Old Female Presented With Complaints Of Primary Amenorrhea With History Of Congenital Short Upperlimbs.
Patient Had No Other Complaints. Physical Examination Demonstrated A Normal Appearing Woman With Tanner Stage3 Breast And Pubic Hair. Abdominal Examination Reveals No Evidence Of Masses Or Organomegaly. Pelvic Examination
Revealed Normal Vulva And Urethral Meatus But Had Blind Vagina. Usg Shows Non Visualized Uterus And Right Ovary
Measures 2.71.6Cm And Left Ovary Measures 2.61.6Cm.Mri Pelvis Shows Non Visualized Uterus With Normal
Ovaries And Vagina Appears Thin ,Patency Cannot Be Ascertained And Pelvic Bones Appear To Be Normal.
Patient Was Submitted To Surgical Management Mcindoe Vaginoplasty Creating Neovagina To Achieve Penetrative
Sexual Intercourse With Skin Graft Harvesting From Thigh Region. Post Operatively Continuous Prolonged Dilatation Of
Vaginal Cavity During Healing To Prevent Contracture Of Opening Is Achieved By A Mold That Stays In Situ For 6 Weeks
After Surgery. And After That Mold Is Used During Nights For 6 Weeks . Later Mold Is Used Occasionally Until Coitus
Occurs. Patient Had Uneventful Recovery And Got Married After 6 Months Of Surgery And Had Satisfactory Outcome.

Conclusion
Mrkh Syndrome Is Rare Anomaly .Surgical Management Using Skin Graft Of Thigh For Vaginal Reconstruction Has Given
A Good Outcome In This Report. Longterm Follow Up Will Be Needed To Assess Longterm Outcome With Regard To
Complications, Sexual Satisfaction Of Partner Or Spouse As Well As Their Adaptation And Resolution Of Fertility Issues.

***************

Cesarean Hysterectomy For Placenta Percreta: A Report Of Two Cases

Author: Dr. Pruthwiraj Sethi
Co Author: Dr A. Vivekananda1, Dr Subharanjan Samantroy2, Dr Parveen Sultana3,

Background:
Placenta Percreta Is One Of The Most Dreaded Complication Of Pregnancy With Invasion Of The Full Thickness Of The
Myometrium Sometimes Invading The Bladder. It Is Frequently Associated With Severe Obstetrics Hemorrahage And
Usually Necessitating Cesarean Hysterectomy. The Incidence Of These Conditions Are In Increasing Trend Due To Increase
Number Of Cesarean Sections Worldwide. We Report Two Cases Of Placenta Percreta Of Our Hospital Which Were Ended
With Cesarean Hysterectomy For Uncontrolled Post Partum Hemorrhage.

Case 1
A25 Year Old Gravida3 Para2 Live2 With 31 Weeks Of Gestation With Two Previous Cesarean Section Presented With
Painless Bleeding P/V. On Examination, Pallor ++,Pulse=100/Min,Blood Pressure Was 90/60Mmhg. Obstetrics
Examination Revealed Fundal Height Of 32 Weeks With Breech Presentation With Fetal Heart Rate Of 140/Min.
Hemoglobin Was 8Gm%. Usg Was Showing Central Placenta Previa With Invasion Of Lower Myometrium.Mri Revealed
Placenta Increta At Inferior Region Of The Uterus With Focal Areas Of Percreta Without Bladder Invasion.A Preterm Baby
Was Delivered With Weight Of 1.75Kg Followed By Cesarean Hysterectomy Due To Placenta Percreta And Uncontrolled
Post Partum Hemorrahage.

Case 2
A 22 Year Old Gravida2 Para1 Live1 With 36 Weeks Of Gestation With Previous Cesarean Section Presented With Pain
Abdomen.Vitals Were Stable.Usg And Mri Revealed Placenta Previa Covering Internal Os With Placenta Percreta.Cesarean
Hysterectomy Was Done For Severe Obstetric Hemorrhage After Delivery Of The Baby.Three Units Of Packed Cell Were
Transfused Intraoperatively.

Conclusion:
Emergency Cesarean Hysterectomy Is A Potential Live Saving Procedure Which Every Obstetrician Must Be Familiar Due
To Increase Incidence Of Placenta Previa With Percreta Specially In Pregnancy With Previous Cesarean Sections..

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3 Years Study Of Ayushmoti Scheme-(Jsy) In Seva Hospital, Tarakeswar, Hooghly ( Rural Bengal)
Author: Dr. Joydeb Kole
Co Author: Dr. Joydeb Kole1, Dr.(Mrs) Sutapa Kole2,

Aim & Objectives:-

1. To Make A Social Survey Of Beneficiaries.

2. To Asses The Most Common Presentation Of Ayusmoti.
3. To Reduce Hours Of Delay In All Levels.
4. To Make Survey Of The Number Of Accredited Hospital.

Materials & Methods:-

This Retrospective Study Was Done In Seva Hospital, Tarakeswar, Hooghly.

A Rural Community Set Up For A Period Of 3 Years (January11-December13).
The Total Number Of Delivery Was 3454 In Ayusmoti Scheme
& Total Number Of Delivery Was 5073 In The Same Period.

Results:-

1.

Ayusmoti Benefit Was Availed By 68.08% Backward Population.

2.

Most Of The Patient Of Ayusmoti Suffer From Anemia, P.E.T, Malnutrition Etc.

3.

Hours Of Delay In All Levels Were Reduced.

4.

Number Of Accredited Hospital Is Comparatively Low In Our State.

Conclusion:-

1. The Above Scheme Has Improved The Basic Health Care Like Maternal Health Care Amongst The Backward Classes.
2. Ayusmoti Has Reduced The Mmr & Pmr All Over India. More Antenatal Check Up Necessary For Ayusmoti Scheme.
3. The Scheme Has Also Reduced The Delay In All Levels.
4. Govt. Will Have To Accredit More Hospitals For Ayusmoti Scheme.

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clinico-Pathological Study Of Ovarian Tumours

Author: Dr. Sony Pipal
Co Author:

Aim & Objective: To Study About The Clinico -Pathological Pattern Of Ovarian Tumors.

Method: Retrospective Cohort Study In 80 Cases.

Participants: Were 80 Cases Admitted In J.K. Lon.Hospital, Govt. Medical College Kota (Raj), Between September 2012 To
September 2014.

Results: Among The 80 Cases, 52.5% Benign Tumors, 15% Malignant Tumors And 32.5% Simple Cyst Were Reported. Pain
Abdomen (60%) Was The Predominant Symptom. Most Of Them Were Multipara. For Benign Tumors Peak Age Incidence
Was 41-50 Years And For The Malignant Tumors It Was >60 Years . Epithelial Tumors Were Most Common (75%).

Conclusion: The Peak Age Incidence Of Ovarian Tumors Is 41-50 Years. Most Common Occurrence In Multipara, Epithelial
Tumors Were The Commonest One. Pain Abdomen Was The Most Common Presentation.

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To Evaluate Causes Of Intrauterine Fetal Deaths

Author: Dr. Anjali Gupta
Co Author: Dr Savita Singal1, Dr Smiti Nanda2,

Aim & Objectives- To Determine The Causes Of Antepartum Intrauterine Fetal Deaths. Material & Methods- A
Retrospective Study Was Carried Out In The Obst And Gynae Department In Pgims Rohtak. The Cases Of Antepartum
Stillbirths In One Year I.E Jan 2013 To Dec 2013 Were Included In The Study. Labour Room Entry Registers Were
Scrutinized And Case Records Were Reviewed And The Data Was Collected And Analysed. Results- There Were 335
Antepartum Still Births Out Of 2824 Deliveries Accounting To 118 Still Births Per 1000 Deliveries. Majority Of The Patients
Were Unbooked (71.42%). Maximum Number Of Still Births Was Present In Age Group 20-25 Yrs (56.71%) Followed By
25-30 Yrs (31.64%). Majority Of Women Were Nullipara (40%). 36.7% Still Births Were Present At Term Gestation. The
Cause Remained Unexplained In 48.45% Still Births Followed By Placental Causes (17.31%), Iugr(8.95%), And
Preeclampsia(6.56%). The Other Causes Included Diabetes Mellitus, Anemia, Jaundice, Eclampsia And Fetal Congenital
Malformations. The Birth Weight Of The Babies Was <2.5 Kg In 70.44% Cases And <1.5 Kg In 38.20% Cases. Conclusion Increased Awareness Of Causes Of Still Birth Is Important In Developing Preventive Strategies. Emphasis Should Be Laid
On Imparting Health Education Regarding Importance Of Attending Antenatal Clinic.
***************

Thermography- A Cost Effective Tool For Mass Screening Of Breast Cancer

Author: Dr. Poonam Mathur
Co Author: Dr Pooja Mathur1, Dr Muffazzal2, Dr.Rajkumar3,

Aims And Objectives- Breast Cancer Is Rapidly Rising.Screening Plays A Pivotal Role In Early Diagnosis & Management Of
Breast Cancer. In India, There Is Felt Need Of A Screening Tool Which Can Reach The Masses Rather Than Waiting For The
Masses To Reach Tertiary Centres To Be Screened. Digital Infra-Red Thermal Imaging (Diti) Or Breast Thermography For
Screening Appears To Be A Promising Tool In Indian Scenario.
Methods- In This Screening Test, 405 Females Of Age 20-60 Years Were Screened Using Thermography. All Those With
Abnormal Thermograms Underwent Triple Assessment That Consisted Of Clinical Examination, Radiological And
Histopathological Examination. Those With Normal Thermograms Were Examined Clinically. Based On Temperature
Gradients In Thermograms, Three Scores Were Generated.
Results- Thirteen Out Of 405 Females Had Abnormal Thermograms Or Score 3, Out Of Which Ten Were Then Proven To
Be Malignant By Triple Assessment And Offered Suitable Treatment. Those With Score Of 1 Or Less Were Excluded For
Malignancy. About 25 Thermograms Had Score 2 In Which Few Were Lactating Mothers Or Had Fibrocystic Breast
Diseases. As A Screening Modality, Thermography Has Sensitivity Of 100%, Specificity Of 99.2%, Positive Predictive Value
76.9% And Negative Predictive Value 100%.
Conclusion- Breast Thermography Is Non-Contact, Pain-Free, Radiation Free ,Costeffective & Comparatively Portable
Modality For Screening. It Can Emerge As A Better Screening Tool, As Well As A Proactive Measure For Early Detection Of
Breast Carcinoma.

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Pregnancy With Pemphigoid Gestationis

Author: Dr. Surbhi Snehi
Co Author: Dr.Sujata Singh1, Dr Sasmita Swain2, Dr Lucy Das3, Dr Anurekha J P4, Dr Monalisa Nanda5

Background
Pemphigoid Gestationis (Pg),A Pregnancy-Associated Autoimmune Disorder,Is Believed To Affect One In Two Million
Pregnancies Worldwide And Is Likely To Be More Severe In Future Pregnancies.Autoantibodies Are Deposited In Skin And
Are Detectable In Circulation.They Are Predominantly Specific For Hemidesmosomal Protein Bpag2.Binding Of Igg To The
Basement Membrane Triggers An Immune Response Leading To Formation Of Subepidermal Vesicles And Blisters.Cross
Reactivity Between Placental Tissue And Skin Has Been Proposed To Play A Role.It Has Been Shown To Be Precipitated By
Ocps And Pregnancy-Like States E.G Choriocarcinoma.
Case
Xyz,A 34 Year G2P1L1,Was Admitted At 4.40 Am On Sept1,2014 With Complaints Of Blisters And Erythema All Over The
Body Associated With Severe Itching For The Past 8 Days.Lesions Started Periumbilically And Spread All Over The
Body.There Was No History Of Any Drug Intake,Fever.Her Blood Investigation Reports Were Within Normal Limits Except
For Slight Rise In Esr And Subepidermal Deposits On Skin Biopsy.7 Days Later She Delivered A Preterm Male Baby.She
Was Suspected As A Case Of Pemphigoid Gestationis By The Dermatologists N Obstetricians At Scbmch,Cuttack And Was
Prescribed Tab Prednisone 30Mg Od,Tab Cetrizine 5Mg Od Along With Advice Of Daily Bath And Covering The Lesion
With Banana Leaves.
Conclusion
Patients With Pg Have Increased Incidence Of Premature Delivery And Sga Neonates And Other Autoimmune
Diseases.Infants May Rarely Have Transient Blistering Disease Making Them Susceptible To Infection,Thermoregulatory
Difficulties And Water-Electrolyte Abnormalities.Treatment Mostly Consists Of Steroids And Antihistamines.In Our
Case,Patient Had Classical Presentation Of Pg In Second Trimester And Responded Well To Treatment,She Had Preterm
Delivery.Baby Did Not Have Any Skin Lesions.

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Immature Teratoma In Pregnancy

Author: Dr. Elizabeth Jacob
Co Author:

Immature Teratoma In Pregnancy

Background: Comprising Of Less Than 1% Of All Ovarian Cancers,Immatureteratoma Is A Malignancy That Mainly Affects
The Young. Immature Teratoma Of The Ovary Together With Pregnancy Is Rare. To Our Knowledge , This Association Was
Reported Only In 12 Cases.

Aim: We Have Discussed A Case Of Immature Ovarian Teratoma Diagnosed During Pregnancy & Its Respective Issues.

Observation: We Report A Case Of A Malignant Immature Teratoma Diagnosed At 7 Weeks Of Amenorrhoea In A 24 Yr

Old Healthy Primigravida. Ultrasound Showed A 11.6 X 8Cm Heterogenous Lesion With Hyperechoic&Hypoechoic Area
Seen In Right Adnexa. A Right Salpingoopherectomy Was Performed By Laparotomy With Surgical Staging Procedure At
10 Weeks Of Amenorrhoea. Surgical Staging Was Designated As Figo Stage 1C. Gross Examination Demonstrated A 20 X
15 Cm Tumour With An Intact Capsule. Histologic Evaluation Indicated A Immature Ovarian Teratoma Grade Ii, With Nests
Of Neuroepithelialtissue.The Patient Underwent Medical Termination Of Pregnancy Due To Many Structural Anomalies
In The Fetus. Patient Was Started On Postoperative Chemotherapy Consisting Of 3 Cycles Of Bleomycin,
Etoposide&Cisplastin.

Conclusion: Immature Teratoma Is Graded From 1 To 3. The Management Of This Association Is Discussed, But It Takes
In Consideration The Surgical Staging, The Grade Of The Tumour.Dilemmas In The Management Of Pregnancy With
Ovarian Malignancy Is Being Discussed And Also Rare Association Of Immature Teratoma Is Being Highlighted Through
This Case Report.

***************

Efficacy Of Low Cost Screening Methods For Early Detection Of Cancer Cervix
Author: Dr. Nirupa S
Co Author: Dr.C.Demonte1, Dr.Geetha Prasad2,

Introduction : The Incidence Of Cancer Cervix In Tamilnadu State Is Ranked As One Of The Highest In India. The City Of
Chennai And ItS Neighboring Districts Of Thiruvallur, Kancheepuram Are Also Rated As High Incidence Areas For
Cancer Cervix. The Very Low Cost Method Screening For Cancer Cervix Which Is Both Simple And Effective Is By Visual
Inspection Of Cervix After Application Of Acetic Acid [Via] And Visual Inspection Of Cervix After Application Of LugolS
Iodine (Vili) Under Low Magnification Using Magnavision .
Settings: Govt.Hospital For Women & Children, Egmore, Chennai A Tertiary Referral , Public , Teaching Hospital .
Study Period: A Period Of Fifteen Months, From January 2013 To March 2014.
Aim : To Study The Efficacy Of Low Cost Screening Methods Of Via/Vili Using Magnavision In Early Detection Of Cancer
Cervix .
Method:
As Per Govt. Ncd Program Guidelines Women Attending Gynecology And Family Welfare Op Were Advised To Undergo
Via/Vili Screening Tests. Women With Positive Results For Tests Of Via, Vili Or Both Were Referred To Colposcopy Clinic.
In The Colposcopy Clinic, Biopsy Of Cervix Was Taken When Indicated .
Results : A Total Of 5340 Women Were Screened. Around 584 Women Had Positive Results For Via/Vili Tests. By
Histopathological Examination Reports Of Colposcopic Directed Biopsy , 28 Women Were Diagnosed With Early Cancer
Cervix. 18 Women With Cin1. 7 Women With Cin2. 11 Women With Cin3.
Conclusion : Low Cost Via / Vili Tests Were Successful In Identifying Early Invasive Cancer Cervix In 100% Of Women .
***************

Universal Screening Of Gestational Diabetes Mellitus And Their Fetomaternal Outcome

Author: Dr. Supriya Goyal
Co Author: Dr Lila Vyas1, Dr.Anjali Jain2, Dr.Shipra Shaiwal3, Dr.Kumkum Gupta4,

Objective : Early Detection And Timely Intervention Of Gestational Glucose Intolerance (Ggi) And Gestational Diabetes
Mellitus (Gdm) By Universal Screening With Diabetes In Pregnancy Study Group India (Dipsi) Criteria And To Study Their
Fetomaternal Outcome.

Method : Randomly Selected 200 Antenatal Women Were Screened Universally For Gdm Using Dipsi Criteria By
Measuring Venous Plasma Glucose Levels 2 Hours After Ingesting 75 Grams Of Oral Glucose In First Trimester And
Following Them Accordingly In Second And Third Trimester. Pre-Gestational Diabetic Were Excluded . Results Were
Analysed Using Chi-Square Test.

Results :
Using Dipsi Criteria, 25 Cases (12.5%) Of Gdm And 17 Cases (8.5%) Of Ggi Were Identified. 10 Cases (40%) Of Gdm And 3
Cases (17.64%) Of Ggi Were Diagnosed In 1St Trimester. Only Polyhydramnios(P= 0.00) And Fetal Distress(P= 0.00) Were
Found Significantly Associated With Glycemic Status Of The Patients 5 Gdm (20%) And 4 Ggi (23.53%) Cases Were
Identified Without Risk Factors. Only 3 Cases (12%) Of Gdm Required Insulin Therapy.

Conclusion: A One Step Procedure With A Single Value Is Dipsi Criteria Serves Both As Screening And Diagnostic Tool For
Diagnosing Gdm In Every Antenatal Women. This Study Validates Credibility Of Dipsi Criteria.

Keywords : Universal Screening, Gestational Diabetes Mellitus(Gdm), Gestational Glucose Intolerance(Ggi), Dipsi

***************

Prevention Of Primary Fragility Fractures In Postmenopausal Women(Dexa Plus Frax)

Author: Dr. M Suganthi
Co Author:

Objective: To Know The Prevalence Of Postmenopausal Women Who Need Medical Treatment For Preventing
Fractures, In Persons Who Doesn`T Suffered A Previous Fracture.
Basically, Calcium-Rich Diets, Sunlight Exposure, Weightbearing Exercise Are Prime Importance. Next Step Is To Know
Whom Should Be Medically Treated With Drugs Like Bisphosphonates, Teriparatide, Calcitonin As Per`` Clinician`S Guide
To Prevention And Treatment Of Osteoporosis``
Materials And Methods: This Is A Retrospective Study Of Central Dexa Scan Results Of Women Aged 50Years And Above
In A Tertiary Care Hospital.Bmd (T-Scores) Of Patient Is Categorized Into Normal, Osteopenia And Osteoporotic According
To Who Criteria. Height And Weight Of Patients Are Noted, Compared With Bmd.
Frax Calculator Is Used To Know The 10-Year Probability Of Major Osteoporotic Fracture And Hip Fracture Including Bmd
Of Femoral Neck And Also Without Bmd. If It Is >3% 10Year Probability For Hip Fracture And >20% For Major Osteoporotic
Fracture, That Patients Should Be Medically Treated.
Results: Out Of 101Patients Studied, 64 Patients Are Aged 50-65 Years ,37 Are Aged >65 Years. Among 37Patients Aged
>65Years, 32% Have Osteoporosis,49% Have Osteopenia, 19% Have Normal Bmd. These 32% Osteoporotic Plus Among
49% Of Osteopenic, Only Those With >3%Probability Of Hip Fracture Using Frax Should Be Treated.
Mean Age Group Of Patients With Normal Bmd Is 58 Years,
With Osteopenia Is 62 Years,
With Osteoporosis Is 68Years.
Conclusion: In Patients Without Risk Factors ,Dexa Scan Should Be Done As A Screening Test For All Postmenopausal
Women Between 65- 70Years Of Age And
* If Hip Or Lumbar Spine T-Score At Or Below -2.5 Medical Treatment Should Be Initiated To Prevent Fracture And Its
Major Consequences.
*If In Osteopenia Range, We Should Use Frax Calculator(As It Includes Other Factors ) And Vertebral Imaging To Decide
Whether Medical Treatment Is Needed In Asymptomatic Female.
---------------------------------------------------------------------------------------------------------------------

***************

Neurological Disorders During Pregnancy And Post-Partum Period: Case Series

Author: Dr. Priyamvada H V
Co Author: Dr. Nirmala Shivalingaiah1, Dr. Harsha Biliangady2, Dr. Sowmya K3,

Objective: To Study The Clinical Profile And Treatment Of Patients Presenting With Primary And Secondary Neurological
Disorders During Pregnancy And Puerperium.
Materials And Methods: Prospective Study At Kims Hospital, Bangalore
Background: Pregnancy And Postpartum Period Are Associated With A Marked Increase In The Relative Risk And A Small
Increase In The Absolute Risk Of Ischeamic Stroke And Cerebral Hemorrhage, With The Highest Risk During Pueperium.
Although Rare During Childbearing Years, Stroke Is Even More Devastating When It Occurs In A Young Woman Trying To
Start A Family. Pregnancy And The Postpartum Period Are Associated With An Increased Risk Of Ischemic Stroke And
Intracerebral Hemorrhage, Although The Incidence Estimates Have Varied. Although Strokes Can Occur At Any Time
During The Pregnancy, Arterial Occlusion Is Most Likely To Occur During The Third Trimester Of Pregnancy And During
The First Week Postpartum.
Case: In This Case Series We Have Discussed About Cerebrovasular Thrombosis, Glioma, Subarachnoid Hemorrhage,
Eclampsia, Tubercular Meningitis And Diabetic Insipedus.
Conclusion: The Incidence Of Neurological Disorders In Pregnancy And Puerperium Was Fairly High. Prompt Recognition
And Treatment Will Decrease The Morbidity And Mortality.

***************

Prevalence Of Urinary Incontinence Among Indian Women A Pilot Study

Author: Dr. Tamilselvi A
Co Author:

Objectives: There Are Very Few Studies Estimating The Prevalence Of Urinary Incontinence (Ui), And Its Impact On Quality
Of Life (Qol) Among Indian Women.
The Study Was Designed To Estimate In A Sample Population (1) Prevalence Of Urinary Incontinence In Women Above
Age Of 20 (2) The Severity & Type Of Urinary Incontinence (3) The Effect Of Urinary Incontinence On The Qol.

Methods: The Method Employed Was A Questionnaire-Based Interview In A Random Sample Population Of 100 Women
Attending A Gynaecology Clinic In A Teaching Institution. Both Storage And Voiding Phase Urinary Problems Were
Included In The Questionnaire. Demographic Details, Obstetrical And Co-Morbid Risk Factors, And Impact On Quality Of
Life (Qol) Were Collected.

Results: Among The Sample Population, Thirty-Seven Percent Of The Women, Reported Episodes Of Stress Urinary
Incontinence, 26% Of Urge Incontinence And 19% Of Mixed Incontinence. Nocturia (> Twice/ Night) Was Reported By
42% And Urinary Frequency (> 7Times /Day) Occurred In 23%.

Conclusion: Urinary Problems Including Urinary Incontinence, Is Not A Problem Of The Western World Alone. A Large
Number Of Our Indian Women Silently Suffer With This Untold Ailment. There Is An Urgent Need To Conduct A Large
Scale Community Based Survey On The Prevalence Of Urinary Incontinence, The Types Of Ui And The Possible Risk Factors.
This Will Help Both The Service Providers And The Patients In Creating Awareness And Planning Management Strategies.

***************

Incidental Diagnosis Of Extensive Peritoneal Metastasis During Emergency Lscs

Author: Dr. Karthika Devi
Co Author:

"What Lies Behind Us And What Lies Before Us Are Tiny Matters Compared To What Lies Within Us"....Hereby Presenting
A Case Of Metastatic Deposits In Peritoneum With Unknown Primary In An Asymptomatic Primigravida Taken Up For
Lscs. A 27 Yrs,Mrs.A, Primi , Term Gestation With Regular Menstrual Cycles And One And A Half Years Of Non
Consanguineous Marriage,Presented To Us With Complaints Of Lower Abdominal Pain For 2 Hours And Draining Per
Vaginum For One Hour. Patient Was Admitted And On Examination,Patient General Condition Was Fair And She Was In
Early Labour . Routine Investigations Were Normal, Ultrasound Abdomen Showed Single Live Intrauterine Gestation With
Cephalic Presentation And Adequate Liqour. Her Antenatal Ultrasonograms Revealed Normal Study And Normal
Fetus.After 6 Hours Of Labour Augmentation, With Failure Of Labour Progression ,She Was Taken Up For Emergency Caes
Arean Section. Intraoperatively,Following Delivery Of Baby, Multiple Extensive Metastatic Deposits Over
Peritoneum,Uterus, Ovary And Sigmoid Colon Was Found With Obliterated Pouch Douglas. Both Ovaries Were
Enlarged,Cystic, Studded With Metastatic Deposits.Metastatic Deposits Were Sent For Histopathological Examination To
Reveal Extensive Metastatic Papillary Serous Adenocarcinoma Deposits. Post Operative Evaluation Showed Ca-125 12089 U/Ml. Ct Abdomen Showed B/L Complex Ovarian Mass. Oesophageal Gastro Duodenoscopy Was Normal .
Colonoscopy Was Planned But As Patient Requested She Was Referred To Higher Center.

Conclusion: A Rare Case Report Of Totally Asymptomatic Primigravida Of Term Gestation Taken Up For Emergency Lscs
Found To Have Extensive Multiple Metastatic Papillary Serous Adenocarcinomatous Deposits Over
Peritoneum,Uterus,Ovary,Sigmoid Colon And Elevated Ca 125 And On Evaluation Post Operatively .This Case Is Presented
Here As Diagnosis Of Gynaecological Malignancies Is Rare In Pregnancy And To Emphasize Its Diagnostic Workup And
Follow Up

***************

Ruptured Cornual Pregnancy - A Case Reoprt

Author: Dr. Pravat Das
Co Author: Dr Om Avishek Das1, Dr Sujata Singh2,

(A)Inroduction:Cornual Gestation Is One Of The Most Hazardous Types Of Ectopic Gestation. Cornual Pregnancy Accounts For 24%
Of Ectopic Pregnancies With A Mortality Rate Of 2.02.5%.The Interstitial Part Of The Fallopian Tube Is The Proximal
Portion That Lies Within The Muscular Wall Of The Uterus. It Is 0.7 Mm Wide And Approximately 12 Cm Long, With A
Slightly Tortuous Course, Extending Obliquely Upward And Outward From The Uterine Cavity. Pregnancies Implanted In
This Site Are Called Interstitial (Cornual) Pregnancies.They Carry A Greater Maternal Mortality Risk Than Ampullary
Ectopic Pregnancy. Because Of Myometrial Distensibility, They Tend To Present Relatively Late, At 712 Weeks Of
Gestation.
(B)Case Report
A 25Yr Hf, Came With Chief Complaints Of Amenorrhoea For 2 Months, Pain & Distension Of Abdomen,Fever For 5 Days,
Admitted In The Medicine Department And Treated For Malaria & With Usg Report Of Iufd Was Admitted In The Lr As A
Case Of Missed Abortion With Severe Anemia In Shock.Patient Was Managed For Shock & Tab. Misoprostol Was Given
For Termination Of Missed Abortion.Subsequently,Was Diagnosed To Be A Case Of Ruptured Ectopic & Laparotomy Was
Done & Found To Be Ruptured Angular Pregnancy In Right Cornu. Repair Was Done.Post-Op Period Was Uneventful
(C)ConclusionCornual Pregnancy Poses A Significant Diagnostic And Therapeutic Challenge And Carries A Greater Maternal Mortality
Risk Than Tubal Pregnancy.Early Clinical Diagnosis By Ultrasound Or Laparoscop Help Effective Conservative
Managementthe Serious Consequences Of Cornual Pregnancy Are Caused Rupture After 12 Weeks Of Pregnancy,Leading
To Catastrophic Haemorrhage And Even Death. Cornual Excision Or Hysterectomy Used To Treatment For Such Cases.
Conservative Management Includes Laparoscopic Conservative Treatment And Medical Treatment With Systemic
Methotrexate

***************

Uterine Perforation Due To Invasive Mole: A Case Report

Author: Dr. Manoj Nayak
Co Author: Dr.Subhra Ghosh1,

(A)Inroduction:Gestational Trophoblastic Disease Is A Pregnancy Related Disorders Arising From Abnormal Placental Trophoblast Cells.It
Encompasses Two Pre-Malignant Conditions: Partial And Complete Hydatidiform Moles And The Malignant Gestational
Trophoblastic Neoplasia Are Classified Histologically Into Three Subgroups: Choriocarcinoma Destruens (Invasive
Mole),Choriocarcinoma And The Very Rare Placental Site Trophoblastic Tumor.Invasive Mole Is A Condition Where A
Molar Pregnancy Invades The Wall Of The Uterus.It Follows Approximately 10-15% Of Complete Hydatidiform Moles And
0.5% Of Patients With Partial Mole.The Imaging Of Choice Is B-Mode Ultrasonography And Color Doppler.With Early And
Accurate Diagnosis,The Cure Rate Is High .
(B)Case Report
A 26 Year Old Lady Presenting With Chief Complaints Of Severe Pain Abdomen, Vomiting Distention Of Abdomen &
Urinary Retention With H/O 3 Months Of Amenorrhoea Followed By Pain Abdomen & Bleeding Pv For Which S & E Done
16 Days Back Evacuating Grape Like Materials. She Has H/O 3 Previous Pregnancy Loss Due To Similar Cause.She Was
Admitted To The Labour Room & Emergency Laparotomy Was Done Revealing An Invasive Mole With Fundal Perforation.
Hysterotomy And S&E Of The Uterine Cavity Was Done.The Patient Recovered Uneventfully & Now Is On Chemotherapy
With Methotrexate & Folinic Acid Showing A Slow But Steady Decline In Hcg Levels.
(D)ConclusionManagement Of An Invasive Mole Includes Treatment With Chemotherapy & Continued Monitoring Of Bhcg. Patients
With Gtn Should Be Followed With Weekly Quantitative Bhcg Levels Until Normal For Three Consecutive Weeks, Then
Monthly For 12 Months.D&E Not Recommended Due To The Risk Of Uterine Perforationwith Methotrexate.Complete
Remission Is Achieved In Most Non-Metastatic And Low Risk Cases.Even In The Presence Of Disseminated Disease, Most
Of The Cases Are Amenable To Treatment With Almost 100% Survival.

***************

Study Of Maternal & Fetal Outcome In Eclampsia At Scb Medical College,Cuttack

Author: Dr. Jenny Gonmei
Co Author: Dr.Balaram Sahoo1, Dr.Sujata Singh2, Dr.Sasmita Swain3, Dr.Lucy Das4,

(A)Inroduction:In Pre Eclampsia When Complicated With Convulsion And Or Coma Is Called Eclampsia.The Hospital Incidence In India
Ranges From 1 In 500 To 1 In 30 .Eclampsia Is Associated With High Maternal & Fetal Mortality & Morbidity . Scb Medical
College Is The Main Tertiary Centre For The State.
(B)Aim And Objectives:
To Study The Fetal And Maternal Outcome, And The Causative Factors For The Mortality And Morbidity In Eclampsia
Patients Admitted To This Hospital And To Explore The Factors And To Take Measures To Prevent Eclampsia In The Future.
(C)Material And Methods:
Patients : 100 Eclampsia Cases Admitted To The Labour Room In Dept. Of O&G Scb Medical College Cuttack From
Jan 2013 To Dec 2013 Enrolled For The Study.
(D)Type Of Study: This Is A Observational Study.
(D)Result: In This Study 100 Eclampsia Cases Were Studied.The Incidence Of Eclampsia In S.C.B.Mch During Study Period
Was 1.21%.Most Of The Patients Were Primigravidae Accounting 87% Out Of Which 60% Were Antepartum,32% Were
Intrapartum ,8% Were Postpartum.Majority Of Cases Had No Anc Or Irregular Anc.Occurance Of Onset Of Eclampsia At
<32 Wks Ga 5%,32-36 Wks 56 % & > 36 Wks 39%.Most Of Patients Were From Rural Area And Having Low Socioeconomic
Status & Illiterate.Out Of 100 Cases 64 % Patients Had Vaginal Delivery And 36 % Had Under Gone Lscs & 80 % Were Live
Birth ,20% Still Births And Perinatal Mortality Rate Was 12%.Maternal Mortality Rate Was 8%.More Fetomaternal
Mortality & Morbidity Due To Delay In Receiving Treatment,More Number Of Convulsions,More + Urine Albumin,Bp
More Than 160/110Mmhg.Prompt Treatment ,Early Intervention Improving Feto Maternal Outcome In Our Set Up.

***************

Menace Of Maternal Near Miss In Obstetrics: Institutional Experience

Author: Dr. Chikati Sunita
Co Author: Dr Gayathri K. B1, Dr Sajana Gogineni2, Dr Nissy Jacintha.B3,

1. Dr. Gayathri.K.B , 2. Dr.Sajana Gogineni , 3.Dr Ch. Sunita , 4.Dr Nissy Jacintha.B
Place Of Study: Dr.Psims & Rf, Chinaoutpalli, Gannavaram .
Objective :To Compare The Causes Of Maternal Near Miss Cases Among Women Attended Dr.Psims & Rf.
Aim: Analysis Of Maternal Near Miss Cases To Have An Insight Into Interventions Which Saved Lives Of Critically Ill
Patients.
Methods : Retrospective Observational Study Over 1 Year From July 2013 August 2014.
Observation : Of The 1400 Admissions Into Labour Ward, Number Of Near Miss Cases Are 104(7.42%) In Which
Potentially Life Threatening Cases Are 88, Life Threatening Cases Are 17, Maternal Mortality 1Case. Severe Maternal
Outcome Ratio Was 12.14/1000 Live Births . Maternal Near Miss Incidence Ratio 11.42/1000 Live Births . Most Common
Causes Are Hypertensive Disorders 43 (3.07%) And Hemorrhage Are 45(3.21%) .24 Cases Had Surgical Intervention 1
Peripartum Hysterectomy, 23 Laparotomies Of Them 2 For Rupture Uterus, 10 For Hemorrhage, 6 For Rupture Ectopic, 5
For Hematoma .
Conclusion: Though Present Analysis Is Over A Short Period Of 1 Yr But Still Can Get To A Conclusion That With Vigilant
Monitoring And Timely Appropriate Intervention Are Crucial In Reducing Maternal Mortality And Morbidity During
Pregnancy, Labour And Postpartum Period.
Ref: 1. Associate Professor. 2 . Professor 3. Postgraduate 4.Postgraduate
***************

is Routine Screening Of Antenatal Women For Thyroid Disorders Beneficial?

Author: Dr. Akanshi Singh
Co Author: Dr B Jyothirmayee1,

1.Dr. Akanshi Singh

Postgraduate Ii Year, M.S Obgyn, Shadan Institute Of Medical Sciences, Teaching Hospital And Research Centre,
Hyderabad, India.

2.Dr B. Jyothirmayee
Professor, Obgyn, Shadan Institute Of Medical Sciences, Teaching Hospital And Research Centre, Hyderabad, India.

Aims And Objectives:-

To Screen All Pregnant Women At The First Antenatal Contact Irrespective Of Gestational Age For Thyroid Disorder. To
Understand The Prevalence Of Undetected Thyroid Disorders In Pregnancy.

Material And Methods:-

This Is A Hospital Based Prospective Observational Study, Conducted At Shadan Institute Of Medical Sciences Teaching
Hospital And Research Centre From August 2013 To July 2014. 1620 Pregnant Women Attended Sims For Antenatal
Checkup. Informed Consent Was Taken To Screen For Thyroid Disorders. Blood Was Drawn And Sent To The Laboratory
Of Shadan Institute Of Medical Sciences For Conducting Serum Tsh, Free T4, Free T3 And Thyroid Antibodies.

Results:-

1620 Antenatal Women Were Screened For Thyroid Disorder In The Study Period. 81Patients Were Found Hypothyroid
Accounting For 5% Of Hypothyroidism And 2 Patients Were Found Hyperthyroid Accounting For 0.12% Of
Hyperthyroidism.

Conclusion:-

The Prevalence Of Thyroid Disorder Increased In The Recent Past All Over The World And Overt Thyroid Dysfunction
Incidence In Pregnancy Is 1 To 2 %. All Over The World And In My Study Hypothyroidism Is More Common I.E. 5% And
Hyperthyroidism Is Comparatively Rare I.E. 0.12%.
By Screening All The Pregnant Women We Are Able To Diagnose Early And Manage Properly, Thereby Reducing Maternal
Complications Viz- Miscarriage, Preterm Delivery, Pre-Eclampsia, Congestive Cardiac Failure, Placental Abruption, Thyroid

Storm, Infections And Fetal Complications Viz- Iugr, Prematurity, Still Birth, Hyperthyroidism, Hypothyroidism, Increased
Perinatal Mortality And Morbidity. These Maternal And Fetal Complications Can Be Avoided By Screening Them In Early
Pregnancy And Giving Them Appropriate Treatment.

***************

Pregnancy With Heart Disease Maternal-Perinatal Outcome

Author: Dr. Rita Nayak
Co Author: Dr.Rita G.Nayak1, Dr.Sanjay Patil2, Dr.Manisha Ladded3,

1.Dr.Rita G. Nayak M.S. Pg Student At Krishana Institute And University,Karad

2.Dr.Sanjay Kumar Patil., Associate Professor In Obgy Department At Kims Karad
3.Dr.Manisha M.Laddad. Assistant Professor In Obgy Department At Kims Karad
Abstract:
Objective: To Evaluate The Maternal And Perinatal Outcome Of Pregnancies Complicated By Cardiac Disease In A
Developing Country.
Method:
A Prospective Analysis Was Carried Out Of 30 Womens With Pregnancy With Cardiac Disease Who Delivered Beyound
28 Weeks Of Gestation And From April 2013 To March 2014 At Obgy Department; Krishna Hospital ,,Karad.
Results: Rheumatic Heart Disease (N=21, 70%) With Isolated Mitral Stenosis (N=16) Was The Predominant Cardiac
Problem. Septal Defects Were The Most Common Form Of Congenital Heart Disease (N=8). In 11 (36.66%) Women, The
Diagnosis Of Cardiac Disease Was Made During Pregnancy. Patients In Nyha Class Iand Ii (N=21, 70%) Had Fewer Maternal
Complications And Their Babies Had A Higher Birth Weight Than Those In Nyha Class Iii And Iv (N=9, 30%). Cardiac
Complications Were Noted In 4 (13.33%) Patients. Commonest Complication Developing During Pregnancy, Labor And
Puerperium Was Congestive Cardiac Failure (N=2, 6.66%). Maternal Mortality Was Noted In 1 Patients (3.33%), Which
Were Due To Cardiac Failure And Pulmonary Edema. Six Patients (20%) Delivered Preterm And Thirteen Patients (43.33%)
Had Low Birth Weight Babies. There Were Three Neonatal Deaths And One Stillborn.

Conclusions: Rheumatic Heart Disease Is The Predominant Type. Patients In Nyha Class Iand Ii Has A Better Maternal And
Fetal Outcome Than Those In Nyha Class Iiiand Iv. Surgically Treated Women Tolerate Pregnancy Well. Vaginal Delivery
Is Safer And Caesarean Section Should Be Reserved Only For Obstetric Indications. Maternal And Perinatal Outcome Can
Be Improved By Team Approach At Tertiary Care Center.
Keywords: Pregnancy, Heart Disease, Fetomaternal Outcome,Rheumatic Heart Disease.

***************

Unusual Combination Of Mullerian Dysgenesis And Unilateral Ovarian Agenesis

Author: Dr. Rubini Mariappan
Co Author:

14Yrs Ms A Presented To Opd With H/O Delay In Puberty. Physical Examination Revealed Normal Healthy Adult Female
With Normal Secondary Sexual Characters. Local Examination Revealed Blind Vaginal Introitus And Replaced By Dimple.
Uterus Could Not Be Felt By Per-Rectal Examination. Ultrasound Was Done Which Shows Infantile Or Hypoplastic Uterus,
Absent Right Ovary With Non-Visualised Right Kidney In Renal Fossa. Karyotyping And Hormonal Study Was Normal.
Skeletal Survey Was Normal. Mri Was Taken Which Shows Segmental Agenesis/Hypoplasia Of Uterus ,Right Ovaries
Found To Be Absent With Absent Right Kidney And Compensatory Hypertrophy Of Left Kidney. Diagnostic Laparoscopy
Was Planned Which Showed Rudimentary Uterus, Stretching Of Round Ligament On Left Side ,Left Ovary Was Polycystic
And Right Tubes ,Ovaries Was Absent.
Conclusion:
Incidence Of Mullerian Anomalies Is 1 In 4000-10000.This Presentation Is To Emphasize That Mullerian
Anomalies Associated With Unilateral Ovarian And Renal Anomalies Is A Very Rare Combination. Proper Psychosocial
Counselling Regarding Functional And Emotional Effects Of Genital Anomalies As Well As Correction Of Anatomical Defect
Is Necessary
***************

Multidisciplinary Approach For Case Of 46Xy Gonadal Dysgenesis

Author: Dr. Suhas Sherekar
Co Author: Dr.Umadevi1, Dr.Vijaylaksmi2, Dr.Valarmathy3,

18 Year Old Person Reared As Female Presented With Complaints Of Change In Voice And Primary Ammenorrhea.There
Is No Turner Stigmata Nor Any History Of Hypertension And Salt Loosing Symptoms.Karyotyping Reveals 46Xy .On Pooled
Sample Level Of Tsh,Lh, Fsh,And Prolactine Was Normal. There Was Increased Level Of Testesterpne 2.4 Ng/Ml.Mri Pelvis
Combined With Usg Revealed Rudimentary Uteris Posterior To Bladder With Both Right And Left Ovaries
Rudimentary.Right Testis Measuring About 2.8X1.7Cm And Left Testis Measurong About 4X2 Cm.Both Testis Were
Located In Labia Majora With Blind Vagina .There Is No Evidance Of Ovarian Tissue Seen.Based On This Result And History
Diagnosis Of 46Xy Mixed Gonadal Dysgenesis Made Which Is Rare Case. Fertility Issue And Sex Acceptibility Issue Discuss
With Patient And Caretaker.Patient Was Managed By Multidisciplinary Approach
***************

Tackling Difficult Hysterectomies Laparoscopically

Author: Dr. Vanitha Anban
Co Author: Dr.Siva Kasirajan1,

57 Cases Of Difficult Hysterectomies Using Different Techniques &Different Energy Sorces In The Period Betwen June
2013 To June 2014 Were Evaluated To Assess The Role Of Laparoscopy
Cases Selected Included Pts With Large Uteri -19 Cases, Cases Of Previous Lscs With Dense Bladder Adhesions14 Cases,
Severe Endometroosis 10 Cases, Previous Multiple Laparotomies With Bowel Adhesions 4 Cases, Multiple Fibroids With
Uteri Larger Than 20 Wks 6 Cases, Combined Factors 4 Cases.
Mean Age Of Patients 46.5 Yrs.
Operating Duration 1.5 To 3.5 Hrs.
Total Laparoscopic Hysterectomy Was Done Using Standard 4 -5Mm Pirts
Myoma Screw Was Used For Manipulation
Energy Sources Used Included Enseal, Harmonic, Bipolar Vessel Ssealer, And Bipolar According To The Case.
Total Lap Hysterectomy Was Done In The Usual Way
Specimen Was Retrieved Either Using A Morcellator Or Vaginally In Piece Meal
Estimated Blood Loss Varied Between 2O Ml To 160 Ml.
Patients Were Started Orals After 6 To 8 Hrs.
All Patients Wete Discharged Between 24 To 48 Hrs.
Results:
There Was A Need For Conversion To Laparotomy In 3 Cases-1 Case Of Broad Fundus And 2 Cases Of Severe Endometriosis
With Frozen Pelvis.
Conclusion:
Laparoscopic Hysterectomy Offers The Surgon The Advantage Of Better Visualisation Of Tissue Planes And A Magnified
Image.
Access To Appropriate Energy Souces Makes The Procedure Safer.
Total Laparoscopic Hysterectomy Is A Safe, Convenient And Patient Friendly Procedure Even In Difficult Scenarios.

***************

An Unusual Case Of Spontaneous Rupture Of Postmenopausal Pyometra Peritonitis In A Case Of Uncontrolled Dm

And Htn With Rt Hemiparesis
Author: Dr. Ritika Rajan
Co Author: Dr.Rekha G. Daver(Proff& Hod ,Obgy)1,

65Yrs, Postmenopausal Since 8 Yrs Was Admitted In Ccu In Pvt Hospital In Dhule From 28/05/14-28/08/14 And Then
Referred To Jjh As A Case Of Dm With Crf With Htn With Right Sided Hemiparesis And Was Admitted In Surgical Ward For
Pain In Abdomen . Her Obstetric History Was Unremarkable With Last Child Birth 30Yrs Ago And An Uneventful
Menopause. She Had No H/O Postmenopausal Bleed Or Vaginal Discharge And Hence Referred To Obgy. Ct Abdo S/O
Pyometra With Uterine Rupture With Peritonitis.
O/E-Vitals Stable
P/A-Distension + With Tenderness In Right Hypochondrium,No Gr
P/S-Cxstenosed,Min.Wd+
P/V-Ut R/V,Ns, Mass Felt In Rif,Adherent To Uterus
28/08/14-Usg(Abdo+Kub)-Mild Ascites.Rest Wnl.
03/09/14-Ct(A+P)-Ut Atrophic With 4.3X4X3.9Cm Collection Within Endometrial Cavity With Multiple Air Foci Within S/O
Pyometra.A 2.4X3.3Cm Defect In Anterior Uterine Wall Communicating With Peritoneal Cavity S/O Uterine Perforation
With Peritonitis.
05/09/14-Exploratory Laparotomy Done With Adhesiolysis With Subtotal Hysterectomy By Gynaecologist And Surgeon
For Peritonitis With Pyometra With Uterine Rupture After Adequate Control Of Sugars And Htn Under Antibiotic Cover.
In Situ Findings-Walled Off Omentum Andcoccon Formation Of Bowel,E/O Thick Purulent And Loculated Fluid. Uterus
Rupture Of 2.5Cm At The Fundus With Exudation Ofpurulent Material Through The Rent.
E/O Bladder Adhesions With Uterus.Adhesiolysis With Subtotalhysterectomy Done.
Pus Culture S/O Streptococcus Faecalis/Enterococcus.
Raised Ada Levels In Peritoneal Fluid.Cat 1 Akt Started.
Hpr- Pyometra Withno E/O Malignancy.
Post-Op Condition Fair.
Pt Continued On Antibiotics, Akt,Insulin And Antihypertensives.
Ruptured Pyometra Should Be Kept In Mind In Elderly Women Presenting With Acute Abdomen As An Unusual But Serious
Condition.Variousbenign And Malignant Lesions Are Known To Cause It,Most Common Being Cervical Cancer In
Developing Countries.

***************

A Rare Case Of Sertoli Leydig Cell Tumor With Spontaneous Conception Following Oopherectomy
Author: Dr. Manju T
Co Author: Dr. Vasanthamani. P1,

A 20 Year Old Woman Presented To The Gynecology Opd With Complaints Of Secondary Amenorrhoea And Deepening
Of Voice Over 3 Years. She Was Married Past 3 Years And Had Nil Conceptions. She Attained Menarche At 13 Years Of
Age And Had Regular Menstrual Cycles. She Gradually Developed Features Of Defeminisation And Virilization Over Span
Of 3 Years Associated With Secondary Amenorrhoea. On Examination, She Had Salient Features Of Clitoromegaly,
Hirsutism, And Male Pattern Of Baldness. Bimanual Pelvic Examination Was Unremarkable Except For Minimal Right
Fornicial Fullness. Hormonal Assays Showed Marked Elevation Of Serum Testosterone. Ct Abdomen And Pelvis Revealed
Right Adnexal Mass Lesion Of Size 4.6X3Cm. Mri Brain Was Nonspecific Except For Pituitary Hyperplasia. Karyotyping Was
Suggestive Of 46Xx. Based On These Findings A Provisional Diagnosis Of Androgen Producing Ovarian Tumor Was Made.
Per-Operative Frozen Section Was Negative For Malignancy And So, Only Right Salphingo Oopherectomy Was Done.
Histopathology Showed Sheets, Cords And Nests Of Sertoli Cells In Odematous Stroma Interspersed With Leydig Cells
Suggestive Of Sertoli Leydig Cell Tumor Of Intermediate Differentiation. With Slight Suspicion Of Ovotestis, Sry Gene
Tracing Was Done By Molecular Genetic Analysis. The Test Was 100% Negative For Sry Gene Ruling Out The Possibility Of
Gonadal Dysgenesis, And Thus The Diagnosis Of Sertoli Leydig Cell Tumor Was Explicit. On Follow Up, There Were No
Evidences Of Local Recurrance Or Distant Metastasis Post Surgery And Repeat Testosterone Levels Were Within Normal
Reference Range. She Resumed Her Regular Menstrual Cycles Within 20 Days Of Tumor Excision And Conceived
Spontaneously 8 Months Later. Now She Is A Primigravida With Single Live Intrauterine Gestation Of 28 Weeks.

Sertoli Leydig Cell Tumor Accounts For Less Than 0.1% Of Ovarian Neoplasms. A Rare Tumor With Classical Manifestations
Credited By Spontaneous Successful Conception Following Tumor Excision Substantiates This Interesting Case
Presentation.
***************

Pregnancy With Anti Phospholipid Positive, Antithrombin Iii Deficiency And Overt Diabetes On Insulin-Triple Trouble
For Pregnancy-A Case Report
Author: Dr. Renuka Sivanandam
Co Author: Dr.Renuka.S1, Dr.Anoop Sreevalsan2, Prof.Dr.Vasantha N.Subbiah3, Dr.Sathiya4,

A 23 Year Old,Gravida 4 Abortion 3 With Rh Negative Pregnancy, On Routine Antenatal Investigation Was Found To Have
Apla Positive And Antithrombin Iii Deficiency At 7 Weeks Of Pregnancy. She Was Also Found To Be Pregestational
Diabetic.Patient Was On Inpatient Care Since 7 Weeks Of Pregnancy And Was Started On Aspirin 75Mg Once Daily And
Lmw Heparin Twice Daily .Glycemic Monitoring Was Done And Treated With Insulin On Sliding Scale.At 20 Weeks Of
Pregnancy, Ultrasound With Doppler Flow Study Showed Increased Ri And S/D Ratio In
Umbilical Artery.Steroid Prophylaxis Was Given At 28 Weeks Of Gestation . At 32 Weeks Of Gestation Pregnancy
Terminated By Emergency Caesarean Due To Non Reassuring Nst. Baby Was Under The Care Of Neonatologist Till Day 32
.On Post-Operative Day 32 Baby And Mother Discharged.Mother Was Discharged With Fixed Dose Of Insulin And Aspirin.

***************

A Better Half But Need Surrogacy- Case Of Cervical Atresia

Author: Mr. P Padmavathy
Co Author: Dr.Rukkayal Fathima1,

A Better Half .......... But Need Surrogacy

A Rare Case Of Cervical Atresia With Partial Vaginal Atresia

Prof. Dr. Padmavathy Md,Dgo ,Dr.Rukkayal2Yrmd
Iog, Egmore

Introduction:
Atresia Of The Uterine Cervix Is An Uncommon Mullerian Malformation Which May Be Associated With
Vaginal Aplasia. It Is Very Rare In Incidence , Less Than 60 Cases Is Reported In Literature So Far.

Case Presentation:
24 Year Old Unmarried Girl Presented To Our Opd With Primary Amennorhoea. She Was Already Evaluated For
The Same In 2007, During Which She Was Diagnosed As Lower Vaginal Atresia And Vaginoplasty Has Been Performed
Then. She Was Advised Regular Vaginal Dilatation With A Mould. But Patient Had Not Resumed Her Menstruation Inspite
Of Dilatation For Six Months And She Lost Follow Up Further.She Presented To Iog Opd In 2014 July With Primary
Amennorhoea And Severe Cyclical Abdominal Pain Restricting Her From Activities Of Daily Living. Per Abdomen
Examination Revealed Uterus 24 Week Size . Investigation Revealed Bulky Uterus With Adenomyosis, Hematometra , B/L
Hematosalphinx, And B/L Endometriotic Cyst.Intra Op Finding Revealed Complete Cerviacal Atresia And Hysterectomy
With B/L Removal Of Endometriotic Cysts After Leaving Behind Ovarian Tissue. Mac Indo Redo Vaginoplasty Done.

Conclusion:
In Conclusion , Diagnosis Of Uterine Cervical Atresia Requires Higher Clinical Suspicion. Diagnosis Should Be
Made As Early As Possible To Avoid Genital Complication That May Lead To Aggressive Surgery Such As Adnexectomy Or
Hysterectomy.Though The Above Patient Presented To Us With Complications, Maximum Efforts Had Been Done In
Leaving Behind Ovarian Tissue And Giving Her A Servicable Vagina.

Ready For Marriage............ But Need Motherhood

***************

Acase Of Giant Fibroid Uterus In Ayoung Lady

Author: Dr. Asuri Sri
Co Author:

A Case Of Giant Fibroid Uterus In A Young Lady

Dr A.Shanti Sri ,Associate Prof In Obg&Gyn ,Deccan College Of Medical Sciences, Hyderabad.
Background:
Leiomyoma Is The Most Common Tumor Of The Female Pelvis. These Neoplasms Frequently Cause Period Disturbances,
Pelvic Pain And Pressure Symptoms.
Case Report:
A Young Unmarried Lady Of 26 Years Reported With A Painless Lump Abdomen And Abdominal Distension Of 6 Months
Duration. There Was No History Of Period Disturbances Or Dysmenorrhea .
On Examination There Was An Intra Abdominal Lump Occupying The Hypogastrium , Umbilical And Extending To The
Lumbar, Iliac, And Epigastric Regions. The Mass Was Mobile Sideways But Not In A Cranio Caudal Direction .The Mass
Was Firm, Non Tender And Palpable On Per Rectal Examination.
On Ultrasound The Mass Was Hyperechoic Arising From The Pelvis Extending To The Epigastric Region Of Size 96 40
Mm Not Seen Separately From The Uterus, Ovaries Not Seen Separately, With Mild To Moderate Hydroureteronephrosis
With Omental Thickening And Without Any Evidence Of Ascites Or Lymphadenopathy. A Diagnosis Of Lipoma Was Made
On Ultrasound And Ct Was Advised.
Ct Scan Was Suggestive Of Right Ovarian Dermoid With Displacement Of The Uterus. Tumor Markers Tested Were
Negative For Malignancy. With A Working Diagnosis Of An Ovarian Mass She Was Posted For Laparotomy
On Laparotomy A Huge Fibroid Was Seen Arising From The Anterior Wall Of The Uterus Extending Into The Lateral And
Posterior Walls Completely Distorting The Anatomy. Both Tubes And Ovaries Were Healthy.
Myomectomy Was Done And Uterine Anatomy Was Restored. The Resected Specimen Weighed 5.5 Kgs With Dimensions
Of 302520Cms. Postoperative Period Was Uneventful. Histopathology Showed A Leiomyomatous-Lipoma Of The
Uterus.
Conclusion :
We Report This Case Of Uterine Lipoleiomyoma Because Of Its Rarity In This Age

***************

A Case Of Krukenberg Tumour With Primary Colon Adenocarcinoma

Author: Dr. Prabha Swaminathan
Co Author: Dr Kavitha R1, Prof A.P.Nalini2, Prof Famidha3, Dr Lalitha4, Dr Shery Angel5

A Case Of Krukenberg Tumour With Primary Colon Adenocarcinoma

Krukenberg Tumour Is One Of The Uncommon Tumours Of The Ovary With Incidence Of 1 To 2 %. Most
Common Malignancy Metastasizing To The Ovary Is Carcinoma Stomach Accounting To 70%. Other Less Common Sites
Are The Colon,Gall Bladder,Pancreas,Lung,Breast. This Is A Case Report Of A 45 Year Old Female With Bilateral Ovarian
Carcinoma That Had Metastasized From The Sigmoid Colon. She Presented With Abdominal Pain And Distension. She Had
No Abnormal Gastrointestinal Symptoms .Ct Scan Confirmed The Diagnosis Of Bilateral Ovarian Malignancy. Laparotomy
Revealed Bilateral Solid Ovarian Tumours, Minimal Serosanguinous Ascites,Nodules In Omentum And Both Paracolic
Areas. The Ovarian Masses Were Removed And Frozen Section Report Came Out As Adenocarcinoma.The Search For
Primary Tumour Was Done And A Stricture Was Identified At The Rectosigmoid Region. Colonoscopy Was Performed
Which Showed A Suspicious Annular Growth In The Sigmoid Colon .Total Abdominal Hysterectomy, Resection And
Anastomosis Of Sigmoid Colon With Total Omentectomy Was Done. PatientS Condition Was Stable In The
Postoperative Period .The Histopathological Examination Report Was Well Differentiated Adenocarcinoma Colon With
Metastatic Deposits In Peritoneum And Omentum.She Was Advised Postoperative Chemotherapy.This Case Once Again
Proves The Significance Of Considering Primary Gastro Intestinal Malignancy In A Patient With Bilateral Malignant
Ovarian Tumour.

***************

A Comparative Study Betweem Laparoscopic Assisted Vaginal Hysterectomy And Total Abdominal Hysterectomy- A
Prospective Case Control Study
Author: Dr. Reshmy Jr
Co Author: Prof Bharati Misra1,

A Comparative Study Between Laparoscopic Assisted Vaginal Hysterectomy And Total Abdominal Hysterectomy- A
Prospective Case Control Study
Background: Laparoscopic Assisted Vaginal Hysterectomy Is Becoming Increasingly Popular As A Definitive Alternative To
Abdominal Hysterectomy.
Aims And Objectives: To Compare The Efficiency And Outcome Of Laparoscopic Assisted Vaginal Hysterectomy And Total
Abdominal Hysterectomy In Terms Of Operating Time, Estimated Blood Loss, Quantity Of Analgesia Use, Postoperative
Pain Perception, Intra And Postoperative Complication Rates And Duration Of Hospital Stay.
Materials And Methods: A Prospective Case Control Study In Which 50 Patients Who Underwent Laparoscopic Assisted
Vaginal Hysterectomy Between August 2013- August 2014 Were Recruited As Cases And Controls Were 50 Patients Who
Underwent Total Abdominal Hysterectomy During The Same Time Period For Benign Gynecological Conditions.
Results: All Surgeries Were Performed By Gynecologists With Same Level Of Surgical Experience And Expertise. Basic
Characteristics Such As Age, Parity, Weight And Uterine Size Of Cases And Controls Were Comparable. Mean Operating
Time Was 108.5+/-11.440 Minutes In Lavh Group Which Was Significantly Longer Than 61+/-9.386 For The Tah
Group(P<0.001). Mean Hemoglobin Drop After 24 Hours Of Surgery Was 1.2Gm/Dl In Lavh Group And It Was 1.4Gm/Dl
In Tah Group And The Difference Was Not Significant. Number Of Dose Of Injectable Analgesics Used Per Patient In 24
Hours Were Significantly More In Tah (3.94) In Comparison To Lavh (2.54). There Was Not Much Difference To Overall
Complication Rates Between Lavh & Tah. The Mean Hospital Stay Was Much Shorter For Lavh (4.42 Days) Than Tah (7.04
Days). Another Advantage Of Lavh Was Significantly Lower Pain Scores In The Postoperative Period.
Conclusion: Although Operating Time Is Significantly Higher In Laparoscopic Assisted Vaginal Hysterectomy, This
Procedure Is Having Lower Postoperative Pain, Lesser Requirement Of Analgesics And Shorter Hospital Stay Than Total
Abdominal Hysterectomy Hence Preferred More By Patients.

***************

A Comparative Study Of Biotechnological And Clinical Pregnancy Outcome In Pcos Vs Non Pcos Patients Undergoing
In Vitro Fertilization
Author: Dr. Isha Kriplani
Co Author: Dr M.L. Swarankar1, Dr Swati Garg2, Dr Manisha Choudhary3, Dr Alka Gahlot4, Dr Sangita Sharma5

A Comparative Study Of Biotechnological And Clinical Pregnancy Outcome In Pcos Vs Non Pcos Patients Undergoing In
Vitro Fertilization.
Dr Isha Kriplani, Dr M.L. Swarankar, Dr Swati Garg, Dr Manisha Choudhary, Dr Alka Gahlot, Dr Sangita Sharma, Dr Ravikant
Soni
Mahatma Gandhi Medical College And Hospital, Jaipur

Introduction
Polycystic Ovarian Syndrome Is A Hormonal And Metabolic Disorder Which Poses Problem Of Infertility. When Assisted
Reproductive Techniques Are Applied There Is A Higher Risk Of Certain Complications.
Aim
To Investigate If Patients With Pcos Who Conceived With Ivf Treatment Had A Higher Risk Of Ohss, Chemical Pregnancy,
Miscarriage And Ectopic Pregnancy Rate Than Non-Pcos Subjects After Controlling For Several Important Confounding
Variables Relating To Pregnancy Loss.
Materials And Methods
This Is A Prospective Study Including Patients Who Conceived At Our Centre Between Jul 2013 And Jan 2014. According
To Inclusion Criteria 56 Patients Were Recruited. 20 Patients Were Pcos And 36 Were Non Pcos. Pcos Patients Were
Classified According To Rotterdam Criteria. Data Including Amh Levels, Stimulation Protocol, Endometrial Thickness And
Oestradiol Levels On Day Of Hcg With Resultant Pregnancy Outcome Were Compared Between The Two Groups. The
Main Outcome Measures Were Biochemical Pregnancy, Clinical Pregnancy, Miscarriage And Ectopic Pregnancy.
Result
20 Pcos Patients Had 24 Pregnancies In The Above Mentioned Time Frame. 4/24 Pregnancies Were Biochemical (16.6%).
5/24 Patients Had Miscarriage (20.8%). 1/24 Patient Had Ectopic Pregnancy (4.1%). 2 Patients Experienced Threatened
Abortion (8.3%) .3/24 Patients Suffered (12.5%) From Ohss.
36 Non Pcos Patients Had 41 Pregnancies In The Above Mentioned Time Frame. 4/36 Pregnancies Were Biochemical
(11.1%). 6/36 Patients Miscarried (16.6%). 2 Patients Had Ectopic Pregnancies (5.5%) Out Of Which One Was Heterotopic
With The Intrauterine Pregnancy Continuing To Term. 3/38 Patients Experienced Threatened Abortion (7.8%). 1/36 Had
Ohss (2.7%) .
Conclusion
Incidence Of Biochemical Pregnancy And Miscarriage Were Found To Be Higher In Pcos Group Along With Higher
Incidence Of Ohss. Remaining Detailed Data Will Be Presented In The Paper.

***************

A Rare Case Of Right Ovarian Cyst Loeys Deitz Syndrome

Author: Dr. Durga R
Co Author: Dr.Durga.R1, Dr.T.K.Renuka Devi2,

A Rare Case Of Right Ovarian Cyst With Loeys Deitz Syndrome:

Background:
Loeys Deitz Syndrome (Lds) Is A Rare Genetic Connective Tissue Disorder Which Is Autosomal Dominantly
Inherited Which Is Caused By Genes Encoding For Transforming Growth Factor 1 And 2 Receptors.This Syndrome Was
Recently Discovered In 2005.Loeys Deitz Syndrome Is Associated With Abnormal Vascular Findings(Arterial
Aneurysms).75% Of Individuals Have Type 1 Lds With Craniofacial Manifestations(Widely Spaced Eyes,Bifid Uvula/Cleft
Palate,Craniosynostasis) And 25% Of Individuals Have Type 2 Lds With Systemic Manifestations And Minimal Or Absent
Craniofacial Abnormalities.23 Cases Of Ovarian Cyst With Loeys Deitz Syndrome Have Been Identified Worldwide.

Case:
39 Years Old P2L2/Previous 2Caesarians/Sterlised Came With Complaints Of Severe Lower Abdominal Pain And
Nausea. The Diagnosis Of Twisted Ovarian Cyst Was Made Clinically.The Laparotomy Was Planned.During Anaesthetic
Assessment Before Laparotomy, Constellation Of Findings Like Aortic And Carotid Aneurysms In The Ct Angiogram,Bifid
Uvula,Hyperextensability Of Joint Were Noted.These Findings Were Found To Be Consistent With This Rare
Syndrome.The Complications Like Cervical Spine Instability,Aneurysmal Rupture,Difficult Intubation Were Suspected
Intraoperatively. She Was Also A Known Case Of Bronchiectasis,Diabetes Mellitus And Hypertension. Her Sister And
Daughter Had Similar Complaints The Laparotomy Was Performed Under Spinal Anaethesia Without Any
Complications.The Histopathological Sections Of Ovary Showed Cyst Wall Lined By Cubocolumnar Cells In Foci And
Hemosiderin Laden Macrophages Consistent With Endometriotic Cyst.In The Postoperative Period The Patient Was
Managed Effectively.The Genetic Analysis Of The Patient Was Done To See The Risk Of This Syndrome For The Future
Generations And To Identify The Gene Of Origin And To Educate The People.

Conclusion:
This Case Is Presented For Its Rarity And Thus It Is Important To Identify This Syndrome Preoperatively To Perform
A Safe Surgery.This Presentation Is Done To Create Awareness And Education Among Medical Community About This
Rare Syndrome To Manage Effectively.

***************

A Rare Case Of Tubo-Ovarian Actinomycosis

Author: Dr. Vidhya Jayashree
Co Author: Dr.Kalaivani1,

A Rare Case Of Tubo-Ovarian Actinomycosis

Background:
Actinomycosis Is A Chronic Suppurative Granulomatous Bacterial Infection. Pelvic Actinomycosis Is An Uncommon
Condition Usually Seen In Iucd Users. Due To Its Nonspecific Presentation And Extension Beyond Tissue Planes, It Can
Mimic Any Pelvic Condition.
Case :
28Yrs Old Female Patient Got Admitted With A Nonspecific Chronic Lower Abdominal Pain. Her Vitals Were Normal.
Ultrasound Showed A Hypoechoic Mass In The Left Adnexa. While On Evaluation, She Suddenly Developed Acute Pain,
Vomiting And Abdominal Tenderness. We Proceeded For An Emergency Laprotomy And Removed A Tubo-Ovarian Mass
Of 20X10Cm After Releasing Adhesions To Adjacent Structures With Pyoperitoneum. The Patient Had A Stormy PostOperative Period Which Required Intensive Medical Care, But Eventually Recovered. The Biopsy Of The Mass Concluded
It As Actynomycisis.

Conclusion:
Most Pelvic Actinomycosis Are Diagnosed From The Examination Of Post-Operative Specimens. It Requires A High Degree
Of Suspicion To Detect It Pre-Operatively. Pelvic Actinomycosis Represents Only A Very Few Percentage Of Human
Actinomycosis And Only Few Pelvic Actinomycosis Occurs Without Iucd In A Female . Our Case Is An Example Of Such A
Presentation.

***************

A Rare Presentation Of Twin: A Live Foetus With Complete Mole

Author: Dr. Meena K
Co Author:

A Rare Presentation Of Twin: A Live Foetus With Complete Mole

Prof Dr. M. Thangamani Md Og
Dr..K.Meena Final Year Pg
Introduction:
Twin Pregnancy With One Foetus And Complete Mole Is Rare With Incidence Ranging From 1 In 20,000 To 1 In 1,00,000
Pregnancies. Management Of Such Cases Is Difficult As Foetal Survival Should Always Be Weighed Against Risk Of
Complication Of Molar Pregnancy.
Case:
20 Yrs Old G2P1L0 With 4 Months Amenorrhoea Admitted With Complaints Of Spotting P/V. Transabdominal Usg
Showed Twin Pregnancy With Live Foetus Of 15 Wks Gestational Age And Vesicular Mole. Serum -Hcg Is 2,25,000Iu.
Patient Was Kept Under Observation And Careful Monitoring. After 5 Days Of Admission Patient Had Profuse Vaginal
Bleeding And Hysterotomy Was Performed. Foetus Died Shortly After Birth. Postoperative Period Was Uneventful.
Patient Was Discharged In Good Condition. Patient Was Followed With Serial -Hcg Which Returned To Normal.
Conclusion:
Twin Pregnancy With Molar Pregnancy Are At Increased Risk Of Haemorrhage And Medical Complications As Well As
Chance To Develop Persistent Gestational Trophoblastic Tumour. Eventhough Antenatal Management Varies These
Patient Needs Careful Surveillance For Persistent Trophoblastic Tumour.
***************

A Study On Knowledge And Utilization Of Mch Services Among Women Attending A Tertiary Care Hospital
Author: Dr. Jeripiti Jyothsna
Co Author:

A Study On Knowledge And Utilization Of Mch Services Among Women Attending A Tertiary Care Hospital
Dr.Jyothsna*,

Dr.P.A.Chandrasekharan**
Aims And Objectives:
To Study Knowledge And Utilization Of Mch Services Among Women Attending Government
Maternity Hospital , Tiruapti.

To Identify The Barrier To Improve Utilisation.

Materials And Methodology:

Study Sample:100 Rural And 100 Urban Women Attending Gmh Tirupati For Their Antenatal Visit.

Sampling Technique: Convenient Sampling

Study Setup:Govt.Maternity Hospital ( A Teaching Hospital With 13500 Deliveries Per Annum) ,Tirupati,
Andhrapradesh.

Type Of Study:Cross Sectional Survey

Study Tool: Questionnaire Containing 15 Questions.

Results:

24% Of Urban And 54% Of Rural Women Were Illiterate

34%In Urban And 54%In Rural Areas Women Were Married Before 18 Years

Only54%Of Urban And 22%Of Women Had Their First Antenatal Visit In First Trimester.

100% Had Antenatal Checkups But Only 80% Of Urban And 44% Of Rural Women Had Minimum Of Three Ante
Natal Checkups With Doctors.

56% Urban And 23%Rural Women Had Awareness Of Hiv , Its Mode Of Transmission And Need For Undergoing
Hiv Screening.

54%Urban And 38% Rural Women Had Idea About Breast Feeding,Colustrum And Prelacteal Feeds.

Among 46 Gravidous Women 56%Urban And 35%Rural Women Had Idea And Records Of The Complete
Vaccination Of Previous Child.

32%Urban And 47%Rural Women Had No Compliance In Using Ifa Tablets.

100%Women In Both Areas Had Received Two Doses Of Tetanus Toxoid Vaccination.

Conclusion:
Mch Services Are Still Underutilized Because Poor Knowledge And Awareness. This Is More So In Case Of Rural Women.
Since Mch Services Are Widly Available, Illietaracy Seems To Be The Main Reason. Hence Literwcy Drives Semms To Be
Theto Be The Best Solution.

*Postgraduate In Obg
**Professor Dept Of Obg,S V Medical College ,Tirupati.

***************

A Study On Knowledge Attitude And Practice Of Hand Hygiene

Author: Dr. Veneela Pasupuleti
Co Author: Dr.P.A.Chandrasekharan1,

A Study On Knowledge Attitude And Practice Of Hand Hygiene

*Dr.Veneela.P **Dr.P.A.Chandrasekharan
Aims And Objectives:
Aim Of This Work Is To Assess The Knowledge Attitude And Practice Of Hand Hygiene Among Doctors (Internees And
Postgraduates) In Government Maternity Hospital, Tirupati, And To Investigate The Presence Of Necessary Facilities And
Supplies Required For Hand Washing.
Materials And Methods:
Study Sample-35 Participants (Internees And Post Graduates)
Sampling Technique - Convenient Sampling.
Study Setup-Government Maternity Hospital, Tirupati , Andhra Pradesh.
Type Of Study -Cross Sectional Survey.
Study Tool- Questionnarie Containing 10 Questions.
Time Period - September 12Th To October 12Th 2014.
Results:
97% People Think That Hand Hygiene Is Very Important In Prevention Of Hospital Acquired Infection.
68.5% People Have Good Knowledge When To Wash Hands.
54.28%People Have Good Knowledge On Types Of Hand Washing.
55% People Have Good Attitude Towards Facilities Making Hand Wash Effective
Only 57% People Know Correct Technique Of Hand Washing.
83%People Have Poor Knowledge And Practice Of Scrubbing Before Surgery.
71% People Think That Facilities Are Inadequate For Hand Washing.
71% People Are Trained In Hand Hygiene.
Conclusion:
Many People Think That Hand Hygiene Is Very Important ,But Knowledge Levels Are Inadequate And Their Attitude
Towards Hand Hygiene Are Not Sufficiently Good.
Even Though Many Of Them Received Training In Hand Hygiene They Have Poor Knowledge On Hand Scrubbing And Hand
Wash Techniques.
So Improvement Of Facilities For Hand Wash And Training Programmes Should Be Conducted To Overcome This
Barrier,So That Many Infections Can Be Prevented With This Small Step.

*Post Graduate In Obg

**Proffessor In Department Of Obg In Sv Medical College Tirupati.

***************

A Study On Risk Factors For Problems In Wound Healing After Major Abdominal Surgeries In A Tertiary Care
Maternity Hospital
Author: Dr. Himaja Kunda
Co Author: P.A.Chandrasekharan1,

A Study On Risk Factors For Problems In Wound Healing After Major Abdominal Surgeries In A Tertiary Care Maternity
Hospital
* Dr.Himaja Kunda **Dr.Sasikanth,

***Dr.P.A.Chandrasekaran Md

Objectives
To Study The Incidence Of Delayed Wound Healing And Risk Factors Associated With Delayed Wound Healing .
Materials And Methods
This Is A Prospective Study Conducted At Government Maternity Hospital Attached( Tertiary Care Hospital )To Sri
Venkateswara Medical College And Hospital Tirupathi. Among 95 Patients Who Underwent Major Abdominal Surgeries
In The Month Of July 2014,The Patients With Delayed Wound Healing Were Identified During Postoperative Follow Up
And Risk Factors Analysed Using Criteria Available In Existing Literature. Delayed Wound Healing Is Identified By Presence
Of Serous, Serosanguenous ,Purulent Discharge And Induration Of Wounds.
Results
Of The 95 Patients Studied,87 Were Lscs,6 Were Total Abdominal Hysterectomies And 2 Were Emergency
Laparotomies.17 Patients(17.89%) Had Delayed Wound Healing . Among Them, Patients With Surgical Site Infection With
Positive Culture Are 6(35.29%).58.8% With Superficial Infections And 41.17% With Deep Involvement Which Required
Secondary Suturing. E.Coli Is The Common Organism Identified And All Strains Were Found To Be Sensitive To Amikacin
.( E.Coli-4,Actinomyces-1,Staphylococcus-1). Wound Induration Was Found In 47%( 8). Regarding Risk Factors: Anemia41.17%(7), Obese Abdominal Wall-17.64%(3), Infection At Other Sites-17.64%(3),Diabetics -2 And Hiv-1. 70.58% Patients
Had Identifiable Risk Factors And 29.41% Had No Risk Factors.

Conclusion
Delayed Wound Healing Is A Common Problem With Surgical Site Infection And Anemia Being The Common Causes
For Delayed Wound Healing. Majority Of The Patients Who Had Delayed Wound Healing Had One Or The Other
Predisposible Risk Factors. Hence Screening For Risk Factors And Taking Necessary Measures Can Be An Effective Method
For Prevention Of Wound Healing
*Post Graduate In Obg
**Intern In Sv Medical College,Tirupati.
***Proffessor In Department Of Obg In Sv Medical College Tirupati.

***************

Clomiphene And Human Menopausal Gonadotropin Regime In Anovulatory Infertility

Author: Dr. Yasmin Iqbal
Co Author: Kazi Amir Irfan1,

Aim & Objectives: To Study The Role Of Clomiphene Citrate And Hmg Regime In Anovulatory Infertility

Materials & Methods: Patients In Whom Complete Infertility Work-Up Was Done And Were Diagnosed To Have
Anoulatory Infertility
A) Who Did Not Ovulate With 100Mg And Higher Doses Of Clomiphene Citrate As Standalone Treatment
B) Those Patients Who Did Not Conceive Despite Ovulation With Clomiphene Citrate

A Total Of 100 Cases Who Met These Criteria Were Included In Our Study. Ovulation Induction Was Done Using This
Regime Followed By Injection Hcg For Ovulation.

Results: With The Above Regime, 97 Women Had Ovulated. The Endometrial Quality Was Better Compared To
The Cases Treated By Clomiphene Alone. A Total Of 64 Patients Conceived Within Three Induction Cycles. No Cases Of
Ovarian Hyperstimulation Syndrome Were Seen. There Was Only One Twin Pregnancy. All These Women Were/ Are On
Antenatal Follow Up. There Was One Abortion. The Tiffa Scans In Rest Of The Foetuses Were Normal.

Conclusion: In Our Previous Experience Of Treatment Of Anovulatory Infertility, It Has Been Noticed That
Increasing The Dose Of Clomiphene Citrate Alone Resulted In Comparatively Poor Endometrial Quality And Less
Conception Rates Compared To The Number Of Ovulatory Cycles. There Was Increased Risk Of Hyperstimulation,
Multiple Pregnancies And Abortion Rates. Therefore, The Combined Clomiphene-Hmg Is A Superior Regime For The
Patients Requiring Greater Than 100Mg Clomiphene Citrate And Also Those Requiring Lower Dose Of Clomiphene But
Showing Poor Endometrial Quality.

***************

Get Ready For Flood Of Fetal Gene Testing

Author: Dr. Neharika Bora
Co Author: Dr Keshav Malhotra1,

Cma(Chromosomal Micro-Array) Is A New Technology Which Provides A Whole Genome Scan To Detect Copy
Number Changes (Cncs).

This Study Is To Compare Cma Versus Conventional Fetal Genetic Testing In Collaboration With Agile Lab ,New
Delhi And Rainbow Hospitals, Agra.

The Study Started Last Year 2013 And 40 Cases Have Been Studied In This Study.

This Study Is Still Ongoing .

Long Term Follow-Up Of Babies Born Will Be Kept For Five Years.

Advances In Invasive Prenatal Diagnosis: Chromosomal Microarray (Array-Cgh, Molecular Karyotyping) Will
Replace Conventional Karyotyping

Non-Invasive Prenatal Analysis In Maternal Plasma Will Replace Other Screening Tests And Further Decrease The
Need For Invasive Testing

***************

Use Of Laparoscopically Mobilized Peritoneum In The Creation Of A Neovagina

Author: Dr. Damodar Rao
Co Author: Dr.S.R.Rao1, Dr.Asha.R.Rao2, Dr.Tts.Preetha3,

use Of Laparoscopically Mobilized Peritoneum In The Creation Of A Neovagina

Dr.Damodar.R.Rao ,Dr.S.R.Rao, Dr.Asha.R.Rao, , Dr.Tts.Preetha

Rao Hospital, Centre For Assisted Reproduction & Endoscopy (C.A.R.E), Coimbatore, Tamil Nadu

Aim: To Present An Alternative Technique For The Creation Of A Neovagina.

Objective: Patient Morbidity And Satisfactory Intercourse.

Materials & Methods: It Was A Case Study In A Private Hospital Setting With Mci Recognized Fellowship In Gynaec
Endoscopy. Here We Present An Unmarried 27Yrs Old Girl With Primary Amenorrhea Diagnosed With Partial Mullerian
Agenesis Secondary Sexual Characters Well Developed. Tubes & Ovaries Were Present But Absent Uterus & A Blind
Vagina. Here We Used DavydovS Technique Of Creating New Vagina By Molilizing The Peritoneum Laparoscopically
& Suturing It To The Introitus After Creating A Space Between Bladder & Rectum Laparoscopically. This Was Followed By
Usage Of Soft Dilators In The Coming Months.

Result(S): The Patient Underwent The Procedure Satisfactorily And Was Discharged Within 48 Hours. She Had No
Perioperative Or Postoperative Complications, And She Became Satisfactorily Sexually Active.

Conclusion(S): The Use Of Laparoscopically Mobilized Peritoneum In The Creation Of A Neovagina Provided The Patient
With A Functional Vagina, Allowing Satisfactory Intercourse.Peritoneum Is Beneficial Because It Allows Development Of
A Vaginal Environment With An Acidic Ph And Is Replaced By Squamous Epithelium 56 Months After Surgery.
***************

Term Secondary Abdominal Pregnancy: Rare Of Rarest Case.

Author: Prof. Colonel Yoginder Singh
Co Author: Col Yoginder Singh1,

Abdominal Pregnancy May Account For Up To 1 Percent Of Ectopic Pregnancies. The Incidence Of
Abdominal Pregnancy Differs In Various Publications And Ranges Between 1: 10000 Pregnancies To
1:30,000 Pregnancies. Have Been Reported Worldwide Ever Since. Abdominal Pregnancies Refer To Those With Extra
Uterine Implantations In Omentum,Vital Organs, Or Large Vessels. These Pregnancies Can Go Undetected Until An
Advanced Gestational Age And Often Result In Severe Hemorrhage. Rates Of Maternal Mortality Have Been Reported As
High As 20%. Advanced Abdominal Pregnancy Carries A Risk Of Hemorrhage, Disseminated Intravascular Coagulation,
Bowel Obstruction, And Fistulae. Frequently, These Pregnancies Are Encountered With A Viable Fetus, Which Complicates
Their Management. Have Been Reported In The Pelvic Cul-De-Sac, Broad Ligament, Bowel, And Pelvic Sidewall. The Site
Of Implantation And Availability Of Vascular Supply Are Believed To Be Factors That May Influence The Possibility Of Fetal
Survival. Abdominal Pregnancy At Term With A Healthy Viable Fetus Is Therefore A Very Extremely Rare Condition And
Very Few Of Such Cases Have Been Published During The Last Ten Years. We Present A Case Of Abdominal Pregnancy
Where The Gestational Sac Was Implanted In The Broad Ligament And Resulted In A Live Baby Without Malformations
Which Is A Rare Of Rarest Event.

***************

Study Of Safety And Efficacy Of Iron Sucrose In Treatment Of Pregnancy With Anemia
Author: Prof. Gopalkrishna Huilgol
Co Author: Prof Somegowda1,

Absract For Paper Presentation In Aicog 2015

Title: Study Of Safety And Efficacy Of Iron-Sucrose In The Treatment Of Pregnancy With Anaemia.
Author: Dr. Gopalkrishna,B Huilgol Professor Of Obg, Bmc & Ri
Applying For: Fogsi Dr. Amarendra Nath Dan Prize
Background
The Causes For Anaemia In Pregnancy Include Increased Demand During Pregnancy, Poor Diet, Repeated Pregnancies
And Pre-Existing Anaemia That Affect 59.9% Of Our Pregnant Women. There Is A Need To Correct Anaemia With Iron
Preparation Which Can Be Administered In Short Period With No Gastro Intestinal Side Effects Like Injection Iron Sucrose
Preparation This Study Was Therefore Done To Evaluate The Safety And Efficacy Of Intra Venous Iron Sucrose Injections
In Pregnant Women.
Materials And Methods
This Was An Interventional Prospective Study Carried Out For A Period Of Six Months , On Pregnant Anaemic Women
At Vanivilas Women And Children Hospital.76 Pregnant Ladies Between 18 To 34 Weeks With The Haemoglobin Level Of
Equal To Or Less Than 8 Gms%. Were Admitted After Obtaining Informed Consent Admitted As In Patients In The Hospital.
The Haematological Investigations Were Done Periodically. The Required Dose Of Injection Iron Sucrose Was Calculated
As Per The Formula=2.4 X Pre-Pregnancy Weightinkgs X Hb% Deficit (11-Actual Hb% Of Pt.)+500. In Milligrams.
Result
There Was Rise In Mean Serum Iron And Ferritin Level On Day 28 When Compared To The Levels On Day 1 Which Was
Statistically Significant ( P Value Being 0.000 ) This Is The Expected Response After Iron Therapy.This Indicates Improved
Iron Stores And Peripheral Iron Levels On Day-28
Conclusion Injection Iron Sucrose Is Safe And Effective In The Management Of Anaemia In Pregnancy.

***************

Laparoscopic Management Of Large Ovarian Cysts At A Rural Hospital.

Author: Dr. Jyoti Ghongdemath
Co Author: V V Shindholimath1, L Krishna2,

Abstract
Aims & Objectives:
To Assess The Feasibility And Outcome Of Laparoscopic Surgery For The Management Of Large Ovarian Cysts In A Rural
Hospital And To Encourage Laparoscopy For The Treatment Of Such Ovarian Cysts.
Materials & Methods:
It Is A Retrospective Study Wherein 24 Patients From March 2006 To February 2014, With Large Ovarian Cysts Of More
Than 10 Cm Diameter, Were Managed Laparoscopically. Preoperative Evaluation Included History, Clinical Examination,
Sonographic Images And Serum Markers. All The Masses Included Were Cystic And Were Not Associated With Ascites Or
Enlarged Lymph Nodes On Ultrasound. Serum Ca 125 Levels Were Within The Normal Range (0-35 U/Ml). The
Management Of These Ovarian Cysts Included Aspiration, Cystectomy Or Salphingo-Oophorectomy, Depending On The
Patient'S Age, Obstetric History And Desire Of Future Fertility. In Cases Of Large, Solid, Fixed Or Irregular Adnexal Masses,
Suspicious Of Malignancy, Laparotomy Was Done.
Results:
Ten Patients Presented With Pain Abdomen, 15 Patients With Abdominal Distension And Discomfort. The Average
Maximum Diameter Of The Ovarian Cysts Was 16.75 Cm (Range, 10-24 Cm). The Mean Duration Of The Operation Was
80 Minutes (60 -120 Min). The Postoperative Hospital Stay Was 4 To 6 Days. No Intraoperative Complications Occurred
And The Hospital Course Of All Patients Was Uncomplicated. In One Case, Laparoscopy Was Converted To Laparotomy.
One Patient Had Minor Wound Infection At Umbilical Port Site. The Patients Did Not Report Any Complaints During
Follow-Up And The Clinical Examination Findings Were Normal In All, Up To 9 Months After Discharge.
Conclusion:
With Proper Patient Selection, The Size Of An Ovarian Cyst Is Not Necessarily A Contraindication For Laparoscopic Surgery.

***************

Placenta Previa : Risk Factors And Fetomaternal Outcome An Eighteen Months Prospective Study
Author: Dr. Sachayta Bali
Co Author: Sachayta1, Parmjit Kaur2, Surinder K.Bhupal3, Ruby Bhatia4, Aman Dev5

Abstract
Aims And Objectives

To Evaluate Socio Economic Status And Various Risk Factors Associated With Placenta Previa.

To Study The Fetomaternal Outcome In Placenta Previa.

Material And Methods

Study Was Conducted In Department Of Gynaecology And Obstetrics, Rajindra Hospital, Patiala.
A Total Of 100 Cases Of Placenta Previa Were Enrolled In The Study. Fetal Well Being And Placenta Localization
Was Done By Ultrasonography. Maternal Morbidities During Antenatal, Intrapartum And Post Operative Period Were
Noted. Fetal Outcome Was Studied As Status Of Baby At Birth, Birth Weight And Apgar Score At 1 And 5 Minutes And For
Any Other Complication Till Discharged From Hospital.
Results
Majority Of Patients Were Multigravida, Unbooked Cases, Belonged To Rural Areas And Low Socio Economic
Class.Majority Of The Patients I.E 91% Were Diagnosed By Ultrasonography While 9 % During Intraoperative Period. 86%
Of Patients Were Major Degree Placenta Previa. 26% Cases Had Malpresentations. Risk Factors Observed Were History
Of Caesarean Sections, Dilatation And Curettage/Evacuation, Placenta Previa In Previous Pregnancy, Twin Gestation And
Myomectomy. 61% Of Patients Had Emergency Caesarean, 35% Cases Had Elective Caesarean And 4% Had Vaginal
Delivery.
Maternal Morbidities Were Observed Were Haemorrhagic Shock, Broad Ligament Haematoma, Bladder Trauma, Post
Partal Haemorrhage, Wound Infection And Gaping, Puerperal Pyrexia, Prolonged Stay In Hospital And Placenta Accreta
Requiring Caesarean Hysterectomy. 65.35% Were Preterm Births, 68.31 % Babies Were Below 2.5 Kgs. 8.91% Were Still
Births, 45.54% Babies Required Nursery Admissions.
Conclusions
Placenta Previa, A Serious Condition, Increases Maternal And Fetal Morbidity And Mortality. An Advanced Radiological
Facility, Round The Clock Availability Of Blood Bank, Nicu Facility, Good Referral System, Experienced Doctors, Reducing
Illiteracy And Women Empowerment Is The Need Of Hour.

***************

Routine Deworming In Pregnancy

Author: Dr. Kruthika Sajjan
Co Author: Dr Manpreet Kaur1,

Abstract

Routine Deworming ?

Objective : To Observe The Change In Hb Level After Iron Supplementation ,With And Without A Single Dose Of
Antihelminthic Albendazole (400 Mg) In Two Groups Of Pregnant Women, In Order To Underline Or Undermine The
Importance Of Routine Deworming In Antenatal Care, As Recommended By Who

Methods: A Double Blind Randomized Control Trial Was Done On 134 Pregnant Women Attending Antenatal Care. They
Were Alternately Chosen And Divided Into Two Groups. Group A Received Albendazole (400Mg Stat Dose) Plus Iron
Supplementation(600Mg/Day* 30D) And Group B Received Placebo (Chewable Antacid) Plus Iron Supplementation. Their
Baseline Hb Level And The Hb Level 4 Weeks After Treatment Was Recorded And Were Asked To Answer A Questionnaire
Prior To And After Treatment To Assess Change In Knowledge And Awareness Regarding Diet And Nutrition In Pregnancy.

Result: The Mean Hb Level Prior To Treatment For Group A Was 9.2567 And For Group B 9.9208 (P=>0.05). Post Treatment
The Mean Hb Level For Group A Was 10.7746Mg/Dl And For Group B Was 10.037Mg/Dl. A Difference Of 1.5175Mg/Dl
Was Recorded In Group A Which Is Statistically Highly Significant(P=<0.001)When Compared To Group B Which Was
0.1165. Hence A Significant Rise In Hb Level Has Been Observed In Group A Post Treatment

Conclusion : Routine Deworming Is A Must In All Pregnant Women.

***************

A Rare Case Of Unruptured Right Rudimentary Horn Pregnancy Presenting As Acute Abdomen With Abnormal
Placental Invasion
Author: Dr. Divya Bharathi Karmegaraj
Co Author: Dr.Ramalakshmi, M.D.,D.G.O.,1,

Abstract
Background
Pregnancy In A Non Communicating Rudimentary Horn Has A Reported Incidence Of 1 In 1,00,000 To 1 In
1,40,000. Rudimentary Horn Pregnancy Can Be Further Complicated By Placenta Percreta Due To Poorly Developed
Musculature, The Reported Incidence Being 11.9%.
Case Report
22 Years Old G3 P1 L1 A1 Was Referred To Our Hospital At 28 Weeks Of Gestation With Severe Abdominal Pain.
There Was No History Of Bleeding Per Vaginum, No H/O Loss Of Fetal Movements, No H/O Trauma, Bladder Or Bowel
Disturbances. On Admission The Patient Was In Shock With Tenderness And Guarding In Suprapubic And Right Iliac Fossa
Region. So, Surgeon And Sonologist Opinion Obtained. Usg Revealed An Alive Fetus Of 28 Weeks, No Retro Placental Clots
And Massive Free Fluid. Appendix Appeared Oedematous.
Diagnosed As? Appendicular Perforation And Planned For Emergency Laparotomy.
Intra Operatively :
1.

Haemoperitoneum Of 2 Litres Removed.

2.
There Was An Enlarged Gravid Intact Right Rudimentary Horn And Numerous Vessels Were Seen Scattered All
Over Its Fundus. The Horn Was Connected To Right Wall Of Uterus Just Above Cervix By Thick Fibrous Band. An Alive Girl
Baby Of 960 Grams Delivered From The Horn. Placenta Was Perforating Through The Thinned Out Uterine Wall And There
Was Brisk Bleeding, Hence Proceeded With Hysterectomy. Right Kidney And Ureter Absent. Hpe Confirmed The
Presence Of Chorionic Villi Invading The Uterine Layer.
Conclusion
As Rudimentary Horn Pregnancies Are Always Associated With Catastrophic Outcome, Every Effort Should Be
Made To Diagnose Them As Early As Possible. High Clinical Suspicion, Early Diagnosis And Timely Laparotomy Can Reduce
The Maternal And Perinatal Mortality. When Diagnosed Early, Excision Of Rudimentary Horn With Ipsilateral
Salphingectomy Is The Recommended Surgical Treatment With Good Prognosis

***************

Gishiri Cutting In Indian Tribal Woman Resulting In A Complete Tear Of Posterior Bladder Wall From Fundus To Tip Of
Urethra And Prolapse Of Anterior Bladder Wall Through It - A Rare Clinical Dilemma.
Author: Prof. Ashok Anand
Co Author:

Abstract
Intoduction - Rupture Of Whole Of Posterior Bladder Wall From Fundus To Tip Of Urethra Is Probably The Rarest Of All
The Bladder Injuries.
Case Report - We Report Such Case, Supposedly Following Gishiri Cutting In Indian Tribal Woman. The 50 Year Old Woman
Resident Of Dahanu, Tribal Belt Of Maharashtra, India, Presented In Opd With Complaints Of Something Coming Out Per
Vagina Since 2 Years. Biopsy Of Prolapsed Part Showed Cin.On Ultrasonography Uterus Was Not Visualised.Urethra Could
Not Be Seen Due To Thick Fibrosis At The Interoitus. It Was Only On Operating Table, After The Fibrous Band Was Cut
And Anterior Peritoneumwas Opened, It Was Realised That The Uterus Was Very Much In Situ. After Opening Posterior
Peritoneum, We Realised That Anterior Vagina Was Cut And Along With It Posterior Bladder Wall From Fundus Till Tip Of
Urethra In The Midline And Was Retracted To Lateral Pelvic Walland Anterior Bladder Wall Was Prolapsed Through
Ruptured Posterior Bladder Wall. After Vaginal Hysterectomy, Bladder Was Repaired And Urethra & Sphincter
Reconstructed. On The Second Day Of Surgery On Direct Questioning Patient Gave History Of Dribbling Of Urine Since
Two Years But Did Not Reveal What Preceded Dribbling Like Trauma , Operation Etc. She Went Home With Continent
Bladder. It Was Only After Social Worker Was Intrusted To Find The Cause We Realised That It Was The Infamous Gishiri
Cutting.
Discussion - Gishiri Cutting Usually Result In Vesico-Vaginal Fistulae [3] But Bladder Rupture From Fundus To Urethra And
Anterior Wall Prolapsing Through It, Is Unique And Rare.
Conclusion - These Gruesome Practices Sometimes Can Result In Real Diagnostic Dilemma. Education, Health Care
Facilities And A Strict Legislation Are Required To Stop Such Practices.

Keywords - Gishiri Cutting, Bladder Rupture, Inversion, Vaginal Hysterectomy.

***************

Hormonal Profiles In Pcos

Author: Dr. Gayatri Thaker
Co Author:

Abstract
Pcos Is A Major Social Female Health Problem Worldwide. Society Is Largely Unaware Of The Condition And Health Care
Providers Do Not Seem To Fully Understand Its Long Term Effects. This Study Includes 516 Patients Out Of 4300 Patients
Of O.P.D. (12 %)In Which Pcos Was Diagnosed. Painful And Irregular Periods Are Most Consistent, Commonest And
Important Symptom. Insulin Resistant Obese Pcos (66 %)And Thin Pcos (34 %)Both Types Were Observed. Usg Criteria
With Painful Menstruation Are Early To Come Symptoms. Bilateral Or Unilateral Breast Discharges (Galactorrhoea) Are
Present In 42 % Without Hyper- Prolactinemia. Hyper -Prolactinemia With Or Without Galactorrhoea Was Present In 22
%Of
Patients .Hypothyroidism Was Present In 18 % Of Patients. Insulin Resistance Was Present In 12% Of Patients.
It Seems That Pcos Should Be Effect Of Some Other Etiology Rather Than Primarily Ovarian Cause.

***************

Case Series Of Mullerian Anomalies In A Tertiary Care Centre And Patients Requiring Hysterectomy: A Two Year
Experience.
Author: Dr. Supriya Poonia
Co Author: Dr. Meena Satia1,

Abstract Aicog 2015: Theme- WomenS Health Nation Health

Title: Case Series Of Mullerian Anomalies In A Tertiary Care Centre And Patients Requiring Hysterectomy: A Two Year
Experience.
Authors: Dr Supriya Poonia, Third Year Resident
Co Authors: Dr Meena Satia, Professor And Head Of Unit
Seth Gs Medical College And Kem Hospital, Mumbai
Abstract
Aims And Objectives: Our Aim Is To Analyse Clinical Course And Management Of Patients With Mullerian Anomalies.
Materials And Methods: A Retrospective Observational Analysis Of Series Of Cases Of Mullerian Anomalies Operated
During Jan 2013 Oct 2014 In The Department Of Obstetrics And Gynaecology, Seth G.S. Medical College And Kem
Hospital, Mumbai. Patients Were Assessed For Age, Clinical Presentation, Physical Examination, Radiological Imaging And
Operative Intervention. This Study Was Multiparametric In Design. It Focused On Multiple Parameters Of An Individual
Case. This Study Involves Case Stratification Of Cases According To Age, Positive Clinical Findings And Detailed
Investigation Reports To Formulate A Diagnosis And Accordingly Appropriate Management Of Each Case.
Results: Of 20 Cases Of Mullerian Anomalies 70% Were In 13-17 Years Of Age Group, Maximum Presented With Cyclical
Abdominal Pain Followed By Primary Amenorrhoea, 5% Cases Had Associated Renal Anomalies And For 25 % Of Cases
Hysterectomy Was Done.
Conclusion: Mullerian Ducts Form Fallopian Tubes, Uterus, Cervix And Upper Two Thirds Of Vagina. Anomalies In Any Of
The Three Phases Of Organogenesis, Fusion Or Septal Resorption Results In The Mullerian Duct Anomaly. Mullerian Duct
Anomalies Occur In 0.1-3.5% Of All Women. Management Protocols And Treatment Modalities Were Individualised As
Per The Case Diagnosed. Radical Surgeries Like Hysterectomy Have Always Been A Difficult Choice In Such Young Patients.

***************

Acceptance And Safety Of Intracesarean Iucd

Author: Dr. Mayuri Korde
Co Author: Dr. R J Wani1,

Abstract For Aicog 2015

Title: Acceptance And Safety Of Intracesarean Iucd
Category: Miscellaneous
Authors: Dr. Mayuri Korde (Senior Resident Ms Obgy), Dr. R J Wani ( Add. Prof.)
Dept. Of Obstetrics & Gynecology, Tnmc & Byl Nair Hospital, Mumbai
Aims& Objectives:
1. To Assess Acceptance Of Immediate Postpartum Insertion Of Iucd At Lscs In Cases Of Elective And Emergency Cesarean
Section.
2. Follow Up Of Acceptors To See The Retention & Continuation Of Method At 6 Weeks, 6 Months And 1 Year.
Material And Methods:
This Is The Prospective Cohort Study Conducted At Tnmc & Byl Nair Hospital, Mumbai. In This Study360 Patients
Undergoing Lscs Were Counseled About Choice Of Intracesarean Insertion Of Iucd Over A Period Of 1 Year.
Results And Conclusions:
Total No. Of Patients Counseled Over A Period Of 1 Year Was 360. The Acceptors Of Intracesarean Iucd Were 85 (24%).
Out Of 360 Patients, 15 Patients Undergoing Elective Lscs And 70 Patients Undergoing Emergency Lscs Accepted
Intracesarean Iucd. Majority Of Patients (78.82%) Followed Up In Person At Our Hospital At 6 Weeks While At 6 Months
And 1 Year Follow Up Dropped To 67.06% And 51.76% Respectively. Cut Threads Were Seen In Majority Of Patients At 6
Weeks While Cut Threads Were Seen At 6 Months In The Remaining Patients. We Found That In 10.8% Cases Iud Threads
Were Not Visible But Usg Showed The Device In Situ Hence Patients Were Counseled And Reassured. Out Of These 9
Patients, Cut Was Expelled In One Of The Patient. Patients Chief Complaints Were Bleeding Per Vaginum, White Discharge
And Pain In Abdomen (9.41%, 7.06% And 3.53% Respectively). We Found 1.18% Expulsion Rate And 93% Continuation
Rate. This Method Increases Patient Choices At The Time Of Cs And Meets An Unmet Need Of Contraception For Spacing
Very Effectively.

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Huge Large Bowel Mesenteric Cyst Complicating 2Nd Trimester Of Pregnancy

Author: Dr. Prabha Janakiram
Co Author: Dr.Prabha Janakiram1, Dr Parimala Devi2, Dr. Uma3, Dr.Edwina4,

Abstract Presentation

Theme :

High Risk Pregnancy And Fetal Medicine

Title : Huge Large Bowel Mesenteric Cyst Complicating 2Nd Trimester Of

Pregnancy
Name Of The Prize :

Fogsi Dr. C. S Dawn Prize

Name Of The Presentors: Dr. Prabha Janakiram, Dr.Parimaladevi ,

Dr.Uma, Dr.Edwina

Background:
Mesenteric Cysts During Pregnancy Are Very Rare, This Case Is Presented For Its Mammoth Size And Surgical Excision
Without Interfering With The Pregnancy.

Case Report:
26 Year Old, G3 A2 , Rakini Married Since 6 Years With History Of 6 Months Amenorrhea, Came With C/O Generalized
Abdominal Pain More On The Left Side, Dull Aching In Nature, No Specific Aggravating Or Relieving Factor, Not Associated
With Vomiting, Bowel &Micturition Habit Being Normal.
Perabdominal Examination Showed Distended Abdomen, Uterus Not Made Out Separately.
Ultrasound Revealed A Huge Echo Free Cystic, Mass Of Size 30 *35 Cms Occupying Midabdomen, Pushing Uterus
Anteriorly ,Gestational Age Of Foetus Being 18-20 Weeks.
Mri Scan Showed: Large Circumscribed Homogenous Cyst Of Above Mentioned Size Occupying Above And Front Of
Uterus , Cyst Was Separate From Ovaries, Spleen ,Kidneys, Uterus And Liver.
Surgical Opinion Obtained And Provisional Diagnosis Of Mesenteric Cyst Was Made. Planned For Excision [If Feasible]
Under General Anesthesia.

Peroperatively Unilocular Thin Walled Translucent Cyst Arising From Large Bowel Transverse Colon Mesentery Was
Seen And Cyst Was Of Size 30X35 Cms, Leash Of Blood Vessels Seen Over The Cyst, Cyst Dissection Carried Out
Meticulously, But Was Difficult Due To Adhesions And Got Ruptured Spontaneously During Handling, Clear Fluid Of 1.5
Litres Drained, Proceeded To Removal Of Cyst Wall, And Sent For Hpe.
Postoperative Period Uneventful, Discharged On 7Th Pod And She Is Coming For Regular Follow Up With 2 Months To
Go For Edd, Scan Being Done At Each Visit, No Trace Of The Cyst Found And Continuing The Pregnancy Quite
Successfully. Histological Diagnosis: Mesenteric Cyst With Attenuated Cuboidal Epithelial Lining Of Cyst Wall.
Conclusion:
Cinical Relevance: Mesenteric Cysts Are Found Incidentally & Often Misinterpreted As Benign Ovarian Tumours, Renal
Mass, Hepatic Mass. Here The Unusual Site Of Cyst In Large Bowel Mesentery Was Found Which Is Rare The Incidence
Being 1 In Lakh Population, Rarely Serious Complication May Occur Such As Torsion, Infection, Haemorrhage Into The
Cyst, Obstruction Of Ivc. This Cyst Arise During Embryologic Development Of Ectopic Implants Of Lymphatic Tissue,
Or Obstruction Of Lymphatic Vessels , Or Incomplete Fusion Of Leaves Of Mesentery.
Nowadays Precise Diagnosis Can Be Made By Mri Scan,. Studies Have Shown That Laparoscopic Cystectomy During
Pregnancy Is Feasible, Safe, Less Invasive. We Preferred Laparotomy Due To Its Large Size And Possible Adhesions
And Cystectomy Done Safely, This Case Is Presented For Its Rare Site And Occurrence.

***********************
Details Of The Presentors:
1.
Dr. Prabha Janakiram
Trichirappalli.
2.

Md.,(Og), Mrcog, Assistant Professor, Mgmgh & Govt. K.A.P.V Medical College,

Dr. Parimala Devi M.D,Dgo., Mnams (Og),Urogynaecologist,

Hod In The Department Of Obstetrics And Gynaecology, Govt. K.A.P.V Medical College, Trichirappalli.
3.

Dr. Uma M.D., D.G.O., Associate Professor, Mgmgh & Govt. K.A.P.V Medical College, Trichirappalli.

4.

Dr.Edwina M.S., Assistant Professor In Department Of The Surgery, Govt. K.A.P.V Medical College, Trichirappalli.

***************

Subclinical Hypothyroidism And Pregnancy Outcome

Author: Dr. Rashmi Baid
Co Author: Dr.Debasmita Mondal1, Dr.Subhankar Chowdhury2, Dr.Sanchita Roy3, Dr.Amitava Das4,

Abstract

Authors:
Dr.Rashmi Baid (Post Graduate Trainee, Obstetrics And Gynaecology, Ipgmer And Sskm Hospital)
Dr.Debasmita Mondal (Assoc. Professor, O&G, Ipgmer And Sskm Hospital)
Dr.Sanchita Roy
Dr.Subhankar Chowdhary (Professor And Hod, Endocrinology, Ipgmer And Sskm Hospital)
Dr. Amitava Das(Professor, O&G, R.G.Kar).

Background:

Pregnancy With Subclinical Hypothyroidism May Have Adverse Outcome. The Prevalence Of Sch In Pregnancy And Its
Relationship With Adverse Pregnancy Outcome Has Not Been Well Studied In Eastern India.

Aims & Objectives:

1)To Find Out The Prevalence Of Sch In Pregnancy.

2)To Find Out The Effect Of Sch On Pregnancy Outcome.

Materials & Methods:

This Prospective Observational Study Was Conducted In The Dept. Of Obstetrics & Gynaecology, Ipgme&R, Kolkata During
The Period Of 1St July 2011 To 30Th June 2012 In Collaboration With The Departments Of Endocrinology & Neonatology.
Seven Hundred Thirty Seven Pregnant Women Were Screened Using Tsh Assay.

Results:

Among All Women Screened 707 Were Euthyroid(Eth) & 30 Were Sch. For Analysis Purpose 90 Euthyroid & 30 Sch Women
Were Compared. Prevalence Of Sch Was 4.07 In Our Institution. Pregnancies With Sch Were More Likely To Be

Complicated With Pih ( 26.67%) , Pet ( 13.33%) , Abruptio Placentae (10%) , Oligohydramnios(16.67%) & Iugr (23.33%) .
In Postpartum Period 10% Of Women With Sch Suffered With Maternal Sepsis & Wound Dehiscence,Whereas
Subinvolution Was Seen In 6.67% Cases.Neonates Also Suffered More With Rds ( 6.67%) , Neonatal Jaundice (20%) And
Sepsis( 13.33%) .There Was Increased Incidence Of Retro Placental Clots(10.00%) & Calcification(13.33%) In Women With
Sch.

Conclusion:

Sch In Pregnancy May Result In Unfavorable Obstetric Outcome. But Timely Screening , Therapeutic Interventions And
Multidisciplinary Approach Will Culminate Into Desired Pregnancy Outcome.

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Presription Patterns In Public Hospitals

Author: Dr. Richa Sankhe
Co Author:

Abstract

Aim: To Study The Prescription Pattern In Public Health Hospitals

Objectives:
1. To Study The Prescription Pattern In Public Hospitals
2. To Analyse And Compare With Standard Practices
Methodology:
200 Different Prescriptions Of Indoor Patients Were Analysed In Order To Study Prescription Patterns.Data Was Collected
From Case Papers Of Patients.
Result:
Only 32% Of Drugs Were Prescribed In Their Generic Names.The Dosage And The Route Of The Drug Were Right In 86%
And 100% Respectively.68% Of Prescriptions Had No Signature Of Doctor.
Conclusion:
The Pattern Of Prescription In Terms Of Completeness And Rationality Was Poor.There Is An Urgent Need To Improve
The Standards Of Drug Prescription.

***************

Placental Pathology In Hypertensive Disorders Of Pregnancy

Author: Dr. Meghana Jetty
Co Author: Dr.Ambarisha Bhandiwad1,

Abstract

Background And Objectives :

Hypertension During Pregnancy Is A Major Health Problem .Hypertensive Disorders Affect 7-10% Of All Pregnancies And
Is A Major Cause Of Maternal And Fetal Morbidity And Mortality, Placental Pathologic Condition Is A Valuable Link That
Explains How Underlying Pregnancy Pathologic Condition Results In Adverse Pregnancy Outcomes
Placenta Has Long Been A Neglected Organ As Far As Its Pathology Is Concerned. This Study Is An Attempt To Observe
The Morphological Features Of Placentae Both Gross And Microscopic In Normal Pregnancy, Preeclampsia, And
Eclampsia.
Infarction, Retroplacental Hematoma, Sub-Chorionic Fibrin Are Also Higher In Incidence In Hypertensive Disorders Of
Placenta.
Foetal Outcome Is Adversely Influenced By Pathological Changes Observed In Placenta.

Objectives:
To Study The Morphological Changes Of Placenta In Hypertensive Disorders Of Pregnancy.

Methods :
148 Placentae Were Studied. The Weight Of The Placenta, Diameter, Thickness, Placental Fetal Ratio, Subchorinic Fibrin,
Retroplacental Hematoma, Infarction, Clacification Were Noted .

Results :
The Placental Weight And Fetoplacental Weight Ratio Was Decreased In The Hypertensive Group. There Was A High
Incidence Of Infarction Retroplacental Hematoma And Calcification In The Hypertensive Group. Fetal Outcome Was Poor
In Presence Of Infarction And Retroplacental Hematoma.

Interpretation And Conclusion :The Hypertensive Disorders Of Pregnancy, Adversely Influence The Morphology Of The Placenta. The Pathological
Changes Observed In Placentae Of Patients With Hypertensive Disorders Of Pregnancy Like Retroplacental Hematoma
And Infarction Adversely Influence The Perinatal Outcome. However, None Of These Pathological Changes Of Placenta
Are Specific To Hypertensive Disorders Of Pregnancy.

***************

A Comparative Study Of Manual Verses Instrumental Insertion Of Intra-Caeserean Postpartum Intrauterine

Contraceptive Device
Author: Dr. N Chakheni
Co Author: Dr. N Chakheni1, Dr. Parneet Kaur2, Dr. Khushpreet Kaur3, Dr. Manjit Kaur Mohi4,

Abstract
A Comparative Study Of Manual Verses Instrumental Insertion Of Intra-Caeserean Postpartum Intrauterine Contraceptive
Device
Dr N.Chakheni, Dr Parneet Kaur, Dr Khushpreet Kaur, Dr Manjit Kaur Mohi
Department Of Obstetrics & Gynaecology, Gmc & Rajindra Hospital Patiala-147001
Postpartum Intrauterine Contraceptive Device (Ppiucd) Is A Form Of Contraception In Which Cu-T 380A Is Administered
In Immediate Postpartum Period. It Is A Safe, Long Acting, Effective And Reversible Method Of Contraception Which
Offers Several Advantages Particularly For Women With Limited Access To Medical Facility.
Aims And Objectives: The Main Objective Of The Study Was To Compare The Two Different Methods Of Intra-Caesarean
Insertion Of Ppiucd I.E. Manual Vs. Instrumental And To Study The Effectiveness, Safety And Continuation Rate Of IntraCaesarean Ppiucd As A Contraceptive Method.
Material And Method: A Total Of 100 Subjects Undergoing Lscs Were Enrolled For The Study. In Group-A Cu-T 380A Was
Inserted Manually In 50 Subjects And In Group-B Consisting Of 50 Subjects, It Was Inserted With Ppiucd Forceps. After
Checking For The Inclusion And Exclusion Criteria And Proper Counselling, Written Consent Was Obtained And Subjects
Were Enrolled For The Study. All The Subjects Were Followed Up Either Clinically Or Telephonically.
Results: The Continuation Rate After The Period Of Follow Up Was 94% In Group-A And 92% In Group-B. There Was Only
One Case (2%) Of Expulsion And That Was In Group-B. 3 (6%) Of The Subjects In Group-A And 4 (8%) Of The Subjects In
Group-B Got Ppiucd Removed. There Was No Case Of Infection, Perforation Or Contraceptive Failure.
Conclusion: Intra-Caesarean Ppiucd Is An Effective Method Of Postpartum Contraception And Both The Methods Are
Equally Effective With Minimum Side Effects And Complications And Good Acceptability.

***************

Microsurgical Recanalisation For Tubal Block Due To Sterilisation

Author: Dr. Mounika Chitikela
Co Author: Mounika Reddy Chitikela1, Dr Mudanur S R2, Dr Neha Chandra3,

Abstract
Aim : The Aim Of The Study Was To Evaluate The Pregnancy Outcome Of 56 Cases Of Microsurgical Tubal Recanalisation
After Sterilization Operation.
Methods: We Carried Out Microsurgical Recanalisation Surgery For 56 Cases At Blde UniversityS Shri.B.M.Patil
Medical College Hospital And Mudanur Multispeciality Hospital At Bijapur. Out Of 56 Cases Who Underwent Tubal
Microsurgery For Recanalisation 14 Cases Were Lost To Follow-Up And Pregnancy Outcome Analysis Of 42Cases Were
Done. The Tubal Microsurgery Was Done Using Operative Microscope Following Standard Microsurgery Principles.
Results: Out Of 42 Cases Who Underwewnt Recanalisation, 27 Women Conceived(67.28%) . Out Of Which 22 Women
(81.4%) Had Full Term Viable Pregnancies , 3 (11.11%) Had Abortions And 2 Women(7.40%) Had Tubal Ectopic
Pregnancies.
Conclusion : Our Study Observed The Favourable Factors For Successful Recanalisation In Younger Patients With Healthy
Tubes With Good Length And Shorter Sterilization-Reversal Interval. The Tubal Microsurgical Recanalisation Provides
Hope For Patients Wishing To Conceive Again After Sterilization Operation For Various Reasons As A Cost Effective
Option Compared To Art.

***************

Intracaesarean Insertion Of Cu T 380A 1 Year Prospective Study In A Tertiary Hospital In Coastal Karnataka
Author: Dr. Gagandeep Kaur
Co Author: Dr. Pundalik Baliga1, Dr. Poornima J.2, Dr. A.Arun Rao3,

Abstract
Aim And Objectives:

To Determine The Efficacy And Safety Of Immediate Post-Placental Intrauterine Device Insertion At The Time Of
Caesarean Delivery.
Materials And Methods:
A Prospective Study Was Conducted In Lady Goshen Hospital, Mangalore, Where Pregnant Women Who Underwent
Caesarean Section And Had An Intracaesarean Cu T380A Inserted, After Obtaining Informed Written Consent,Between
March, 2013 To August, 2014 Were Followed Up At 6 Weeks Postpartum To Know The Complications Related To Iucd
Insertion, Expulsion Rate And Overall Satisfaction. Patients Who Did Not Follow Up On A Opd Basis Were Communicated
Via Telephonic Conversation And Information Was Obtained.Statistical Analysis Was Done By Chi Square Test, Using
PearsonS Correlation Co-Efficient.

Results:
Total Number Of Patients Enrolled In The Study Was 234. Mean Age Of The Women Was 27 Yrs. Mean Gestational Age
At The Time Of Caesarean Was 38.1 Weeks. Primigravidas And Multigravidas In The Study Group Was 78.2% And
21.8%Respectively. Patients Who Turned Up For Follow Up In Our Hospital Were 23.07%, Who Turned Up For Follow Up
Elsewhere Were 21.36% And Who Did Not Turn Up For Follow Up And Were Communicated Via Telephonic Conversation
Were 55.5%. Rate Of Expulsion Was 1.7 %. Rate Of Voluntary Removal Of Iucd Was 1.7%. Number Of Patients Who Were
Satisfied With The Choice Of Contraception Was 95.7% And Who Were Dissatisfied Was 4.3%. Patients With Complaints
Of Heavy Bleeding Were 2.6% And With Abdominal Cramps Were 1.3%.

Conclusion:
Women Who Receive Intracaesarean Insertion Of Iucd Show A High Level Of Satisfaction With This Choice Of
Contraception, And The Rates Of Expulsion Were Low Enough Such That The Benefits Of Contraceptive Protection
Outweigh The Potential Inconvenience Of Needing To Return For Care For That Subset Of Women.

***************

Comparison Of The Outcome Of Induced Labour By Intracervical Foley Catheter With Misoprostol Verses
Misoprostol Alone
Author: Dr. Swati Singh
Co Author: Prof. S. P. Jaiswar1, Prof. Sujata2, Dr. P. L. Sankhwar3,

Abstract
Aim And Objectives: To Compare The Induction Delivery Interval Using Intracervical Foley With Misoprostol And
Misoprostol Alone And To Compare The Feto-Maternal Outcome In Both Groups.

Materials And Methods: We Randomized 200 Women Undergoing Induction Of Labor With Singleton Pregnancies At
34 Weeks Of Gestation With An Unfavorable Cervix (Bishop Score6) To Intracervical Foley Plus Vaginal
Misoprostol (N=100) Or Vaginal Misoprostol Alone (N=100). Women With Fetal Malpresentation, Multifetal Gestation,
Spontaneous Labor, Contraindication To Prostaglandins, Anomalous Fetus, Fetal Demise, Or Previous Cesarean Delivery
Or Other Significant Uterine Surgery Were Excluded. The Primary Outcome Measure Was Induction-To-Delivery Interval.
Secondary Outcomes Were Mode Of Delivery, Induction To Active Phase Interval, Tachysystole With Fetal Decelerations,
Postpartum Hemorrhage, Neonatal Apgar Scores, And Neonatal Intensive Care Unit Admission.

Results: The Mean Induction-To-Delivery Time Was Shorter With The Combination Of The Foley Bulb And Vaginal
Misoprostol (16.258.52) When Compared With Vaginal Misoprostol Alone (22.1611.45) (P=0.002). The Combination
Also Resulted In Shorter Induction To Active Phase Duration (12.74 7.69) Than Misoprostol Alone (19.2710.13)
(P=0.001). There Were No Differences In Labor Complications Or Adverse Neonatal And Maternal Outcomes.

Conclusion: A Combination Of The Foley Bulb And Vaginal Misoprostol Resulted In A Shorter Induction-To Delivery Time
When Compared With Vaginal Misoprostol Alone Without Increasing Labor Complications.

***************

prediction Of Pelvic Organ Prolapse By Using Pelvic Floor Symptom Questionnaire

Author: Dr. Shivaranjani K.S
Co Author: Dr.Shivaranjani.Ks1, Dr.Jayasree.M2, Dr.Sasikala.K3,

Abstract
Aim: To Evaluate The Relationship Between Pelvic Organ Prolapse (Pop) Staging And Symptoms
Materials And Methods: We Conducted A Cross-Sectional Study Between Two Groups. The Study Group Consisted Of 50
Women With Symptomatic Pop Stage 2 Or More Treated At The Gynaecology Outpatient Clinic Of The Sri Manakula
Vinayagar Medical College And Hospital. The Control Group Consisted Of 50 Women Who Were Referred To The
Gynaecology Outpatient Clinic For Other Complaints But Not Seeking Medical Care For Pop .For The Measurement Of
Pelvic, Bladder And Bowel Symptoms We Used A Validated And Translated Pfdi 20 Questionnaire. Differences In Stage Of
Pelvic Organ Prolapse, Patient Characteristics, And Reported Pelvic Floor Symptoms Between The Study And The Control
Group Were Evaluated Using The StudentS Independent Samples T-Test For Gaussian Distributed Variables And The
Chi-Square Test For Nominal/Ordinal Variables.

Results:

The Mean Age And Parity Of Women In The Study Group Was 52 & 3.9 Respectively While The Mean Age And Parity In
The Control Group Were 47 And 3.1. . The Prevalance Of Stage 1,2,3,&4 Prolapse Were 7%, 7%, 66%& 14% Respectively.
The Study Group Reported More Of Urogenital Symptoms. Feeling Of Vaginal Protrusion And Over Active Bladder
Symptoms Were The Most Frequent Symptoms In Study Group. In Control Group, The Most Frequent Symptoms Were
Pressure And Heaviness In Pelvic Area There Was No Difference In The Defecation Symptoms Between Two Groups. All
The Patients With Prolapse Had Symptoms Suggestive Of Overactive Bladder, But Only 50% Had Symptoms Suggestive Of
Stress Incontinenece. Defecation Symptoms Were Unrelated To Anatomical Abnormalities. Frequentjy Reported
Defecation Symptoms Were Obstructed Defecation And Incomplete Defecation.
Conclusion:
Stage Of Pop And Pelvic Symptoms Are Associated But Such A Strong Association Does Not Exist Between Pop And
Micturition Or Defecation Symptoms.

***************

Study Of Association Of Low Serum Calcium Level In Pregnancy Induced Hypertension

Author: Dr. Anita Kumari
Co Author: Dr(Prof.) Khalda Huda1,

Abstract
Aims And Objectives: To Compare Total Serum Calcium Levels In Pregnant Women Complicated With Hypertension With
Those In Normotensive Control.
Materials And Methods: This Is A Case-Control Hospital Based Study Carried Out At N.M.C.H, Nalanda Medical College
And Hospital, Patna, Bihar. One Hundred Thirty-Five Women Were Enrolled In This Study. 90 Women With Pregnancy Induced Hypertension (Pih) Admitted After 20Th Week Of Pregnancy Represented The Study Group. Forty Five Women
With Normal Pregnancy, At Same Age; Same Gestational Age Were Selected As Control Group.
Results: The Mean (Sd) Serum Calcium Of The Study Group Was 8.181.05 Mg/Dl, While That Of The Control Group
Was 9.051.05Mg/Dl (P= 0.001).
Conclusion: In This Study It Has Shown That Decline Serum Ca2+ Level May Have A Role In Development Of Pih And Sr
Ca2+ Level Can Be Used As Marker Of Pih And Women At Risk Of Developing Pih May Be Benefited By Consuming
Additional Dietary Calcium.

Keywords: Calcium, Pre-Eclampsia, Calcium Supplementation, Pregnancy Induced Hypertension

***************

Crcritical Analysis Of Outcomes Of Obstetric Admissions To Critical Care Unitanalysis Of Outcomes Of Obstetric
Admissions To Critical Care Unit
Author: Dr. Rashmi P S
Co Author: Prabhudev Prema1, Jahnavi2,

Abstract
Aim-To Analyse The Indications,Diagnosis,Course Of Stay,Duration Of Stay,Proceedures Undertaken And Outcome Of
Obstetric Patients Admitted To Ccu(Critical Care Unit).
Type Of Study-Retrospective
Duration -5Years,2009-2014
The Study Was Conducted In A Ccu Of Tertiary Care Hospital
Materials And Methods-Age,Parity,Gravidaindex,Primarydiagnosis,Modedelivery,Interventionsdone,Outcome Were
Noted
Results-The Total Number Of Deliveries Were 4200 In 5 Years.Admissions To Ccu Were N=53 Which Is 1.2%.Most Of The
Admissions Were In The Postpartum Period The Cause Being Hypertensive Disorders In Pregnancy With Its Complications
N=24 Which Is 45.2% Next Being Obstetric Haemorrhage N=12 Which Is 22.6%. Cardiac Disease Complicating Pregnancy
Constituted A Small But Significant Group N=10 Which Is 0.23%,Congenital Heart Block Being The Rarest.The Commonest
Intervention Done Were Intra-Arterial Line And Artificial Ventilation.The Commonest Cause Of Mortality Was Multi Organ
Dysfunction Secondary To Haemorrhage And Hypertension N=13 Which Is 24.5%.The Statistical Analysis Was Done By
Fractional Percentage And Chi-Square Test.
Conclusion-The Ccu Admissions Were High Because Ofit Being A Referral Centre.The Absence Of High Density Unit(Hdu)
In Our Set Up May Have Increased The Ccu Admission Rate . Inspite Of All The Antenatal Care Hypertension In Pregnancy
Still Remains The Killer Disease.

***************

Critical Analysis Of Outcomes Of Obstetric Admissions To Critical Care Unit (Ccu)

Author: Dr. Rashmi P S
Co Author: Prabhudev Prema1, Jahnavi2,

Abstract
Aim-To Analyse The Indications,Diagnosis,Course Of Stay,Duration Of Stay,Proceedures Undertaken And Outcome Of
Obstetric Patients Admitted To Ccu(Critical Care Unit).
Type Of Study-Retrospective
Duration -5Years,2009-2014
The Study Was Conducted In A Ccu Of Tertiary Care Hospital
Materials And Methods-Age,Parity,Gravidaindex,Primarydiagnosis,Modedelivery,Interventionsdone,Outcome Were
Noted
Results-The Total Number Of Deliveries Were 4200 In 5 Years.Admissions To Ccu Were N=53 Which Is 1.2%.Most Of The
Admissions Were In The Postpartum Period The Cause Being Hypertensive Disorders In Pregnancy With Its Complications
N=24 Which Is 45.2% Next Being Obstetric Haemorrhage N=12 Which Is 22.6%. Cardiac Disease Complicating Pregnancy
Constituted A Small But Significant Group N=10 Which Is 0.23%,Congenital Heart Block Being The Rarest.The Commonest
Intervention Done Were Intra-Arterial Line And Artificial Ventilation.The Commonest Cause Of Mortality Was Multi Organ
Dysfunction Secondary To Haemorrhage And Hypertension N=13 Which Is 24.5%.The Statistical Analysis Was Done By
Fractional Percentage And Chi-Square Test.
Conclusion-The Ccu Admissions Were High Because Ofit Being A Referral Centre.The Absence Of High Density Unit(Hdu)
In Our Set Up May Have Increased The Ccu Admission Rate . Inspite Of All The Antenatal Care Hypertension In Pregnancy
Still Remains The Killer Disease.

***************

Abdominal Cerclage For The Treatment Of Recurrent Cervical Insufficiency- Case Reports
Author: Dr. Kalpana Jain
Co Author:

Abstract
Background
Preterm Birth Is The Leading Cause Of Neonatal Morbidity And Mortality. Cervical Cerclage Is Commonly Used In The
Management Of Women Considered To Be At Risk Of Second Trimester Loss And Spontaneous Preterm Birth Due To
Cervical Insufficiency. Transabdominal Cervicoisthmic Cerclage Is A Procedure Used To Increase The Fetal Salvage Rates
In Women Who Are Poor Candidates For The More Usual Procedure Of Transvaginal Cerclage Or Those With Previously
Failed Vaginal Procedures.
Below Two Clinical Cases Of Recurrent Cervical Insufficiency Managed With Transabdominal Cerclage Is Reported.
Case 1
A 30 Years Old Female, Gravida 3 , Abortions 2 ( Both Outside) Was Referred In Her Third Pregnancy At 6 Weeks Of
Gestation As A Case Of Cervical Insufficiency For Further Management. In 1St Pregnancy Usg Done At 18 Weeks Showed
Cervical Insufficiency With Bulging Of Fetal Membranes And The Patient Spontaneously Aborted At Around 18 Weeks Of
Gestation.
In Her 2Nd Pregnancy Transvaginal Cervical Cerclage Was Done Outside In View Of Cervical Insufficiency.
Unfortunately, However, The Patient Had Spontaneous Abortion At 18 Weeks Of Gestation , This Time With Cervical
Cerclage Stitch In Situ.
In View Of Recurrent Second Trimester Abortions And Failed Transvaginal Cerclage , Abdominal Cerclage Was
Performed. She Gave Birth To A Live, Male Baby At Term Gestation By Caesarean Section.
Case 2
A 24 Years Old Lady Referred As A Case Of Cervical Insufficiency With 2 Mid Trimester Pregnancy Losses. Laparoscopic
Abdominal Cerclage (Preconceptual) Was Performed In View Of Two Mid Trimester Abortions. Post Operative Period
Was Uneventful.
Conclusion
Although Transabdominal Cerclage Involves The Disadvantage Of Two Surgeries Or Laparotomies, Reports Suggest That
It Can Be A Safe And Effective Procedure In The Highly Selected Patient With A History Consistent With Cervical
Insufficiency.

Dr.Kalpana Jain

***************

A 5 Year Review Of Ectopic Pregnancies In A Tertiary Care Centre In South India

Author: Dr. Preethy Solomon
Co Author: Dr.Preethy.A.Solomon1, Dr.Mary Daniel2, Dr.Tahmina.S3,

Abstract
Background: Ectopic Pregnancy Is One Of The Leading Cause Of Mortality And Morbidity In Developing Countries.
Aims & Objectives: To Determine The Incidence, Risk Factors, Clinical Presentation, Management And Morbidity
Associated With Ectopic Pregnancy.
Materials&Methods: Retrospective Analysis Of Patients With Ectopic Pregnancy At Pondicherry Institute Of Medical
Sciences, Pondicherry Between 2009-2014 Was Done. Their Demographic Data, Parity, Risk Factors, Clinical Features,
Mode Of Management And Need For Blood Transfusion Were Obtained. Data Was Entered In Ms Excel Sheet And
Analysed Using Spss 17.0
Results: During The Period Of Study There Were 55 Cases Of Ectopic Pregnancy Out Of 6142 Deliveries. The Incidence Of
Ectopic Pregnancy Was 8.14/1000 Deliveries. Majority Were Aged 20-30Yrs(49%). 30% Were Nulliparous & 36% Were
Multiparous. 13(24%) Resulted From Previous Failed Sterilisation. The Commonest Risk Factors Present Were History Of
Abortion (44 %), History Of Pelvic Surgery (42%), Infertility (20%) And Pelvic Inflammatory Diseases(20%), Ectopic (5.5%),
Iucd (3.6%).The Commonest Symptoms Were Abdominal Pain (90.9%) And Amenorrhea(92.7%). Clinical Diagnosis Was
Made In 33(60%) And 53(96.4%)Were Diagnosed By Ultrasonographic Features. Tubal Pregnancies Constituted 50(91%),
Cervical Pregnancy 1(1.8%) And Ectopic Pregnancy Of Unknown Site 4(7.2%). The Main Mode Of Treatment Was
Surgical(75%). However 20% Of The Patients Benefited From Medical Management Using Methotrexate And 5%
Underwent Surgery After Failed Medical Management. Of The 44 Women Managed Surgically, 32(58.2%) Were Ruptured
And 12(21.8%) Were Unruptured. Blood Transfusion Was Required For 22(44%) And 2(3.6%) Had Trali Following Blood
Transfusion. No Maternal Mortality Noted.

Conclusion: Diagnosis Of Ectopic Pregnancy Requires A High Index Of Suspicion. Common Risk Factors Must Be Identified.
Ultrasound Imaging Especially Tvs And Hcg Has Revolutionised And Replaced Culdocentesis To Arrive At Early Diagnosis,
Providing Appropriate Management And Preventing Complications Inspite Of Increasing Incidence. Early Diagnosis Is
Instrumental In Decreasing Mortality And Morbidity.

***************

: Primary Fallopian Tube Carcinoma With The Classical Clinical Features: A Case Report.
Author: Dr. Jasmina Begum
Co Author: Dr. Seetesh Ghose1, Dr. Pallavee2,

Abstract
Background: Malignant Neoplasm Of Fallopian Tube Is One Of The Rarest Female Genital Cancers. The Resemblance To
Epithelial Ovarian Carcinoma Leads To Difficulty In Diagnosing The Condition Clinically As Well As Histopathologically.
Case: We Present A Case Of A 50 Year Old, Postmenopausal Woman With History Of Watery Vaginal Discharge And Lower
Abdominal Pain. Clinical Examination Revealed A Solid Adnexal Mass Which Was Confirmed Upon Pelvic Ultrasonography
With Additional Feature Of Increased Vascularity. Her Ca-125 Was 8.5Iu/Ml. The Decision For Laparotomy Was Taken
When Abdominopelvic Cect Failed To Confirm The Nature Of The Mass.
Results: Intraoperative A Solid Mass Of 6Cm X 5Cm X 5Cm Size Was Present At The Fimbria With Distended Left Fallopian
Tube. Uterus, Bilateral Ovaries, Contralateral Fallopian Tube Appeared Normal. No Evidence Of Intraperitoneal
Dissemination, Ascites Was Seen. A Staging Laparotomy Comprising Of A Total Abdominal Hysterectomy, Bilateral
Salpingo-Oophorectomy, Omentectomy And Lymph Node Dissection Was Performed. A Diagnosis Of Left Tubal Papillary
Serous Adenocarcinoma Was Confirmed By Histopathology Report. She Is Undergoing Chemotherapy And On Regular
Follow Up.
Conclusion: A Correct Preoperative Diagnosis Is Made Only In 4.6 % Of The Cases. The LatzokoS Triad Of Watery
Vaginal Discharge, A Colicky Lower Abdominal Pain And A Pelvic Mass Typical Of A Fallopian Tube Carcinoma Is Noted
Only In Less Than 15% Of Patients. This Case Is Being Reported For Its Diagnostic Dilemma Which Resulted Due To Its
Rarity Even Though It Presented With LatzokoS Triad.
Key Words: Primary, Fallopian Tube, Carcinoma, Adenocarcinoma

***************

Effectiveness Of Intravenous Iron Sucrose Among Southindian Antenatal Women

Author: Prof. Sendhil Arumugam
Co Author: Dr. Sharmila Murugesan1, Dr. Lopamudra B John2, Dr. Seetesh Ghose3,

Abstract
Context: Anemia Is A Common Medical Problem Among Antenatal Women Throughout The Developing World. It Is An
Important Cause Of Direct And Indirect Maternal Mortality In India. Oral Iron Supplementation Becomes A Must To
Improve Hemoglobin But Not Without Side Effects. Intravenous Iron Is An Option With Fewer Side Effects.
Objectives: The Study Aims To Evaluate The Safety And Efficacy Of Intravenous Iron Sucrose Among South Indian
Antenatal Women With Moderate Iron Deficiency Anemia In The Second Trimester Not Responding To Oral Iron.
Methods: The Study Was A Prospective Interventional Study Conducted In The Department Of Obstetrics And
Gynaecology At Mgmcri, Pondicherry, South India. During A Study Period Of 18 Months Starting From December 2011,
A Total Of 61 Antenatal Women Were Included In The Study. 32 Received Intravenous Iron Sucrose In Divided Doses, As
They Did Not Respond Well To Oral Iron. Haemoglobin, Pcv And Serum Ferritin Were Measured Before And After Intra
Venous Sucrose. The Results Were Tabulated And Analysed Using Spss Software. A P Value Of < 0.001 Was Considered
Statistically Significant.
Results: After Oral Iron Therapy The Mean Haemoglobin Was 8.97 0.80 Gm%, The Mean Pcv Was 28.16 2.6, And
The Mean Serum Ferritin Was 13.32 2.49 Micrograms Respectively. After Iv Iron Sucrose Therapy The Mean
Haemoglobin Was 10.15 0.36, The Mean Pcv Was31.5 2.10 And The Mean Serum Ferritin Was 44.09 7.02
Respectively. There Was A Statistically Significant Difference In The Rise Of Mean Haemoglobin, Pcv And Serum Ferritin
After Therapy With Iron Sucrose. There Were No Significant Side Effects Related To Intravenous Iron Sucrose Therapy.
Conclusion: Iron Sucrose Is Safe And Effective Without Any Serious Side Effects In Correcting The Iron Deficiency Anemia
In Pregnancy Among Those Who Are Not Responding Or Intolerant To Oral Iron.

***************

Comparative Study Of Vaginal Hysterectomy Versus Total Abdominal Hysterectomy In Nondescent Uterus
Author: Dr. Karthika Reddy
Co Author:

Abstract
Dr Karthika Reddy E Pg
Dr Leelavathi Professor,
Dr Ambarish Bhandiwad Hod And Prof

From The Department Of Obstetrics And Gynaecology , Jss Hospital, Mysore, Karnataka
Aims And Objective:

Hysterectomy Is The Most Common Procedure Performed By The Gynecologists, Next Only To Cesarean Section. The Past
Few Years Have Seen Growing Indications For Vaginal Hysterectomy Which Is Now Preferred Over Abdominal
Hysterectomy.
The Present Study Is To Show That Vaginal Hysterectomy Requires Shoter Duration Of Surgery, Less Blood Loss, Early Post
Operative Recovery With Early Ambulation Of The Patient, Less Operative Complications And Less Duration Of Hospital
Stay Compared To Total Abdominal Hysterectomy.Vaginal Hysterectomy Is The Better Choice Than Total Abdominal
Hysterectomy When Ever Feasible.
Materials And Methods:
. A Prospective Comparative Randomized Study Was Carried Out On 100 Women. 50 Undergoing Vaginal Hysterectomy
For Non Descent Uterus And 50 Undergoing Abdominal Hysterectomy For Similar Indications.
Results:
The Most Common Indication Was Fibroid Uterus (61%). Statistically Significant Decrease In The

Blood Loss During Surgery,Duration Of Surgery, Post Operative Pain, Wound Infection, Length Of

Hospital Stay Occurred In Ndvh Group When Compared To Tah Group.

Conclusion:

Vaginal Hysterectomy Is A Safe, More Feasible, Least Invasive And Provide More Patient Comfort

For Benign Nondescent Uterus Compared To Abdominal Hysterectomy.

***************

Correlation Between Clinical And Histopathological Changes In Placenta In Pre-Eclampsia And Eclampsia And Its
Perinatal Outcome
Author: Dr. Falaq Raza
Co Author:

Abstract
Introduction :
Placenta Being A Foetal Organ But Still Connected To Maternal Interface Shares The Disease Process Effecting Both
The Mother And The Foetus . Thus , It Plays A Central Role In The Pathogenesis Of Pre-Eclampsia And Eclampsia And Its
Perinatal Outcome.

Aims And Objectives :

1.

To Study The Histopathological Changes Of Placenta In Pre-Eclampsia And Eclampsia.

2.

To Correlate Between Clinical And Histopathological Changes Of Placenta In Pre-Eclampsia And Eclampsia.

3.

Whether Morphological And Histopathological Changes Of The Placenta Correlate With The Perinatal Outcome.

Material And Methods :

100 Patients Were Studied Between A Period Of 2 Years ( Nov 2011-Oct 2013 ). The Inclusion Criteria Was Pregnant
Woman With Gestational Age More Than 28 Weeks With Pre-Eclampsia And Eclampsia.
Placentas Of All The Patients Were Observed For Gross Features And Then Sent For Histopathology Reporting .
The Neonates Were Observed For Their Condition After Birth , Birth Weight , Apgar Score And Their Wellbeing.

Observations And Results :

Most Of The Women In Our Study Were Between The Ages Of 18-23Yrs.

The Incidence Of Pe And E Was Higher In Primigravida (68%) Than Multigravida (32%).

Out Of 100 Placentas , 99 Showed Gross And Hp Changes I.E 99% Of Placenta Were Effected . This Shows A Very
Positive Correlation Between Clinical Features And Changes In The Placenta.

The Severity Of Placental Changes Was More In Woman Of Early Onset Of Pe And Those Of Very High Bp I.E
More Than 160/110 Mmhg.

In All Women With Sb (10%) The Placental Weight Was Less Than 300Gms.

The Most Common Hp Findings Were The Presence Of Infarcts And Fibrinoid Degeneration Which Were Also
Associated With Higher Incidence Of Foetal Mortality And Morbidity.

Conclusion :

Thus The Result Of The Present Study Was That There Is A Definite Correlation Between Maternal Clinical Features
And Changes In The Placenta And The Perinatal Outcome.

***************

Evaluation Of Intrauterine Lesions In Infertile Women By Hysteroscopy And Transvaginal Sonography

Author: Dr. Princy Mittal
Co Author:

Abstract
Introduction:Infertility Is More Of A Social Problem Rather Than A Medical Problem.
Aims And Objectives:To Evaluate The Accuracy Of Hysteroscopy And Transvaginal Sonography(Tvs) In Detection Of
Intrauterine Lesions In Infertile Women.
Material And Method:50 Infertile Couples Coming To Department Of Obstetrics And Gynaecology,Government Medical
College, Patiala Were Enrolled For The Study And They Were Evaluated By Tvs And Hysteroscopy With Reference To
Hysteroscopy As Gold Standard Method.
Results:Intrauterine Lesions Were Found By Tvs In 8(16%)Cases.Endometrial Polyp Was The Most Common Abnormality
Detected(8%).However On Hysteroscopy ,Intrauterine Abnormalities Were Seen In 10(20%) Cases.Here Also Endometrial
Polyp Was Most Commonly Detected Abnormality (10%).2 Cases 1 Each Of Intrauterine Adhesions And Polyp Were
Diagnosed Only On Hysteroscopy Which Were Not Picked By Tvs.So With Reference To Hysteroscopy As Gold Standard
Method ,Tvs Had 83.3% Sensitivity ,100% Specificity For Detecting Endometrial Polyp And 50% Sensitivity,100% Specificity
For Detecting Adhesions While It Had 100% Sensitivity And 100% Specificity For Detecting Other Intrauterine Cavity
Abnormalities Including Calcifications,Uterine Septa And Submucosal Myomas.Tvs However Was Beneficial In Evaluating
Adenexal Pathology.
Conclusion: Examination Of The Uterine Cavity Is An Integral Part Of Any Thorough Evaluation Of An Infertile Woman,
Both Hysteroscopy And Tvs Are Complementary To Each Other.

***************

Pregnancy Outcome In Stripping Of Membrane At 39, 40 And 41 Weeks Of Gestation

Author: Dr. Vandana Singh
Co Author: Dr Nidhi1, Dr Vijay Zutshi2, Dr Renu Arora3, Dr Sumitra4,

AbstractObjective- A Study To Assess The Feto-Maternal Outcome In Stripping Of Membranes At 39, 40 And 41 Weeks Of
Gestation.
Method- This Was A Prospective Case Control Study Conducted In Vmmc And Sjh New Delhi. Total Of 100 Primigravida
Women Enrolled. Fifty Cases In Study Group And Fifty Controls Were Taken. Stripping Of Membrane Was Done At 39
Weeks In Opd And Again At 40 And 41 Weeks Of Gestation If Patient Did Not Go Into Labour. Three Rounds Of Stripping
Of Membrane Was Only Done. The Response Was Assessed In Terms Of Onset Of Labour, Need For Medical Method Of
Induction And Labour Outcome
Result - Baseline Characteristics Were Comparable In Both Groups. Spontaneous Onset Of Labour Occurred In 39% Of
Cases Between 39 And 40 Weeks Period Of Gestation And Only 30 % In Control Group, 20% Cases Between 40 And 41
Weeks Of Gestation And In 8% Of Controls . At 41 Weeks 31% Cases In Study Group And 42% In Controls Group Required
Medical Method Of Induction. Lscs Was Done In 10 % Of Cases In Study Group And 20% In Control Group.
Conclusion- Stripping Of Membrane Is A Completely Safe And Effective Way Of Stimulating Uterine Contractions. There
Was A Difference Of Outcome Between 40-41 Weeks Of Gestation. More Studies With Large Number Of Patients Are
Needed To Assess The Effectiveness Of This Method.

***************

To Evaluate The Accuracy Of Saline Infusion Sonography For Detection Of Uterine Cavity Abnormalities In Patients Of
Infertility
Author: Dr. Indu Chawla
Co Author: Dr Indu Chawla1, Dr Anita2,

Abstract
Objective: To Evaluate The Accuracy Of Transvaginal Sonography (Tvs) And Saline
Infusion Sonography (Sis) For Detection Of Uterine Cavity Abnormalities In Patients Of
Infertility Taking Hysteroscopy As Gold Standard.
Method: This Was A Prospective Study Done In The Department Of Obstetrics And
Gynaecology Of A Tertiary Care Post Graduate Teaching Institution. Sixty Patients Of
Infertility Underwent Tvs, Sis And Hysteroscopy. The Presence Of Abnormality And Type
Of Abnormality I.E. Polyp, Submucous Myoma, Intrauterine Synechiae And Endometrial
Abnormality Was Noted. The Results Of Tvs And Sis Were Compared With Hysteroscopy.
Results: On Hysteroscopy 36.7% (N=22) Were Diagnosed With Intra Cavity
Abnormalities. Sis Showed Sensitivity, Specificity, Positive Predictive Value (Ppv) And
Negative Predictive Value (Npv) Of 36.4,100, 100 And 73.1% Respectively. In
Comparison Tvs Showed Sensitivity, Specificity, Ppv And Npv Of 27.35, 100%,
100%And 70.4 % Respectively. The Abnormalities Detected On Hysteroscopy Were
Endometrial Polyp 36.4 % (N=8), Intrauterine Synechiae 36.4% (N=8) Submucous
Myoma (N=5) And One Patient Had Thin Endometrium.
Conclusion: The Sensitivity Of Both Tvs And Sis For Detection Of Uterine Cavity
Abnormalities In Patients Of Infertility Was Low In The Present Study And They Cannot Be
Recommended As Replacement For Hysteroscopy.
Key Words: Infertility, Saline Infusion Sonography, Transvaginal Sonography,
Hysteroscopy

***************

Effectiveness Of Condom Hydrostatic Tamponade In Management Of Intractable Atonic Postpartum Haemorrhage In

Comparision To Other Methods: Prospective Observational Study
Author: Dr. Priya Mahajan
Co Author: Dr. Reena Srivastava1, Dr. Vani Aditya2,

Abstract
Objective: To Study The Effectiveness Of Condom Tamponade In Management Of Intractable Atonic Postpartum
Hemorrhage In Comparison To Other Methods (Uterine Packing, Artery Ligation, Arterial Embolisation, Compression
Sutures, Hysterectomy) In Low Resource Setting.
Methods: 58 Women Who Went Through Intractable Pph Were Studied For Its Management By Condom Catheter
Tamponade (29) In Comparison Other Methods (29) Conducted At Nehru Hospital, B.R.D. Medical College , Gorakhpur
During June 2013 - May 2014. It Is A Prospective Observational Study.
Results: Patients Managed By Condom Catheter Tamponade As Compared To Other Methods: Used Preferably In Vaginal
Delivery(P=0.00),Had Less Amount Of Blood Loss(P=0.013),Blood Transfusion(P=<0.05). It Was Cost Effective (Rs.0200)And At The Same Time With Improved Survival(100%).On An Average 380Ml Saline At Normal Body Temperature
Was Needed To Inflate Condom Catheter For Effective Management Of Pph Within 15 Mins. Postpartum And Is To Be
Left For Approximately 24Hrs . None Of The Patient Had Infection.
Conclusion: Condom Tamponade Is A Simple, Readily Available, Safe, Cost Effective, Time Buying Method For
Management Of Pph.

***************

Maternal And Fetal Outcome In Gestational Diabetes Mellitus Diagnosed By Single Step Test
Author: Prof. Krishna Dahiya
Co Author: Jyoti Sahu1, Pushpa Dahiya2,

Abstract: Gestational Diabetes Mellitus Is One Of The Most Common Medical Disorders Found In Pregnancy. Clinical
Recognition Of Gdm Is Important Because Timely Intervention By Dietary Measures Or Insulin And Fetal Surveillance Can
Reduce The Well Described Associated Maternal And Fetal Complications.
Material And Methods: This Observational Study Was Done Over A Period Of One Year. Single Step Test Using 75 Gms
Oral Glucose Was Used As Screening And Diagnostic Test For Gdm. A Total Of 500 Pregnant Women Attending Antenatal
Clinic Were Selected Randomly For The Study At Less Than 16 Weeks Period Of Gestation. All The Selected Women Were
Given A 75 Gm Anhydrous Glucose Powder Dissolved In A Glass Of Water, To Be Consumed Over 5 Minutes, Irrespective
To The Time Of Last Meal. A Venous Blood Sample Was Collected At 2 Hours For Estimating Plasma Glucose By The
Glucose Oxidase Peroxidase (God-Pod) Method. Gestational Diabetes Mellitus Was Diagnosed If 2 Hrs Plasma Glucose Is
>140 Mg/Dl. If The Glucose Level Was >200 Mg/Dl, She Was Labeled As Overt Diabetes. In Women Who Were Found To
Have Normal Glucose Level At First Antenatal Visit, The Test Was Repeated At Around 24-28 Wks Period Of
Gestation.Feto-Maternal Outcome Was Studied In All The Subjects.
Results And Conclusions: Prevalence Of Gdm Was Found To Be 7% In Present Study. Age 25 Years, Obesity,
Multigravidity And Family History Of Diabetes Mellitus Were Major Risk Factors For Developing Gdm. Maternal And Fetal
Outcomes Were Poor In Gdm Group As Compared To The Control Group. In Gdm Group Common Maternal Complications
Were Polyhydroamnios And Recurrent Vaginal Infections.
In Indian Context With A High Prevalence Of Gdm The Universal Screening Is Superior To Selective Screening In Detecting
More Cases, Facilitating Early Diagnosis And Associated With Improved Pregnancy Outcome With Appropriate
Management. Present Study Concurs With The Who Recommendation Of 2-Hr 75Gms Ogtt As Single Step Procedure For
Both Screening As Well As Diagnosis Of Gdm. Hence We Suggest The Adaptation Of 75Gms Glucose Single Step Test For
Screening And Diagnosis Of Gdm.

***************

A Three Year Study Of Peripartum Hysterectomy At A Tertiary Care Hospital

Author: Dr. Priya Ranganath
Co Author: Dr Sunanda N1,

Abstract:
Aim: To Review The Incidence, Various Indications, Risk Factors, Rates Of Maternal Morbidity And Mortality As Well As
Neonatal Outcome Associated With Peripartum Hysterectomy In A Tertiary Care Hospital Over 3 Years.
Study Design: Retrospective Observational Study
Source Of Data: The Study Was Conducted In The Department Of Obstetrics And Gynecology At Cheluvamba Hospital
Allied With Mmcri, A Tertiary Care Hospital, From Jan 2011 To Dec 2013.
Materials And Methods: All Cases Of Emergency Lscs Done For The Period Of 3 Years Were Reviewed. 26 Cases Of
Peripartum Hysterectomy Was Isolated, Antecedent Causes, Intrapartum Complications And Postpartum Outcome Was
Studied.
Results: A Three Year Study Yielded 26 Cases Of Which Majority Were Multigravida (16 Cases=61.4%); Were In The Age
Group 21-25(14 Cases=53.8%), Majority Were Referred Case (12Cases=46.1%). Those Delivered By Lscs Were
(12Cases=46.1%). Most Common Indication For Peripartum Hysterectomy Was Atonic Pph (14Cases=53.8%); Second
Major Cause Was Uterine Rupture (6Cases=23.1%). There Were 5 Cases Of Traumatic Pph, 1 Case Of Placenta Increta And
A Rare Case Of Uterine Artery Pseudoaneurysm Presenting With Secondary Pph. Uterotonics Were Tried In 53.8% Of
Cases With Bilateral Uterine Artery Ligation Done In 3 Cases And B-Lynch Sutures Tried In 1 Case. Subtotal Hysterectomy
Was Performed In 53.8% Of Cases. Operative Complications Involving Bladder Injury Was Seen In 4 Cases And Bowel
Injury In 1 Case. Perinatal Mortality Was Very High (11 Cases=42.3%) With Maternal Mortality Noted In (4 Cases=15.3%).
Conclusion: Improving Quality Of Health Care With Good Antenatal Checkup, Early Identification Of High Risk Cases And
Prompt Referral To Tertiary Center Is Key To Lowering The Incidence Of Peripartum Hysterectomy And Complications
Associated With It.

***************

Contraceptive Awareness Among Reproductive Age Group Women

Author: Dr. Surya P
Co Author:

Abstract:
Aim: To Study About The Awareness,Knowledge And The Use Of Contraceptive Method Among Reproductive Age Group
Women In The Rural Community.
Type Of Study: Descriptive Study.
Materials And Methods: This Study Has Been Carried Out In The Department Of Obstetrics And Gynaecology,Chettinad
Hospital. A Questionnaire Has Been Prepared And All Reproductive Age Group Women Irrespective Of Their Marital
Status Were Asked To Fill The Questionnaire After Explaining In Their Own Language Regarding Their Awareness,
Knowledge And The Use Of Contraceptive Methods.
Results: Awareness, Knowledge And The Use Of Contraceptive Methods Are Not Sufficient Enough In The Rural
Community. Health Education And Community Based Health Programs Are Needed To Improve The Awarenessand
Increase The Use Of Contraceptive Methods In The Rural Population.
***************

Evaluation Of Abnormal Excessive Uterine Bleeding And Its Management With Ormeloxifene
Author: Dr. Manikonda Lakshmi
Co Author:

Abstract:
Aim:To Study And Evaluate The Abnormal Excessive Uterine Bleeding And Its Management With Ormeloxifene.

Objectives:
1.

To Evaluate Patients With Abnormal Uterine Bleeding To Reach A Definitive Diagnosis .

2.
To Assess The Efficacy ,Safety And Acceptability Of Ormeloxifene In Medical Management Of Abnormal Uterine
Bleeding.

Materials And Methods:

Forty Two Women Of Age Group 35-45Yrs Who Attend The Outpatient Gynaecology Department With
Complaint Of Heavy Menustral Flow Were Recruited For The Study.After Excluding Structural Abnormalities Of Genital
Tract,Hypothyroidism And Atypia Of Endometrium With Investigations Women Are Counselled About Effects Of
Ormeloxifene.With The Consent Ormeloxifene (60Mg)Was Given Orally Twice A Week For First 3Months And Then Once
A Week For Upto Next 3Months.Treatment With Ormeloxifene Was Evaluated By Menustral Blood Loss Measurement
Using Pictorial Blood Loss Assessment Chart(Pbac Scoring),Blood Haemoglobin Levels And Endometrial Thickness Were
Measured Before And After Completion Of Treatment.

Results:There Was A Significant Reduction In Menustrual Blood Loss,Rise In Haemoglobin Concentration And Decrease In
Endometrial Thickness After The Treatment With Ormeloxifene.
Conclusion:Ormeloxifene Is An Effective And Safe Therapeutic Option For Medical Management In Abnormal Excessive
Uterine Bleeding.It Has A Convenient Dose Schedule And Is Cost Effective And Is Oncologically Protective To The Breast
And Endometrium.

***************

Ferric Carboxymaltose Vs Iron Sucrose In The Treatment Of Iron Deficiency Anemia Due To Abnormal Uterine
Bleeding- A Randomized Controlled Trial
Author: Dr. Krishna Deepti
Co Author: Kriplani A1, Mahey R2, Kachhawa G3, Saxena R4,

Abstract:
Aims And Objectives:
To Evaluate The Efficacy, Safety And Improvement In Fatigue Levels Using Intravenous Ferric Carboxymaltose (Fcm)
Versus Intravenous Iron Sucrose (Isc) In The Treatment Of Anemia Due To Abnormal Uterine Bleeding
Materials And Methods:
Sixty Women With Iron Deficiency Anemia Due To Abnormal Uterine Bleeding Were Randomized To Receive Either Iv
Fcm (1000 Mg Over 15 Min, Repeated Weekly To Achieve A Total Calculated Replacement Dose) Or Iv Isc (300 Mg Over
2 Hrs Repeated Twice Weekly).

Results:
The Baseline Hematological Parameters Were Similar In Both The Groups.The Mean Rise In Hb After 1 Week Of Starting
Therapy Was Greater In Fcm Compared To Isc(1.960.7 G/Dl Vs 1.341.27 G/Dl; P= 0.02). By The End Of 12 Weeks,
75.9% Of The Patients Receiving Fcm And 65.5% Receiving Isc Achieved Target Hb Levels Of 12 G/Dl (P Value 0.38).
The Mean Rise In Hb By The End Of 12 Weeks Was Greater With Fcm
(4.951.4 G/Dl Vs 4.311.5G/Dl; P= 0.11).
Serum Ferritin By The End Of 12 Weeks Was Significantly Greater In Ferric Carboxymaltose Group (112.2 100.5 g/L
Vs 61.39 31.09g/L, P Value- 0.01). Both The Drugs Caused Significant Improvement In Fatigue Levels. There Were
No Serious Adverse Drug Reactions In Both The Groups.

Conclusion:
In Patients With Anemia Due To Abnormal Uterine Bleeding, Iron Carboxymaltose Causes Rapid Rise In Hb, Greater
Buildup Of Iron Stores And Is Well Tolerated. The Significantly Less Number Of Visits To Complete The Ferric
Carboxymaltose Therapy Decreases The Overall Cost Of Therapy As Compared To Iron Sucrose

***************

Fallopian Tube Carcinoma In Postmenopausal Women

Author: Dr. Archana Kondreddy
Co Author:

Abstract:
Fallopian Tube Cancer Accounts For 0.3% Of All Female Genital Tract Cancers. Most Cancers Are Epithelial And Some
Are Serous Type .The Fallopian Tube Is Frequently Involved Secondarily From Other Primary Sites ( Ovaries ,Endometrium
,Git).This Is A Rare Case Of Primary Fallopian Tube Cancer Of Transitional Type.
Key Words:
Fallopian Tube Cancer. Transitional Type, Primary Origin.
Case Report:
Mrs. X , Aged 57 Years Obese P3L3,Tubectomised Presented With Postmenopausal Bleeding Per Vaginum Since One
Month, Not Associated With Pain/ Mass Per Abdomen . Attained Menarche At 13 Years ,Had Regular Normal Cycles And
Attained Menopause At 52 Years .On Examination ,Her Vitals Are Stable. On Examination Abdominal Wall Is Obese ,No
Mass Felt Or Ascites Noted Clinically. External Genetalia Healthy. On Per Speculum Examination Cervix And Vagina Are
Healthy And Minimal Bleeding Through Os Seen . On Pervaginal Examination Uterus Is Normal In Size ,Mobile, Anteverted
And Fornices Free. Investigations:Hb:10Gm%,Pap Smear And Usg Are Normal With Endometrial Thickness Of 5 Mm
.Fractional Curettage Done And Hpe Showed Endometrium In Proliferative Phase .Though Ct Was Planned CouldnT
Be Done Because Of Practical Problems .In View Of Continued Bleeding Per Vaginum Patient Was Taken Up For Total
Abdominal Hysterectomy With Bilateral Salpingo- Oopherectomy . Intraoperatively Uterus Is Freely Mobile With
Adenexal Mass Of 9Cm X3Cm On Right Side With Intact Serosa ,No Free Fluid In Abdomen,Omentum Normal,No
Peritoneal Deposits,No Discharge From Fibrial End. Total Abdominal Hysterectomy With Bilateral Salpingooopherectomy
Was Done. After Hpe Case Is Confirmed To Be Primary Transitional Cell Carcinoma Of Fallopian Tube,Stage 1A.

Discussion:
Fallopian Tube Cancers Mostly Seen In The 5Th And 6Th Decade.The Classical Triad Of Symptoms And Signs Are
1)Prominent Watery Vaginal Discharge I.E,Hydrops Tubae Profulens 2)Pelvic Pain 3)Pelvic Mass Observed In Less Than 15
% Of Patients .Vaginal Discharge/Bleeding Is The Most Common Symptom Reported In More Than 50% Of Patients.
Spread To The Paraaortic And Pelvic Lymph Nodes Is Common
Staging According To Figo Is Based On The Surgical Findings At Laparotomy .According To This System 20% -25% Of
Patients Have Stage 1 Disease .Post-Operatively Chemotherapy With Carboplatin And Placlitaxel Is Given.The Overall 5
Year Survival For Patient With Stage 1 Carcinoma Is About 96%.
Conclusion:
Primary Fallopian Tube Cancer Is Rarely Considered Preoperatively It Is The Histopathological Examination Which Proves
The Diagnosis .

***************

Comparison Of Saline Contrast Sonohysterography And Hysteroscopy In The Diagnosis Of Abnormal Uterine
Bleeding In Perimenopausal Women .
Author: Dr. Ananthi Swamy
Co Author: Dr.S.Ananthi1, Dr.Anjalakshi Chandrsekar2, Dr.Santhamani3,

Abstract:
Objective:
The Initial And Most Frequent Procedure Performed On Women With Abnormal Uterine Bleeding Is Transvaginal
Ultrasound . Saline Contrast Sonohysterography Is A Better Technique To Reliably Detect Endometrial Pathology And
Distinguish Focal From Diffuse Intracavitary Lesion. Hence The Aim Of The Study Is To Compare The Diagnostic
Effectiveness Of Saline Contrast Sonohysterography And Hysteroscopy In Detecting Intrauterine Lesions In
Perimenopausal Women With Abnormal Uterine Bleeding.
Materials And Methods:
This Prospective Study Was Done In Srm Medical College Hospital And Research Centre, Katankulathur From Feb 2013 To
Feb 2014.About 100 Women With Abnormal Uterine Bleeding Were Submitted To Saline Contrast Sonohysterography
And Hysteroscopy. The Presence Of Intracavitary Lesions And The Type Of Lesions Were Noted. The Findings Were
Verified With The Histopathological Results Obtained By Dilatation And Curettage. The Positive And Negative Likelihood
Ratios (Lr+ And Lr-) Of Sis And Hs Were Calculated By Comparison With The Final Pathological Diagnosis.
Results:
Endometrial Polyp Was The Most Common Abnormal Pathology. In The Detection Of Any Abnormal Pathology The
Sensitivity, Positive Predictive Value And Diagnostic Accuracy Of Saline Contrast Sonohysterography Was 90.91% ,85.11%
, And 89% Respectively And That Of Hysteroscopy Was 90.2% , 95.83% , And 83% Respectively.The Positive Likelihood
Ratio ( Lr+) Of Sis And Hysteroscopy Were 22.1% And 7.273% Respectively.
Conclusion:
Our Results Have Substantiated That Diagnostic Effectiveness Of Sonohysterography Is Same As Hysteroscopy For The
Assessment Of Intrauterine Lesions And Hence Can Be Used As An Initial Investigation In The Diagnosis Of Abnormal
Uterine Bleeding.

***************

Pregnancy In The Shortest Achondroplastic Dwarf A Rare Case Report

Author: Dr. Ranga Goud
Co Author: Dr.Kaliki Hymavathi Reddy1,

Achondroplasia, The Commonest Cause Of Short-Limbed Dwarfism, Is A Rare Genetic Disorder Inherited As An Autosomal
Dominant Trait. Incidence Being 1 In 15,000 To 1 In 40,000 Live Births. We Report An Interesting Case Of Pregnancy In
The Shortest Acondroplastic Dwarf (108 Cm) With Successful Maternal And Perinatal Outcome.
***************

Acute Pancreatitis In Pregnancy : Successful Outcome

Author: Prof. Nandini . G
Co Author: Dr Avinash1,

Acute Pancreatitis In Pregnancy Is Rare. In The Past,The Prognosis Was Poor With High Maternal Mortality And Fetal
Loss.In Pregnancy Acute Pancreatitis Ranges From Mild To Serious Form Associated With Necrosis ,
Abscesses,Pseudocysts & Multiple Organ Dysfunction Syndrome .
We Do Report A Case Of Acute Pancreatitis In Pregnancy .
Conclusion : Early Diagnosis , Multidisciplinary Approach In A Critical Care Can Help In Successful Outcome .
***************

Safety To Mother, Breathing To Family And Pride To Health Care System

Author: Dr. Meena Jain
Co Author:

AimVision & Mission Is To Prevent Maternal Mortality & Morbidity In Laparoscopic Sterilization In Camps (Our Safety Points)
And At The Same Time Not To Refuse Women Who Really Desired For It.

MethodologyDuration Of Study; 15 Years..

Total No. Of Lap Sterilization Were Fifty Five Thousand With Modified Standard Operating Procedure Without Mortality
& 005% Morbidity. After Counseling Of Its Benefits, Alternatives & Potential Risk, The Voluntary Decision By Both
Partners Taken.

Inclusion CriteriaIn Multiparious Menstrual Or Post Menstrual, Pre Ovulatory, Lactational, One Previous Scar, 2 Previous Scar After
Confirming Mobility, Previous Failed Ltt Of Govt. Hospital, Apendisectomy Scar, Previous Upper Abdomen Laparotomy
Scar Etc. Were Selected.

Exclusion CriteriaSevere Cardiac Disorder, Acute Bronchial Asthma, Pregnancy With Size Of Uterus > Than 12 Wks, Clinically Palpable Mass
In Formix, Fixed Immobile Uterus, Acute Pid, Presence Of Organomegally, Hb <8 Gm, Bp >160/90 Mm Hg.

One Day Prior To CampCamp Area Inspected, Fumigated, Culture Taken. Patient Advised To Come After Taking Bath, Wear Clean & Washed
Clothes & Nil Orally. After Counselling, Registration & Form Filling Were Done. Hb Done, Urine Tested For Albumin &
Sugar. Clinical Examination Included Pulse, Bp, Rs, Cvs, Inspection And Palpation Of Abdomen And P/V Done. ReCounseling Of Pt And Husband In Complicated Cases And Re-Consent Obtained. Tag Was Applied On Fore Head Of Pt.

Pre ProcedureInj Xylocain, Penidure After Sensitivity And Tetanus Toxoid, Calmpose, Fortwin, Atropine Administered.

Procedure And ResultPatient Advised To Lie Down On Cot. Only Petticoat & Blouse Were Permitted. 1% Xylocain Infiltrated Around Umbilicus.
Any Abnormality Noted In Discharge Paper. Full Dose Of Penicillin Given In Post Operative Period. Extravasation Of Air
Extraperitoneally In 5 To 6 Cases. Insignificant Problems Encountered.

Conclusion:
With Specified Sop, Zero Mortality And Insignificant Morbidity Encountered In Camps, Which Will Be Discussed.

***************

A Simple Measure For Early Diagnosis Of Bladder Injury During Total Abdominal Hysterectomy In Patients With H/O
Previous C- Section.
Author: Dr. Abha Rani Sinha
Co Author: Abha Rani Sinha1,

Aim & Objective

To Study The Effect Of Pre Operative Instillation Of Dilute Sterile Methylene Blue Solution In The Bladder For Early
Diagnosis Of Intra Operative Bladder Injury When Performing Tah In Women With History Of Previous C- Section For
Gynaecological Indications.
Material And Methods
The Study Was Carried Out In The Department Of Obstetrics & Gynaecology From August 2011 To September 2014. All
Patients With History Of Previous C-Section Undergoing Tah For Gynaecological Indications Were Included In The Study.
Preoperative FoleyS Indwelling Catheter Was Inserted. After Inflating The Balloon About 10Ml Of Dilute Sterile
Methylene Blue Solution Was Instilled In The Bladder And A Clamp Was Applied At The Distal End Of The Catheter.
Sharp Dissection Was Done To Separate The Bladder Before Applying Clamps On The Uterine Artery. Visual Inspection
Was Done To See Any Leakage Of The Dye And To Confirm The Integrity Of The Bladder And The Clamp On The Catheter
Was Released.
Results
In 75 Cases Of Previous C Sections Tah Was Performed And In All Of Them Methylene Blue Solution Was Instilled
Preoperatively In The Bladder. In 6 Cases Bladder Injury Was Detected And In 2 Of These Cases The Injury Was Very Small
And Was Detected Only By Visualising The Very Small Spurt Of Methylene Blue From The Injury Site. Delayed
Complications Were Not Observed In Any Of The Patients.
Conclusion
Multiple C.S. Deliveries Are Associated With Difficulty In Bladder Dissection During Tah And Bladder Can Be Injured.
Simple Measure Like Instillation Of Pre Operative Methylene Blue Solution In The Bladder Can Help In Early Detection Of
Intra Operative Bladder Injury And It Is Cost Effective When Compared To Cystoscopy.

***************

Various Methods Of Second Trimester Abortion : A Tertiary Care Centre Experience

Author: Dr. Kavita Khoiwal
Co Author: Dr. Aparna Sharma1, Dr.Vatsla Dadhwal2, Dr. Dipika Deka3, Dr. Neena Malhotra4, Dr. Sumita Agarwal5

Aim & Objective : To Compare The Efficacy And Safety Of Various Methods For Second-Trimester Abortion.
Materials & Methods : A Prospective Study Was Conducted At A Tertiary Centre Among Fifty Women Of Gestational Age
Of 1326 Weeks With Fetus Having Congenital Malformation Or Anomaly/ Missed Abortion Or Iud/ Pprom/ Unwanted
Pregnancy. Mean Age Of The Patients Was 27+ 5 Years. Of The 50 Women, 12 Were Primigravida And 4 Had Previous
One Lscs. Three Patients Had Associated Hypothyroidism, Two Had Severe Ms, One With Type Ii Dm, One With
SjogrenS Syndrome And One Had Chronic Kidney Disease. Prenatal Invasive Testing Was Done In 8 Patients, Of Which
Two Were Diagnosed To Have Trisomy 21, Two Had Thalassemia Major, One With Cystic Fibrosis, One With Hemophilia.
Congenital Malformations Was Present In 7/50 Women. Mifepristone Followed By Misoprostol Was Administered In
24/50 Women, Misopostol Only In 23/50, Dinoprostone Gel In 1/50, Ethacridine Lactate In 1/50 And One Woman
Received Oxytocin.
Results : Mean Induction To Abortion Interval Was 11 Hours 50 Minutes (Mifepristone - Misoprostol - 10 Hours 17
Minutes, Misoprostol Only - 10 Hours 15 Minutes, Dinoprostone Gel - 21 Hours 35 Minutes, Ethacridine Lactate - 12
Hours, Oxytocin - 4 Hours). Out Of The 50 Women, 27 (13 In Mifepristone + Misoprostol Group, 12 From Misoprostol
Only Group, One With Dinoprostone Gel And One With Ethacridine Lactate) Did Not Expel The Placenta Within 1 Hour Of
Expulsion Of Fetus And Required Further Surgical Evacuation. The Side Effect Profiles For The Different Methods Did Not
Differ Significantly And Acceptability Of The Treatments Was High.
Conclusion : Mifepristone - Misoprostol Is More Efficacious Than Misoprostol Alone However The Difference Was Not
Statistically Significant.
***************

Effectiveness Of 3D (Three Dimensional) Antenatal Care On Pregnancy & Childbirth Outcome.

Author: Dr. Shubhada Neel
Co Author: Prof. E.V. Swaminathan. B.Tech.Mba1, Dr.Supriya Gugle. Phd.M.D. (Ayr)2, Dr.Dilip Nalage. M.D. (Ayr)3,
Prof.E.V.Gireesh. Mba4,

Aim & Objective

To Study The Effectiveness Of 3D Antenatal Care On Pregnancy & Childbirth Outcome.

Material & Methods

532 Women Attending The Antenatal Clinic At Neel Clinic In Panvel, Navi Mumbai, India Were Enrolled Between 18-28
Week Of Pregnancy From May 2012 & April 2014, In Prospective NonRandomized, Matched, Interventional Study.
254 Woman Were Enrolled In Study Group. 278 Woman Were Enrolled In Control Group. Women Were Matched For
Age, Gravida, Parity, Educational, Religion, And Residential Area.

3D Antenatal Care Included:

1. Stress Management Through Rajayoga Meditation (Brahma Kumaris)
2. Nutritious & Satwik Food
3. Antenatal Physical & Breathing Exercises

Exercises, Walking & Meditation Were Practiced By The Study Group From Date Of Entry Into The Study Until Delivery.
The Control Group Walked Half An Hour Twice A Day (Standard Obstetric Advice) During Study Period. Compliance In
Both Groups Was Ensured By Frequent Telephone Calls And Maintenance Of A Daily Activity Charts.

Result

Preterm Labour Was Significantly Lower (< 0.02) In Study Group. The Number Of Babies With Birth Weight > Or = 2500
Gram Was Significantly Higher (< 0.02) In Study Group. Vaginal Delivery Was Significantly Higher (< 0.01) In Study Group.
Complication Seen As Isolated Intra Uterine Growth Retardation Iugr (< 0.002) And Pregnancy Induced Hypertension With
Associated Iugr Were Significantly Lower (< 0.001) In Study Group.

Conclusion

Stress Management Through Meditation & Nutritional Management May Contribute To Decreased Risk Of Premature
Delivery Or Low Birth Weight Babies, And Eventually Would Decrease Problems In The Infant, Children, Adolescent And
Foetal Origin Of Adult Diseases. Exercise During Pregnancy Would Reduce The Risk Of Cesarean Delivery.
3D Antenatal Care Is Safe, Relatively Cheap To Implement & Would Reduce The Costs Of Long Term Health Care."

***************

The Effect Of Hyoscine Butylbromide On Labor In Primigravid Women: A Double Blind Randomized Controlled Clinical
Trial
Author: Dr. Renu Singh
Co Author: Prof Vinita Das1, Prof Urmila Singh2, Prof Sujata3,

Aim & Objective: To Determine The Effects Of Hyoscine Butylbromide On Labor In Primigravid Women.
Method: It Was A Randomised Double Blind Placebo Controlled Clinical Trial Carried Out In Department Of Obstetrics &
Gynaecology, Kgmu, Lucknow. The Study Was Approved By The Institutional Ethics Committee. After Informed Consent
The Women Were Recruited Based On The Inclusion & Exclusion Criteria And Were Consecutively Randomised Into The
Experimental & Control Groups. When The Women Entered Into Active Phase Of Labor, 2Ml Of Either Hyoscine
Butylbromide (Hbb) Or Placebo (Distilled Water) Was Given Intramuscularly. Since The Exact Time Of Full Dilatation Of
Cervix Was Difficult To Determine, Delivery Was Taken As The End Point. The Primary Outcome Was The Injection Delivery
Interval. The Secondary Outcomes Were Blood Loss At Delivery, Mode Of Delivery And Neonatal Apgar Scores. Data Was
Analysed Using Spss (15.0). StudentS T Test Was Used For Statistical Analysis.
Results: A Total Of 245 Women, Who Were Eligible, Consented For The Study. Further 25 Women Were Excluded Due To
Inappropriate Selection. Only 220 Yielded Data For Analysis. Of These 110 Women Received Placebo And 110 Received
Hbb. The Two Groups Were Comparable In Age And Gestational Age. The Mean Injection Delivery Interval (Minutes Sd)
In Placebo Group Was Significantly Higher As Compared To Hbb Group (312.0 76.6 Vs. 119.238; P=0.001).The
Neonatal Apgar Scores, Blood Loss & Mode Of Delivery Was Comparable. No Adverse Maternal Or Neonatal Effects Were
Observed.
Conclusion: Hyoscine Butylbromide Is An Effective Labor Accelerant. Its Use Is Not Associated With Any Apparent Adverse
Maternal Or Neonatal Outcomes.

***************

Randomised Control Trial To Compare The Various Modalities Of Medical Management Of Pre Menopausal Dub
Author: Dr. Shreya Thapa
Co Author: Nisha Rani Agrawal1, Lavina Chaubey2,

Aim & Objectives

A Randomized Clinical Trial To Compare The Efficacy Of Various Methods Of Medical Management Of Dub In
Premenopausal Age Group.
Materials & Methods
A Prospective Study Was Conducted After Ethical Clearance On Premenopausal Women With Dub, Who Attended
To Out Patient Department Of Obstetrics & Gynaecology In A Tertiary Care General Hospital. 80 Patients, Who Met The
Inclusion Criteria, Underwent Baseline Assessment And Were Treated With Either Progesterone Or Ormeloxifene Or
Combined Oral Contraceptive Pills Each For 6 Months Or Levonorgesterol Releasing Intrauterine System (Lng- Iud) For 5
Years. The Efficacy Of The Study Drugs Was Analyzed By Comparing The Baseline And Post Treatment Pabc Score,
Menstrual Cycle Pattern, Haemoglobin Level, Endometrial Thickness And Satisfaction With Treatment. Statistical Analysis
Was Performed Using Spss.
Results
76.25% Has Irregular Menstrual Cycle. Proliferative Endometrium Was The Most Common Histopathological
Finding. 40% Were Overweight And 17.5% Were Obese. There Was Statistically Significant Decrease In Median Pabc Score
And Endometrial Thickness With Ormeloxifene, Coc And Lng- Iud. The Mean Haemoglobin Level Difference Was Not
Statistically Significant. The Menstrual Pattern Regularised In 100% With Lng-Iud, 64.3% With Coc, 77.8% With
Ormeloxifene And 34.5% With Progesterone After 1 Year. 90% Patients Were Satisfied With Lng-Iud, 65% With Coc, 67.8%
With Ormeloxifene And 27.5% With Progesterone. No Major Adverse Events Were Experienced By Patients In This Study.
Conclusion
The Most Common Endometrial Pattern In Dub Was Proliferative Endometrium. Weight Reduction Should Be
Considered As A Conservative Treatment. Ormeloxifene, Coc And Lng-Iud Were Found To Be Equally Effective In Reducing
Menstrual Blood Flow. Ormeloxifene And Lng-Iud Group Decreased The Pbac Score Most. Coc And Lng-Iud Group Made
Menstrual Cycles Regular Which Was Later Maintained. The Satisfaction Level Was Significantly Greater With (Lng-Iud)
As Compared With Other Groups.

***************

Vibroacoustic Stimulation Test & Cardiotocography A Reliable Indicator For Prediction Of Perinatal Outcome
Author: Dr. Sneh Kiran
Co Author: Dr Abha Rani Sinha1,

Aim & Objectives - To Evaluate The Role Of Vibroacoustic Stimulation Test & Cardiotocography For The Prediction Of
Perinatal Outcome.
Materials & Methods- This Study Was Conducted In Department Of Obstetric & Gynaecology, Patna Medical College &
Hospital, Patna On 60 Women From January 14 To August 14. All Women In Early Latent Phase Of Labour With Cephalic
Presentation Were Subjected To Cardiotocography & Vibroacoustic Stimulation Test. Results Were Correlated With The
Fetal Outcome.
Results- Of 60 Fetuses Subjected To Cardiotocograpy , 36(60%) Were Reactive , 20(33.3%) Suspicious, 4(6.6%) Ominous.
Vibroacoustic Stimulation Test Was Reactive In 50(83.3%) & Nonreactive In 10(16.6%). Among Nonreactive Vas, 8 (13.3%)
Babies Had Low Apgar Score At 1 Mints , 5 (8.3%) Babies Required Nicu Admission And Among 5 Babies , 3(5%) Died In
Nicu.
Conclusion- Both Vast & Ctg Are Good Predictors Of Perinatal Outcome Because They Are Less Time Consuming , Easy
To Perform, Inexpensive & Noninvasive Test.

***************

A Retrospective Study Of Alleged Female Victims Of Sexual Abuse :

Author: Dr. Arpana Singhal
Co Author: Dr. R.P. Khuteta1, Dr. Vineeta Garg2,

Aim & Objectives : To Know The Different Aspects Of Sexual Abuse Among Female Victims Reported At State Tertiary
Care And Referral Hospital, Jaipur.
Materials & Methods : The Present Study Was Carried Out On 51 Victims Of Sexual Offences Between The Period Of Nov
2013 And Oct 2014. All The Cases Of Sexual Abuse Reported During The Study Period Were Cases Of Natural Sexual
Offences Committed On Female Victims.
Results : The Ages Of Victims In Our Study Ranged From 4 To 50 Years. The Most Frequently Affected Age Group Was
Victims Between 21-30 Years (50.9 %) Followed By 11-20 Years (33.3%). Three Cases Of Sexual Abuse Belonged To The
Age Group Of 0-10 Years. Majority Of The Victims Were Hindu Females (90%), Unmarried (60.7%), Educated Up To
Secondary Level (33.3%) And From Low Socio Economic Status (58.8%). The Assailant Was A Known Person To The Victim
In A Vast Majority Of Cases (88.24%). Only 23.5 % Of The Cases Reported Within 3Rd Day Of The Incident For Medical
Examination. A Large Numbers Of Cases Reported With Old Tears In The Hymen.
Conclusion : This Study Highlights The Importance Of Addressing Sexual Abuse As A Public Health Issue And Focuses On
The Demographic Profile Of Victims In The Urban Area. However This Study Still Needs Involvement Of A Multidisciplinary
Team For Evaluation Of A Good Outcome.

***************

Minimal Open Surgery In Cases Of Severe Acute Ruptured Ectopic Pregnancy In Poor Resources Without Mopping.
Author: Dr. Swet Nisha
Co Author: Dr. Alka Sinha1, Dr. M.S.Thakur2,

Aim & Objectives - To Determine The Outcome Of Minimal Open Surgery Without Mopping In Poor Resource Setting In
Treatment Of Severe Acute Ruptured Ectopic Pregnancy.

Materials & Methods - A Cross Sectional , Observational Study At Department Of Obstetrics & Gynecology(Dmch),
Laheriasarai, From Oct 2013 - Oct 2014. A Total Of 32 Patients With Severe Acute Ruptured Ectopic Pregnancy Were
Included In The Study. 12 Patients Were Managed By Conventional Laprotomy And 20 By Minimal Open Surgery Without
Mopping.

- Small Period Anesthesia

- Small Subumbilical Incision ( Except For Cornual Involvement)
- Clots Poured Out
- Grasp The Tube With Hand Bringing It Up Into The Incision To Visualise Which Side And At What Site, Is Affected Or
Ruptured .
- Salpingectomy / Ligation Of Bleeding Sites Done.
- Examination Of Other Tube And Ovary.
- No Mopping.
- No Drain.
- Close The Abdomen.
- Follow Up Of Patients With Repeated Urine Pregnancy Test For Residual Product Of Conception - Growth Or Abdominal
Pregnancy.
- Not Even A Single Case Found. All Patients Became Negative By 8Th Day .
- All Patients Were Followed For Future Obstetric Career And Intestinal Obstruction , If Any.

Results Short Term - No Features Of Infection.

Long Term - 2 Patients Conceived.
- No Patient Turned Up With Features Of Intestinal
Obstruction Till Date

Conclusion - As Compared To Conventional Laprotomy My Procedure Has Following Advantages :-

- Minimal Trauma
- No Blood Needed For Transfusion
- Quick Improvement As Compared To Conventional Laprotomy.
***************

Impact Of Prom On Maternal And Fetal Health

Author: Dr. Kshama Vishwakarma
Co Author: Dr. Kalpna Yadav1, Dr. (Prof) Meena Bhargava2,

Aim & Objectives(1)

To Study Incidence Of Prom With Respect To Age, Gravidity, Gestational Age And Abnormal Presentation.

(2)
To Study Impact Of Prom On Maternal Health In Terms Of Mode Of Delivery, Maternal Morbidity And Fetal
Morbidity.
Material & Methods- 150 Married Women Of Age More Than 18 Years, Who Had Premature Rupture Of Membranes,
Delivered In G.M.H., Rewa Over The Period Of Six Months Were Included In The Study And Enquired About Various
Demographic Factors And Its Effect On Pregnancy Outcome And Maternal Health.
Results- Incidence Of Prom Came Out To Be 3.61%. Majority Of Women Came From Rural Area, Majority Were Of Age
Group 21-25 Years, Primigravidae, 66% Women Delivered Within 24 Hours Of Ruptured Membranes, 46% Of Women
Who Delivered After 24 Hours Of Ruptured Membranes Have Undergone Caesarean Section. Over All Caesarean Section
Rate Among These Patients Was 35.3%. Abnormal Presentation Has A Higher Incidence Of Prom. Women With Prom Had
Higher Maternal Morbidity In Form Of Post Operative Fever, Wound Sepsis, Abdominal Distension, Chorioamnionitis And
Neonatal Sepsis And Still Birth.
Conclusion- Prom Has A Great Impact On Maternal Health And Perinatal Outcome, Hence These Patients Should Be
Managed Aggressively. Women With Adequate Pelvis And Favourable Conditions For Vaginal Delivery Should Be
Augmented/ Induced And Decision For Caesarean Section Should Be Taken Early To Avoid Complications.
Keywords: Prom; Caesarean Section ; Maternal Morbidity; Neonatal Morbidity.

***************

Successful Conception With Infertility Workup In 100 Cases

Author: Dr. Vatsavaya Raghu Rama Krishna Raju
Co Author: Dr. V. Sita Rama Raju1,

Aim & Objectives :

To Evaluate The Male And Female Factors Among The Infertile Couple Presented At Krishna Hospital.

Materials & Methods:

It Is A Prospective Study Of Successful Conception After Infertility Workup Among The 100Couples Presented At Krishna
Hospital With Infertility Between The Time Period Of Jan 2012- May 2013

Male :
Past Medical And Surgical History
Personal History
Occupational History
Coital Frequency
Physical Examination
Semen Analysis (Sperm Dna Fragmentation Index In Diabetics)
Sr Fsh And Colour Doppler Scrotum In Selected Patients.
Results : Primary Infertility 63% Secondary Infertility 37%

Female:
Age
Bmi
Medical,Surgical And Gynecological History
General Examination
Hormonal Profile (Fsh,Lh,Tsh,Prolactin)
Hsg/ Hysteroscopy And Laparoscopy
Post Coital Test
Method Of Conception

Conclusion:

In An Infertility Case , Initial Evaluation , History , Physical Examination Of Both Patners , Female And Male Factors Should
Be Ruled Out .
***************

An Audit Of Cases Of Placenta Praevia In A Tertiary Care Centre In Chotanagpur Plateau.

Author: Dr. Anubha Singh
Co Author: Anubha Singh1, Rita Lal2, Kiran Trivedi3,

Aim & Objectives :To Find The Incidence, Risk Factors, Maternal And Perinatal Outcomes In Patients With Placenta
Praevia.
Materials And Methods: A Retrospective Review Of The Cases Of Placenta Praevia From September 2013 To August 2014
In A Tertiary Care Center In Chhotanagpur Plateau.
Results: There Were 151 Cases Of Placenta Praevia Out Of 8304 Deliveries Giving An Incidence Of 18.2 Per 1000
Deliveries. Fifty One Percent Were Of More Than 30 Years Of Age. Around 80% Were Multiparous Out Of Which Around
30% Had A Parity Of 3 Or More. Thirty Percent Had A History Of Caesarean Section And 26% Had Dilatation And
Evacuation. Emergency Hysterectomy Was Done In 10%. Morbid Adherent Placenta Was Seen In 8 % Of Cases. Thirty Two
Percent Had Preterm Delivery, 8% Early Neonatal Deaths, 22% Were Stillborn.Post Partum Haemorrhage Occurred In 45
% Cases. There Was A Single Maternal Mortality.
Conclusion: The Commonest Association Of Placenta Praevia Was With Multiparity. Uterine Scarring And Previous
Abortion Are Also Important Risk Factors. Foetal Loss Was Around 30%. Placenta Praevia Should Be Compulsorily
Managed In A Tertiary Care Hospital For Better Perinatal And Maternal Outcomes.
***************

Chorionic Villus Sampling In A Tertiary Care Centre

Author: Dr. Priyanka Pipara
Co Author: Reeta Vijayaselvi1, Ruby Jose2,

Aim & Objectives To Analyze The Indications And Results Of Chorionic Villus Sampling.
Material & Method - This Is A Descriptive Analytical Study Conducted At Cmc Vellore In A Single Unit From August 2013
To August 2014. All Women Underwent This Procedure After Genetic Counselling And All The Cases Were Done By
Transabdominal Puncture Guided Ultrasound. The Indications And Results Of Chorionic Villus Sampling Were Analysed
Retrospectively From A Prospectively Maintained Database.
Results Out Of Total 36 Chorionic Villus Sampling 35 (97.22 %) Were Successful. In 2 (5.55 %) Patients Samples Were
Contaminated. Most Common Indication For The Procedure Was Previous Child With Chromosomal Abnormality Or
Genetic Disease That Was Noted In 28 (77.77 %) Cases. In 4 (11.11%) Cases Indication Was Foetal Malformation Detected
On Ultrasonography.
Twenty Patients (55.55 %) Were Noted To Have Normal Results, 12 (33.33%) Had Abnormal Results And Result Of 1
Patient Is Awaited. Out Of 12 Abnormal Results 7(19.44%) Foetuses Were Disease Affected And 5 (13.88%) Were Found
To Have Carrier State. Out Of 12 Disease Affected Foetuses 3 Were Found To Have Chromosomal Abnormalities, 2 Had
Haematological Disorder, 1 Had Metabolic Disorder And 1 Had Neurofibromatosis. Out Of 5 Carrier Foetuses 3 Were
Carrier For Thalassemia, 1 Was Carrier For Haemophilia And 1 For Haple Syrup Disease. Majority Of Abnormal Results
Were Found When Indication For The Procedure Was Previous Affected Child.
Conclusion Chorionic Villus Sampling Is A Reliable Method For Couples At High Risk Of Giving Birth To A Child With
Significant Chromosomal Abnormalities Or Genetic Disease And Is Strongly Recommended In High Risk Pregnancies For
Foetal Abnormalities.
***************

Incidence, Maternal & Epidemiological Factors & Fetal Outcome Of Lethal Congenital Malformations In A Tertiary
Care Centre: A Prospective Study
Author: Dr. Purnima Gupta
Co Author: Madhavi Mathur Gupta1, Avantika Gupta2, Ashok Kumar3,

Aim & Objectives- To Know The Incidence Of Various Structural Lethal Congenital Malformations (Lcm), Their Association
With Various Maternal And Epidemiological Factors, And Outcome Of Affected Babies Who Were Born Alive In A Tertiary
Care Centre Over 1 Year.
Materials & Methods- We Did A Prospective Observational Study In Which All The Babies Affected With Structural Lcm,
Born Either Alive Or Dead, In A Tertiary Care Institute Were Evaluated. Incidence Of Lcm Was Calculated And Associated
Maternal And Epidemiological Factors Were Studied.
Results- Over The One Year Period There Were 56 Cases Of Lcm, Of Which 28 Were Stillborn And The Remaining 28 Live
Born Of Total 14530 Deliveries That Took Place During This Time. Various Malformations Included Anencephaly (17.86%),
Sirenomelia (7.14%), Cyclops Proboscis (3.57%), Severe Congenital Diaphragmatic Hernia (12.50%), Severe
Meningomyelocele (12.50%), Hypoplastic Left Heart Syndrome (5.36%), Severe Hydrocephalus (16.07%), Lissencephaly
(3.57%), Holoprosencephaly (3.57%), Bilateral Lung Hypoplasia (1.79%), Bilateral Renal Agenesis (5.36%), Bilateral
Multicystic Dysplastic Kidney (5.36%) And Encephalocele (3.57%). Twenty Three Mothers (46.43%) Were Primigravida
And Twenty Four (42.86%) Were Unbooked. Only 6 Mothers Took Folic Acid In The First Trimester. Consanguinity Was
Found To Be Present In 10 Patients. One Fourth Patients (25%) Did Not Have Any Antenatal Ultrasonography (Usg) Done;
And Among Those Patients Who Got It Done, Lcm Could Be Detected Only In 48.21%, Mostly After 20 Weeks. Five Babies
Were Born By Lscs. Mean Survival Period Of The Babies Born Alive Was 14 Hrs With 100% Mortality.
Conclusion- Rare Lcm Like Anencephaly And Sirenomelia Had Higher Incidences Than Previously Reported. In This Era Of
Awareness And Advancement, Still Many Unbooked Patients Present To Health Care Facilities Only After 20 Weeks
Carrying Lcm Issues Without Any Antenatal Usg. Emphasis Should Be On Prenatal Diagnosis In Order To Minimize
Operative Interventions For Babies With Poor Prognosis.

***************

Clinicopathological Evaluation Of Abnormal Uterine Bleeding In Perimenopausal Women With Special Reference To
Endometrial Hyperplasia
Author: Dr. Ashmina Rekhi
Co Author: Dr. Anjuman Alam1, Dr. R.K. Hazarika2,

Aim & Objectives- To Study The Bleeding Patterns And The Histopathological Picture Of Endometrium In Perimenopausal
Women Presenting With Abnormal Uterine Bleeding.
Materials & Methods- A Hospital Based Descriptive Study Carried Out Over A Period Of One Year In Perimenopausal
Women Attending The Gynaecological Opd And Presenting With Abnormal Bleeding Patterns. It Included Women In Age
Group Of 43-52 Years Presenting With Various Forms Of Bleeding Disturbances And Excluded Pregnant Patients And
Those On Cyclical Hormones. A Clinical Diagnosis Of Abnormal Uterine Bleeding Was Made On Basis Of Examination And
Ultrasound Finding And Each Patient Was Subjected To A Dilatation And Curettage Procedure. The Sample Was Sent For
Histopathological Evaluation.
Results- Most Common Clinical Diagnosis Was Dysfunctional Uterine Bleeding (58.3%), Mostly Patients Presented With
Menorrhagia (50.7%), And The Most Frequent Histopathological Finding Was Of Endometrial Hyperplasia (44.5%) Out Of
Which Simple Hyperplasia Predominanated.
Conclusion- Functional Disturbance Predominates In Perimenopausal Women However Organic Causes Should Always Be
Drawn In Mind. Occurrence Of Endometrial Hyperplasia Increase In This Age Group And Is Important To Be Diagnosed As
It Is A Precursor Lesion For Endometrial Carcinoma.

***************

Trends, Causes And Risk Factors In Maternal Mortality In The District Of Bolangir In Odisha
Author: Dr. Sujnanendra Mishra
Co Author: Dr.Sujnanendra Mishra1,

Aim & Objectives -To Study The Trends, Causes And Risk Factors Of Maternal Deaths With Relation To Socioeconomic
Factors And Institutional Maternal Health Care Services During Pregnancy And Delivery. And To Find Out Means To
Improve The Maternal Mortality Ratio.
Materials And Methods -A Retrospective Studies Of 234 Recorded Maternal Deaths In The District Of Bolangir Of Odisha,
India Over A Period From January 2011 To September 2014. Available Information Regarding Demographic, Reproductive
Parameters, Cause Of Death, Time Interval From Admission To Death, Nature Of Institutional Care And Place Of Death
Were Collected And Results Were Analyzed By Using Percentage And Proportion.
Results - Few Socio-Demographic Characteristics Contribute To Maternal Death. Postpartum Hemorrhage And Pregnancy
Induced Hypertension Continue To Be The Leading Direct Causes While Anemia Was The Leading Indirect Cause. The
Proportion Of Death En-Route During Referral Is Alarming. The Age Group Of 19 To 24 Years Was Mainly Affected. The
Higher Birth Order Contributes Significantly To Maternal Deaths.
Conclusion -Most Maternal Deaths Are Preventable By Optimum Utilization Of Existing Maternal Health Care Facilities,
Identifying The Bottlenecks In Health Delivery System, Early Identification Of High Risk Pregnancies And Their Timely And
Protocol Based Intervention Before Referral To Higher Center. Strengthening Family Planning And Comprehensive
Abortion Care Will Change The Scenario Dramatically.

***************

Analysis Of Awareness,Acceptance,Safety And Continuation Rate Of Post-Placental And Intra-Caesarian Insertion Of

Intrauterine Contraceptive Device(Ppiucd):Health Education-Ensuring Change.
Author: Dr. Shivani Barala
Co Author: Dr.Shivani Barala1, Dr.Sunita Maheshwari2, Dr.Sumer Singh3,

Aim & Objectives

Given The Global Evidence Of Ppiucd As A Safe,Effective,Long Term Reversible Method Of Contraception,Unfortunately,A
Large Number Of Women Who Wish To Delay Or Prevent Future Pregnancies Receive Little Or No Information About It.
This Study Examines The Awareness Among Pregnant Women According To Their Socio-Demographic,Educational
Status,Source Of Information,Incidence Of Acceptance And Refusal,Reasons Of Refusal,Acceptance Level After Clearing
Their Doubts And Their Follow Up For Continuation,Removal,Causes Of Removal And Any Side Effects So As To Make
Strategy To Increase The Acceptance Rate In Future
.
Materials & Methods
The Study Was Conducted At Pannadhay Mahila Chikitsalya,Rnt Medical College,Udaipur(Rajasthan) From 1St July 2013
To 31St January 2014.
Women Admitted And Delivered At This Tertiary Hospital Were Interviewed.Cut380A Was Inserted Within 10 Minutes Of
Delivery Of Placenta In Acceptors Who Fulfilled The Medical Eligibility Criteria And Had No Contraindication For
Ppiucd.They Were Followed Up Till 31St July 2014.

Results
Total Women Interviewed=1024.Out Of Which 256 Women Were Already Aware Of Ppiucd And 768 Were Totally
Unaware.Main Source Of Information Was Media And Health Workers In Already Awared Group.
Out Of 1024,Total Women Accepted Ppiucd=364,Declined=660.
Ppiucd Not Inserted =12(Due To Postpartum Haemorrhage).Lost To Follow Up=42,
Followed Up=310.
Side Effects:86(Bleeding=46,String Problem=31,Expulsion=9).
Removal=22,Continuation=288.

Conclusion
Ppiucd Was Demonstrably Safe,Effective And High Retention Rate(97% In Followed Up Cases).The Expulsion Rate Was
Not Very High(3% In Followed Up Cases).
Awareness Of Ppiucd Among Indian Women Was Very Poor.Lack Of Service Providers,Myths And Misconception Among
Community,Limited Access To Skilled Service Providers And Poor Awareness Among People Were The Reasons For Low
Acceptance Levels.

Increasing Awareness Of Benefits Of Ppiucd Will Surely Ensure The Change In The Acceptance Rate.The States Need To
Strengthen The Counselling System At The Facilities With High Load And In Order To Do So,Placement Of
Reproductive,Maternal,Newborn,Child & Adolescent Health(Rmnch+A) Counsellors Would Be Key Strategy.

***************

Hour Glass Compression Suture In The Management Of Primary Pph

Author: Dr. Debjyoti Santra
Co Author:

Aim & Objectives

Nearly 125000 Mothers Die Of Pph Worldwide Each Year. Out Of Which 25% - 40 % Are In The Developing World. Bleeding
From The Uterus Within 24 Hours Of Delivery Is Primary Pph, Of Which 75%- 90% Are Due To Uterine Atony. The Standard
Techniques To Control The Primary Pph Are Administration Of Uterotonic Agents , Bimanual Uterine Compression Failing
Which Different Surgical Technique Like Uterine Packing, Intracavitary Balloon Application, Uterine Compression Suture,
Selective Ligation Of Major Vessels Are Employed ; And Hysterectomy Is The Last Resort. Uterine Brace Suture Introduced
By Christopher B-Lynch In 1997 Is Popular And Successful, However Several Modifications To Make It Simpler And Fast
Applicating Have Been Attempted By Many Round The Globe.
Materials & Methods
Our Technique Is Placing Two Hour Glass Suture Over The Uterus Without The Need Of Mandatory Opening The Uterine
Cavity.
Results
Here We Present Our Two Years Experience. No Of Cases Of Primary Atony Pph Was 10 From January 2010 To October
2012. The Range Of Estimated Blood Loss Was 1000--2000Ml. In All Cases Uterus Was Preserved Successfully; Regular
Menstruation Returned Within Three To Four Months Of Follow Up Except In One Case Who Conceived During Lactational
Amenorrhea. No Complication Like Pyometra, Amenorrhea, Oligomenorrhea Or Suture Cut Down Was Faced During The
Procedure Or Following Procedure.
Conclusion
This Could Be A Simple, Safe And Effective Method To Control Primary Pph.

***************

Rare Case Of Maple Syrup Urine Disease (Msud) A Challenge For Future Pregnancies
Author: Dr. Rukini Ramamohan
Co Author: Dr.Ljayanthi Reddy1,

Aim & Objectives

Presenting Rare Case Of Baby With Msud Delivered At Jj Hospital
Material & Methods
27 Years Primigravida Had Regular Antenatal Checkups.
Patient Had History Of 1St Degree Consanguineous Marriage. Nt & Tiffa Scans Were Normal. Triple Screening Test Was
In Red Zone. Amniocentesis Showed Normal Karyotype. Following Failed Induction, A C-Section Was Done And A Female
Baby Weighing 4 Kgs, Apgar10 Delivered. Post Op Period Uneventful. Mother And Baby Discharged On 6Th Day.
On 10Th Day Baby Was Brought With Complaints Of Dullness, Poor Feeding And Seizure Episodes. Baby Admitted In Nicu,
Required Ventilator And Inotrope Support. Newborn Screening Suggested Msud, Confirmed By Urine And Plasma Amino
Acid Estimation.Mri Scan Showed Msud Like Features.
Result
Baby Was In Nicu For 10 Days Msud Feeds Were Started With Support Treatment. Baby Slowly Improved But Continued
To Require Ventilator. Parents, Despite Intense Counseling Decided For Discharge Against Medical Advice.
Conclusion
Msud Is A Rare Autosomal Recessive Metabolic Disease With Incidence Of 1:185000 Babies. It Is Caused By Mutation In
At Least 4 Genes Which Encode The Components Of The Bcakad Complex Which Catalyses The Catabolism Of The Branch
Chained Amino Acids. Accumulation Of These Amino Acids And Keto Acids Leads To Encephalopathy And Progressive
Neurodegeneration, Seizures And Death In Severe Forms
Treatment Options
Msud Diet
Thiamine Supplements
Liver Transplant
Gene Modification And
Stem Cells Are Future Potential Therapies
This Case Represents A High Risk And Challenge For Future Pregnancies.
Follow Up Advice
Dna Testing Of Parents, Genetic Counseling Regarding Risk Assessment
Prenatal Diagnosis In Pregnancy By Enzyme Testing/Dna Testing On Cultured Amniocytes Obtained By Chorionvillus
Sampling Or Amniocentesis
Newborn Screening If Pnd Not Done

***************

Effect Of Meconium Staining Of Liquor On Perinatal Outcome

Author: Dr. Neha Goyal
Co Author: Dr Nirlep Kaur1, Dr Ritu Bassi2,

Aim & Objectives:

To Study

Mode Of Delivery In Meconium Stained Amniotic Fluid (Msaf)

Clinical Correlation Of Peri-Natal Outcomes With Msaf

Materials And Methods:

Ours Was A Prospective Cohort Study Of Pregnant Women In Labour With Cephalic Presentation, Singleton Pregnancy,
With Meconium Stained Liquor Irrespective Of Age, Parity& Stage Of Labour& Type Of Previous Delivery. The Outcomes
Studied Included Type Of Delivery, Apgar Score At 1&5 Minutes, Occurrence Of Mas, Birth Weight& Admission To Nicu
And Their Relation To Grade Of Meconium Staining(Thin(I)& Thick(Ii)). In Statistical Analysis, Continuous Data Are Given
As MeanSd, Range Or Median. Qualitative Variables Are Presented As Numbers & Compared By Pearson Chi-Square
Test.
Results:
A Total Of 62 Patients Were Included In The Study (19-35 Years Of Age), With 33 Primigravida. 26 Patients Had Thin
Meconium Staining And 36 Had Thick Meconium Staining. Only 12 Patients Had A Normal Vaginal Delivery, 46 Needed
Lscs, 3 Forceps Delivery And 1Vento Suction. Though 29 Newborns Had An Apgar Score Of <=7 At 1 Minute It Improved
And Only 6 Newborns Had An Apgar Score Of <=7 At 5 Minutes. 7 Neonates Were Admitted To Nicu And Two Neonates
Developed Mas. There Were Two Deaths, Both In Neonates With Thick Meconium Staining.
Conclusion:
Meconium Staining Of Amniotic Fluid Is A Common Occurrence With Equal Distribution In Primi And Multi Gravida.
Majority (81%) Of The Women Needed Assisted Delivery Techniques Or Lscs For Delivery. Though Apgar Scores Were
Low At 1 Minute In 47% It Became Normal In 90% Of Neonates At 5 Minutes. Statistically Significant Difference In The
Thin And Thick Meconium Groups Were Observed In Incidence Of Mas, Nicu Admission& Apgar Whereas There Was No
Difference In Birth Weight. Thus Thick But Not Meconium Staining Has An Impact On Peri-Natal Outcome.
***************

Is Low Amniotic Fluid Index (Afi) A Real Indicator Of Fetal Compromise And Hence Delivery?
Author: Dr. Meghna Pai
Co Author: Roopa S1, Muralidhar V Pai2,

Aim & Objectives: (1) To Determine Whether Low Amniotic Fluid Index (Afi) Is An Indicator Of Fetal Compromise And
Hence Delivery By Studying The Neonatal Outcome In Women That Had Induced Vaginal Or Direct Caesarean Deliveries
For Various Indications And Also Having Low Afi. (2) To Find Out The Incidence Of Instrumental Delivery And Emergency
Caesarean Section For Fetal Distress In Women With Induced Labor In Women With Low Afi
Methods: It Was A Prospective, Observational Study, Conducted At Department Of Obg, Kmc, Manipal Between Aug 2013
And Aug 2014. After Obtaining Ethical Clearance And Informed Consent, 150 Subjects That Had Induced Labor Or Direct
Caesarean Deliveries For Various Indications And Also Having Low-Normal (5 8) / Low (< 5) Afi, Were Recruited For
The Study. Subjects With Fetal Anomalies Were Excluded. Outcome Variables Studied Included, Fetal Distress In Labor,
Mode Of Delivery In Induced Labor, Perinatal Asphyxia, And Respiratory Distress Syndrome. Statistical Package For The
Social Sciences (Spss Version 16) Was Used For The Statistical Compilation And Analysis.
Results: Out Of 150 Subjects 68 (45.4%) Had Low And 82 (54.6%) Had Low-Normal Afi. Both The Groups Were Matched
For Demographic Characteristics And Confounding Factors For Neonatal Outcome. In Low Afi Group The Incidence Of
Perinatal Asphyxia (11.7%) And Rds (16.1%) Were Significantly Higher Compared To That In Low-Normal Group (1.2% And
2.4% Respectively) P = 0.025 And 0.009. There Was No Significant Difference Between The Groups With Respect To Mode
Of Delivery In Induced Labor.
Conclusion: Afi < 5 Is An Indicator Of Fetal Compromise, One May Anticipate Perinatal Asphyxia And Rds. Hence ItS
An Indication To Deliver Without Delay

***************

Evaluation Of Screening, Treatment And Feto-Maternal Outcome Of Hypothyroid Disorders In Pregnancy In A

Tertiary Care Center In Northern India
Author: Dr. Monika Gupta
Co Author: Dr Tabassum Bano1, Dr Swaraj Batra2,

Aim & Objectives: 1.To Study The Status Of Antenatal Screening Of Thyroid Disorders And Their Treatment Amongst The
Females Delivering At A Tertiary Care Centre In Northern India. 2. To Study The Prevalence Of Subclinical And Overt
Hypothyroidism Amongst Those Screened. 3. To Compare The Maternal And Fetal Outcome In Normal, Subclinical
Hypothyroid And Overt Hypothyroid Patients.
Materials & Methods: Retrospective Analysis Of Case Records Of All The Delivered Patients In A Tertiary Care Centre Over
The Period Of One Year. Those Patients In Whom Serum Tsh Levels Were Done Any Time In The Antenatal Period Were
Included In The Study. According To Serum Tsh Levels Patients Were Divided Into Normal, Subclinical Hypothyroid And
Overt Hypothyroid Groups. Maternal Outcome In All These Pregnancies Was Evaluated In Terms Of Demographic
Characteristics, Gestation At Delivery, Mode Of Delivery, Maternal Complications And Fetal Outcome In Terms Of Birth
Weight, Stay At Nursery. Observation Regarding Evaluation Of Anti-Thyroid Peroxidase Antibody And Treatment Given In
Any Of The Patients Was Also Made. The Results In All The Groups Were Compared Using Appropriate Statistical Analysis.
Results: A Total Of 809 Deliveries Occurred In The Study Period And 284 Patients Were Included In The Study. 23.6%
Patients Were Subclinical Hypothyroid And 13.6% Were Overt Hypothyroid. Majority Of The Patients Were Screened
During First Trimester. Age Group, Mode Of Delivery, Birth Weight In All The Groups Was Comparable. Thyroid Antibody
Status Was Not Determined In Any Of The Subclinical Hypothyroid Group. 8.9% In Subclinical Hypothyroid Group And
57.6% In Overt Hypothyroid Group Received Treatment. Statistically Insignificant Raised Incidence Of Prematurity,
Antepartum Haemorrhage, Gestational Diabetes And Oligohydramnios Was Seen In Untreated Subclinical Hypothyroid
Group.
Conclusion: Screening And Treatment Of Hypothyroid Disorders In Pregnancy Still Remains A Dilemma And A Targeted
Approach Should Be Practiced.

***************

Power Morcellation Inside Specially Designed Endobags At Laparoscopy

Author: Dr. Krishnakumar S
Co Author: Dr Pratik Tambe1,

Aim & Objectives: Aim Of The Present Study Is To Address The Issue Of Using Endobags Specially Designed For Isolating
Tissues During Power Morcellation At Laparoscopic Surgery To Prevent The Risk Of Disseminating Malignant Cells And Its
Morbidity To Patients While Retrieving Specimens Like Uterus And Fibroids With The Use Of Power Morcellators In
Laparoscopic Surgeries.
Material & Methods: All Patients Undergoing Laparoscopic Myomectomy And Those Undergoing Laparoscopic
Hysterectomy For Very Large Uteri Which Could Not Be Retrieved Vaginally. All The Surgeries Were Done In A Urban
Private Hospital Center With Facilities For Endoscopic Surgery.
Results: Morcellation Inside The Endobag Was Completed Successfully In All The Cases
Conclusion: Tissue Morcellation By Power Morcellators Is Feasible In Specially Designed Endobags Like Morsafe Bag, With
Little Training And Extra Skill. The Use Of Specimen Retrieval Bags Should Be Further Investigated For Safety & Outcomes
In Preventing Dissemination Of Occult Uterine Cancers In Controlled Settings.

***************

Hypothyroidsm In Pregnancy And Its Perinatal Outcome

Author: Dr. Batiston Waanbah
Co Author: Dr. M Patwari1,

Aim & Objectives: Comparison Of The Perinatal Outcome In Normal Pregnant Women And In Pregnant Patients With
Hypothyroidism.
Materials & Methods: A Prospective Comparative Study Was Conducted In Dept. Of Obstetrics And Gynaecology, Assam
Medical College And Hospital, Dibrugarh. Total Of 100 Women Were Studied, 50 Were Hypothyroid Pregnant Women,
And 50 Were Normal Pregnant Women. Chi-Square Test Was Used To Compare The Results. Differences Were Considered
Significant When P < 0.05.
Results: Higher Rates Of Caesarean Sections (50%), Nicu Admissions (30%) And Lbw Babies (64%) Were Seen In Pregnancy
Complicated With Hypothyroidism As Compared To Normal Pregnant Women.
Conclusion: Hypothyroidism In Pregnancy Is Related With Poor Perinatal Outcome.

***************

An Epidemiology Study To Determine The Prevalence And Risk Factors Associated With Recurrent Spontaneous
Miscarriage In India
Author: Dr. Ameet Patki
Co Author: Naveen Chauhan1,

Aim & Objectives: The Worldwide Prevalence Of Spontaneous Miscarriage (Sm; Pregnancy Loss Of 20 Weeks Of
Gestation) Is Around 15%, While That Of Recurrent Spontaneous Miscarriage (Rsm; 3 Pregnancy Loss Of 20
Weeks Gestation) Is 0.5% To 3%. The Aim Of This Study Was To Determine The Prevalence Of Rsm In Indian Women.

Methods: This Cross-Sectional, Outpatient Clinic Based Epidemiology Study In Female Patients (Aged 18 To 45 Years) With
At Least One Sm Examined The Prevalence Of Rsm, Probability Of Subsequent Miscarriage And Risk Factors Associated
With Rsm. The Demography, Medical History, Gynaecological History And Results Of Gynaecological Examination Were
Recorded.

Results: Of The 2398 Patients Screened For Eligibility, 767 (32%) Had A History Of At Least One Sm. The Prevalence Of
Rsm Amongst The 753 Patients (Mean Age 29.76 5.85 Years) Who Satisfied The Eligibility Criteria Were Enrolled In The
Study Was 7.46%. Among These Patients, A Statistically Significant Association (P=0.0007) Was Found Between Sm And
Age. A Higher Number Of Women In The Age Group Of 23-27 Years (95.65%, N=220) Had < 3 Sm While Rsm Was Mostly
Recorded In The Age Group Of 33 Years (14.68%, N=32). In Patients With Rsm, The 2Nd And 3Rd Miscarriages Were
More Prevalent During 7Th Week To End Of 11Th Week Of Gestation. The Probability Of Having A Subsequent Miscarriage
After The 1St, 2Nd And 3Rd Miscarriage Was 0.25, 0.34 And 0.22 Respectively. There Was A Significant Association
(P<0.05) Between Rsm And Risk Factors Including Clotting Disorders, Immunological Factors, Infections And Genetic
Disorders.
Conclusion: The Study Revealed A Higher Prevalence Of Rsm Amongst The Indian Women As Compared To Western Data.
Age, Clotting Disorders, Immunological Factors, Infections And Genetic Disorders Were The Significant Risk Factors
Associated With Rsm.

***************

Comparative Study Of Intravenous Labetalol And Oral Nifedipine For Control Of Blood Pressure In Severe PreEclampsia.
Author: Dr. Ramprasad Dey
Co Author: Dr.Swagata Biswas.1,

Aim & Objectives: To Compare Efficacy Of Intravenous Labetalol And Oral Nifedipine When Used Rapidly To Lower High
Blood Pressure In Severe Pre-Eclampsia.
Materials And Methods: It Is A Hospital-Based Prospective Interventional Randomised Control Trial Conducted At Bankura
Sammilani Medical College From April2013 To March3014. 100 Pregnant Women Of More Than 34 Weeks Gestation
With Bp160/110 And Significant Proteinuria Were Recruited For The Study. They Were Randomly Allocated Into Two
Groups. In Group A, Intravenous Labetalol 20Mg Was Given And Drug Was Repeated At 20 Minutes Interval In An
Escalating Dose Regimen Of 40, 80, 80 And 80 Mg To Achieve The Target Blood Pressure(Bp<150/90). In Group B,
Nifedipine 10 Mg Was Given Orally, 20 Minutes Interval Up To A Maximum Of 5 Doses. Maternal Parameters Studied Are
Amount Of Drug, Time Required, Crossover Treatment, Any Complication & Mode Of Delivery. Results Were Analysed
With The StudentS T-Test And Mann-Whitney U Test.
Results: Mean Sbp Was 186.212 Mm Of Hg In Group A And 17512 Mm Of Hg In Group B(P=0.669). Mean Dbp Was
118.118 Mm Of Hg In Group A And 1128 Mm Of Hg In Group B(P=0.745). The Mean Amount Of Drug Required Were
9637.8 Mg In Group A And 22.812.9 Mg In Group B (P<0.001). The Mean Time Required Were 47.213.5 Minutes
In Group A And 45.614.5 Minutes In Group B (P =0.511). Most Of The Patients Were Controlled By Two Doses Of Each
Drug, 56% In The Labetalol Group And 62% In The Nifedipine Group. No Significant Side Effects Were Noted In Either
Group. There Was No Significant Difference In Mode Of Delivery & Perinatal Outcome Between Two Groups.
Conclusion: Oral Nifedipine And Intravenous Labetalol Are Equally Effective And Well Tolerated In Acute Control Of
Severe Hypertension In Pre-Eclampsia.

***************

Patterns Of Plasma C-Reactive Protein Levels In Early Pregnancy And Consequent Risks Of Preterm Delivery
Author: Dr. Shabdika Kulshreshtha
Co Author: Dr Shabdika Kulshreshtha1, Dr Rajrani Sharma2,

Aim & Objectives: To Examine The Hypothesis Correlating The Association Of Raised Maternal Serum C-Reactive Protein
Levels With The Increased Risk Of Preterm Labour And To Identify The Role Of Infections As Well As Inflammations In
Preterm Labour.
Materials & Methods: The Prospective Study Was Conducted Among 100 Primigravida Patients With Singleton
Pregnancies Aged Between 18-35 Years.The Study Was Conducted At R.N.T Medical College Hospital For A Period Of One
Year. The Patients' Quantitative Serum C-Reactive Protein Level Was Measured At 5-20 Weeks Of Gestation According To
Their Enrolment In The Antenatal Clinic.
Results: Majority Of Patients Who Had Serum Crp Levels In Higher Range Delivered At Preterm. 70% Of Patients Who Had
Delivered At Preterm Had Serum Crp Levels >7 Mg/L.None Of The Patients With Serum Crp Level < 2.5 Mg/L Delivered At
Preterm. 73.3% Of Preterm Patients Presented With Leaking Per Vaginum Along With Other Complications. Serum Crp
Level In These Patients Was 7.6Mg/L.
Conclusion: Our Endeavour In This Research Was To Examine A Marker(Serum Crp) Which Is Not Only Easily Sampled But
Also Is Cost Effective Especially In Our Indian Setup. Raised Serum Crp Concentrations In Early Pregnancy Is Associated
With Increased Risk Of Preterm Birth.
***************

Evaluation Of Awareness Of Abortion Pills And Complications Of Its Misuse

Author: Dr. Kavita Agarwal
Co Author: Dr. Sunita Malik1, Dr. Achla Batra2, Dr. Abha Aggarwal3,

Aim & Objectives: To Find The Awareness About Correct Use Of Abortion Pills For Termination Of Pregnancy Upto 9
Weeks Of Gestation And Complications Arising As A Result Of Abortion Pills Misuse. Material And Methods: A CrossSectional Study Was Conducted Over A Period Of 9 Months In 1300 Women Attending Gynaecology Casualty With History
Of Abortion Pill Intake. They Were Questioned According To The Pre Structured Proforma Regarding Their Awareness
About Abortion Pills. Condition At Admission And Treatment Given Were Also Recorded In That Proforma. The Main
Outcome Variables Were Awareness About The Drug, Its Side Effects And Patients Considering It As An Emergency
Contraceptive Measure. The Secondary Outcome Were The Complications Arising Out Of Its Misuse. Results: Abortion
Pills Were Purchased From Chemists By 85% Women, 96% Women Had Self Intake Of Abortion Pills Due To Lack Of
Awareness, 18% Considered It As Emergency Contraceptive Pill, 55% Took Abortion Pill In Incorrect Way And 22% Took
After 9 Weeks Of Gestation. Pregnancy Was Confirmed By Ultrasound In Only 7% Women. Complications Recorded Were
Incomplete Abortion In 66%, Septic Abortion In 0.8%. For Heavy Bleeding, 60% Patients Had Emergency Suction
Evacuation And 16.4% Women Required Blood Transfusions. Laparotomy Was Done In 2.4% Cases. Conclusion:
Awareness About Correct Use Of Abortion Pills, Its Complications And Need For Medical Supervision Can Reduce Maternal
Morbidity To A Large Extent.
***************

Le Fort 'S Procedure- An Option For The Elderly Women

Author: Dr. Amrita
Co Author: Dr. Rajani Sharma1,

Aim & Objectives:

Medical Professionals Worldwide Have Been Challenged To Reduce The Risk Of Age Related Diseases And To Find
Alternative Treatment That Is Safe And Improves The Quality Of Life.
The Objective Of The Study Is:
To Evaluate The Efficacy Of Le Fort'S Operation In A Selected Group Of Patients Who Are (1) Medically Not Fit For
Anaesthesia And Operation (2) Very Elderly , Medically Fragile And Not Fit For Operation (3) Not Fit For Prolonged
Lithotomy Position (4)Not Desirous Of Sexual Function.
Materials And Methods:
40 Patients Were Selected From Opd Of Pmch From March 2013 To September 2014 By Its Checklist.
Exclusion Of Pelvic Pathology Was Done By (1) Usg(Tvs) (2) Cervical Cytology .
Spinal Or Local Anaesthesia Was Used According To Patients Condition.
Only Chromic Catgut No 1 And 0 Was Used . Perineorrhaphy Was Done In 36/40 Cases. Levatorplasty Was Done In 10/
40 Cases. Kelly'S Plication Was Done In 4/ 40 Cases For Stress Incontinence. Theirsch Was Done In 1/40 Case For Rectal
Prolapse. Follow Up Was Done At 3 Months Interval In First 6 Months And Then 6 Months Interval For 2 Years And Then
Yearly Afterwards.
Result:
2 Patients Were Lost To Follow Up. Of The Remaining 38, 37 Were Very Satisfied With The Operation., Both Subjectively
And Objectively.One Patient Who Was A Poorly Controlled Diabetic Developed Vaginal Discharge With Intense Pruritus
Due To Moniliasis, Which Was Treated.
Conclusion:
Partial Colpocleisis Is An Excellent Operation For Treatment Of Pop In A Very Selected Group Of Patients. The Advantages
Are Simple Technique, Permanent Cure, Symptomatic Relief So Better Quality Of Life, Minimal Surgical Risk, Minimal Cost,
Minimal Complications. Hence, Le Fort'S Operation Still Remains A Sound And Viable Option For Compromised Elderly
Women.

***************

Role Of Tvs Cervical Length In Predicting Successful Induction Of Labor In Term Gestations
Author: Dr. Sangeetha Sivaraman
Co Author: Dr.Komal Revankar1,

Aim & Objectives:

To Assess The Role Of Tvs Measured Cervical Length Vs. Bishops Score In Predicting Successful Induction.

Materials & Methods:

Design: Prospective Observational Study
Sample Size-78
Methodology: 78 Consecutive Term Gestations Having Valid Indication For Induction Meetinginclusion Criteria
1.Indication For Induction Noted.
2.Transvaginal Scan Performed,Mean Of 3 Measurements Taken As Cervical Length.
3.Ultrasound Was Performed By A Trained Obstetrician. Bishops Score Assigned By Obgyn Residents Unaware Of Usg
Findings.
4.Cervical Induction According To Institute Protocol.
5.The Outcome Noted Was- Successful/Failed Induction

Results
Out Of 78 Inductions,13 Have Bishops Score Of >=4. Based On The Bishop Score Of >=4, In 16.7% Of Induction We Can
Predict The Successful Induction. Most Of The Inductions (83.3%) Have A Bishops Score Of<4 And Is Not Useful In
Predicting In 65 Inductions.Out Of The 67 Successful Inductions Bishop Score Of >=4 Explains Only 19.4% Successful
Inductions. 80.6% Of Successful Induction Have Bishop Score<4.The Pearson Chi-Square Value For Bishops Score And
Successful Induction Is 2.561 With A P-Value Of 0.11. Hence, The Bishops Score Is Not A Good Predictor For Successful
Induction.The Pearson Chi-Square Value For Cervical Length And Successful Induction Is 5.616 With A P-Value Of
0.018.Hence, The Cervical Length <=2.5 Is A Better Predictor Than Bishop Score Of >=4.A Binary Logistic Regression Shows
That Cervical Length Explains The Successful Induction. The Estimated Coefficient For The Cervical Length Is Significant At
0.04 Indicating Cervical Length <=2.5 Explains The Successful Induction.A Binary Logistic Regression Was Attempted For
Successful Induction And Bishop Score. The Estimated Coefficient For Bishop Score Is 19.612 Which Is Not
Significant.From Both The Counts The Cervical Length Is A Better Indicator For Predicting Successful Induction.

Conclusion
Ultrasound Measured Cervical Length Is A Better Predictor Of Successful Induction Than Bishops Score.

***************

Critical Evaluation Of The Increasing Incidence Of Primary Caesarean Section

Author: Dr. Sudha S
Co Author: Dr.Vijaya1,

Aim & Objectives:

To Critically Evaluate The Increasing Incidence Of Primary Caesarean Section And The Factors Affecting Maternal And
Fetal Outcome And To Identify The Means Of Reducing Primary Caesarean Section.
Methods:
The Indications For Primary Caesarean Section And Maternal And Fetal Outcome Was Critically Evaluated From The
Obstetric Records In A Retrospective Manner From July 2012 To June 2014 At The Institute Of Social Obstetrics And
Kasturba Gandhi Hospital, A Tertiary Care Hospital In Tamil Nadu. A Cohort Of 15735 Delivered Women Were Studied.
The Various Factors Included In The Study Were MotherS Age, Parity,, Maternal Height, Maternal Weight, Antenatal
Visits, Associated Risk Factors,Indications For Caesarean Section , Fetal Weight, 5-Minute Apgar Scores And Post
Operative Complications.
Results:
The Overall Caesarean Rate Was 51% With The Rate Of Primary Caesarean Section Was 57%. The Main Indications For
Primary Caesarean Section Were Fetal Distress, Followed By Failure Of Progression Of Labour, Failed Induction,
Cephalopelvic Disproportion , Oligohydramnios, Preeclampsia, Antepartum Haemorrhage In Descending Order.Among
The Fetal Distress Abnormal Fetal Heart Rate Tracing In Cardiotocogram Contributed To 48% Of Cases.About 22% Of The
Cases Of Fetal Distress Were Due To Failed Induction.Most Of The Cases Decided After One Gel Induction Due To
Abnormal Cardiotocogram,Meconium Stained Liquor And Maternal Factors.Only 14% Of The Babies Born Among The
Fetal Distress Group Required Nicu Admission.Overall Perinatal Mortality Rate Was 4% .
Conclusion:
In Our Study, The Leading Cause Of Primary Caesarean Section Was Found To Be Fetal Distress, Determined By Abnormal
Fetal Heart Rate Tracing In Cardiotocogram. To Reduce The Primary Caesarean Rate Standard Protocols Should Be
Followed In Interpretating The Fetal Heart Tracing ,Close Monitoring Of Progression Of Labour And Periodic Training Drill
For Junior Residents For Interpretation Of Cardiotocogram.

***************

Obstetric Emergencies, Near-Miss Cases And Maternal Deaths In A Tertiary Care Hospital: An Audit
Author: Dr. Shravya Tallapureddy
Co Author: Dr.M.Tripura Sundari1, Dr.T.Radha2, Dr.P.Himabindu3, Dr.Saritha4,

Aim & Objectives:

To Determine The Frequency Of Severe Maternal Complications, Maternal Near-Miss Cases And Maternal Deaths

Materials & Methods:

This Is A Retrospective Hospital Based Cross Sectional Study. The Study Was Done At Government General Hospital,
Vijayawada (A Tertiary Referral Centre). Data From January 2014 To August 2014 ( I.E., For A Period Of 8 Months) Was
Analysed. Tools Used Are The Who Near-Miss Approach Published In 2011. This Was Implemented In Two Steps
Baseline Assessment And Situation Analysis.

Results:
There Were 3900 Deliveries And 3784 Live Births During The Study Period. A Total Of 184 Women Were Identified With
Potentially Life Threatening Conditions. Of These, There Were 32 near-Miss Cases And 6 Maternal Deaths. The
Maternal Near Miss Incidence Ratio Was 8.4/1000 Live Births, Maternal Near Miss To Mortality Ratio Was
5.3:1, And Mortality Index Was 15.7%. Maternal Mortality Ratio (Mmr) Was 158/100000 Live Births.
Haemorrhage Was The Leading Cause (43.7%), Followed By Hypertensive Disorders (31.2%) And Other Causes (15.6%) In
Near-Miss Cases Whereas Hypertensive Disorders Were The Leading Cause In Both Women With Potentially Life
Threatening Conditions (66.8%) And Maternal Deaths(66.6%)

Conclusions:
Haemorrhage And Hypertensive Disorders Are The Leading Causes Of Near Miss Events. Rate Of Normal Deliveries And
Caesarean Sections Was Equal In Both - Women With Potentially Life Threatening Conditions And Women With Severe
Maternal Outcomes. The Incidence Of Perinatal Mortality Also Increased In The Above Conditions. Early Identification Of
High Risk Cases And Early Referral Might Reduce Morbidity And Prevent Mortality.

***************

Maternal Serum Triglyceride Level At 24-32 Weeks In Prediction Of Macrosomia In Non- Diabetic PatientsProspective Non- Randomised Controlled Study
Author: Dr. Seetha Mohan
Co Author:

Aim & Objectives:

To Determine Whether Elevated Mid-Pregnancy Maternal Serum Lipid Levels Predict New Born Weight At Term And The
Risk Of Macrosomic Infants In Non-Diabetic Women.
Materials And Methods:
This Prospective Non Randomised Controlled Study Enrolled Pregnant Non-Diabetic Women Between 24-32 Weeks Of
Gestation Not Having Comorbid Diseases. There Were Two Arms In The Study, Arm A With Patients With Triglyceride
Level Of More Than 150 Mg/Dl And Arm B With Triglyceride Level Of Less Than 150 Mg/D. Babies Having More Than 95
Percentile Of The Birth Weight Were Considered As Macrosomic.
Results:
The Study Enrolled 151 Women. Fasting Serum Triglyceride Was Accessed At A Median Of 28 Weeks. The Average Serum
Triglyceride Level Was 154.4 Mg/Dl (Sd: 29.95, Range: 109 272). The Median Gestational Age At Delivery Was 38.4
Weeks. The Mean Birth Weight Was 3.03 Kg (Sd: 0.40, Range: 2.02 3.9). Ten Patients In Arm A And 4 In Arm B Had
Macrosomia. Serum Triglyceride At Mid-Gestation And The Birth Weight Showed A Statistically Significant Positive
Correlation ( R=0.2, Ci 0.042 To 0.35, P=0.0138). The Relative Risk Of Having Serum Triglyceride Of More Than 149 Mg/Dl
And Macrosomia Was 2.40 (Ci 0.79 To 7.32) And The OddS Ratio Was 2.6 (95% Ci 0.78 To 8.73). Among The Study
Population, No Correlation Was Seen Between Birth Weight And Other Variables.
Conclusion:
In Non-Diabetic Women, Fasting Triglyceride Levels At 2432 Weeks Showed Statistically Significant Positive
Correlation With Newborn Weight At Term. Maternal Fasting Serum Triglyceride Levels In Mid-Pregnancy Might Be An
Independent Predictor Of Fetal Macrosomia.

***************

Peripartum Cardiomyopathy-Observational Study

Author: Dr. Amrutha Kasipa
Co Author: Dr.Rani1, Dr.Vijaya Krishna2, Dr.Radhika Ganesh3,

Aim & Objectives;

To Analyse Patients With Peripartum Cardiomyopathy With The Objective To Decrease The Morbidity
In The Mother Thereby To Improve Maternal And Fetal Outcome.
Materials & Methods:
It Is An Observational Study Conducted In Gandhi Hospital Over A Period Of 1 Year From August
2013-August 2014.
13 Pregnant & Postpartum Women Who Presented With Shortness Of Breath Were Evaluated & Diagnosed As
Peripartum Cardiomyopathy By Pearson Criteria.These Patients Were Admitted And Standard Treatment For Heart
Failure Was Given.
Further Management Like Mode Of Delivery,Need For Induction Was Based On Obstetric Factors.
Result:
Out Of 13 Cases, 8 Cases Had Uneventful Outcome,2 Cases Had Worsening Of Shortness Of Breath From Nyha 2
To 4 Who Recovered With Medication,1 Patient Developed Pulmonary Required Ventilatory Support For 3 Days But Died
Inspite Of Treatment, 1 Patient Developed Cardiogenic Shock And Had Cardiac Arrest & Died After 8 Days.
Conclusion:
Maternal Mortality Was 15.4% Which Is Comparable With Other Series.
There Is No Increase In Incidence Of Preterm Birth, Iugr.However In Our Study 3 Babies Were Diagnosed With Congenital
Anomalies.
***************

Role Of Oxytocin In Blood Loss In Cesarean Section

Author: Dr. Nimisha Gupta
Co Author: Dr.Nimisha Gupta1, Dr.U.K.Ghosh2, Dr.Sunita Gupta3,

Aim &Objectives: To Determine The Effect Of Adding An Oxytocin Infusion To Bolus Oxytocin On Blood Loss At Caesarean
Section.
Material & Methods: Present Study Was A Double Blind, Placebo Controlled, Randomised Trial, Conducted From 20122104 In Subharti Medical College And Associated Hospital, Meerut Uttar Pradesh In 274 Women For Elective/ Emergency
Caesarean Section At Term With A Singleton Pregnancy. We Excluded Women With Multiple Pregnancy, Placenta Praevia,
Thrombocytopenia, Coagulopathies, Women Receiving Anticoagulant Treatment. Intervention Group: Intravenous Slow
5 Iu Oxytocin Bolus Over 1 Minute And Additional 40 Iu Oxytocin Infusion In 1000 Ml Of 0.9% Saline Solution Over 4 Hours
(Bolus And Infusion) & Placebo Group: 5 Iu Oxytocin Bolus Over 1 Minute And 1000 Ml Of 0.9% Saline Solution Over4
Hours (Placebo Infusion) (Bolus Only). Main Outcome: Major Obstetric Haemorrhage (Blood Loss >1000 Ml) And Need
For An Additional Uterotonic Agent.

Results: 19.22% Subjects In Bolus And Infusion Group And 37.9% In Bolus Only Group Had Blood Loss Between 6001000Cc Respectively. Statistically Significant Difference Regarding Blood Loss Was Found Among 2 Groups. We Found No
Difference In The Occurrence Of Major Obstetric Haemorrhage Between The Groups. The Need For An Additional
Uterotonics Agent In The (10.2%) Bolus And Infusion Group Was Lower Than That In The (19.49%) Bolus Only Group. The
Most Common Indication For Use Of Uterotonic Agent Was Uterine Atony And Blood Loss. The Occurrence Of Vomiting
And Hypotension Was Seen More In Bolus And Infusion Group.

Conclusion The Addition Of An Oxytocin Infusion After Caesarean Delivery Reduces The Need For Additional Uterotonic
Agents But Does Not Affect The Overall Occurrence Of Major Obstetric Haemorrhage.

***************

Middle Cerebral Artery Doppler Velocimetry For Timing The Second Intrauterine Blood Transfusion In Fetuses With
Anaemia
Author: Dr. Aparna Yethirajyam
Co Author: Dr.Indrani Suresh1, Dr.Aparna Yethirajyam2, Dr.Sulbha R.Tupe3,

Aim :- To Assess The Sensitivity Of Peak Systolic Velocity (Psv) Of Middle Cerebral Artery (Mca) Doppler In The Prediction
Of Moderate To Severe Fetal Anaemia , After One Intrauterine Blood Transfusion.

Methods: - This Was A Retrospective Study Of The Antenatal Patient Population At Mediscan Systems, From January 1998
To June 2014.
Of The 250 Total Intrauterine Transfusions (Iuts) Done In 162 Fetus, 71 Fetuses Underwent Repeat Iuts.
Exclusion Criteria Were Multiple Gestation And Procedures Planned Using Methods Other Than Mca Doppler
Velocimetry.
After Exclusion, Our Study Included 61 Fetuses, Which Underwent Repeat Iuts. Of The Iuts Done, 95% Were For Fetal
Anemia Due To Rhesus Isoimmunisation.
The Mean Gestational Age Was 25 Weeks, Ranging From 19 To 33 Weeks.
Mca Psv Values And Fetal Haemoglobin Were Expressed As Multiples Of Median (Moms) For Gestational Age. Mca Psv
Of >=1.5 Moms Was Used As A Cutoff Above Which Iut Was Done.
Degrees Of Anaemia Were Categorized According To Haemoglobin Mom Thresholds As Mild (0.83 - 0.65), Moderate (0.64
0.55) And Severe (<0.55).
Regression Analysis Was Used To Determine The Significance Of Association Between Pretransfusion Mca Psv Mom
Values And Pretransfusion Fetal Haemoglobin Moms.

Result : - In Our Study Group Of 61 Fetuses Which Underwent Second Iut, 58 Fetuses Had Mca Psv Mom >=1.5, Which
Correlated Well With Haemoglobin Mom Of <0.84. 54 Out Of 58 Fetuses Had Haemoglobin Mom <0.65 .Thus The
Sensitivity Of Mca Psv Mom Values In Predicting Moderate To Severe Fetal Anaemia Was Close To 93%.

Conclusion: - A High Degree Of Association Was Observed Between Pretransfusion Mca Psv Mom And Haemoglobin Mom
Values, Even After One Iut, And Thus Mca Doppler Velocimetry Can Be Successfully Used For Timing The Second Iut,
Avoiding The Need For Multiple Invasive Procedures.
***************

Modified Early Obstetric Emergency Warning System (Meows)

Author: Dr. Harshala Shankar
Co Author: Dr Nirmala Shivalingaiah1,

Aim : To Assess The Use Of Meows As A Tool To Predict Maternal Morbidity, By Measuring Its Sensitivity, Specificity And
Predictive Value.
Materials And Methods : Prospective Study From February 1 To June 30 2014. All Pregnant Women Of > 20 Weeks
Gestation And Who Delivered In Kims Bangalore Were Included In The Study. Pulse Rate , Blood Pressure ,Respiratory
Rate, Saturation Were Measured At Least Every 12 Hours. Trigger Was A Single Markedly Abnormal Observation (Red) Or
Two Mildly Abnormal Observations (Yellow). Outcomes Measured Were Obstetric Interventions, Icu Admissions ,
Discharge Alive , Morbidity And Death
Results : Meows Has Sensitivity Of 90% Sensitivity And 98.7% Specificity , Positive Predictive Value 98.4% And Negative
Predictive Value Of 97.8%
Conclusion : Our Study Recommends The Use Of Meows Chart For Monitoring Of All Obstetric Patients Because Of Its
High Sensitivity And Specificity
***************

Comparative Study Of Oral Versus Parentral Iron In Moderate Iron Deficiency Anemia During Antenatal Peroid
Author: Dr. Smita Kumari
Co Author: Dr S Singh1,

Aim : To Evaluate The Safety And Efficacy Of Parentral Iron & To Compare With Oral Iron Therapy In Terms Of Result,
Compliance & Complication.

Material And Method : Randomised Prospective Study Was Done On 100 Antenatal Women With Moderate Degree Of
Iron Deficiency Anemia At 20-34 Wks Of Gestation. Patients Were Divided Into Two Groups. 50 Were Given Iron Sucrose
With Normal Saline As Parentral Iron On Alternate Days As Inpatient And 50 Were Given 200Mg Of Oral Iron For 8 Wks.
To Analyse The Result Hb And Reticulocyte Count Was Done On 2,4 & 8 Wks Of Therapy. Serum Ferritin Was Done On 0
& 8 Wks.

Result : Most Patients Were Between 20-25 Yrs Of Age. Mean Hb % Rise Was 3.2Gm% In Parentral Group And 2.1Gm%
In Oral Group. Drug Compliance Was Better In Parentral Group & Symptomatic Improvement Was Also Earliar In This
Group. Minor Adverse Effects Like Itching, Rashes And Phlebitis Was Seen In 8% Patients In Parentral Group. No Serious
Adverse Effect Was Seen In Either Group.

Conclusion: Parentral Iron Is Safe, Effective & Convenient In The Treatment Of Iron Deficiency Anemia.As There Is No
Serious Adverse Effect It Can Be Used As An Outpatient Therapy.
***************

Twin Pregnancies With Single Fetal Death: A Clinical Review

Author: Dr. Sri Lakshmi Priyanka Yerra
Co Author: Vijayasree1,

Aim : To Study The Clinical Profile, Management Options , Maternal And Fetal Outcome In Twin Pregnancies With Single
Fetal Death .

Materials And Methods : We Had A Total Of 37 Twin Deliveries Out Of 2133 Deliveries In Mamata Hospital , Khammam
During My Study Period. Out Of Them, 5 Were Complicated With Single Fetal Demise In 2Nd Or 3Rd Trimester.The Cases
Were Studied For Antenatal Complications, Placental Chorionicity With Intensive Fetal Surveillance. Neonatal And
Maternal Outcome In The Postpartum Period Was Also Studied.

Results: One Out Of 5 Cases Had Pre-Eclampsia , 3 Cases Had Coagulation Abnormalities.All The Mothers Were Anaemic.
There Was 1 Case Of Twin To Twin Transfusion, 3 Were Foetus Papyraceous.
Only One Case Could Be Extended Up To Term , All The Other Ones Preterm Deliveries. One Case Had Vaginal Delivery, 4
Cases Were Delivered By Cesarean Section. None Of Them Had Postpartum Haemorrhage Or Postpartum Complications
. One Had Stillbirth, One Case Of Perinatal Mortality And 3Were Fine.

Conclusion : Although Our Study Was Small, We Found Out That With Timely Intervention ;The Other Live Foetus Could
Be Salvaged.
***************

Pelvic Floor Function Before And After Bariatric Surgery

Author: Dr. Kalaivani Ramalingam
Co Author:

Aim :To Identify And Quantify Pelvic Floor Function In Obese Women Before And After Laparoscopic Bariatric Surgery.

Methods

A Prospective Cohort Study Of Patients With A Bmi Greater Than 40Kg/M2 Undergoing Bariatric Surgery In Southampton,
Uk
Of The 133 Patients Invited, 59 Consented And 46 Completed Follow-Up. Questionnaires For Vaginal Prolapse(Spsq),
Urinary(Bfluts), Bowel Incontinence(Cleveland) And Sexual Function(Fsfi) Were Completed Along With Baros
Score(Bariatric Outcome Surveillance) And Pop Q (Pelvic Organ Prolapse Quantification)Scores Before And 6 Months
After Surgery.
Results

Prolapse Symptom Questionnaire (Spsq)

There Was A Significant Improvement Between The Pre-Op And 6 Month Post-Op Score In Patients Perception Of
Prolapse Symptoms(Spsq). This Showed An Improvement -6.7 (P<0.05).
Urinary Symptoms(Bfluts)
There Was A Significant Improvement In Urinary Symptoms As Assessed By The Bfluts Questionnaire -7.6(P<<0.05).
84% Of Patients Reported An Improvement In Stress Incontinence, 90% An Improvement In Overactive Bladder
Symptoms And 66% Reported A Decrease In Urinary Tract Infections.
Bowel Symptoms(Cleveland Score)
There Was An Overall Post-Operative Improvement In Bowel Incontinence Score
-1.7(P=0.01)
88% Of Patients With Solid Stool Incontinence Reported An Improvement , 73% Patients With Liquid Stool Incontinence
Reported An Improvement.
26% Of Patients Developed New Onset Flatus Incontinence Post-Operatively.
Baros- Bariatric Analysis And Reporting Outcome System Score
Very Good-19
Good-21
Fair-5

Failure-1
Popq Scores
Popq Scores Improved Significantly In The Apical And Posterior CompartmentsC -0.7(P<0.05) Bp -1.1(P<0.05) And A Statistically Insignificant Improvement Occurred In The Anterior Compartment
Ba -0.1(P=0.2). There Is No Study To Date That Has Reported Prospective Objective Improvement In Popq Scores With
Weight Loss.
Conclusion
Weight Loss Is Associated With Global Improvement In Pelvic Floor Function With Both Subjective And Objective
Improvement. There Are Significant Improvements In Quality Of Life Issues. This Is The First Study Which Reports
Quantitative And Objective Improvement In Pelvic Floor Function After Weight Loss.

***************

Pep Study (Predictor Of Pre Eclampsia Study

Author: Dr. Roshini Kasi Viswanathan
Co Author: Dr.Roshini Kasi Viswanathan1, Dr.N.Palaniappan2,

Aim To Use Maternal Triglyceride Level As A Predictor Of Pre Eclampsia In A Primi Gravid Woman
Objective To Evaluate The Out Comes Of Women Who Were Screened Using Triglyceride Levels As A Predictor Of Pre
Eclampsia.
Materials And Methods-Patients Attending The Out Patient Department Of Ob-Gyn At Sri Ramachandra Medical College
And Research Center Will Be Included In The Study. History And Examination Is Done. All Primi Gravidas Within 30 Years
Of Age And 16- 20 Weeks Of Gestation Are Enrolled In The Study If They Fit The Inclusion Criteria. A Base Line Blood
Pressure Is Taken In The Left Upper Arm In The Sitting Posture Using A Standard Riva Roce Cuff And Sphygmo Manometer
And Recorded In A Master Chart. A Urine Albumin Chart Is Also Maintained Using Standard Dipstick Method. A Request
For Fasting Triglyceride Value Is Given And The Patient Is Asked To Come Back With Reports. A Cut Off Value Of 150Mg/Dl
Is Taken And Patients Are Divided Into Two Groups. Group 1 With Normal Triglycerides And Group 2 With Increased
Triglycerides And Are Followed Up Till 40 Weeks Of Gestational Age.
Results Out Of 403 Patients 79 Patients Developed Pre Eclampsia. In Which Group 2 ,44 Patients Developed Pre
Eclampsia When Compared To Group 1 In Which Only 29 Patients Developed Pre Eclampsia. Group 2 Is Statistically More
Significant.
Conclusion We Thereby May Hypothesize That Hypertriglyceridemia May Evolve As A Single Most Important
Predictor Of Pre Eclampsia.

***************

A Prospective Analysis-Surgery For Borderline And Malignant Ovarian Tumours

Author: Dr. Sivasundari M
Co Author: Dr.S.Gouthaman1, Prof Jaya Vijayaraghavan2,

Aim And Objectives:

Ovarian Cancer Remains The Most Lethal Of The Gynaecological Cancers..Our Aims Are To Analyse The
Tumour Factors In Ovarian Tumours And To Study Prospectively The Morbidity And Mortality Pattern Following Surgery
In Ovarian Tumours.

Materials And Methods:

Prospective Analysis Of 17 Consecutive Patients Who Underwent Surgery For Ovarian Tumours During The
Period Of June 2014-July 2015 At Sri Ramachandra University .Patients With Advanced Epithelial Ovarian Tumor Received
Neoadjuvant Chemotherapy Followed By Interval Cytoreduction Whereas Patients With Borderline Tumors Underwent
Staging Laparotomy.Surgery Included Total Abdominal Hysterectomy With Bilateral Salphingo Oophorectomy,Bilateral
Pelvic Lymph Node Dissection , Omentectomy And Paraortic Lymph Node Dissection In Selected Cases.Tumor Factors
Affecting Recurrence Pattern Was Analysed . Analysis Of Morbidity Pattern Following The Surgery Done.

Results:

In Our Study The Mean Age At Presentation Was 51 Years (Range 21- 70Years).6Patients(35%)Had Unilateral
Tumours.Pathological Complete Response Following Neoadjuvant Chemotheraoy Was Observed In 2 Patients(11.7)%.The
Most Common Histopathological Type Was Serous Papillary Carcinoma-12Patients(70.5%).Borderline Serous Pathology
Was Observed In One Patient(5.8%) And Borderline Mucinous Was Observed In 2 Patients(11.7%).1 Patient Had
Granulosa Cell Tumour(5.8%).
6 Patients (35%) Had High Grade Tumours.The Mean Nodal Yield In Our Study Was 14 Nodes(Range 6-28).Three Patients
Had Node Positivity(17.6%).Omental Involvement Was Observed In5 Patients(29.4%).
Peritoneal Nodule Involvement Was Observed In7 Patients(41.1%).At One Year Follow Up 2 Patients Developed Distant
Metastasis(11.7%) And 1 Patient Had Regional Recurrence(5.8%).Morbidity In The Form Of Wound Infection And
Mortality Was 0%.1 Patient Had Lung Morbidity And 1 Patient Had Prolonged Ileus(5.8%).2 Patients Developed (11.7%)
Incisional Hernia At A Later Date.

Conclusion:

Patients With Extensive Residual Viable Disease Following Neoadjuvant Chemotherapy Tend To Develop
Regional And Distant Recurrence.Major Cytoreductive Surgeries Can Be Done With Minimal Morbidity And Absent
Mortality With Meticulous Perioperative Care And Multidisciplinary Approach.

***************

Study On Haemorrhage In Early Pregnancy And Its Evaluation By Tvs.

Author: Dr. Chitra Sinha
Co Author:

Aim And Objective

Diagnosis.

-To Evaluate The Role Of Tvs In Haemorrhage In Early

Pregnancy For Confirming The Clinical

Material And Method-The Study Is Done In The Dept Of Obst And Gynae ,Patna Medical College Hospital, Patna.100
Cases Of Haemorrhage In Early Pregnancy Were Selected In This Study Group. After Clinical Examination And Routine
Investigations Trans Vaginal Sonography Was Carried Out And Evaluation Of Tvs Findings And Clinical Diagnosis Was
Done.
Results-Clinical Diagnosis Of Threatened Abortion Was Confirmed By Tvs In 96%.In Incomplete Abortion It Was About
82%, And In Missed Abortion It Was Almost 100% .Tvs Is Of Great Help In The Diagnosis Of Ectopic Pregnancy And
Molar Pregnecy With The Accuracy Of 99% To100%
Conclusion-Tvs Is A Simple ,Non Invasive And Gold Standard Modality For Diagnosis In Cases Of Haemorrhage In Early
Pregnancy.It Is Of Great Help For Clinicians In Managing The Cases And Also Spares The Patients From Unnecessary
Interventions.

***************

Misplaced Iucd Into Posterior Fornix Case Report

Author: Dr. Sarala Kuramu
Co Author: Dr. L. Jayanthi Reddy1, Dr. G. Bhavya2,

Aim And Objective :- Reporting A Rare Case Of Misplaced Iucd Into Posterior Fornix

Material And Method :A 30 Year Old Patient P1 L1 A2 Has Been Referred From A Local Hospital For A Misplaced Cut Which Was
Inserted 10 Months Back. Post Insertion Period Was Uneventful With Regular Menstrual Cycles. She Missed Her Periods
7 Months After Insertion And Found To Be 7 Weeks Pregnant. The Case Has Been Labeled As, Failed Cut With 7 Weeks
Pregnancy And Posted For Cut Removal And Mtp. The Referring Doctor Performed Mtp Under Anesthesia And Could Not
Remove Cut As It Was Not Found In The Uterine Cavity. She Was Then Referred To Our Hospital Where, On P/S
Examination Cervix Was Found To Be Healthy And Threads Were Seen Projecting From Posterior Fornix. Tvs Confirmed
That The Cut Was Behind The Cervix. Her Routine Investigations Were Normal. X-Ray Pelvis Ap & Lateral With Uterine
Sound In Uterine Cavity Confirmed Cut Outside The Uterus. On Proctoscopy Cut Not Seen In The Rectum.
Results :She Was Planned For Cut Removal Under Ga In Double Setup For Hysterolaparoscopy & Colpotomy. On
Hysteroscopy Cut Was Not Visualized In Cavity. Threads Were Seen Protruding Into Posterior Fornix. After A Tiny
Colpotomy The Threads Were Pulled Gently And The Cut (Multiload) Was Removed. Post Operative Period Uneventful
And Patient Was Discharged The Same Day.
Discussion :Misplacements Of Cut Is A Rare But Could Be A Serious Complication. This Case Has Been Presented In
View Of Its Rarity With The Threads Of Iucd Protruding Into Posterior Fornix After Complete Perforation. There Is A
Possibility Of Insertion Into Posterior Fornix. The Threads Would Have Been Coiled In The Fornix And Missed During The
Mtp.

***************

Retrospective Review Of Ectopic Pregnancy Over 2 Yr Period: Comparison Of Medical Versus Surgical Management
Author: Dr. Amber Aggrwal
Co Author: Dr. Amber Aggrwal1, Dr. Swapanjeet Kaur2, Dr. Nirlep Kaur3,

Aim And Objective

To Compare Medical And Surgical Management Of Ectopic Pregnancy For Reduction Of Maternal Mortality And
Morbidity.

Material And Methods

A Retrospective Study Of Admitted Patients Was Conducted In Gmsh 16 Chandigarh In Department Of Obg To Assess 100
Cases Over 2 Yr Period (September 2012-2014).
Patients Included Are: All Women Diagnosed With Ectopic Pregnancy Ruptured And Unruptured.
A Complete History Was Taken Comprising Age, Chief Complaints, History Of Present Illness, Antenatal History, Menstrual
History, Obstetrical History, Whether She Conceived Spontaneously Or With Infertility Treatment, If Contraception Was
Used And Its Type, Past History Including Previous Ectopic Pregnancy, Tubal Surgery, Sterilization Operation Or Any Other
Surgery, Pelvic Inflammatory Disease And History Of Chronic Illness. Detailed General Physical Examination Of Patient,
Her Status At Time Of Admission In Form Of Bp, Pulse Rate, Complete Systemic Examination And Per Vaginal Findings.
Investigations

Complete Haemogram

Bt/Ct

Coagulogram

Urine C/E

Rft

Lft

Upt

-Hcg

Ultrasonography

Methods Of Treatment Employed:

Medical- Single Dose Methotrexate 50Mg/M2 Given I/M In

1.

Hemodynamically Stable

2.

Ectopic Mass Diameter <3.5 Cm With No Cardiac Activity

3.

Hcg <1500 Miu/Ml

4.

No Intra-Abdominal Haemorrhage

Surgical

Results
In The Study 72% Patients Were Of 21-30 Yrs Of Age, 75% Were >2 Parity. Abdominal Pain And Amenorrhoea Was Present
In 98% And 85%. Bleeding Per Vaginum In 30%. Fainting In 35%. Commonest Site Of Ectopic Pregnancy Was Tubal (98%).
Medical Management Was Done In 23%, Surgical In 60% And Rest Expectant Of Which Some Included Pregnancy Of
Unknown Origin.

Conclusion
Ectopic Pregnancy Is The Most Lethal And Morbid Gynaecological Emergency. There Is Increase In Incidence Of Ectopic
Pregnancy And The Advanced Diagnostic Techniques Help In Early Diagnosis Which Makes Medical Management Possible
And Better Than Surgical Techniques.

***************

Impact Of Social And Demographic Factors On Teenage Pregnancy

Author: Dr. Balaji T.E
Co Author: Dr.Baby Vasumathi1,

Aim And Objective

To Evaluate The Impact Of Social And Demographic Factors On The Outcome Of Teenage Pregnancy
Methods
A Retrospective Study Was Conducted To Compare Different Social And Demographic Factors,Literacy Level And Maternal
And Perinatal Outcome Of Teenage Primigravida Mothers With Those Of Adult Primigravida Mothers.The Data Was
Collected From Medical Case Records Over The Period Of Three Years At The Institute Of Social Obstetrics And Kasturba
Gandhi Hospital,Chennai.The Case Group Included About 100 Teenage Primigravida Aged 15-19 Years And The Control
Group Included About 100 Adult Primigravida Aged 20-25.
Results

The Urban Population Included In The Study Were 98% And The Slum Population Around 2%.All The Women Selected
Were Housewives.Based On Their Literacy Levels,Illiterate Were Nil,Upto Fifth Std Were8%,Upto Middle School Were
62%,Upto Higher Secondary Were26%,Upto College Were 4%. The Complications Among The Teenage Mothers Such As
Anemia,Preterm Delivery,Hydramnios,Malposition,Pre-Eclampsia,Eclampsia,Pprom Were Higher Than Adult
Primigravida .About 70% Had Normal Vaginal Delivery ,28% Had Caesarean Section And 2% Had Vaccum Delivery.About
24% Of The Deliveries Were Preterm In The Teenage Primigravida When Compared To About 14% Among Adult
Primigravida .About 38% Of The Babies Of Teenage Group Were Havin Low Birth Weight And 29% In The Adult
Primigravida Group.Among The Teenage Group Still Births Was 2% And In Adult Primigravida About 0.4%.
Conclusion
Our Study Concludes That There Is Increased Incidence Of Maternal Morbidtidy ,Preterm Deliveries,Still Birth And Low
Birth Weight Babies Among Teenage Primigravida Group When Compared To Adult Primigravida.The Teenage Pregnancy
Can Be Prevented By Improving The Literacy And Socioeconomic Status Thereby Preventing The Associated Maternal
Morbidity ,Preterm Deliveries,Neonatal Morbidity And Mortality.

***************

Awareness Of Pap Test Among Women Attending A Tertiary Care Hospital

Author: Dr. Jyothi G.S
Co Author: Megha Prakash1, Dr. N S Murthy2,

Aim And Objective: The Aim And Objective Of This Study Were To Evaluate The Knowledge Of Pap Test Among Women
Attending A Tertiary Care Hospital And Also To Study The Association Between Symptomatology And Reasons For Availing
The Pap Test.
Materials And Methods
Design: Cross Sectional Study
Data Sources: 251 Women Attending The Obstetrics And Gynaecology Opd At A Tertiary Care Hospital In Bangalore, India
Were Interviewed On Their Awareness Of The Pap Test And Cervical Cancer.
Eligibility Criteria:
A. Subjects Aged Between 20 And 65 Years.
B. Sexually Active Women.
Results: This Study Was Conducted Over A Period Of 2 Months In A Tertiary Hospital In Bangalore Metropolis, India. The
Findings Revealed That 80.1% Of The Subjects Were Not Even Aware Of The Term cervical Cancer And A Mere
11.6% Were Aware Of The pap Smear Test. It Was Noted That Only 36.6% Of The Subjects Had Experienced One
Of The Chief Symptoms Of Cervical Cancer, While Only 2% Approached The Doctor To Avail The Test. The Remaining
Underwent The Test On Recommendation By The Physician.
Conclusion: The Findings Of This Study Will Help To Increase The Awareness About Pap Test And Cancer Cervix. Thereby
It Will Help In Paving The Path For Prevention And Control Of Cancer Cervix.

***************

Incidence Of Syphilis In Pregnant Women.

Author: Dr. Juveria Jahangir
Co Author: Dr. Juveria Jahangir1, Dr. K.Saraswathi2,

Aim And Objective:

Syphilis Is Still A Major Public Health Problem In Many Parts Of The World. Throughout The World , Annually 340 Million
Cases Of Std Occur Every Year. Syphilis Accounts For About 12 Million Cases Throughout The World , The Incidence In
Pregnant Women Being 2 Million. The Aim Of My Study Is To Determine The Incidence Of Syphilis In Pregnancy. Syphilis
Has Disastrous Affects On The Outcome Of Pregnancy, Being Responsible For Late Abortion, Still Birth, Neonatal Infections
And Fetal Loss With Increased Risk Of Hiv Infection.
Material And Methods:
This Study Was Carried Out In Shadan Institute Of Medical Sciences And Post Graduate Research Centre, Hyderabad. In
Our Study , Serum Samples From Total 6786 Antenatal Women Were Tested For Syphilis For A Period Of 2 Years From
July 2012- June 2014. All Serum Samples Were Subjected To Rapid Plasma Regain Testing, Which Was Done Using
Standard Methods And Quantitative Methods Were Performed On Positive Samples. A Positive Rapid Plasma Reagin
Indicates That The Sample Is Positive For Syphilis.
Result:
Out Of 6786 Samples Tested 7 Were Tested Positive For Syphilis, Showing A Seroprevelance Of 0.10%. The Positive Cases
Were Young Pregnant Women In The Age Group Of 18- 24 Years
Conclusion:
The Prevalence Of Syphilis Throughout The World Ranges From A High Of 12.1% To As Low As 0.02%. In My Study The
Incidence Is As Low As 0.10%.There Has Been A Decline In The Incidence Of Syphilis In The Last Few Decades. This Is
Mainly Because Of Wide Spread Of Antibiotics, Safe Sex Practices And Effective Health Education Regarding Hiv And
StdS.

***************

A Retrospective Study Of The Prevalance Of Hiv In Pregnant Women At A Teaching Hospital In South India
Author: Dr. Nazia Afreen
Co Author: Dr. Nazia Afreen1, Dr. K.Saraswathi2,

Aim And Objective:

The Aim Of This Study Was To Determine The Seroprevalance Of Hiv (Human Immunodeficiency Virus) In Pregnant
Women At A Tertiary Care Hospital In South India. Hiv Is Increasingly Prevalent In Many Parts Of The Country And Its
Screening In Antenatal Women Is Important Because It Can Be Transmitted From An Infected Mother To Her Child During
Pregnancy, Labour And Breast Feeding.

Material And Methods:

This Was A Hospital Based Study Which Included 5790 Women Attending The Antenatal Clinic From Aug 2007 To Dec
2013 At Shadan Institute Of Medical Sciences Teaching Hospital And Research Centre, Hyderabad.

At The Antenatal Clinic, A Pre-Test Counselling Is Done Followed By An Informed Consent And A Blood Sample Is Collected
To Test For Hiv Antibodies As Per Naco Guidelines. Based On The Test Results, Confidential Post Test Counselling Is Done.
If The Result Is Positive, The Counsellor Conveys Result To The Individual In Gentle Approach To Deal With The Feelings.

The Infected Women Is Explained About The Risks To The Partner, Partner Notification, Importance Of Regular Antenatal
Care, Care During Delivery And Discuss The Infant Feeding Protection. The Hiv Positive Women Get Their Cd4 Count Done
And Examined For Any Other Infections. Proper Antenatal Care Is Given And Hospital Delivery Is Advised For Them.

Result:
5790 Pregnant Women Were Included In The Study Which Lasted For Duration Of 77 Months From Aug 2007 To Dec
2013. 12 Women Were Detected Positive For Hiv Accounting For 0.27%. One Woman Had Pulmonary Tb.

Conclusion:
Mother To Child Transmission Of Hiv Infection During Pregnancy, Delivery Or Breast Feeding Is Responsible For More
Than 90% Of The Hiv Infections In Babies. Antenatal Screening, Proper Intervention Of Preventive Strategies During
Pregnancy, Delivery Or Breast Feeding Will Bring Down Mother To Child Transmission Of Hiv.
***************

Prediction Of P.I.H By Maternal Serum Beta Hcg Level In The Sencond Trimester 13 20 Weeks Of Pregnancy
Author: Dr. Jyotirmoyee Pradhan
Co Author: Asst Prof Dr Ojaswini Patel1, Asst Prof Dr Sharmila Pradhan2, Prof Dr S K Behera3,

Aim And Objectives : The Abnormal Placentation Has Been Considered As One Of The Initial Event In The Disease Process.
During Mid Trimester, Immunological Changes Occurs In The Trophoblast Resulting In Rise Of Secretory Levels Of Serum
Beta Hcg In Early Pregnancy. Our Study Aimed To Assess That Women With High Serum Beta Hcg Are At Higher Risk Of
Developing Pih.
Material And Method: This Was A Prospective Study In Which120 Indian Women With A Singleton Pregnancy,
Normotensive, Nonprotienuric Were Randomly Selected Between The Gestational Age Of 13 20 Weeks Attending
The Anc Clinic Irrespective Of Parity.
Result: The Serum Beta Hcg Estimation Was Done By Chemiluminescent Immunometric Estimation Assay (Clia) Method.
The Multiple Of Median Was Calculated From The Median Of The Diagnostic Test Employed. The Raised Beta Hcg Level >
30,000 M.I.U./Ml In The Mid Trimester Was Associated With Pih.
Conclusion: The Study Showed That Measuring Second Trimester Beta Hcg Level Is Useful In Clinical Practice To Identify
Women Who Will Develop Pih In The Same Pregnancy. Also Higher Levels Of Beta Hcg Are Associated With Increased
Severity Of Pih. Therefore, If Prediction Becomes Possible, Prevention Will Follow Naturally.

***************

comparative Study Between JohnsonS Formula And HadlockS Formula For Estimating Fetal Weight At
Term Gestation
Author: Dr. Neena M
Co Author: Dr. Dwarakanath L1,

Aim And Objectives Of The Study :

To Assess The Comparative Effectiveness Of Estimated Fetal Weight (Efw) By Using JohnsonS Formula And
HadlockS Formula With The Actual Birth Weight At Term Gestation.
Methodology:
18 Months Duration Study Was Done At Sri Siddhartha Medical College And Hospital.200 Cases Were Taken. Patient
Who Were Admitted For Delivery Were Clinically Examined And Fetal Weight Was Estimated By Johnsons Formula And
By Ultrasound Using Hadlocks Formula And Were Compared With The Actual Fetal Birth Weight.
Result :
***************

Intracervical Dinoprostone Versus Sublingual Misoprostol In Labour Induction

Author: Dr. Dilshath Meera
Co Author: Dr Jaya Vijayaraghavan1, Dr Bhuvana2, Dr Sheela3,

Aim And Objectives

The Study Was Undertaken To Compare The Efficacy Of Intracervical Dinoprostone With Sublingual
Misoprostol In Induction Of Labour.

Materials And Methods

This Randomized Observation Study Was Performed On 410 Women With Medical Or Obstetric Indications
For Labor Induction. The Patients Were Divided Into Two Groups On An Alternative Basis. In First Group, 0.5 Milligram Of
Dinoprostone Was Placed Intracervically Every 6-12 Hours For A Maximum Of Three Doses And The Second Group
Received 25 g Misoprostol Sublingually, Every 4 Hours For A Maximum Of Five Doses. Maternal And Neonatal
Outcomes Were Analyzed. I.E., Mean Number Of Doses Required, Time Intervals From Induction To Rupture Of
Membranes, Induction To Delivery Interval, Need For Oxytocin, Mode Of Delivery, Maternal And Foetal Side Effects .
Statistical Significance Was Considered As 0.05 Level(P Value).

Results
There Was No Significant Difference In The Demographic Characteristics Between Two Groups. There Were
No Significant Difference In The Mean Number Of Doses Needed With Regard To BishopS Score When Misoprostol
Was Used, But Significant When Dinoprostone Was Used . There Were No Significant Difference Detween The Two
Groups In Induction To Active Phase Interval, Induction To Delivery Interval, Mode Of Delivery,Abnormal
Cardiotocogram,Incidence Of Contractility Disturbances, Meconium Stained Liquors,Side Effects Or Neonatal Outcomes.
There Was Significantly Higher Cases With Failed Induction With Dinoprostone Than Misiprostol Group (33.3% Vs 18.5%,
P = 0.016). There Was Less Need For Oxytocin.Augmentation (63.9% Vs 48.3%, P = 0.001) When Misoprostol Was Used

Conclusion
Sublingual Misoprostolstol Is As Efficacious As Intracervical Dinoprostone For Labour Induction .

***************

Hba1C & Fpg + Hba1C In Gdm Screening At 24-28 Weeks Pog And Correlation Of Hba1C With Adverse Pregnancy
Outcomes
Author: Dr. Soumya Siramshetty
Co Author: Dr. Minakshi Rohilla1, Dr. Pinaki Dutta2,

Aim And Objectives:

- To Calculate Sensitivity, Specificity, Positive And Negative Predictive Value Of Hba1C And Combination Of Fasting
Plasma Glucose (Fpg) & Hba1C In Diagnosing Gdm
- To Correlate Hba1C With Adverse Pregnancy Outcomes
Methods And Methodology:
500 Antenatal Women Attending Our Antenatal Opd Between January To December 2013 Screened For Gdm With
Hba1C, Fpg And Ogtt With 75Gm Glucose At 24-28 Weeks Pog.
Hba1C And Fpg Calculated From Fasting Sample Of Ogtt.
Iadpsg Criteria For Ogtt With 75Gm Glucose Used To Define Gdm.
Delivery Details Of All 500 Women Recorded.
Correlation Of Hba1C With Adverse Pregnancy Outcomes Derived Using Binary Logistic Regression.
Results:
Incidence Of Gdm Was 9%.
Mean Hba1C At 24-28 Wks Was 6.240.59% In Gdm Vs 5.40.48% In Normoglycemics.
Auc Of Hba1C For Diagnosing Gdm Was 0.826.
Hba1C Cutoff Of 5.35% Had Sensitivity 95.6%, Specificity 51%, Npv 99%, Ppv 16%. Using Hba1C Value 5.35% As Screening
Test Would Avoid Ogtt In Nearly Half Women While Missing ~5% Cases Of Gdm.
A Combination Of Hba1C 5.75% With Fpg 92Mg/Dl Had Sensitivity 73.3%, Specificity 75.6%, Npv 94.6%, Ppv
47.6% And Would Have Detected All Cases Of Gdm While Misclassifying ~25% Normoglycemics As Gdm. This Strategy
Would Have Avoided Ogtt In 74.3% Of Women.
Hba1C At 24-28 Weeks Also Correlated With Adverse Pregnancy Outcomes Like Macrosomia, Polyhydramnios, Shoulder
Dystocia, Neonatal Hypoglycemia (Odds Ratio - 2.9, 2.6, 25.1, 2.47 Respectively; P<0.005)
Conclusion:
Hba1C Can Be A Good Alternative For Screening Women Who Cannot Tolerate Ogtt Or In Resource Limited Setting, As
Its Use Can Avoid Ogtt In Nearly Half Of The Subjects. The Diagnostic Strength Of Hba1C Is Improved By Adding Fpg Since
The Combination Has Better Sensitivity & Specificity And Both Can Be Determined From A Single Blood Draw. Hba1C Also
Correlates With Occurrence Of Certain Adverse Pregnancy Outcomes.

***************

Vitamin D Deficiency In Postmenopausal Women With Pelvic Floor Disorders

Author: Dr. Preethi R N
Co Author: Aruna Kekre.M.D1, Lilly Varghese M.D2, K S Jacob M.D3,

Aim And Objectives: The Aim Of This Study Is To Evaluate The Association Of Vitamin D Deficiency And Pelvic Floor
Disorders (Pfd) Including Pelvic Organ Prolapse And Stress Urinary Incontinence In Postmenopausal Women.
Materials And Methods: This Is A Prospective Case Control Study On One Hundred And Twenty Women With Or Without
Symptoms Of Pfd. Relevant History And Clinical Examination Were Conducted. Serum 25-Hydroxy Vitamin D Levels Were
Measured In All Women. Chi Square And Student T Test Were Used To Test Significance Of Association. Logistic
Regression Was Used To Adjust For Age. Odds Ratios And 95% Confidence Intervals Were Calculated.
Results: Of The 120 Postmenopausal Women Included, 51 Had Pfd On Clinical Examination. Of The 51 Cases, 28 Women
Had Pelvic Organ Prolapse (Pop) And 14 Women Had Stress Incontinence (Sui) While 9 Women Had Both Pop And Sui.
The Study Showed That Vitamin D Levels Were Significantly Lower In Women With Pfd Than Those Without Pfd.
Menopausal Status Of More Than 5 Years Was Also Significantly Associated With Pfd. 77.5% Of The Postmenopausal
Women Were Vitamin D Deficient.
Conclusion: Findings Suggest Association Of Vitamin D Deficiency And Pelvic Floor Disorders In Postmenopausal Women.
In Addition, Postmenopausal Women Have A High Prevalence Of Vitamin D Deficiency Indicating A Need To Evaluate
Vitamin D Levels In These Women.
***************

comparison Of Reproductive Health Awareness In Adolescent School Girls Of Rural And Urban Background
Author: Dr. Gunvanti Meena
Co Author: Dr Amrit Pal Kaur1, Dr Harbhajan Kaur Shergill2,

Aim And Objectives: To Assess And To Compare The Reproductive Health Awareness Of Rural And Urban Adolescent
School Girls.
Materials And Methods: The Present Study, A Cross Sectional Study, Done In The Department Of Obstetrics And
Gynaecology, G.M.C. Amritsar. Total 1400 Subjects (700 Girls From Rural Schools And 700 From Urban Schools) Consisting
Of Girls Studying In 6Th To 12Th Classes Were Included In Study. A Questionnaire Containing 38 Questions; Regarding
Physical Changes And Secondary Sexual Developments, Menstruation And Personal Hygiene, Std, Aids, Contraceptives;
Was Prepared Which Was Pretested And Pre-Designed And Was Used To Assess The Awareness Of Adolescent Girls About
Reproductive Health. A Written Consent Was Taken From The Principal Of The Concerned Schools.
Results: Only Few Girls 5.3% Urban And 3.3% Rural Girls Were Aware Of Age Of Adolescence. Knowledge Regarding Term
Puberty And Age Of Its Onset Of Puberty Was More In Urban Girls.
Changes Of Adolescence Were Known More By Urban Girls. Menstruation Is Considered Normal Phenomenon By 61.9%
Urban And 57.1% Rural Girls. Fatigue Was Most Common Symptom.
Knowledge About Legal Age Of Marriage Was More In Rural Girls. Knowledge About Impacts Of Early Marriage Was
Almost Equal In Both Groups. The Knowledge Regarding How Pregnancy Occurs And Contraceptives Was More In Urban
Girls. Equal Number Of Urban And Rural Girls Heard About Hiv And Availability Of Treatment For It. Knowledge About
Mode And Prevention Of Transmission Of Hiv Was More In Rural Girls. Awareness About Symptoms Of Sexual Diseases
Was More In Urban Girls.
Conclusion: The Awareness Amongst Adolescent Girls Regarding Various Aspects Of Reproductive Health Is Poor In Both
Urban As Well As Rural Girls. The Basic Information About Reproductive Health, Contraception And Hiv/ Stds Should Be
Provided To The Adolescent Girls To Improve Their Health.

***************

A Prospective Study Of Effect Of Preoperative Rectal Misoprostol On Intraoperative Blood Loss And On Apgar Score
In Cesarean Section
Author: Dr. Akanksha Agrawal
Co Author: Akanksha Agrawal1, Rajrani Sharma2,

Aim And Objectives: To Evaluate The Effect Of Preoperative Rectal Administration Of 600 Microgram Misoprostol On
Intraoperative Blood Loss And Its Effect On Apgar Score At 1 Min And 5 Min In Cesarean Section
Materials And Methods: A Randomized Controlled Trial Was Conducted Among 200 Women Scheduled For Cesarean
Delivery Who Did Not Have Any Risk Factor For Postpartum Hemorrhage. The Study Group (N= 100) Received 600
Microgram Of Misoprostol. The Control Group(N=100) Received Placebo. Misoprostol Was Administered Rectally Just
After Spinal Anaesthesia. Primary Outcome Measures Were Estimated Amount Of Intraoperative Blood Loss And
Difference Between Apgar Scores In Both Groups At 1 Min And 5 Min.
Results: The Mean Intra Operative Blood Loss Was Significantly Lower In The Study Group Than The Control Group (440
252 Ml Versus 635360 Ml: P=0.03. Admission To The Neonatal Intensive Care Unit And Apgar Scores At 1 And 5 Min
Were Comparable Between 2 Groups. {7.41.4 And 7.9 1.4 At 1 Min (P=0.28) And 9.00.7 And 8.80.6 At 5 Min
(P=0.24)}. The Incidence Of Shivering Was Higher In Study Group.
Conclusion: Preoperative Treatment With Rectal Administration Of 600 Microgram Misoprostol Significantly Reduces
Blood Loss Related To Cesarean Delivery. However, Occurrence Of Transient Side Effect Such As Shivering Was Noted
More Frequently With The Use Of Misoprostol.

***************

Analysis Of Gestational Trophoblastic Diseases

Author: Dr. Bhavani Chinimilli
Co Author: Dr.K.Prabha Devi1, Dr.C.Vasantha Kumar2,

Aim And Objectives: To Study The Clinical Presentation And Management Of Gestational Trophoblastic Diseases (Gtd) At
A Teaching Hospital. Study Objectives Include Analysis Of Risk Factors, Incidence, Types, Presentation, Management And
Follow Up.

Material And Methods: The Present Study Is A Retrospective Study Of All Patients Diagnosed With Gtd At Nri Medical
College And General Hospital, Chinakakani, Andhra Pradesh 2011- 2013.

Results: 30 Patients Were Diagnosed With Gtd. Out Of Total Cases, 16 Complete Moles, 2 Partial Methotrexate+Folinic
Acid Moles,7 Invasive Moles, 3 Choriocarcinomas, 3 Persistent Gtn, 1 Epitheloid Trophoblastic Tumor. 57% Were Referral
Cases And Diagnosed Also Late. 16 Patients Were Below 20 Years; 14 Patients Were Between 20 To 25 Years. 18 Cases
Were Diagnosed Less Than 12 Weeks Gestation And 12 Cases More Than 12 Weeks Gestation. Most Had -Hcg
Between1,000-1,00,000 Miu/Ml. There Was A Good Correlation Between Ultrasonogram And Histopathology Findings In
Benign Gtd But Not In Gtn. Gtn Was Preceded By Mole In 8, Abortion In 4 And Term Gestation In 2 Patients. 8 Were High
Risk, 3 Were Low Risk Gtns. 1 Patient Had An Interval Of > 12 Months. One Patient With Invasive Mole Had Emergency
Hysterectomy. Single Drug Chemotherapy (Methotrexate+Folinic Acid) In 5 Patients, Ema-Co Was Given In 2 And 1
Received Mtx+FaEma-CoEma-Ep. 4 Patients Refused Chemotherapy And Lost To Follow Up. 50 Percent Of Patients
Had Good Follow Up As Per Advice And 50 Percent Failed To Come For Follow Up Even With Good Counseling.

Conclusions: Incidence Of Molar Pregnancy Was 1 In 500 In Our Study. Gtn Developed In 14% Of Molar Pregnancies. We
Conclude That Gtd Is An Eminently Curable Disease Provided Diagnosed Early During Follow Up And Given Proper
Treatment. A Good Counseling Regarding Follow Up By Medical Personnel As Well The Compliance Of Patient Are
Essential.

***************

Incidence Of Urinary Tract Infections In Antenatal Women In A Tertiary Care Hospital

Author: Dr. Manasa Reddy
Co Author: Dr.Madadi Manasa1, Dr.K.Saraswathi2,

Aim And Objectives: Urinary Tract Infection Has An Estimated Global Incidence Of 250 Million. It Is More Common In
Females As Factors Like Short Urethra, Pregnancy And Easy Fecal Contamination Of The Urinary Tract. In Pregnancy,
Additional Factors Like Decreased Bladder Tone And Decreased Urethral Tone Cause Urinary Stasis. The Aim Of My Study
Is To Find Out The Incidence Of Urinary Tract Infections In Pregnant Women, Because, If Untreated, It Can Cause
Complications Like Acute Pyelonephritis, Anemia, Sepsis, Renal Failure And Shock. It Can Cause Fetal Complications Like
Intra-Uterine Growth Retardation, Acute Respiratory Distress Syndrome And Prematurity.
Material And Methods: Pregnant Women Attending The Antenatal Clinic At Shadan Institute Of Medical Sciences And
Teaching Hospital, Who Had Symptoms And Signs Of Urinary Tract Infections Were Included In This Study. Study Period
Was From July 2013-Aug 2014(14 Months).After Informed Consent, Mid-Stream Urine Specimens From 430 Patients
Were Sent For Culture And Antibiotic Sensitivity.
Results: Out Of The 430 Urine Samples Tested, Significant Bacteriuria Was Noted In 32 Specimens. Of These, Escherichia
Coli Was The Most Common Organism Isolated.

Uropathogenesis

No. Of Isolates

Escherichia Coli

21

65.62

Klebsiella

15.62

Staphylococcus Aureus

9.37

Proteus Species

6.25

Streptococcus

3.1

The Antibiotic Sensitivity Pattern Showed That They Were Sensitive To

Amikacin
Cefotaxime
Norfloxacin
Amoxiclav
Nitrofurantoin In That Order.

They Were Resistant To

Ciprofloxacin
Ampicillin
Co-Trimoxazole
Gentamycin In That Order.

Conclusion: In My Study, Escherichia Coli Was Found To Be The Commonest Uropathogen In Pregnant Women And
Amikacin Was Found To Be The Drug Of Choice In These Cases. Urinary Tract Infection Has To Be Treated Energetically So
That Complications To The Mother And The Neonate Can Be Prevented.

***************

Study Of Thyroid Dysfunction In Patients With Dysfunctional Uterine Bleeding

Author: Dr. Vijaylaxmi Gobbur
Co Author: Dr Ashwini Patil1,

Aim And Objectives:

Dub Accounts For 10% Of All Gynaecology Related Complaints.The Purpose Of This Study Is To Evaluate And Detect
Thyroid Dysfunction In Patients With Dub In Reproductive Age Group .
It Is Important As It Is Completely Treatable Medically And Sugery Can Be Avoided. This Study Will Also Help Us To
Know The Prevalence Of Thyroid Dysfunction In Dub Patients In Our Area.
Materials And Methods:
This Study Is Carried Out In The Department Of Obstetrics And Gynecology, Sri B M Patil Medical College On 140 Women
Who Were Clinically Given The Provisional Diagnosis Of Dub. All These Patients Were Subjected To Routine Investigations
And T3, T4 , Tsh & Tpoab Estimation And Were Grouped As Euthyroid, Subclinical Hypothyroid, Hypothyroid Or
Hyperthyroid.

Results:
Out Of The 140 Patients Taken Into Study 17 Had Thyroid Disorders, Out Of Which Subclinical Hypothyroidism Was Most
Prevalent Accounting For 10 Cases, 5 Cases Were Found To Have Hypothyroidism And 2 Case Of Hyperthyroidism.

Conclusion

There Is A High Prevalence Of Thyroid Disorders In Cases Which Are Clinically Diagnosed As Dub. Hence The Biochemical
Evaluation Of T3, T4, Tsh, Tpoab Is Extremely Important And Valuable In Detecting These Patients. Unnecessary Surgery
Was Avoided In 12% Of Patients And They Were Treated Medically Which Was More Accurate And Cost Effective. Hence
Thyroid Function Evaluation Should Be Made Mandatory In Cases Of Dub To Detect Thyroid Dysfunction.

***************

A Study On Obstetric And Ultrasonographic Parameters In Patients With Early Miscarriage

Author: Dr. Parvathy Ganesan
Co Author: Dr Ramesh P1, Dr Aswathy2, Dr Kr Sundaram3, Dr Sudha S4,

Aim And Objectives:

To Assess Obstetric And Ultrasonographic Factors Including Yolk Sac Diameter And Morphology In Early Miscarriage.
Materials And Methods:
This Was An Observational Study Carried Out In The Department Of Obstetrics And Gynecology, Amrita Institute Of
Medical Sciences, Kochi From September 2013 To August 2014. A Total Of 50 Subjects Who Had Miscarriage Were
Analyzed For Factors Associated With It Including Age, Parity, Duration Of Married Life, Co-Existing Medical Disease,
Gestational Age( Assessed By Last Menstrual Period, Mean Gestational Sac Diameter And Crown-Rump Length),
Gestational Sac Morphology, Yolk Sac Diameter And Morphology, And Mode Of Termination.
Results:
The Mean Age Of The Group Was 27.48+/- 4.2 Years And Mean Duration Of Married Life Was 4.3+/- 3.4 Years. Fetal Pole
Was Absent In 44% Of The Subjects. Gestational Sac And Yolk Sac Morphology Was Abnormal In 36% And 32%
Respectively. Echogenic Yolk Sac Was Seen In 4%. Yolk Sac Diameter Was <2Mm In 12%, 2-6 Mm In 48% And >6Mm In
40%. Mean Gestational Age Assessed By Last Menstrual Period And Mean Gestational Sac Diameter Was 60 +/-11 Days
And 45+/-7 Days Respectively. Associated Medical Diseases Were Identified In 38% And Nearly 62% Of The Group Was
Multiparous.
Conclusion:
Abnormalities In Diameter And Morphology Of Yolk Sac And Gestational Sac Are Seen More Associated With Miscarriages.
Multiparity Is Also More Associated With It. It May Be Stressed That Routine Assessment And Documentation Of Yolk Sac
And Gestational Sac Diameter And Morphology In All Early Pregnancy Scans Might Help To Predict Chances Of
Miscarriage.

***************

Incidence Of Meconium Stained Liquor And Fetal Outcome In Labour Induced With Misoprostol
Author: Dr. Namburi Sivani
Co Author: Dr. V Sita Rama Raju1,

Aim And Objectives:

To Evaluate The Incidence Of Meconium Stained Liquor And Fetal Outcome In Labour Induced With Misoprostol Vaginally.

Materials And Methods:

This Study Consists Of 150 Women With Gestational Age 37 To 42 Weeks Divided Into 3 Groups
1St Group:Women For Induction With Uncomplicated Pregnancy.
2Nd Group:Women For Induction With Complicated Pregnancy.
3Rd Group:Women Who Delivered Spontaneously Without Any Induction.

Women Were Subjected To Basic Pelvis Examination And Was Assigned A Bishop'S Score Based On Cervical Status. Each
Women Had Received 25Mcg (Every 3Rd Hrly) Of Misoprostol .
Every 3Rd Hrly Pelvic Examination Done To Note The Progress Of Labour
At About 4Cm Of Diltation , Membranes Ruptured To Note The Colour
Of Liquor
After The Baby Is Delivered , Apgar Score Was Recorded .Baby With Meconium Stained Liquor And Any Other
Complication Were Shifted To Nicu For Observation.

Results:
Incidence Of Meconium Stained Is Higher In Cases Induced With Misoprostol Compared To Control.

Conclusion:
Higher Incidence Of Meconium Associated With Misoprostol Is Not Only Due To Hypoxia But Can Also Occur Due To
Action Of Drug On The Gastrointestinal Tract Of Fetes . Hence Fetal Outcome Is Good With Misoprostol .

***************

Clinical Study Of Medical And Obstetric Complications Of Dengue Fever During Pregnancy
Author: Dr. Sama Padma
Co Author: Dr.S Padma1, Dr.Kavitha,Professor Of Obg Department In Mamata General Hospital 2, Dr.G C Prabhakar Hod
Of Obg Department In Mamatha General Hospital3,

Aim And Objectives:To Study The Medical And Obstetric Complications Of Dengue Fever During Pregnancy
Material And Methods:Clinical ,Laboratory ,Maternal ,Fetal Outcome Collected From Patients With Confirmed Dengue
Infections During Pregnancy Treated In Mamata General Hospital.
Results:6 Seropositive Dengue Infected Pregnant Women Were Diagnosed In The Period Of 18 Months. Multi Organ
Failure Leading To Intrauterine Fetal Death And Maternal Death Occurred In One Case Of Dengue Hemorrhagic Fever,
Another Case Had Antepartum Haemorrhage With Preterm Delivery .Two Cases Were Managed With Random Donor
Platelet Transfusion .Other Cases Maternal And Perinatal Outcome Were Satisfactory.
Conclusion : Dengue Infection In Pregnancy Requires Early Diagnosis And Treatment.Close Monitoring And Aggressive
Management Is Necessary In Dengue Fever With Pregnancy As An When Required.

***************

Continuation Rate Of Postpartum Iucd Insertion: Randomised Trial Of Post Placental Versus Immediate Postpartum
Insertion
Author: Dr. Manas Dandapat
Co Author:

Aim- To Study The Continuation Rate Of Postpartum Iucd Insertion-Post Placental Versus Immediate Post Partum
Insertion.

Materials And Methods The Prospective Study Was Conducted In Sub- Divisional Hospital Rairangpur, Mayurbhanj,
Odisha From August 2013 To July2014. The Antenatal Cases Were Counselled For Ppiucd During Antenatal Check Up,
Early Labour And Immediate Postpartum Period. 200 Cases Were Selected And Cut-380A Was Inserted In The Uterine
Cavity Within 48 Hours Of Delivery By Kelly Forceps After Taking Infection Prevention Protocol. The Follow Up Cases Were
Done In 6 Week And Then 3Month. They Were Instructed To Come Back If They Had Any Problems. All Complications
Were Noted And Managed Properly.

Result-200 Cases Were Included In The Study. The Counselling Was Done During Antenatal Period-48 %,Early Labour22%,Immediate Post Partum-30%,Primi Para-48%,Multi Para-52%.The Cut380-A Inserted During Post Placental(Within
10 Min)50%,Immediate Postpartum(Within 48 Hr-)-50%,. Expulsion Rate-3%In Post Placental,5% In Immediate Post
Partum, Removal On Request -2% Cases, String Shorted In-48% Cases, Missing String-6% Cases, Complications-4% Cases.

Conclusion- Provision Of Ppiucd Services Required Careful Coordination And Collaboration Of Antenatal, Intrapartum &
Postpartum Care Services. Expulsion Rate Is Less In Post Placental Insertion. Cut-380A Is Best Contraceptive In India For
Population Stabilization. All Fogsians Should Think About Ppiucd While Conducting Deliveries.

***************

Management Of Twin Pregnancies- Changing Trends At Tertiary Care Centre

Author: Dr. Nevatha C
Co Author: Dr. Chitra K S1, Dr. Gayathri S S2,

Aim
To Evaluate The Associated Comorbid Conditions And Changing Trends In The Management Of Twin Pregnancies
And To Assess The Maternal And Fetal Outcome.

Material And Method

121 Cases Of Twin Pregnancy Admitted During August 2013- July 2014 In Government Rajaji Hospital Was
Assessed And Evaluated.

Results
Total Deliveries-13,059.
Incidence Of Twins- 0.93%.
Associated Co Morbid Conditions Present In 89 Cases 73.55%.
Conception After Infertility Treatment 15 Cases-12.39%.
Spontaneous Conception 106 Cases 87.6%.
Both Cephalic 74 Cases - 58.68%.
Both Non Cephalic 5 4.13%.
First Twin Non Cephalic - 20 - 16.53%.
Second Twin Non Cephalic 26 18.18%.
79 65.2% Delivered Via Naturalis, Of Them
20 Had Anemia - 25.32%,
12 Had Pih

- 15.2%,

6 Developed Pph 7.6% Medically Managed.

42Cases 34.7% Delivered By Lscs, Of Them,

Anemia - 36 85%,
Pih - 21 50%,
Pph-12- 28.5% .

Analysis
Increase In Incidence Of Twins Due To Infertility Treatment.
Increase In Pregnancy Associated Complications In Twins.
Increase Incidence
Than Malpresentations.

Of

Caesarean

Section

Due

To

Associated

Comorbid

Conditions

Rather

Conclusion
There Is Increase In Antepartum, Intrapartum And Postpartum Complication In Twins Due To Higher Incidence Of
Associated Comorbid Conditions Such As Anemia, Pih, Iugr Oligohydramnios..Etc And This Has Increased The
Caesarean Section Rate.

***************

Usefulness Of Uterine Artery Doppler Velocimetry At 24- 26 Weeks In Prediction Of Preeclampsia

Author: Dr. Shruthi R
Co Author: M G Hiremath1,

Aim
Hypertensive Disorders Complicate 5 To 10% Of All Pregnancies And Together They Form One Member Of The Deadly
Triad, Along With Haemorrhage And Infection, Which Contribute Greatly To Maternal Morbidity And Mortality Rates.
Performing Uterine Artery Doppler Studies At 23- 26 Weeks Gestation Instead Of 19- 22 Weeks Gestation Increases
The Predictive Value For Adverse Pregnancy Outcomes.
Objective
To Evaluate The Performance Of Screening For Prediction Of Preeclampsia Using Midtrimester Uterine Artery Doppler
Study In High Risk And Low Risk Pregnancies.
Materials And Methods
This Is A Prospective Study Involving 183 Pregnant Women Less Than 16 Weeks Attending The Kims Antenatal Clinic. They
Were Divided Into High And Low Risk Group And Uterine Artery Velocimetry Studied At 24 To 26 Weeks Gestation. Uterine
Artery Notching And Resistivity Index Of >0.6 Or Pulsatality Index Of >1.6 Were Considered Abnormal And Patients
Followed Up To Look For The Development Of Preeclampsia.
Results
Of The Total 183 Pregnant Women 42 Were Of High Risk And 141 Were Of Low Risk. The Sensitivity And Specificity Of
Abnormal Uterine Artery Doppler In Prediction Of Preeclampsia Were 93.75% And 73.08% Respectively In High Risk Group
And 64.29% And 79.65% Respectively In Low Risk Group. The Positive Likelihood Ratio Was 3.48 In High Risk Group And
3.16 In Low Risk Group.
Conclusion
Uterine Artery Doppler Velocimetry At 24 To 26 Weeks Is An Effective Tool In Prediction Of Preeclampsia Especially In
High Risk Group.
Keywords
Uterine Artery Doppler, Preeclampsia, Screening, High Risk And Low Risk Group.

***************

Prevalence And Risk Factors For Domestic Violence Against Infertile Women
Author: Dr. Khushboo Bagdi
Co Author: Dr. Shakun Bagdi1,

Aim
Our Objective Was To Find Out Prevalence, Instigating Factors And Help Seeking Behavior Of Physical Domestic Violence
And Distress Level Among Women With Female Factor Infertility

Materials And Methods

In This Cross-Sectional Survey Conducted From October 1, 2013 To June 30, 2014, 355 Women With Primary Infertility
Attending Department Of Obstetrics & Gynecology In A Private Hospital In Raipur, Were Interviewed. After Informed
Consent, Required Information Was Collected On Predesigned Performa Including Demographic Details, Prevalence,
Instigating Factors, Help Seeking Behavior For Physical Domestic Violence And Their Distress Levels.

Results:
There Was No Significant Relationship Between The Age And Education Level Of The Women And Distress Levels. Mental
Distress Was Higher In Women Who Did Not Work And Those Being Treated For Infertility For More Than Three Years.
The Employment Status Of The Women And Physical, Emotional, And Sexual Violence Had A Statistically Significant
Relationship. About 40% (142) Of Women Reported Lifetime Physical Domestic Violence. The Most Common Type Of
Violence Was Psychological (N=109 [30.7%]), Followed By Physical (N=29 [8.2%]) And Sexual (N=4 [1.12%]), With 18
Women (5%) Reporting Injuries. It Was Severe Enough To Require Medical Care In 3.9% (14) Cases. Only 1.4% (5) Women
Sought Social And Legal Aid. Husbands And In-Laws Were Perpetrators In 69% (98) And 31% (44) Cases Respectively.

Conclusion:
Marital Violence Is A Factor Increasing The Distress Of Infertile Women. Routine Screening For Domestic Violence In
Infertility Clinics Is Necessary To Give Affected Women An Opportunity To Access Appropriate Health Care And Support
Services. Healthcare Staff Serving Infertile Couples Should Consider The Possibility Of Domestic Violence Against Women
As A Factor Affecting The Psychological Infertility Distress Level. There Is Need To Identify And Address This Menace
Effectively.

***************

Determination Of Gestational Age From Fetal Kidney Length In Second Trimester

Author: Dr. Divya Pv
Co Author: Komal Revankar1,

Aim&Objective
The Aim Of The Study Is To Evaluate The Application Of Fetal Kidney Length Measurement In Determining The Gestational
Age In Second Trimester And Compare Its Accuracy With Gestational Age Derived Using Fetal Biometric
Indices(Bpd,Hc,Ac,Fl).
Materials&Methods
Consecutive 50 Pregnant Women With Excellent Dating And Meeting The Inclusion Criteria Were Included In The Study
After Obtaining Consent. Transabdominal Ultrasonography Was Performed Between 23-25Weeks Of Gestation For Both
The Fetal Kidney Lengths, In Addition To Bpd,Hc,Ac&Fl By A Single Obstetrician.Obstetrician. Biometric Measurements
Were Obtained Using Well Defined Reference Points. Fetal Kidney Was First Scanned In The Transverse Plane Until The
Kidneys Were Visualized Just Below The Stomach. The Probe Was Then Rotated Through 90Degree To Outline The
Longitudinal Axis Of The Kidneys. Markers Were Placed On The Image Of The Renal Capsule, Excluding The Adrenal Gland
.Lower Pole Of The Kidney Was Clearly Distinguished From The Gastrointestinal Tract. All Measurements Were Obtained
During Fetal Apnea. Mean Kidney Length In Mm Was Correlated With Gestational Age In Weeks Assigned By Excellent
Dating And Compared With Gestational Age Assigned By Fetal Biometric Indices.

Result
The Mean Fetal Kidney Length In Mm Showed A Linear Correlation (R=0.6)With Gestational Age In Weeks. The Mean
Fetal Kidney Length In Mm Strongly Correlated With Gestational In Weeks As Calculated By Bpd,Hc, Ac&Fl As Well As
Gestational Age Assigned By Lmp(P<0.001). Fetal Kidney Length Is More Accurate Method (+_ 6 Days)In Determining The
Gestational Age Than The Other Fetal Biometric Indices(+_14 Days)
Conclusion
Kidney Length Is A More Accurate Method Of Determining Gestational Age Than The Fetal Biometric Indices.It Aids In
Recognizing Abnormal Renal Development. It Can Be Used As An Independent Variable To Assess Gestational Age In 2Nd
Trimester With Accuracy Of 6 Days And Also Be Incorporated With The Biometric Indices To Date Pregnancy.

***************

Deep Breathing And Humming Induced Vibration For Neuro-Endocrinal Balance In Pregnancy
Author: Dr. Vibha Kumari Singh
Co Author: Sumi Singh1, Dr. Umeshwar Prasad Singh2, Dr. Anshuman Singh3, Anurag Singh4,

Aim/Objective:
The Aim Of This Study Is To Evaluate The Combined Effectiveness Of Non-Pharmacological Procedures Of Deep Breathing
(Db) And Humming Induced Vibration (Hv) In Safe And Successful Maintenance Of Pregnancy. Db And Hv When
Performed In Conjunction With Each Other, Are Expected To Reduce Stress, Improve Hormonal Balance And Facilitate
Healthy Fetal Growth. They Will Also Reduce Pregnancy Related Sleep Disorder, Chances Of Pre-Term Pregnancy And
Hypertension.

Materials And Methods:

Forty Four Pregnant (Primi Gravida) Subjects Were Randomized Into Test (T) And Control (C) Sets Of Equal Cardinality.
Subjects In T Were Trained To Alternately Perform Db And Hv For 5-10 Minutes Twice Daily Till Term. At Every Month
Brachial Systolic/Diastolic Blood Pressure (Bdbp, Bsdp) Was Measure, Stress Evaluation Was Performed Using CohenS
Perceived Stress (Cps), And Sleep Evaluation For Pregnancy Related Sleep Disturbance Was Performed Using Modified
Epworth Sleepiness Scale (Ess). After Childbirth Apgar Score For Fetal Wellbeing Were Recorded.

Results:
Set T Demonstrated Significant (Pval <.05) Decrease In Bdbp/ Bsdp Variability Over Patients In Set C, Reduced Csp (6.57
2.5), Low Average Ess (4.85 1.9), Increased Apgar Score At 1 Minute (8.11.1), Low Preterm Delivery (2% For T, 5%
For C, Pval <.05). No Significant Difference In The Mode Of Delivery Was Observed.

Discussion/Conclusion:
(Db) Helps In Smooth Muscle Relaxation, Maintaining Bdbp/ Bsdp Within Normal Range. Smooth Muscle Relaxation
Prevents Premature Delivery And Premature Rupture Of Membrane. Hv Simulates Centric And Eccentric Muscle
Contraction That Helps Stimulate Cns And Reticular Formation. By Stimulating The Neuro- Endocrinal System Hv Balances
The Entire Endocrine Systems, Like By Decreasing Cortisol Concentration And Intern Reducing Stress (As Seen From
Reduced Cps) And Improving Sleep (As Seen From Reduced Ess). Hv Together With Db Helps In Safe And Successful
Pregnancy.
***************

Title - Maternal Mortality Magnitude Of The Problem And Its Prevention At Vss Mch, Burla A Rural Based
Tertiary Care Centre
Author: Dr. Debabrat Sahoo
Co Author: Dr. C. Mohanta1, Dr. P. Khuntia2,

Aim: 1.To Estimate The Number Of Maternal Death And Identify Its Cause
2. Interventions And Solutions To Prevent Maternal Death
Materials & Methods: A Study Was Conducted In The Department Of Obstetrics And Gynaecology Vss Medical College
Hospital, Burla From September 2012 To August 2014. All Maternal Deaths Were Studied In Detail With Respect To
Maternal Age, Parity, Booking Status, Residence, Referral, Socioeconomic Class, Admission- Death Interval, The Cause Of
Death And Preventable Factors.
Result: Maternal Mortality Ratio Was 1258.45/1,00,000 Live Births In This Study.
The Causes Of Death Were
Hypertensive Disorders (40.3%), Unsafe Abortion (13.6%), Puerperal Sepsis (12.8%), Hemorrhage (11.7%), Embolism (3%)
And Other Indirect Causes (18.6%). Maximum Number Of Deaths (78.3%) Occurred In Women Between 20-29 Years Of
Age. 52% Of Deaths In The Postpartum Period, 88% Were Unbooked Cases, 75.6% Belonged To Low Socioeconomic Status
And 80% Were Referred Cases.
Conclusion: In The Present Study Such A High Mmr Is Because Our Institution Is The Only Tertiary Health Center In
Western Odisha And Majority Of The Cases Were Referred And Critically Ill Cases. Majority Of The Cases Had No Anc.
Poverty, Illiteracy, Lack Of FamilyS Awareness, Deliveries And Abortions Conducted At Home By Untrained Persons,
Delayed Referral And Lack Of Transport Facilities Are Contributed To Increased Maternal Deaths. Had Measures Been
Taken Many Death Could Have Been Prevented.

***************

Comparison Of Sublingual ,Vaginal And Oral Misoprostol In Cervical Ripening Prior To First Trimester Surgical
Abortion
Author: Dr. Jagadevi Sajjan
Co Author: Dr Jagadevi Sajjan1, Dr Arun Rao2, Dr. Anupama Suresh3, Dr. Nikil Shetty4,

Aim: Comparison Of Sublingual, Vaginal And Oral Misoprostol As A Cervical Ripening Agent 4 Hours Prior To Surgical
Abortion
Objective: To Compare Effectiveness And Tolerability Of Misoprostol As Cervical Ripening Agent In 1St Trimester Surgical
Abortion Through Different Routes.
Materials And Methods: Hospital Based Prospective Randomized Study In Which
90 Women Were Divided Into 3
Groups Sublingual, Vaginal And Oral And Single Dose 400g Misoprostol Was Administered 4 Hours Prior To
Evacuation. Efficacy Was Assessed On The Basis Of Dilation Achieved And Duration Of Procedure, The Tolerability Was
Evaluated Based On The Side Effects.
Results: Cervical Dilatation Achieved In Oral Group Was Better Than The Other Routes And Had Statistical Significance.
Duration Of Procedure Was Also Lesser In Oral Group (10.6 Minutes) Compared To Vaginal (12.05 Minutes) And
Sublingual (13.1 Minutes) Group. Side Effects Were Seen In All Groups, But Vomiting And Nausea (57%) Being More
Common In Oral Group, And Uterine Cramps (62.5%) In Vaginal Group And Loose Motions Maximum In Sublingual Group.
Conclusion: Administration Of Misoprostol By Oral Route Is Better Than The Vaginal And Sublingual Routes For Cervical
Ripening. (On Going Study..)

***************

Effect Of Administering Vaginal Sildenafil To Clomiphene Citrate Stimulated Cycles On Thin Endometrium And
Pregnancy Out Come In Iui Cycles
Author: Dr. Rabindra Ray
Co Author: Sunita Sharma1, Abha Sarkar2, B . N. Chakravarty3,

Aim: We Aimed To Determine The Effect Of Vaginally Administered Sildenafil On The Endometrial Thickness
(Et),Pregnancy And Miscarriage Rates In Cc Stimulated Iui Cycles.
Material And Methods: This Was A Prospective Observational Study Of 480 Women Undergoing Their First Iui Cycle.
Women Were Prescribed Clomiphene Citrate 100Mg Daily From Day 3 To Day 7. Patients Who Met The Criteria For
Ovulation Trigger ,I.E. Follicular Diameter 18Mm With Endometrial Thickness > 7Mm In The Study Cycle(N=355)
Were Excluded. Rest Of 125 Women Were Divided Into Two Groups. Gr A Received Vaginal Sildenafil (25Mg) Thrice Daily
(Group A; N = 56) And Group B( N = 69) Was The Control Group. Iui Was Not Performed In Women With Luteinised
Unruptured Follicle (Gr A N= 5, Gr B N=11) Or Failed Semen Collection By Husband (N = 6). All Women Received 300 Mg
Micronized Progesterone Intravaginally Daily For 15 Days.
Results: 8/103 (7.76%) Pregnancies Were Achieved Including 5 Patients In Group A And 3 In Group B. The Endometrial
Thickness Was Significantly Higher (P <0.05) In The Cc + Sildenafil Group (A Vs. B: 8.12.1Mm And 7.41.4 Mm).
Cancellation Rates Were Significantly Higher In Group A Compared To Group B. Miscarriage Rates Were Comparable.
Discussion And Conclusion: Adding Vaginal Sildenafil To Cc Stimulated Cycles Led To A Significant Increase In Endometrial
Thickness Where The Endometrium Fails To Develop In Synchrony With The Follicles Following Cc Stimulation. Thus It
May Be Effective In Improving Iui Outcome.

***************

Comparative Study To Assess The Accuracy Of Colposcopy And Pap Smear Cytology As Screening Test Of Cervical
Cancer
Author: Dr. Swarupa Jaiswal
Co Author: Dr. B.M Rakshit1, Dr. P.K Banerjee2, Dr. K Choudhury3, Dr. B.P Choudhury4,

Aim:
To Compare The Diagnostic Accuracy Of Colposcopy And Pap Smear Cytology As Screening Test To Diagnose Preclinical
Cervical Cancer.

Materials And Method:

It Was A Prospective Comparative Study Conducted In Gynaecology Opd Of Burdwan Medical College And Hospital On
100 Women Attending Opd With The Complains Of White Discharge, Irregular Menstruation, Post Coital Bleeding Or Post
Menopausal Bleeding. Pap Smear, Colposcopy With Application Of 3% Acetic Acid And On Spot Cervical Biopsy Was Done
On All Patients.

Results:
71% Of Women Were In The Age Group 20-40 Years. 54% Had Parity Between 3-4. 69% Of Women Presented With The
Complain Of White Discharge. 88% Had Normal Pap Smear, 1% Had Lsil, 2% Had Hsil And 4% Had Ascus On Pap Smear.
40% Of Women Had Aceto- White Reaction On Colposcopy, 6% Had Low Grade Lesions And 54% Had Normal Colposcopic
Findings. Final Histopathology Correlated With A Diagnosis Of Cin 2/3 In 6%, Cin 1 In 1% And Squamous Cell Carcinoma
In 4%, While 89% Had Chronic Non Specific Cervicitis. 72.72% Of All Those With A Positive Histopathology Presented With
The Complain Of White Discharge And Positivity Increased As The Parity Increased.
Overall Sensitivity Of Pap Smear Was72.72% Which Was Much Lower As Compared To Colposcopy Which Was 100%.
But The Specificity Of Pap Smear Was 95.5% And Of Colposcopy Was 67.42%.

Conclusion:
Hence Colposcopy Is A Superior Test For The Screening Of Cervical Cancer As It Is More Sensitive Than Pap Smear In
Detecting Precancerous Lesions.

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Can Estradiol Level Predict Art Outcomes In Women Undergoing Frozen Embryo Transfer?
Author: Dr. Kavitha Gautham
Co Author: Dr Vijayasarathi1, Dr Jaletha2,

Aim:
Endometrial Thickness, Volume And Blood Flow Are Commonly Used As Markers To Decide Suitability For Embryo
Transfer And Also To Predict Positive Fertility Outcome. Though Estradiol Has A Definitive Role In Priming Endometrium,
There Is Paucity Of Information About The Use Of Estradiol Levels As A Marker In Predicting Fertility Outcome In Women
Undergoing Frozen Embryo Transfer (Fet). The Aim Of This Study Is To Ascertain Whether Measurement Of Estradiol
Levels On Day 13 Can Be Used As A Clinical Marker In Predicting Fertility Outcomes In Frozen Embryo Transfer Technique.

Materials And Method:

A Retrospective Analysis Was Conducted On Clinical Case Records Of 36 Patients Who Underwent Frozen Embryo Transfer
Between January And August 2014. The Estradiol Levels Were Measured On Day 13 Using Chemiluminescence
Immunoassay Technique And Was Cross Verified For Accuracy Between The Patient Records And Electronic Laboratory
Data System. A Binary Logistic Regression Was Performed Using Spss In Which The Estradiol Level Was The Predictor
Variable And Pregnancy Outcome (0-Negative And 1-Positive) Was The Dependent Variable.

Results:
The Age Range Of All Patients Was Between 24 And 44 Years And The Estradiol Levels Varied Between 114 And 770Pg/Ml.
Of All Patients, 24(66.6%) Were Tested Positive For Pregnancy While The Rest Were Not Successful With The Fet. The Blr
Model Statistics Was 2(1)=0.023, P>0.05 And The Regression Analysis Indicated That Day-13 Estradiol Level Was A
Statistically Non-Significant Predictor Of Pregnancy Outcome In Fet [B(.000), Se (.002), Odds Ratio Of 1.000 With A 95%
Ci Of .995 1.004]. The Blr Lacked Adequate Power Due To Smaller Sample Size.

Conclusion:
Although Not Conclusive Due To Smaller Sample Size, A Statistical Trend Was Found In Which The Estradiol Levels Have
No Effect On The Pregnancy Outcome In Fet.

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Assessment Of Pelvic Floor Muscle Thickness Of Continent And Incontinent Primigravida Women
Author: Dr. Antima Rathore
Co Author: Pratima Mittal1, Shabnam Bhandari Grover2, Jyotsna Suri3,

Aim: Assessment Of Pelvic Floor Muscle Thickness Of Continent And Incontinent Primigravida Women.
Material & Methods: We Recruited 100 Primigravidae At 22 To 24 Weeks For The Study And Divided Them Into 2 Groups
According To Presence Of Urinary Incontinence. The Pelvic Floor Muscle (Pfm) Thickness Was Measured Using
Transperineal Ultrasound.
Results: The Difference In The Pelvic Floor Muscle Thickness Among The Continent And Incontinent Women Was
Statistically Significant. Continent Women Had Thicker Pfm Than Incontinent One. Pfm Thickness Of Study Group And
Control Group During Relaxation Was Found To Be Ranging Between 5.1-7.1 Mm (Mean = 5.94 0.51) And 6.1-7.2 Mm
(Mean = 6.63 0.26) Respectively. Pfm Thickness During Contraction Was Between 6.4 8.8 Mm (Mean = 7.29
0.56) And 8.2 9.4 Mm (Mean = 8.70 0.24) In Study And Control Group Respectively. Increase In The Pfm Thickness
Observed In Study Group And Control Group Was 1 2.1 Mm (Mean = 1.35 0.24) And 1.6 2.4 Mm (Mean = 2.07
0.18) Respectively.
Conclusion: Pfm Plays An Important Role In The Continent Mechanism & Transperineal Ultrasound Can Become An
Important Tool In Assessment Of Pfm Function.

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comparative Evaluation Of The Effects Of intravenous Oxytocin Bolus (5 Iu) And Infusion Vs.
infusion Alone On The Blood Loss During Cesarean Section.
Author: Dr. Priyanka Mathe
1,
Co Author: Aruna Batra Achla Batra2, Suniti Kale3, Rekha Bharti4, Pratima Mittal5

Aim: Comparison Of Estimated Blood Loss During Cesarean Section In Patients Receiving Iv Bolus Oxytocin (5 Iu) And
Infusion ( Group A) Vs Placebo And Infusion (Group B), Need Of Additional Uterotonic Agents For Control Of
Blood Loss, Hemodynamic Changes And Side Effects In The Two Groups.
Methods: Double Blind Randomized Placebo Controlled Trial In 250 Females Posted For Lscs, >= 18Yrs Of Age With
Singleton Term Pregnancy, Planned For Spinal Anesthesia, Fulfilling Asa I Or Ii Criteria With Hb10 Gm%.
Results: Objective Blood Loss Was Found Higher In Group B (MeanSd=1076.90241.45) Than Group A
(MeanSd=844.37189.15) With A Highly Significant Difference (P<0.001). Subjective Blood Loss Was More In Group
B (MeanSd=1100224.15) Than Group A (MeanSd=891.94 226.62) Which Was Statisticaly Significant (P<0.001).
Blood Transfusion Was Required In 12 Subjects In Group B (9.6%) And 4 Subjects In Group A (3.2%). Higher Number Of
Patients Required Additional Uterotonics In Group B Than Group A. Uterine Tone As Assessed By Likert Scale, Was Found
To Be Better In Group A. Hemodynamic Variable Were Comparable In Both The Groups. Vomiting Was The Only Side
Effect, Observed In 3.2% In Group A And 5.6% In Group B.
Conclusion: Combination Of Bolus And Infusion Is Found Better Than Placebo And Infusion, Due To Lesser Blood Loss
During Cesarean Section, Alongwith Lower Need For Additional Uterotonics And Blood Transfusion.

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Study On Ultrasonographic Parameters In Predicting Abortion In Patients Between 6-12 Weeks Of Pregnancy
Author: Dr. Chinmayie Ramakrishna
Co Author:

Aim: The Aim Of This Prospective Study Was To Assess The Value Of Ultrasound Ndings At 612 Weeks For
Predicting Early Miscarriage.
Methods: Women Between 6-12 Weeks Of Gestation, Who Came For Routine Anc Or Those Who Presented With
Complaints Of Pain Abdomen, Bleeding Or Spotting Pv Were Included In The Study. They Were Subjected To Usg And
Crown Rump Length (Crl), Fetal Heart Rate (Fhr), Yolk Sac Diameter (Ysd) Were Measured And They Were Followed Upto
20 Weeks. The Outcome Was Categorised Into 2 Groups, I.E, A) Those Who Continued Pregnancy Beyond 20 Weeks, B)
Those Who Had Abortion Within 20 Weeks. Changes In Usg Factors In Both The Groups Were Analysed.
Results: Out Of 120 Cases, 19 Of Them Had Miscarriage And 101 Cases Continued Pregnancy Beyond 20 Weeks. Chi
Square Test And Logistic Regression Analysis Demonstrated That The Chance Of Abortion Was Higher When Patients
Present With Spotting / Bleeding Pv (Or 9.4), Larger Ysd (Sensitivity -50% And Specificity -92%), And Fetal Bradycardia
(Sensitivity 80%, Specificity-92)

Conclusion: In Early Pregnancy, Miscarriage Can Be Predicted By Using Usg Parameters Such As Ysd, Fhr And Presenting
Complaints And The Estimated Risk Can Be Used To Follow Up And Rationalize Treatment.

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Utility Of First Trimester Anomaly Scan In Screening Of Congenital Abnormalities In Low And High Risk Pregnancies
Author: Dr. Neeta Natu
Co Author:

Aim: The Primary Objective Of The Present Study Is To Assess The Feasibility And Value Of First Trimester Anomaly Scan
In Both High Risk And Low Risk Pregnant Patients.
Material And Methods: A Total Of 1500 High Risk And Low Risk Patients With Live Fetus And 11- To 14-Week Gestation
Were Enrolled In Study After Informed And Written Consent. All Women Were Screened For Congenital Anomalies By
11-14 Week Ultrasound Scan (First Trimester Anomaly Scan) As Part Of Routine Prenatal Care. Second Trimester Scan
Was Conducted At 18 To 22 Weeks Gestation. The Results Of The First Trimester Anatomic Survey Were Correlated With
Second Trimester Target Scan To Evaluate Value Of First Trimester Scan For Early Detection Of Anomalies.
Results: Overall Prevalence Of Congenital Anomalies In Study Population Was 2.6%. Out Of These 64.4% Were Detected
By First Trimester Anomaly Scan, While Another 35.6% Were Detected By Mid Gestation Scan. Prevalence Of Congenital
Anomalies Detected By Ftas In Low Risk Group Was 0.72% (N=3), While In High Risk Group The Prevalence Was 3.6%
(N=15)
Conclusion: Detailed First Trimester Anomaly Scan And First Trimester Fetal Echocardiography Should Be Performed To
Detect The Fetal Anomalies Early
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Impact Of Surgical Menopause On Quality Of Life In Young Women

Author: Dr. Wills Sheelaa
Co Author: Dr Suthanthira Devi1,

Aim: To Assess Menopause Related Symptoms In Young Women Who Underwent Hysterectomy 3 Years Back And Its
Impact On Quality Of Life. Study Design: Hospital Base Cross Sectional Study. Material - 60 Women Belonging To Low
Socioeconomic Strata In The Age Group 35 - 40 Presenting To Menopausal Symptoms In Sssmch Were The Study Subjects.
Method: Women Were Interviewed Using Menopause Specific Quality Of Life Questionnaire(Menqol). Vaginal Smear
And Local Examination Done. Results: Mean Age 37.5 Yrs. 14 Abdominal, 46 Vaginal Hysterectomies. Insomnia, Anxiety,
Easy Irritability In 30%, Hot Flushes, Palpitation 10%, Back Aches 80%. Some Had More Than 1 Symptom. 2 Stitch Fistula
And Exploration. Avoided Sex Due To Fear, Dry Vagina, Dysperunia 10%. Had Vault Prolapsed 3 And Uti 25%.
Inflammatory Smear 30 (50%), Dry Smear 14, Bacterial Vaginosis 16. Conclusion: In Sexually Active Surgical Menopausal
Women Gynecological Morbidity Is More. Physical Psychological Factors Have Negative Impact On Quality Of Life.

Keywords: Hysterectomy Menopause Young Women

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Comparison Of Two Interval Regimen Of Mifepristone And Misoprostol 24 Hours Versus 48 Hours For Second
Trimester Termination Of Pregnancy.
Author: Dr. Shweta Dhruw
1,
Co Author: Dr Nivedita Sarda Dr Seema Singhal2, Dr Vijay Zutshi3, Dr Renu Arora4, Dr Sumitra5

Aim: To Compare The Efficacy Of A Shorter Interval (24 Hours) Between Misoprostol And Mifepristone Administration
With That Of The Conventional Dosing Interval (48 Hours) For Second Trimester Termination Of Pregnancy (Top).
Methods: This Was A Prospective Randomized Controlled Open Label Study Of 60 Healthy Women Opting For MidTrimester Top. The Women Were Randomized To Receive 200 Mg Mifepristone Orally, Followed 24 Hours (Group A) Or
48 Hours (Group B) Later By Misoprostol (800g, Then 400g Every 3 Hours). The Primary Outcome Measure Was The
Percentage Of Successful Abortions Within 24 Hours, Induction To Abortion Interval (Measured From Misoprostol
Administration), Total Dose Of Misoprostol Used, Complete And Incomplete Abortion Rates .The Secondary Outcomes
Were The Frequencies Of Complication And Adverse Effects.
Results: The Rate Of Successful Abortions Was Similar With The 24Hour And 48-Hour Dosing Interval (100 %; P =
0.315). The Mean Induction To Abortion Interval Was Also Comparable Between The 2 Groups (8.64.1Hours Versus
7.33.22 Hours; P =0.37). Complete Abortion Rates Were Similar In Both The Groups (90% Versus 96.7% Respectively P
=1.00) And Incomplete Abortion Rates Were Also Comparable (10% Versus 3.3%, P=1.00). The Mean Number Of Dose
Required By Both Groups Was (2.61.0 Versus 2.51.0; P=0.307) Which Was Statistically Insigficant. Nulliparous
Women And Women With Pregnancy Duration Of 16 Weeks Or More Had A Longer Induction To Abortion Interval In Both
Groups.
Conclusion: The 24-Hour Dosing Interval Between Misoprostol And Mifepristone Administration Seems To Be As Effective
As 48Hour Dosing Interval For Second Trimester Top

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A Comparative Evaluation Of Oral Vs. Intravenous Labetalol For Acute Control Of Severe Hypertension In Pregnancy
Author: Dr. Manisha Meena
Co Author: Aruna Batra1, Achla Batra2, Rekha Bharti3, Pratima Mittal4,

Aim: To Compare The Efficacy Of Labetalol By Oral Vs Intravenous Route For Control Of Severe Hypertension In
Pregnancy.
Material And Methods: In The Present Study 211 Patients With Bp 160/110 Mmhg Were Screened From Gynae
Emergency, Opd, Obstetric Wards And Labour Room, Data Of Total 60 Patients Was Analyzed After Considering Inclusion
And Exclusion Criterions. Patients Were Randomized To 2 Groups (30 Patients Each) Using A Computer Generated
Random Number Table. Group A Received Intravenous Injection Of Labetalol In Escalating (20 Mg, 40 Mg, 80 Mg, 80 Mg
) Repeated After Every 15 Min To A Maximum Allowed Dose (220 Mg) Or Until The Target Bp (150/100 Mmhg) Was
Achieved. Group B Received Tablet Labetalol 200 Mg Orally, To A Maximum Of 3 Doses 30 Min Apart Or Until Target Bp
Was Achieved. Patient In Which Target Bp Was Achieved And Sustained For 2 Hours Was Compared In 2 Groups.
Results: In Both The Groups The Systolic And Diastolic Bp After Treatment Was Comparable. Systolic Bp Was
137.4412.48 Mmhg In Iv Group And 136.209.09 Mmhg In Oral Group, While Diastolic Bp Was 90.488.58 Mmhg
In Iv Group And 91.676.39 Mmhg In Oral Group. Median Time Taken To Achieve The Target Bp Was Same I.E. 30 Min
(Iqr 30-45 Min) In Intravenous And 30 Min (Iqr 30-60 Min) In Oral Group With P=0.140. However Mean Time Taken By
Intravenous Route (34.812.03 Min) To Achieve The Target Bp Was Significantly Lower Than Oral Route (4721.84
Min).
Conclusion: Both Oral And Intravenous Route Of Labetalol Were Found To Be Equally Effective For Acute Control Severe
Hypertension In Pregnancy.

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Comparison Of Perioperative Outcomes Of Radical Hysterectomy In Endometrial Cancer By Robotic, Laparoscopic

And Open Approaches
Author: Dr. Smitha Chintalapelli
Co Author: Dr.Jagdishwar Goud Gajagowni1, Dr.Kaveri Shaw2, Dr.M.B.Vikas Kumar3,

Aim: To Compare The Safety, Morbidity, Intraoperative And Post Operative Outcomes Between Robotic(Rrh)
,Laparoscopic(Lrh) And Open Radical Hysterectomy(Orh) In Endometrial Cancer.
Methods: Prospective Data Of All Women Diagnosed With Endometrial Cancer (Figo 2008 Stage 1 And Ii)Who Underwent
Radical Hysterectomy At Krishna Institute Of Medical Sciences From May 2012 To April 2014 Collected And Analyzed By
Spss System.
Result: During The Study Period Total 55 Cases Underwent Radical Hysterectomy By Either Of The Three Routes. The
Mean Age (59.488.6 Year) And Bmi (25.663.2) Was Found Significantly High In Rrh Patients. The Average Duration
Of Surgery Was Orh Vs Lrh Vs Rrh (98.54Min89.1Vs 231.38 Min50.0Vs215.36 Min 32.1) With Significant Difference
In Orh As Compare To Lrh And Rrh.The Intraop Blood Loss Was Minimal In Rrh(92.6Ml 64,P<0.05) As Compare To
Other Two.Lymph Node Retrieval
Was Significantly Higher In Minimally Invasive Routes(Robotic Vs
Lap15.8,Laparoscopic- 13.3)Compared To Open Route(11.8,P<0.05). The Post Operative Outcomes Were Comparable In
All The Three Routes. Significant Difference Was Noted In Analgesics Use(2.16Days & 2.61Days, P<0.05)In Rrh & Lrh
Compared To Orh .Hospital Stay Was Significantly Shorter In Rrh(3.44Days) Compared To Lrh(4.46Days) &Orh(6.41Days).
None Of The Robotic Or Laparoscopic Procedures Required Conversion To Laparotomy.
Conclusion: We Have Found Robotic Surgery To Be A Better Option For Older And High Bmi Patients .The Extensive
Dissection ,Better Visibility And High Lymph Node Retrieval By Robotic Route Provides Better Surgical Clearance.Similarly
Perioperative Morbidity ,Analgesics Use And Return To Work Has Been Found Less By Robotic Route As Compare To Open
And Laproscopic Route In Endometrial Cancer.

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The Impact Of Endometrial Thickness On The Day Of Hcg On Implantation And Pregnancy In Icsi
Author: Dr. Siddhartha Reddy
Co Author: Sanjeeva Reddy N1, Tamizharasi M2, Radha V3, Kanimozhi K4, Latha G5

Aim: To Correlate The Endometrial Thickness On The Day Of Ovulation Trigger And Reproductive Outcome Of Icsi
Objectives: To Correlate Endometrial Thickness On The Day Of Hcg Trigger With Various Parameters Of Reproductive
Outcome Of Icsi.
Material & Methods:
A.

Type Of Study: Retrospective Observational Study

B.
Study Protocol: 86 Patients Who Underwent Icsi In The Department Of Reproductive Medicine At Sri
Ramachandra Medical Center, Chennai, Were Included In The Study. Endometrial Thickness Measured By Transvaginal
Ultrasound On The Day Of Hcg Trigger, Was Obtained From The Patient Records. The Study Subjects Were Divided Into 3
Groups; Group I Et: <8Mm (N=4), Group Ii Et: 8-12Mm (N=64), Group Iii Et: >12Mm (N=18). The Three Groups
Were Correlated With Various Parameters Of Reproductive Outcome.
Results: The Three Groups Were Comparable By Age, Bmi, Basal Fsh Levels, Antral Follicular Count, And Protocol Of Coh.
The Implantation And Pregnancy Rates In The Three Groups Were 10% & 25%; 23.75% & 48.4%; 14.5% & 27.8%,
Respectively.
Conclusion: Endometrial Thickness Of 8- 12 Mm On The Day Of Hcg, Has The Highest Implantation And Pregnancy Rates
In Icsi Cycles. However, Further Large Prospective Clinical Trials Are Required To Confirm These Findings.

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Prevalence Of Hypothyroidism In Patients With Polycystic Ovarian Syndrome Attending A Tertiary Care Teaching
Hospital
Author: Dr. Saswati Tripathy
Co Author: Muthulakshmi M1, Gayathri Sr2, Satyajit Mohapatra3,

Aim: To Find Out The Prevalence Of Hypothyroidism In Pcos Patients Attending The Obstetrics & Gynaecology
Department Of A Tertiary Care Teaching Hospital.
Materials & Methods: An Observational Study Was Done Among 146 Female Patients Who Came With Complaints Of
Menstrual Irregularities And Hypertrichosis. Only 112 Patients Were Defined As Pcos According To The Rotterdam
Criteria. The Thyroid Dysfunction Was Diagnosed By Measurement Of Thyroid Stimulating Hormone (Tsh), Free Thyroxin
Level (Free T3 And Free T4). The Other Biochemical Parameters Like Serum Lh, Fsh, Insulin And Prolactin Were Evaluated.
Results: The Average Age Of The Patients Were 25.4 5.7 Years. About 33.04% Of Patients Were In Age Group Of 2125 Years. High Tsh Was Detected In 41 Patients (36.6 %) Of The Total Pcos Patients. The Mean Tsh In These Patients Was
6.432.17Miu/Ml And Free T3, Free T4 Were 2.86 0.81 Pg/Ml And 1.140.35Ng/Dl Respectively. In Those Patients
The Bmi Was 25.96 6.27. The Serum Insulin Level And Prolactin Level Were 17.15.52 And 14.836.83.
Conclusion: Hypothyroid Can Initiate, Maintain Or Worsen Pcos Syndrome. Screening Of Hypothyroid In At Early Stage
Can Help In Management Of Pcos In A Better Way.
Key Words: Polycystic Ovarian Syndrome, Hypothyroidism, Hyperinsulinemia

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Role Of Counselling And Its Impact On Contraceptive Trend In Pmch

Author: Dr. Pragya Richa
Co Author: Dr. Rita Kumari Jha1, Dr. Prof. Pushpa Roy2,

Aim: -To Show The Contraceptive Trend

-Role Of Counselling In Family Planning
Material & Methods: This Study Was Done In Department Of Obstetrics & Gynaecology, Patna Medical College & Hospital
(Pmch) From Jan2011 To Dec2013. Women Attending Rch Opd Were Counselled About The Role Of
Contraceptives In Family Planning. Basket Approach Was Given By The Counsellor. Methods Chosen By The Candidates
Were Provided, Common Side Effects Explained And Follow-Up Register Maintained.
Results: Studies Show That With Efficient Counselling, The Contraceptive Use Has Increased In The Last 3 Years. Most
Commonly Practiced Method Is Barrier Method (Nirodh-50%). Oral Contraceptives Are Used By 20% Of Female. Rate Of
Iucd Insertion (Cut-380A) Has Increased From 10.6% In 2011 To 17.3% In 2013. Interval Female Sterilization Rate Has
Decreased. Intra-Caesarean Ligation Rate Has Increased Because Of Increased Incidence Of Lscs And Small Family Norms.
Conclusion: Increasing Contraceptive Prevalence Is Most Cost-Effective Of All Health Measures. Antenatal And Post
Partum Period Are Golden Periods For Counselling. Not Only The Woman But Her Family Member Specially Husband
And Mother-In-Law Should Be Motivated. Providing basket Of Contraception And Helping A Couple To Choose A
Method Of Their Choice Has Increased Acceptance And Follow-Up Rate, And Also Reduced Discontinuation Rate.
Injectable Contraceptives Are Not Much Used Because Of Cost & Unawareness Among Rural Population. Thus, Good
Counselling & Dedicated Follow-Up Can Go A Long Way In Birth Spacing, Limiting Family Size, Reducing Maternal Mortality
& Morbidity, And Avoiding Unsafe Abortions.

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A Clinical Study On Awareness Of Maternity Scheme Among Antenatal Women In Rural Area Of Tamilnadu.
Author: Dr. Lakshmi Subburaj
Co Author: Dr Rajarajeshwari1,

Aim:- To Study The Awareness Of Muthulakshmi Reddy Maternity Scheme By Government Among Antenatal Women In
Rural Tamilnadu And Its Association With Socio Demographic Factors.And To Find Out Important Sources To Create
Awareness And Motivation.
Materials And Methods:-Sixty Antenatal Women From Rural Area Around Madurai Who Were Willing To Participate In
The Study Were Included.They Were Given A Prefilled Questionnaire After Informed Written Consent.The Answers Were
Documented And Analysed.
Results And Discussion;- Among The 60 Women Included 23 (38%) Were Above 25 Years And 37 ( 62%) Belonged To Age
Group Of <25 Yrs.Among That Twenty Five (41%) Were Primigravida And 35(58%) Were Mutigravida.And 77% Had
Complted Their School Education 13% Completed College And 10% Were Illiterate.It Included 13% Of Working Women
And 87% Of Housewives.Awareness Score Given For Answers Given To Various Questions Regarding The
Scheme.Awareness Was Better Among Multigravida Than Primigravida (P Value 0.0014) Statistically Significant And Also
Among Working Women(Mean Score 6.63) Than Housewife (Mean Score4.6)(P Value 0.0183) Statistically Significant.And
All Antenatal Mothers Preferred The Scheme Would Be Beneficial If Implemented In Private Hospitals Also.
Conclusions:-Very Few Studies Have Been Carried Out Regarding Evaluation Of Implementation Of The Scheme In
Tamilnadu.Regarding The Scheme More Awareness To Be Created Among Primigravidas And Housewives As They Are
Not Aware Of Many Aspects Of The Scheme.

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Vaginal Hysterectomy Under Local Anaesthesia - A Boon For High Risk Patients
Author: Dr. Deepika Arikati
Co Author: Dr J.Venkateshwar Reddy (Professor & Hod)1, Dr C.V. Laxmi Rao (Associate Professor)2,

Aim: To Study The Feasibility And Success Of Vaginal Hysterectomy Under Local Anaesthesia In High Risk Patients.

Objective: To Illustrate That Local Anaesthesia Limits The Risks Associated With Regional Or General Anaesthesia In High
Risk Patients Who Are Unfit For Regional Or General Anaesthesia.

Methodology: A Prospective Study Was Done In Gandhi Hospital, Secunderabad, Telangana Over A Period Of 1 Year From
July 2013 To June 2014 On 14 Patients With High Risk Factors Requiring Vaginal Hysterectomy For Various Pathologies
But Unfit For Regional Or General Anaesthesia. Patients Were Operated Under Local Anaesthesia With The Use Of 0.5%
Lignocaine For Pudendal Block And Local Infiltration Into Tissues. Ligasure Is Also Used For The Procedure.

Results: Out Of 14 Patients, 6 Were Prolapse Uterus, 6 Were Fibroid Uterus Unresponsive To Medical Treatment, 3 Were
Prolapse Uterus With Cystocele And Rectocele And 1 With Menorrhagia And Vesicovaginal Fistula. Risk Factors Seen Were
Cardiac Disease Complicating Like Af, Skeletal Abnormalities, Extremes Of Age, Morbidly Obese, Uncontrolled Diabetes
Mellitus. Mean Age Of Patients Ranged Between 40-70 Yrs. None Of The Patients Had Intraoperative Pain Score >1.
Incidence Of Hypotension, Vomiting And Blood Loss Was Lower. The First Request For Postoperative Analgesia Was At A
Later Time Than Their Counterparts In Regional Or General Anaesthesia. Average Hospital Stay When Compared With
Other Patients WasnT Different. All 14 Patients Had Satisfactory Experience With Their Anaesthesia.

Conclusion: Local Anaesthesia Can Be Successfully And Safely Employed For Vaginal Hysterectomy In High Risk Patients
With Low Postoperative Complications And High Satisfaction Rate.

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Prevalence Of Hypothyroidism In Urban , Low Income Group Pregnant Women

Author: Dr. Anitha Patibandla
Co Author: Dr.Jagityayini1,

Aim: To Study The Prevalence Of Hypothyroidism In Urban, Low Income Group Pregnant Women Attending Antenatal
Out Patient Clinic.
Material And Methods: This Is A Retrospective Study Conducted At Esi Hospital, Sanatnagar, Hyderabad. Thyroid Profiles
Of All The Pregnant Women Attending Outpatient And Inpatient Services Over A Four Month Period ( April 2014
August 2014) Were Analysed.
Inclusion Criteria: Tsh Levels Above 2.5 Miu In First Trimester And 3 Miu In Second And Third Trimester Were Taken As
Abnormal.
Results: A Total Of 1062 Cases Were Studied. Out Of These 215 Cases ( 20.24%) Were Detected To Have Hypothyroidism
. Of These , 149 ( 14.03%) Had Subclinical Hypothyroidism ( Raised Tsh With Normal T4 Values) And 66 ( 6.21%) Had Overt
Hypothyroidism ( Raised Tsh And Low T4 Values).
Conclusions: Our Study Demonstrated High Prevalence Of Hypothyroidism In Urban, Low Income Group Pregnant Women
. Hypothyroidism In Pregnancy Is Associated With Low Iq And Neurodevelopmental Delay In Off Spring. High Prevalence
Of Clinical And Subclinical Hypothyroidism Demonstrated By This Study Justifies Universal Screening For Thyroid
Dysfunction In Pregnant Women.

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The Relationship Between Umbilical Cord Arterial Ph And Serious Adverse Neonatal Outcome
Author: Dr. Kiruthiga Thangasamy
Co Author: Dr. Pushpalatha1,

Aim: To Study The Relationship Between Umbilical Cord Arterial Ph At Birth In Singleton, Term Neonate And The Serious
Adverse Neurological Outcome
Objectives: Adverse Neonatal Outcome Was Assessed In Terms Of Hie, Hie With Seizures <24Hours, Nicu Admission And
Apgar Score <7 At 5 Minutes.
Methods: 1000 Ante Natal Women Delivering At Term (37 Completed Weeks Of Ga) Singleton, Non - Anomalous Fetus
Were Included In This Study. Preterm Deliveries, Multi-Fetal Gestation And Anomalous Fetus Were Excluded From The
Study. The Study Group Was Followed During Labour With Continuous Ctg Monitoring, Immediately After Delivery Paired
Umbilical Cord Blood Samples Were Collected In Two Labeled, Pre Heparinized Syringes. The Samples Were Analyzed
Immediately In Radiometer Abl 800 And The Neonates Were Followed During The Post - Partum Period. The Results Of
The Study Were Tabulated And Statistically Analyzed Using Chi Square / Fischer Exact Test.
Results: The Median Arterial Ph Was 7.26. The Risk For Adverse Neurological Outcome Was Significantly Increased When
The Ph Is Less Than 7.15. Similarly When The Ph Is More Than 7.16 There Is No Significant Adverse Neurological Event In
The Study Population. Apgar Score < 7 At 5 Minutes [Odds Ratio 175.9 (42.222 733.114)], Nicu Admission [Odds
Ratio 15.059 (10.228 22.172)] Hie [Odds Ratio 135.085 (18.100 1008-188)] Was Significantly Increased When
The Ph Is Less Than 7.15. There Was 1 Neonatal Death Due To Stage Iii Hie In The Study Period.

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Vaginismus & Erectile Dysfunction: A Double Whammy In Unconsummated Couples

Author: Dr. Jaletha Helan
Co Author:

Aim: Vaginismus Is The Most Prominent Cause For Unconsummated Marriage. The Present StudyS Aims Are To
Emphasise The Clinical Relevance And Importance Of Ruling
Out Vaginismus In Unconsummated Couples And Demonstrate A Proven Strategy To Help Such Couples Achieve PenoVaginal Penetration.

Materials And Method:

Twelve Married Couples Who Presented With Unconsummated Marriage And/Or Situational Erectile Dysfunction As Their
Primary Complaint(S) Were Included In The Study. Data Were Retrieved From Case Records And A Brief Follow-Up
Telephone Survey Was Conducted.

Results:

Husbands Were About 4.5 Years Older Than Their Partners And The Length Of Current Marriage Ranged Between 15 Days
To 60 Months. Most Couples Rated High Or Very High Degree Of Satisfaction With Their Marital Relationship.
Unconsummated Marriage (N=7) And Situational Erectile Dysfunction (N=5) Were The Main Presenting Issues. Seven
Women (58%) Did Achieve Total Peno-Vaginal Penetration After About 2-3 Sessions Involving Cognitive Behaviour
Therapy, Basic Sex Education And Motivational Interviewing. To-Date, Two Women Have Not Had Peno-Vaginal
Penetration And Of Note They Both Have Very Thin Body Built And The Age Difference Between The Partners Is 8
Years. These Two Women Are Under Vaginal Training Program Involving A Medical Sex Therapist And Female
Physiotherapist And Have Successfully Finished Up To Three Stages Of Therapy. The Rest Were Lost In Follow-Up. None
Of The Women Had Traumatic Sexual Experience In The Past Or Had Any Specific Phobia. In Men Who Presented With
Erectile Dysfunction (Treated Elsewhere And Failed), Vaginismus Was Found To Be The
Precipitating And Perpetuating Factor And Erection Improved With Appropriate Management Of Vaginismus.

Conclusion:

Vaginismus Is A Well Treatable Sexual Problem Using A Team Approach And By

Addressing The Physical And Psychosocial Dimensions Of Sexuality. In Management Of Situational Erectile Dysfunction,
It Is Highly Essential And Recommended To Assess Their
Female Sexual Partners To Rule Out Vaginismus.
***************

Impact Of Addition Of Nasal Bone (Nb) In Routine First Trimester Screening

Author: Dr. Uma Ram
Co Author: Mathangi T1, Shobana Mahadevan2,

Aim:

To Assess The Impact Of Addition Of Nasal Bone (Nb) In Routine First Trimester Screening

Materials And Methods:

A Retrospective Chart Review Of All Normal Singleton Pregnancies Who Underwent 11- 14 Weeks Scan Between July
2013 And July 2014. Nuchal Translucency Was Measured And Nasal Bone Identified By Standard Techniques. Women
Reported To Have An Absent Nasal Bone Were Counselled. Screen Positives Were Offered Invasive Testing.

Results:

Of The 1019 Women Scanned, 18.1% O Were Done Between 11-12 Weeks, 66.3% 12-13 Weeks, And 15.5% At 13-14
Weeks. Nb Was Present In 925 Patients, Of Whom 844 Underwent Combined First Trimester Screening (Fts). Only One
(0.1%) Was Screen Positive With Normal Karyotype On Invasive Testing.

Nb Was Absent In 92 And 89 Continued Care. 81 Underwent Fts. 20 Were Screen Positive (22.4%) And 15 Opted Invasive
Testing. Only One (6.6%) Had Down Syndrome. All Others Had Risk < 1:1000 Without Nb Addition. The One T 21 Would
Have Been Screen Positive (1:66) With Nt + Biochemistry Alone.
42.6%% Of Absent Nasal Bones Were Reported At 11-12 Week Group, 56.1%% In 12-13 Week Group And 1.1% In The 1314 Week Group.
Of The 61 Screen Negatives One Opted Invasive Testing And Had Normal Karyotype.
5 More Patients Opted For Direct Invasive Testing Without Fts (2 For Increased Nt &Absent Nb, 3 For Only Absent Nb)
And All Karyotypes Were Normal. On Follow Up, 80% Of Absent Nb Ossified At Tiffa. Of The Remaining 74, 50 Have
Delivered Normal Babies And 24 Pregnancies Are On-Going.

Conclusion:

Absent Nb Is Seen In 8.7% Of Our Population. Absence Of Nb Reduces With Increasing Ga. The Addition Of Nb Using The
Current Likelihood Ratios Seems To Significantly Increase The False Positive Rate Of Combined First Trimester Screening.

***************

Hypo And Hyper

Author: Dr. Saranya Ravindran
Co Author: Dr N. Palaniappan1,

Aim:
To Assess Whether Serum Calcium At 11-14 Weeks Is A Good Predictor For The Development Of Gestational Hypertension
And Pre-Eclampsia.

Materials And Methods:

This Was A Prospective Observational Study Carried Out On 635 Antenatal Patients. Serum Calcium Was Taken At 11-14
Weeks And Patients Were Followed Up,To Watch For The Onset Of Gestational Hypertension And Preeclampsia. Other
Medical And Obstetric Complications Were Also Observed.

Results:
Out Of The 635 Patients, 89.7% Remained Normotensive And 10.3% Developed Gestational Hypertension And
Preeclampsia. Of The 65 Patients Who Developed Hypertension, 53% Developed Gestational Hypertension, 40% Mild
Pre Eclampsia And 6.1% Severe Preeclampsia. Serum Calcium Less Than 8.5Mg/Dl Showed A Increased Risk Of
Development Of Gestational Hypertension And Pre-Eclampsia. Of Those Patients With Serum Calcim Less Than Or Equal
To 8.5Mg/Dl 86% Developed Hypertension. In This Group 55% Developed Gestational Hypertension, 35% Mild Pre
Eclampsia, 10% Developed Severe Pre Eclampsia.

Conclusion:
Serum Calcium Estimation At 11-14 Weeks Of Gestation Is A Reasonably Good Predictor Of Gestational Hypertension And
Pre-Eclampsia With A Sensitivity Of 61.5%, Specificity Of 98.9%, Positive Predictive Value Of 86.9% And Negative
Predictive Value Of 95.7%.

***************

Antenatally Diagnosed Fetal Intra-Abdominal Cyst

Author: Dr. Radhika Bajpai
Co Author: Dr Mandakini Pradhan1,

Aim:
To Delineate The Etiology Of Fetal Intra Abdominal Cyst And To Analyse Its Outcome.

Material & Methods:

A Retrospective Analysis Of Obstetric Ultrasounds Done Between July 2009 To June 2014 At Maternal And Reproductive
Health Department Was Done. Fetuses Detected With Dilated Urinary Bladder Due To Lower Urinary Tract Obstruction
Were Excluded From The Analysis As There Antenatal And Postnatal Management Is Well Delineated.

Results:
Twenty(1.4%) Fetuses Were Detected To Be Having Intra Abdominal Cysts. Out Of These Ten(50%) Fetuses Detected To
Have Ovarian Cyst, Four(20%) Fetuses Urinary Tract Involvement I.E. Two Each Of Isolated Renal Cysts And Megacystis,
One Each Had Adrenal Neuroblastoma, Mesenteric Cyst And Meconium Peritonitis And Three Cases(15%) With UroRectal Septum Malformation.
Five Couple (25%) Opted For Termination Of Pregnancy. One Case Of Fetal Megacystis Had Repeated Aspiration (6 Times)
Of Fetal Urinary Bladder And One Case Of Fetal Ovarian Cyst Required Aspiration Due To Large Size.
All Newborns With Ovarian Cysts Are Normal At Various Stages Of Postnatal Life. One With Adrenal Neuroblastoma Died
At Day 2 Of Life. One Newborn With Solitary Renal Cyst Was Critical At Day 10 Of Life.

Conclusion:
Causes Of Antenatally Detected Intra-Abdominal Cysts Are Variable And Delineation Of Etiology Is Important For Better
Management Of Pregnancy.

***************

Clinicalstudyofendometrialpolypand Roleofdiagnostichysteroscopyintreatingthe Same

Author: Dr. Janu Kanthi
Co Author: Dr.Chithra1, Dr.Sudha2, Dr.Saralasreedhar3,

Aim:Clinical Study Of Endometrial Polyp And Role Of Diagnostic Hysteroscopy In The Treatment Of Same
Material And Methods:86Women In The Period Of January 2008 To December 2010 In Amrita Institute Of Medical
Sciences Who Have Been Diagnosed To Have Endometrial Polyp By Ultrasongraphy And Confirmed By Histopathology
Were Included In The Study.Clinical Characteristics Like Age,Menopausal State,Symptoms,H/O Previous D&C ,Associated
Other Gynaecological Conditions Are Noted Down. They Underwent Diagnostic Hysteroscopy Followed By Polypectomy
By Ovum Forceps/Kochers Forceps / Small Spongeholding Forceps.Check Hysteroscopy Was Done To Ensure The
Complete Removal.Findings Of Diagnostic Hysteroscopy -Size Of The Polyp,Site Of The Polyp Are Noted.Histopathological
Report Was Followed Up.They Are Followed Up For 5Yrs.20Patients Lost To Follow Up.
Results:Mean Age Is 48.5Yrs,67 Are Premenopausal And 19Are Postmenopusal Women.Abnormal Uterine Bleeding Was
The Commonest Symptom.Fibroid Uterus Was Commonly Associated With This.4Patients .The Commonest Site Of Polyp
Is Lateral Walls.
3Women Had Endometrial Hyperplasia Without Atypia,2 Had Atypical Polypoid Adenomyoma And 3Had Leimyomatous
Polyp.4Patients Had Recurrence Of Polyp
Conclusion:Endometriapolypiscommon In Perimenopausal Women,Diagnostichysteroscopyhelpsindiagnosing And
Removingcompletely Usingovumforceps

***************

The Impact Of Maternal Bmi At Labour Admission On The Route Of Delivery

Author: Dr. Medempudi Sruthi
Co Author: Prof Usha Vishwanath1,

Aim:To Determine The Impact Of Maternal Bmi At Labour Admission On The Route Of Deliverymaterials&Methods:It Is
A Prospective Observational Study Conducted From July 2012 To July 2014. 1584 Antenal Mothers With Term Singleton
Pregnancies With Excluding Short Stature<145Cm,Non Cephalic Presentations,Multiple Pregnancies,& Preterm Deliveries
Were Selected And Their Respective Bmi Is Calculated At Labour Room Admission Using QuetletS Index And The
Primary Outcome ,The Route Of Delivery Was Observed Results:The Lscs Rate In The Normal Bmi Women Was Only
14.6%.Whereas In The Overweight Bmi Women The Lscs Rate Was 39.2%.Women Of Class 1 Obesity Bmi Had 71.1% Lscs
Rate.88.1% Of Women With Class 2 Obesity Bmi & 92.1% Women Of Class 3 Obesity Bmi Had Caesarean Section.There
Was Significant Statistical Difference Among The Bmi And The Mode Of Delivery With P Value <0.000 By Pearson Chi
Square Test.Conclusion:The Lscs Rate Increased With Increased Bmi With Each Class Of Bmi,Also Women With Increased
Bmi Had Increased Risk Of Gdm &Htn.So There Ia Need To Optimize The Prepregnancy Bmi To Lower Limit Of Normal
Bmi ,And Also The Women Should Have A Check On The Weight Gain During Pregnancy ,So That Their Bmi At Term Will
Be In The Non Obese Bmi Category And Their Chance Of Lscs Is Less.
***************

S.L.E Complicating Pregnancy

Author: Dr. Neelima Varaganti
Co Author: Dr.Mahitha1,

Aim:-To Study The Pregnancy Outcome In S.L.E Cases.

Material& Methods: This Study Was Conducted At Mgmh, Hyderabad. Six Cases Were Identified During The Period Of
Twelve Months From October 2013 To September 2014.
Results: Patients Belong To The Age Group Of 2235 Years. Five Were Primigravida. Two Cases Were Registered In The
First Trimester And Four Cases Were Referrals In The Second Trimester. The Two Patients Were Conceived During The
Period Of Remission, Pregnancy Was Near Uneventful Except Mild Maternal Flares.
The Four Referral Cases Were Conceived During Active Phase Of The Disease And Were On High Glucocorticoid Therapy.
Among Them One Had Lupus Nephritis Grade Ii, Developed Pre-Eclampsia. Pregnancy Was Terminated By Lscs At
34Weeks For Iugr. The Baby Was Live. The Rest Three Cases Had Grade Iv Lupus Nephritis. These Pregnancies Were Also
Terminated But During 16-20 Weeks Of Gestational Age For Deteorating Renal Status And Uncontrollable Hypertension
(As Advised By Nephrologist). Out Of These Three Women, One Had To Undergo Dialysis After Abortion.
Conclusion: S.L.E Is More Prevalent Among Reproductive Age Group Women. Patients With S.L.E Have A Greater
Incidence Of Pre-Eclampsia, Abortions (Spontaneous Or Induced). I.U.G.R, Preterm Labour And Still Births. Foetal Loss Is
Further Increased When The Disease Is Active During Conception, With Lupus Nephritis, Hypertension. Pregnancy Should
Be Planned When The Disease Is Quiescent For 6 Months And Medication Is At Lowest Dosage.
Overall, To Improve The Pregnancy Outcome Patients Should Be Made Aware About The Diseases & Drugs.
Preconceptional Counseling Is A Must And The Patient Should Be Treated In High Risk Obsteric Unit Under The Care Of
Concerned Specialists To Anticipate, Prevent And To Deal With Complications Arising Out Of Sle With Pregnancy.
***************

Implementation Of Maternal Blood Cell-Free Dna Analysis As A Tool For Non Invasive Prenatal Testing For
Aneuploidies In The Fetus
Author: Dr. Sushrut Ghaisas
Co Author: Dr. Shreepad Venkatesh Karhade1, Dr. Kartik S Morajaya2, Dr. Swati D Thakker3, Dr. Govindarajar
Yuvabalkumaran4,

Aims And Objectives :

To Explore The Feasibility And Review The Performance Of Routine Maternal Blood Cell-Free Fetal Dna For Non Invasive
Prenatal Testing ( Nipt ) Of Aneuploidies In Fetuses

Materials And Methods:

A Case Series Has Been Prepared By Retrospectively Studying The Profile Of Women Who Opted For Non Invasive Prenatal
Testing Cell Free Dna Analysis To Screen For Aneuploidies In Fetuses At A Single Private Centre Since Its Introduction.
The Parameters Studied Include Maternal Age, Gestational Age At Presentation, Indication For Nipt, Genetic Counselling
Done And The Results Of The Test.

Results :

14 Women Opted For Nipt At Our Centre ( Jan-Sept. 2014 ), With A Median Maternal Age Of 32 Years. After Genetic
Counselling In All Cases, The Maternal Serum Sample Withdrawn Has Been Couried To A Private Laboratory Abroad, And
Conclusive Results Have Been Provided In All Cases Within Two Working Weeks. The Reasons Women Opted For Nipt
Included Intermediate Risks In Ultrasound Based Screening For Aneuploidies, Isolated Markers Pointing Towards Genetic
Syndromes, Fear Of Invasive Testing Coupled With The Risk Of Miscarriage And Maternal Anxiety. 13 Case Results Came
Negative (Risk < 0.01%) For Trisomy 21, 18, 13, Triploidies And Monosomy X. One Positive Result Was Confirmed On
Amniocentesis For Trisomy 21. Five Babies Have Been Normal On Postnatal Evaluation, Two Of Which Confirmed On
Karyotyping , Four Are Ongoing Pregnancies And Four Women Have Been Lost To Follow-Up.

Conclusions:

Testing Cell-Free Fetal Dna In Maternal Blood Is A Test Of High Sensitivity And Accuracy To Screen For Aneuploidies.
Although Positive Results Require Confirmation By Invasive Testing, This Has Merits Of Annulling The Risk Of Miscarriage,
Ease Of Performance And Can Be Done At Any Gestational Age. However , The Feasibility Of Application For Routine
Screening In Low-Risk Population Needs To Be Explored.

***************

Maternal And Perinatal Outcome In Patient With Multiple Gestation

Author: Dr. Nilu Kumari
Co Author: Dr Banashree Das1, Dr Monika Rajput2, Dr Nikita Kumari3, Dr Gunjan Gulati4, Dr Ruchi Hooda5

Aims & Objective : To Study Maternal And Perinatal Outcome In Patient With Multiple Gestation.
Methods : This Retrospective Study Was Carried Out Over A Period Of One Year, Jan 2013 To Dec 2013, In Vmmc & Sjh,
New Delhi Which Is A Tertiary Care Centre, To Find The Maternal And Fetal Outcome In Multiple Gestation.
Result : There Were A Tolal Of 365 Women Diagnosed With Multiple Pregnancies, With Overall Incidence Of 1.4 %
During The Study Period And Was Highest In The Age Group Of 21 25 Yr ( 69 % ) . Out Of These Only 41.1% Patients
Had Antenatal Supervision . Family History Was Present In 20 % And History Of Ovulation And Induction In 5 %.
Commonest Obstetric Complication Is Preterm Labor ( 64 % ), Nutritional Anemia (55 % ) And Pregnancy Induced
Hypertension (14 % ) .Incidence Of Caesarean Section Was 26.9 % And The Commonest Indication For Caesarean Was
Malpresentation ( 43 .5 %) . Most Common Perinatal Complication Is Low Birth Weight. 49.8% Of Babies Had Birth Weight
Between 1.5 2 Kg And 7.35% Were > 2.5 Kg. Nicu Care Required By One Fourth Of Twins . Perinatal Mortality Was
11 .2 % Of Which 5.44% Early Neonatal Deaths . Extreme Prematurity And Very Low Birth Weight Predisposed Majority
Of Perinatal Death.
Conclusion : Multiple Gestation Is A High Risk Factor For Maternal And Perinatal Morbidity And Mortality . Preterm Labour
,Extreme Prematurity And Very Low Birth Weight Leading Factor For Perinatal Mortality In Patients With Multiple
Gestation.

***************

Association Of C677T And A1298C Polymorphism In The Mthfr Gene With Preeclampsia And Eclampsia In Pregnancy
Author: Dr. Shilpi Gupta
Co Author: Dr Sangeeta Gupta1, Dr Usha Manaktala2, Dr Seema Kapoor3, Dr .Vineeta V. Batra4,

Aims & Objective : To Evaluate Association Of C677T And A1298C Polymorphism In The Mthfr Gene With Preeclampsia
And Eclampsia In Pregnancy .

Materials And Methods : Twenty Five Patients With Singleton Pregnancy Diagnosed With Preeclampsia And Eclampsia
Were Recruited. Equal Number Of Women With Low Risk Pregnancy Were Taken As Controls. The Mthfr Genotypic
Analysis For Two Polymorphisms Mthfr C677T And Mthfr A1298C Was Done In All These Patients.

Results : Genotype Distributions For Mthfr C677T Were Observed In The Frequencies Of Cc Wild Homozygotes In 13
Cases Vs 14 Controls (52% Vs 56%) And Mutant Alleles (Combined Ct Heterozygotes & Tt Homozygotes)In 12 Cases Vs
11 Controls (48% Vs 44%) . This Difference Was Not Statistically Significant (P = .7773). Genotype Distributions For Mthfr
A1298C Were Observed In The Frequencies Of Aa Homozygotes In 8 Cases Vs 14 Controls(32% Vs 56%) And Mutant
Alleles (Combined Ac Heterozygotes And Cc Homozygotes ) In 17 Cases Vs 11 Controls (68% Vs 44%) . This Difference
Was Not Statistically Significant (P = .0875).

Conclusion : Mthfr C677T And A1298C Polymorphism Are Not Significantly Associated With Preeclampsia And
Preeclampsia. Results Of Our Study Give Us Impression That Mthfr A1298C May Closely Influence Pregnancy Outcomes
With P Value Of .0875. These Results Give Us Direction That Mthfr A1298C Has Higher Chances Of Association With
Preeclampsia In Indian Population.

***************

Aub In Perimenopausal Women-A Clinicopathological Study.

Author: Dr. Reena Pant
Co Author:

Aims & Objective Occurrence Of Menstrual Disorders Increases With Advancing Age . When Women Approach
Menopause , Cycles Shorten And Often Become Intermittently Anovulatory Because The Number Of Follicles Decreases
And Estadiol Levels Fall .
Aim Is To Study The Clinical And Histopathological Spectrum Of Endometrium In Abnormal Uterine Bleeding In
Perimenopausal Women Attending A Tertiary Care Hospital In Rajasthan .

Material & Methods A Prospective Study Was Conducted In The Department Of Obstetrics And Gynecology, S M S
Medical College , Jaipur . One Hundred And Fifty Perimenopausal Women With Different Patterns Of Abnormal Uterine
Bleeding Were Included In The Study . Detailed History Including - Mode Of Contraception , Previous D&C , Relevant
Medical History And Hormonal Treatment Was Documented . Abnormal Pelvic Examination Findings , D&C Findings And
Histopathological Description Of Endometrium Were Recorded . Inadequate Samples Were Excluded From The Study.

Results The Predominant Histological Finding Was Proliferative Endometrium (58%) , Followed By Secretory (20%),
Cystic Glandular Hyperplasia (7%), Complex Hyperplasia (2%),Atrophic Endometrium (2%) And Atypical Hyperplasia (1%).
Organic Lesions Were Found In About 9% Of Cases 4% Polyps, 3.3 % Chronic Endometritis & 2% Endometrial
Carcinoma .

Conclusion A Thorough Histopathological Workup Along With Clinical Correlation Is Essential To Rule Out Organic
Lesions In Perimenopausal Aub Cases.

***************

Comparison Of Oral, Vaginal And Sublingual Misoprostol For Induction Of Labour In Prom After 34 Weeks Of
Gestation
Author: Dr. Chandana Galidevara
Co Author: Dr.Latha Chaturvedula1, Dr.S.Habeebullah2,

Aims & Objective:

To Study The Efficacy And Neonatal Outcome Of Oral, Vaginal And Sublingual Misoprostol Used For Labour
Induction In Women With Prom After 34 Weeks Of Gestation.
Materials & Methods:
A Randomized Clinical Trial Of 246 Antenatal Women With Prom After 34 Weeks Of Gestation And Requiring
Induction Of Labour Was Conducted. The Women Were Randomized Into Three Groups To Receive Either 50g Oral
Misoprostol (N=80) Or 25g Vaginal Misoprostol (N=83) Or 50g Sublingual Misoprostol (N=83). The Dosage Was
Repeated Every 4 Hours Until Active Labour Was Established. A Maximum Of 4 Doses Was Allowed.
Results:
The Primary Outcome Measure - Mean Induction To Active Labour Interval Showed No Significant Difference In
The Three Groups. (7.52 Hours Vs 7.75 Hours Vs 7.68 Hours). The Mean Induction To Delivery Interval Was 10.9 Hours In
The Oral Group, 11.2 Hours In The Vaginal Group And 11.4 Hours In The Sublingual Group With No Significant Difference.
The Number Of Vaginal Deliveries, Instrumental Deliveries And Cesarean Sections Were Comparable
Mean Apgar Score At 1 Minute And 5Minutes Was Highest In The Vaginal Group .Vaginal Group Had Least Number
Of Neonates With Apgar Score <7 At 1 Minute Compared To The Other Two Groups Which Was Statistically Significant
(Apgar Score <7 At 1 Minute Oral Vs Vaginal Vs Sublingual, 16.2% Vs 7.2% Vs 20.5) But Apgar Score <7 At 5 Minutes
Was Not Significantly Different Among The Three Groups. (Apgar Score <7 At 5 Minutes Oral Vs Vaginal Vs Sublingual,
0% Vs 2.4% Vs 3.6%). Nicu Admission Rate Showed No Significant Difference.
Sublingual Group Had Higher Rates Of Hyperstimulation And Fetal Heart Rate Abnormalities But This Was Not
Statistically Significant. Vaginal Route Required Lesser Amount Of Drug And It Was The Least Expensive Of The Three
Routes.

Conclusion:
The Study Shows That Oral, Vaginal And Sublingual Routes Of Misoprostol Are Equally Effective For Labour
Induction In Women With Prom. Neonatal Apgar Scores Are Better With Vaginal Misoprostol.

***************

: Grandmultiparity: Is It Still A Challenge?

Author: Dr. Subrat Panda
Co Author: Subrat Panda1, Santasingh2, Ananya Das3, Gauri Sankar4,

Aims & Objective:to Analyse Pregnancy And Labour Outcomes In Multipara, Grand And Great Grand Multiparous
Women.
Study Design: A Retrospective Hospital -Based Study Was Conducted For 4 Years From January 2010 To December 2013.
Parturients Were Classified Into Three Groups: Multiparous; 14 Prior Deliveries, Grand Multiparous; 59 Prior
Deliveries And Great Grand Multiparous With > 10Deliveries. Stratified Analyses Included Multiple Logistic
Regression Models And 2 Test (2 Degrees Of Freedom), FisherS F Test (2 Tailed Tests).
Result: A Significant Linear Association Was Found For Socioeconomic Status And Antenatal Care In Women With
Increased Parity. Theere Was Linear Association Of Prevalence Of Anaemia (Hb,<7Gm%),Preterm Labour And Post
Dated Pregnancy With Extreme Parity, There Was A Weak Evidence Of Dystocia With Increased Parity, But Significant
Increase Of Caesarean Delivery With Increased Parity, Perinatal Morbidity And Mortality Was Not Increased With Extreme
Parity.
Conclusion: Extreme Parity Is Associated With Adverse Obstetric Outcome, But It Does Not Appear To Be An Independent
Risk Factor For Perinatal Outcome In The Setting Of Improved Socioeconomic Background And Good Perinatal Care.
.
***************

Isosorbide Mononitrate ( Nitric Oxide Donor)- A Study Of Its Role As An Agent For Cervical Ripening
Author: Dr. Anupama Dave
Co Author: Dr Priyanka Nigam1,

Aims & Objectives

To Study The Efficacy And Safety Profile Of Isosorbide Mononitrate (Imn) As An Agent For Cervical Ripening
Material & Methods
This Study Was Conducted In The Department Of Obstetrics & Gynaecology, M Y Hospital & M G M Medical College
Indore From September 2011 To February 2013. Pregnant Women Attending The Antenatal Clinics, Were Screened For
Possible Participation In The Study After Explaining The Nature Of The Study. It Was Conducted On 150 Patients .An Initial
Dose Of 40 Mg Imn Was Applied In The Posterior Vaginal Fornix And The Same Dose Was Repeated After 6 Hrs. Cervical
Ripening Was Assessed By The Change In Bishop Score 12 Hours After The Initial Application
Results
In A Study Of 150 Cases, Mean Maternal Age - 22.2 2.6 Year (Range: 19-35Years), Mean Gestational Age - 40.5 1.07
(Range: 40-42Weeks). 52 Women Were Primigravidas, While 98 Were Multigravidas), Mean Fetal Heart Rate Was 137
6.2 Bpm.The Mean Of Bishop Scores Before Imn Administration Was 1.94 1.3 And After Drug Administration Was
6.7 2.2; Mean Difference Was Equal To 4.76., P Value Equal To 0.0001. By Conventional Criteria, This Difference Is
Considered To Be Statistically Significant.
The Mode Of Delivery - 96 (64%) Delivered Vaginally While 54 (36%) Were Delivered By Cesarean Section. Mean Apgar
Score At One Minute Was 8.2 0.9 Sd (Range: 7-10), While Mean Apgar Score At 5 Minute Was 9.4 0.6 (Range: 810) The Only Side Effect Noted Was Headache, 30 Cases (20%) Complained Of Headache Which Was Tolerable.
Conclusion
Imn Seems To Be Effective, Safe, Inexpensive, And Well Tolerated Agent For Cervical Ripening. It Is Cost Effective
Compared To The Drugs Which Are Commonly Being Used And Comparatively Safe With Minimal Side Effects .

***************

To Correlate Serum Lactic Dehydrogenase Levels With Severity Of Disease In Patients Of Pre- Eclampsia & Eclampsia
And Feto- Maternal Outcome
Author: Dr. Smita Goswami
Co Author: Dr.Shreya Desai1, Dr.Neelu Soni2,

Aims & Objectives1. To Correlate The Severity Of Disease With Serum Lactic Dehydrogenase (Ldh) Levels In Patients Of Pre-Eclampsia And
Eclampsia.
2. To Correlate Serum Lactic Dehydrogenase (Ldh) Levels In Patients Of Pre-Eclampsia And Eclampsia With Perinatal And
Maternal Outcome.

Matrerials And MethodsThis Prospective Case Control Study Was Conducted In The Department Of Obstetrics And Gynecology At Choithram
Hospital And Research Centre, Indore. Observations Were Made On 100 Women Of Child Bearing Age Who Were Divided
Into Two Groups. Control Group (N=50): Normal Pregnant Women With>20 Weeks Of Pregnancy. Case Group (N=50):
Patients With Pregnancy Induced Hypertension Divided Into, Mild, Severe Preeclampsia And Eclampsia Sub-Groups.All
Women With Voluntary Informed Consent Were Followed Until Delivery And Early Post Partum Period And Babies Till
Early Neonatal Period. Parameters Observed Were-Maternal-Antepartum Complications, Mode Of Delivery, Post Partum
Complications. Fetal-Birth Weight, Maturity, Apgar Score, Intrauterine Growth Retardation, Mortality.
ResultsMean Serum Ldh Levels Were Significantly Higher With Severity Of Pre-Eclampsia.In Control Group Mean Ldh Levels
Were 274.36+/- 42.69.In Patients With Severe Pre-Eclampsia Mean Ldh Levels Were 1487.77+/- 1625.52 Which Is
Stastically Significant(P<0.001);Higher Blood Pressures Were Associated With Higher Serum Ldh Levels (P<0.05);Higher
Serum Ldh Levels Were Associated With Lower Neonatal Birth Weight(P<0.05).Mean Birth Weight Was 1271+/-384 In
Patients With Ldh >800Iu/L;Higher Serum Ldh Levels Were Associated With Low Apgar Score At 1 & 5 Minutes
(P<0.001);Higher Serum Ldh Levels Were Associated With Higher Numbers Of Iugr And Perinatal Deaths (P<0.05) And
Higher Numbers Of Maternal Complications (P<0.001).
ConclusionsElevated Levels Of Lactic Dehydrogenase Indicate The Cellular Damage, Dysfunction&Death, And Can Be Used As A
Biochemical Marker.It Reflects The Severity Of Disease, Fetal Outcome & Occurrence Of Complications Which Are
Preventable.Detection Of Such High Risk Cases Mandate Close Monitoring To Decrease Both Maternal And Fetal
Morbidity-Mortality.

***************

Plgf Assay As A Screening Test For Early Onset Preeclampsia-How Useful Is It?
Author: Dr. Pooja Mathur
Co Author: Dr Poonam Mathur1, Dr Laxmi Maru2, Dr Anupama Dave3,

Aims & Objectives :

To Study Incidence Of Women At Risk Of Developing Early Onset Preeclampsia By Plasma Placental Growth Factor
Biomarker Assay In High Risk Patients.
To Assess The Maternal Outcome In Patients With Plgf Values Below Cutoff For Presenting Gestational Age.
To Calculate Sensitivity, Specificity, Positive Predictive Value And Negative Predictive Value Of Plgf Assay In Predicting
Preeclampsia.
To Conclude Whether Plgf Biomarker Assay Can Be An Effective Screening Test In High Risk Patients For Prediction Of
Early Onset Preeclampsia.

Materials &Methods:
The Study Was Carried Out In The Department Of Obstetrics & Gynecology Of Mgm Medical College And M.Y. Hospital,
Indore. It Is A Prospective Study And Study Period Extended From April 2012 To October 2013.
100 Pregnant Women With 20-34 Weeks Gestational Age With Possible High Risk For Developing Preeclampsia Attending
The Antenatal Clinics, High Risk Opds Were Screened In The Present Study After Explaining The Nature Of The Study.Plgf
Concentration Was Quantitated Using Plasma And Processed In Triage Kit Device(Flourescence Immunoassay Device).Plgf
Concentration Were Categorised Against A Specific Range For Specific Gestation &Values Below The Range Or < 12 Pg/Ml
Were Considered Screen Positive. Follow Up Of Cases Done Till Delivery.
Results :
22 Cases Were Screen Positive Out Of Which 20 Developed Preeclampsia With A Strong Positive Prediction Value Of More
Than 90%.

Conclusion:
Plgf Is A Strong Predictor & A Useful Assay For Early Onset Preeclampsia.

***************

11-14 Weeks Anatomy Scan- Where Does It Stand?

Author: Dr. Elavarasi Elamaran
Co Author: Dr. Saly Daniel1, Dr.Regi George2, Dr.Sareena Gilvaz3, Dr. Annie Thadicaren4, Dr. Bindhu5

Aims & Objectives :

To Evaluate The Efficacy Of 11-13+6 Weeks Anatomy Scan, In Unselected Population, In Visualizing The Normal
Fetal Anatomy As Well As Detecting Fetal Anomalies Compared To Traditional Mid-Trimester Anatomy Scan.
Materials And Methods :
In This Prospective Observational Study Over A Period Of 12Months, 200 Singleton Pregnant Women Between
11-13+6 Weeks Participated. The Scan Was Performed By Transabdominal Route At First And Then, If A Full Fetal Anatomy
Survey Was Not Achieved, By Transvaginal Route. A Mid-Trimester Fetal Anatomy Scan Was Then Performed In Patients
Who Had Not Dropped Out, Miscarried Or Undergone Pregnancy Termination.
Results:
Complete Fetal Anatomical Surveys Were Achieved By Tas In 148(74%) Of Cases Versus 184(92%) Of The Cases
In Which It Was Attempted By Tvs(P < 0.01). Tvs Was Significantly Better In Visualizing The Cranium, Spine, Kidneys,
Bladder And Upper &Lower Limbs (P < 0.01). The Duration Of The Scan Was Significantly Longer Using Tvs. At The FirstTrimester Scan, Anomalies Were Detected In 6 Cases (5 Of These Cases The Parents Chose Pregnancy Termination). A
Single Additional Anomaly Was Detected In The Subsequent Mid Trimester Scan. Skull/Brain Abnormalities Were Found
In 2 Fetal Images, Renal Abnormalities In 1, Skeletal Abnormalities In 2 Images And Cardiac Abnormalities In 2 Fetal
Images.
Mean Maternal Age In Our Study Is 25.9 Years(+/-4.3) And 6Women Have Advanced(>35Yrs). Median Nt Is 1.58.
Increased Nt Is Found In 8(4%) Scans. Absent Fetal Nasal Bone Were Present In 6(3%) Women With Increased Nt
Compared To 2(1%) Women With Normal Nt.
Conclusion:
The 11-13+6 Weeks Anatomy Scan Is An Important Diagnostic Tool That Is Under Utilized &Should Be Offered To All
Pregnant Women As A Routine Standard Of Antenatal Care. However As Fetal Anomalies Can Present At Varying
Gestational Age, Standard 18-20 Weeks Anatomy Scan Cannot Be Abandoned.

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Efficacy Of An Integrated Bipolar And Ultrasonic Energy Device Thunderbeat In Total Laparoscopic
Hysterectomies
Author: Dr. Anusha Raaj
Co Author: Dr.Meenakshi Sundaram1,

Aims & Objectives :

A Retrospective Study To Evaluate Thunderbeat A Vessel Sealing Device In A Small Group Of Patients Undergoing
Laparoscopic Hysterectomy To Test The Safety And Efficacy In Achieving Hemostasis.
Materials & Methods:
Thunderbeat Was Used In 50 Cases Of Total Laparoscopic Hysterectomy. Management Of Intra-Operative
Bleeding By Achieving Hemostasis Using Various Methods Like Sealing, Coagulation, Cutting , Dissection, Tissue
Manipulation And Duration Of Surgery Were Evaluated. The Subjects Chosen For The Study Were Cases Of Abnormal
Uterine Bleeding With Clinically Normal Or Bulky Sized Uterus.
Results:
No Intra Operative And Post Operative Complications Were Encountered. A Significant Reduction In Total Operating Time
Was Also Observed.
Conclusion:
Thunderbeat Is An Efficient Vessel Sealer And Can Be Safely Used In Laparoscopic Hysterectomy With Immense Benefit
To The Patient.

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Role Of Vaginal Progesterone In Reducing The Rate Of Preterm Labour In Women With A Sonographic Short Cervix.
Author: Dr. Rabinarayan Dash
Co Author: Dr. Kirti Rekha Mahapatra1,

Aims & Objectives :

To Determine The Efficacy & Safety Of Using Micronized Vaginal Progesterone To Reduce The Risk Of Preterm Birth &
Associated Neonatal Complications In Women With A Sonographic Short Cervix.
Materials & Methods :
This Is A Hospital Based Case Control Study Which Included Antenatal Mothers With Singleton Pregnancy Between 19+0
To 23+6Wks With A Sonographic Short Cervix (10Mm 25Mm ) With Or Without History Of Preterm Birth Or
Midtrimester Abortion As Cases Who Were Treated With Micronized Vaginal Progesterone Till 36Wk Or Rupture Of
Membrane Or Delivery Whichever Is Earlier . The Control Group Included Subjects Similar To Case Group But Without
Any History Of Preterm Birth Or Midtrimester Abortion, Not Treated And Were Followed Up Till Delivery. The Primary
Outcome Of Study Is The Incidence Of Preterm Birth( Before 37Wks) Among Both The Groups . The Secondary Outcome
Was The Associated Neonatal Complications.
Results :
Out Of The 100 Cases Studied, Among Case Group Term Deliveries Occured In 81.7% (N=49), Preterm Birth Occurred In
18.3%(N=11) Whereas In Control Group Term Deliveries Occurred In 60%(N=24),Preterm Birth Occurred In 40%(N=16)
With A P Value Of 0.017. Progesterone Treatment Also Reduces Incidence Of Preterm Birth Before 34Wks I.E.
19.2% In Case Group Vs 25% In Control Group.Progesterone Treatment Is Also Associated With Improved Neonatal
Outcomes.
Conclusion :
The Administration Of Micronized Vaginal Progesterone To Women With A Sonographic Short Cervix In The MidTrimester Is Associated With A Significant Reduction In The Rate Of Preterm Birth And With Improved Neonatal Outcome.

***************

A Critical Review Of Aetiological Factors In Infertility By Diagnostic Laparascopy

Author: Dr. Priya Jayasingh
Co Author: Dr P. Srilekha1, Dr B.Pande2, Dr P. Khuntia3,

Aims & Objectives- The Present Study Was Carried Out To Evaluate The The Different Aetiological Factors, Mostly The
Tubal Factors, Ovarian Factors, Peritoneal Factors And Other Associated Pelvic Pathology By Diagnostic Laparascopy.
Material Methods- This Study Was Carried Outin The P.G. Department Of Obstetrics And Gynecology Of Vss Mch,
Burla,During The Period Of 2013 June To 2014June, Including A Total 52 Numbers Of Infertile Females Attending Opd.
Results- In The Study Majority Of Patients(41) Were Primary Infertility Cases And Maxiumum Number Of Infertile Patients
Were In The Age Group Of 21-30Yrs. The Duration Of Infertility Was Less Than 5Years In Majority Of Patients. From Total
Of 51 Cases Laparascopic Finding Was Normal In 18(35.29%) And Abnormal Finding In 33(64.70%) Cases. Gross Tubal
Pathology Was Found In 14(27.45%) Ovarian Pathology In 7(13.72%), Endometriosis In 5(9.8%) And Suspected KochS
Disease Was Found In 6(11.76%) Cases. Tubal Patency Was Present In 31(60%) Of Cases And Some Variety Of Block Was
Found In40% Of Cases. In 5(9.8%) Cases There Was Some Uterine Anomally. There Are Very Few Milder Complications Of
Subcutaneous Emphysema, Port Site Bleeding And Wound Inection Each In One Case. In 1 Patient There Was Failure To
Create Pneumoperitoneum Due To Obesity.
Conclusion- In Conclusion, Diagnostic Laparascopy With Chromopertubation Is The Optimum Method, Not Only Assessing
The Tubal Pathology But For Discovering Other Hitherto Unsuspected Disease Of Possible Significance To The Infertile
Couple. Though Other Investigative Procedures Like Tvs With Hysteroscopy Can Give Some Added Advantage In Terms
Of Cost Effectiveness And Non-Invasive Nature, But The Diagnostic Laparascopy Done By An Experienced And Vigilant
Surgeon With Proper Safety Measures Can Detect Many Unseen Aetiological Factors With Minimum Complications.
Therefore It Is The Gold Standard And Should Be A Primary Method Of Investigation In Female Infertility Work Up.

***************

Effect Of Low Forceps Delivery On Lscs Rates

Author: Dr. Vaijayanti Bhoraskar
Co Author: Vaijayanti Bhoraskar1, Dr.Purva Kataria2, Dr.Najneen Akhtar3,

Aims & Objectives To Asses The Effects Of Low Forceps Deliveries On Lscs Rates.
Materials And Methods:-A Retrospective Analytical Study Was Done At A Private Hospital Data During The Period From
October 2010 To April 2014 Was Analyzed. Total 4184 Patients Ware Delivered: Out Of Which 2578 Had Normal Vaginal
Delivery , 105 Had Ventouse Assisted Vaginal Delivery 1301 Were Delivered By Lscs, 200 Had Forceps Out Of Which 68
Were Delivered By Outlet Forceps And 132 Were Delivered By Low Forceps Application. Assuming That Patients Delivered
With Low Forceps Application Would Otherwise Land Up In Lscs And Those Delivered With Ventouse Or Outlet Forceps
Application Could Deliver By Vaginal Route Only Those Delivered With Low Forceps Were Considered In The Calculations.
Also Maternal Complications Were Compared.
Results The Lscs Rate As 31.1% Which Otherwise Would Have Been 34.1% If These Patients Underwent Lscs. This
Difference Was Found To Be Statistically Significant By Application Of Both Chi Square Test And S.E. Of Difference
Between Proportions. The Complication Rates Were Comparable Except Slight Increase Incidence Of Pain In Stitches For
Short Duration.
Conclusion:- Application Of Low Forceps Significantly Reduces The Lscs Rates Without Increasing Neonatal Or Maternal
Complications.

***************

Antibiotic Prophylaxis In Emergency Lscs

Author: Dr. Nitika Sharma
Co Author: Nitika Sharma1, Bengia Chirchi2, Banushree Das3,

Aims & Objectives- To Compare The Incidence Of Wound Infection After 24 Hours And 5 Days Course Of Antibiotic In
Women Undergoing Emergency Lscs.
Material & Methods- The Study Was Conducted In The Department Of Obstetrics & Gynaecology In Vmmc & Safdarjung
Hospital From November 2014 To January 2014. A Total Of 200 Patients Undergoing Emergency Lscs Without Any High
Risk For Infection Were Recruited In The Study. Patients With Leaking Per Vaginum For More Than 24 Hours, Dai Handling,
Obstructed Labor, Patients With Anaemia, Diabetes, Hiv Or Any Other Systemic Or Local Infection Were Excluded From
The Study. Out Of Which, 100 Patients Were Given Antibiotics For 24 Hours (Group A) Following Lscs And The Rest 100
Patients Were Given 5 Days Course Of Antibiotics (Group B). Their Outcome Was Compared In Terms Of Wound InfectionFever, Signs Of Inflammation, Discharge From Wound And Wound Gape Or Burst Abdomen.
Results-In Group A, 12 Patients Had Serous Discharge From The Stitch Line And 2 Patient Had Developed Fever With
Purulent Discharge From The Stitch Line, Whose Wound Gaped Requiring Resuturing, Antibiotic Course Was Restarted
According To The Culture And Sensitivity. In Group B, 8 Patients Had Minimal Serous Discharge From The Stitch Line And
2 Patient Had Gaped Wound Requiring Resuturing. None Of The Patient Had Burst Abdomen. Hence, 14(14%) Patients In
Group A And 10 (10%) Patients In Group B Developed Wound Infection.
Conclusion- The Incidence Of Wound Infection In Patients Receiving 24 Hours Antibiotics Is Comparable To Patients
Receiving 5 Days Antibiotics.

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A Study Regarding Knowledge, Source Of Information And Health Education In Menstrual Hygiene Among Young
Girls.
Author: Dr. Madhulatha Alexander
Co Author:

Aims & Objectives-

1) To Study The Awareness And Beliefs Regarding Menstrual Hygiene In Two Lower Socio- Economic Areas In Hyderabad.
2) To Find Out The Main Source Of Knowledge Regarding Menstruation And Menstrual Hygiene In Young Girls And To
Empower Them To Ensure Change
Methodology-

A Target Population Was Selected In Urban Hyderabad. Young Girls ( Both Married And Unmarried) In The Age Group Of
15-25 Years Were Included. A Pretested Questionnaire Was Then Distributed Among The Population. After Collecting The
Filled Questionnaire, An Informal Chat Was Organized Among The Girls. They Were Educated About Menstruation And
Menstrual Hygiene. The Data Was Analysed By Simple Proportions.

Results & Conclusions-

The Girls Who Were Selected Were Below The Poverty Line. In Spite Of This, The Majority (98 %) Were Using Disposable
Pads. Personal Hygiene Was Adequate, But The Method Of Disposal Seemed To Be Inadequate (58 %). The Source Of
Information About Menstruation Was The Peer Group In The Majority Of Girls (82%). When The Principals Of The Schools
That These Girls Attended Were Questioned About Health Education On This Aspect, They Were Rather Vague In Their
Answers.

When Informal Health Education Talks Were Given (After The Questionnaire Was Collected), The Interactive Sessions
Were Very Heartening. The Girls Expressed The Need For More Information About Sex, Family Planning And Also Asked
Intelligent Questions. Menstrual Hygiene And Sex Is Still A Taboo To Be Discussed In Schools. So, If A Change Has To
Brought About In The Population, Health Education Should Be Given To All Girls First Hand Preferably In Schools Within
Their Peer Groups.

***************

Optimizing Preterm Labour

Author: Dr. Kusum Kusum
Co Author: Dr Harbhajan Kaur Shergill1, Dr Amrit Pal Kaur2,

Aims & Objectives

1.

To Identify The Etiological Factors Of Preterm Labour,

2.

Line Of Management Of Preterm Labour,

3.

Outcome Of Treatment In Prolonging Pregnancy,

4.

To Assess The Neonatal Mortality And Morbidity Associated With Preterm Labour.

Material & Methods

This Study Was Conducted On 100 Patients Presenting With Preterm Labour In Deptt. Of Obstetric & Gynaecology Gmc,
Amritsar From Nov. 2012 To Sept.2014. The Patients Were Evaluated By History Taking, Clinical Examination, Lab Tests,
Ultrasonography Reports. They Were Managed Accordingly With Rest, Sedation, Tocolysis, Progesterone, Antibiotics
With Probiotics, Inj, Steroid Along With Inj. Vit.K & Cervical Encerclage( Where Needed) To Get The Favourable Outcomes
& To Prolong Pregnancy To Optimum Time Period.
Results
Out Of 100 Patients Presented With Preterm Labour ( 10 Were Having Twin Pregnancies), 73 Delivered At Term And 27
Delivered Before Term (<37 Weeks) After Investigating The Cause And Managing Them Accordingly. Out Of Total 110
Delivered Newborns, 16 Of Preterm Delivered Babies Were Admitted & 3 Babies (<30 Weeks Of Gestation) Died Due To
Rds. Various Contributing Factors Like Age ( P Value 0.145), Height ( P Value 0.001), Years Of Marriage( P Value 0.007),
Effect Of Therapy On Prolongation Of Preterm Labour ( P Value 0.000) Etc. Were Studied. Urine And Vaginal Culture Swab
Were Found Positive In 13% & 24% Respectively.
Conclusion
As It Is Seen That Preterm Labour And Delivery Have A Considerable Health Impact, Because They Are One Of Leading
Cause Of Perinatal Morbidity And Mortality. Various Risks Factors That Lead To Preterm Labour Are Identifiable. Early
Identification Of Risk Factors And Early Interventions Can Improve The Neonatal Outcome. Prolonging The Pregnancy
With Tocolysis Has The Advantage Of Gaining Time For Antenatal Steroid Prophylaxis Which Improves Neonatal Outcome.

***************

To Compare The Effect Of Oral And Parenteral Iron In Correction Of Post Partum Anaemia
Author: Dr. Neha Tibrewal
Co Author:

Aims & Objectives

To Compare The Effect Of Oral And Parenteral Iron In Correction Of Post Partum Anemia

To Compare The Effect Of Iron Sucrose And Ferric Carboxymaltose

To Compare Cost Effectiveness And Patient Acceptability Of Various Iron Preparations

Materials & Methods

150 Cases Of Postpartum Anemia Were Selected From Outdoor And Indoor Patients At Department Of Obstetrics And
Gynaecology Of Bebe Nanki Mother And Child Care Hospital Attached To Govt. Medical College, Amritsar. Participants
Were Allocated In Random Sequence To Receive Oral Iron Or Iron Sucrose Or Ferric Carboxymaltose In The Ratio Of 1:1:1.
Inclusion Criteria
Presence Of Postpartum Anemia Hb< 10 Gm/Dl
Proven Iron Deficiency (Serum Ferritin <15 G/L)
All The Investigations Done 24-48 Hrs After Delivery
After Selecting Patients On The Basis Of Investigations Like Hemoglobin,Peripheral Blood Smear, Serum Ferritin
Estimation And Ruling Out Other Causes Of Anemia By Performing Urine C/E And Stool For Ova Cyst Patients Will Be
Randomly Allocated To One Of The Three Intervention Groups A. Patients Receiving Oral Iron Preparation B. Patients
Receiving Iron Sucrose And C. Patients Receiving Ferric Carboxymaltose

Results
Iron Carboxymaltose Was As Effective As Oral Iron Sulfate In Changing Hemoglobin, Despite The Much Shorter Treatment
Period. Ferritin Levels Were Significantly Higher. Iron Carboxymaltose And Iron Sucrose Were Better Tolerated Than
Ferrous Sulfate, Mainly Concerning Gastrointestinal Side Effects.

Conclusion
Lack Of Iron Supplementation During Pregnancy And Postpartum Hemorrhage Are Important Causes Of Postpartum
Anemia(Ppa). It Is Important To Treat Ppa As It Causes Decreased Physical Endurance In Mothers, Impair Mother-Child
Bonding, Increase Maternal Morbidity And Also Increase The Risk Of Iron Deficiency In The Next Pregnancy. Parenteral
Iron Supplements Have Unique Advantages Over Oral Iron And Can Correct Iron Deficiency Anemia At Faster Rate.

***************

Comparative Study Of Labetalol Vs Methyldopa In Management Of

Author: Prof. Jayanthy Thammiah
Co Author: Dr.Kirana T1, Dr.Nirmala S2,

Pre Eclampsia

Aims & Objectives

To Compare The Efficacy And Safety Of Labetalol With Methyl Dopa In Preeclampsia In Relation To1)Control Of Blood Pressure
2) Prevention Of Convulsions
3) Prolongation Of Pregnancy

Materials & Methods

A Total Of 100 Patients Were Included In The Study.Group A (50 Cases) Were Treated With Of Labetalol (200Mg To Max
Of 2400Mg) And Group B ( 50) Received Methyldopa(1000Mg To 2000Mg). If Bp Was Not Controlled Treatment Was
Taken As Failure And Additional Drugs Given.
Necessary Investigations Done.Steroid Prophylaxis For Fetal Lung Maturity Given When Ga Was < 34 Weeks.
Patients Were Followed Up Till Delivery.
The Efficacy Of Drugs In Controlling Bp, Side Effects, Dosage Required, Pregnancy And Fetal Outcome Were Noted.

Results
Control Of Blood Pressure Was Faster,Additional Drugs Required Was Less, With Labetalol As Compared To Methyldopa.

Side Effects Like Drowsiness,Postural Hypotension And Head Ache Was More Common With Methyldopa.
There Was No Difference In Mode Of Delivery.But Spontaneous Labor Was More In Labetalol Group.
No Difference In Fetal Outcome.

Conclusion
Labetalol Is Very Effective And Causes Early Control Of Blood Pressure,Fall In Map Was Statistically Significant.Pregnancy
Can Be Prolonged.Side Effects Are Less Compared To Methyldopa.
Spontaneous Onset Of Labor Was More In Labetalol Group.
Labetalol Is Safe,Quicker Control Of Bp,Has Fewer Side Effects Compared To Methyldopa.

***************

Making Induction Of Labour More Successful How It Can Be Achieved?

Author: Prof. Rahul Mayekar
Co Author: Dr. Nandanwar Ys1, Dr. Bansal Richa2, Dr. Bhosale Archana A3,

Aims & Objectives

To Evaluate The Bishops Score And Use It Conjunction With The Ultronographic Status Of The Internal Os For Facilitating
Induction Of Labour.

Material & Methods

The Study Was Carried Out In Tertiary Teaching Centre Of Mumbai In Pregnant Patients At Term With Single Fetus And
Vertex Presentation And No Contraindication For Vaginal Birth. Only Primi Gravid And Second Gravidas Were Included.
Bishops Score Was Evaluated And In Addition Ultrasonography Was Performed To Evaluate The Status Of The Internal
Os. Induction Was Carried Out By Approved Methods Based On A Combination Of Both Findings. Duration Of Latent
Phase, Active Phase, Augmentation Dosage And Time, Maternal And Fetal Effects Were Noted.

Observation & Results

A Total Of 100 Patients In Each Group ( Primi And Second Gravida ) Were Enrolled. 130 Patients Had Pre Induction Score
<3. 43 Had A T Shaped Internal Os And Took Longer To Deliver As Compared To The U Shaped Internal Os. The Incidence
Of Lscs Was Also More In The T Shaped Internal Os Status. When Patients With T Shaped Internal Os Were Primed With
Foleys Manual Traction, They Fared Better.

Conclusion
If The Methods Of Induction Are Combined In Accordance To The Internal Os Status In Conjunction With Bishops Score
The Outcome Of Labour Cannot Only Be Better But Can Also Be Better Predicted, Thus Avoiding Maternal And Fetal
Morbidity

***************

Role Of Socio- Demographic And Obstetric History In Spontaneous Preterm Prediction And Prevention
Author: Dr. Rujul Jhaveri
Co Author: Dr. Rujul Jhaveri1, Dr. Trupti Nadkarni2, Dr. M. J. Jassawalla3, Dr. Sarita Bhalerao4,

Aims & Objectives

To Study Association Between Socio-Demographic And Obstetric Factors And Preterm Labour
Material & Methods
This Was A Prospective Observational Study Involving 150 Women Presenting To The Emergency Department With
Complaints Suggestive Of Preterm Labour. A Detailed History Was Taken To Include Individual Socio-Demographic And
Obstetric Data (Age, Height, Weight, Parity, History Of Cigarette Smoking Or Illicit Drug Abuse, Occupational History For
Prolonged Standing Or Walking Or Long Commuting Hours, Family History Of Preterm Labour, Obstetric History E.G.
Previous History Of Preterm Labour Or D& C For Spontaneous Or Induced Abortion Or Cervical Cerclage, Multiple
Pregnancy, Vaginal Bleeding). Standard Care For All Patients With Threatened Preterm Labour Was Administered To All
Patients And Obstetric Outcomes In Terms Of Control Of Preterm Labour With Routine Management And Delivery Within
48 Hours Of Admission Were Observed.
Results
The Odds Of Preterm Labour Are Significantly Higher With Strenuous Activities (Odds- 3.982). The Odds Are Higher With
Working Outside Home (Odds-3.52), Long Commute Hours (Odds- 3.077) And In The Presence Of Any Dental Problems
(2.767), But Not Statistically Significant.
Also The Odds Of Preterm Labour Were Significantly Higher In Women With History Of Previous Preterm Labour Or
Delivery (Odds- 1.822) And With History Of Previous Dilatation And Curettage (Odds-2.336). The Odds Are Also Higher
With Short (Odds-1.538) Or Long (Odds-1.36) Interval Between Two Pregnancies And With History Of Previous Late
Abortion (Odds-1.365), But Not Statistically Significant
The Odds Of Preterm Labour Being Were Significantly Higher In Multiple Pregnancies (Odds-5.027). Though, The Odds Of
Preterm Labour Were Higher With History Of Cervical Cerclage, History Of Vaginal Bleeding And Pre-Pregnancy Low Bmi,
They Were Not Statistically Significant.

Conclusion
Socio-Demographic And Obstetric History Play A Small But Important Role In The Prediction Of Preterm Labour.
***************

A Comparitive Study Between Ultrasound And Endoscopic Findings In Abnormal Uterine Bleeding
Author: Dr. Shimanku Maheshwari
Co Author: Dr. Shimanku1, Dr. Manjit Kaur Mohi2, Dr. Manjeet Kaur3, Dr. Balwinder Kaur4, Dr. Jaswinder Kaur Mohi5

Aims & Objectives.

To Evaluate The Causes Of Abnormal Uterine Bleeding (Aub) With Ultrasound (Usg) And Endoscopic Methods And To
Compare The Above 2 Methods With The Findings On Histopathology Which Is The Gold Standard Method.

Materials And Methods

A Prospective Study Was Carried Out In The Department Of Obstetrics And Gynaecology , Rajindra Hospital, Patiala From
December 2012 To September 2014. 75 Cases Were Selected For This Study From Patients Attending The Opd Or
Admitted With The History Of Abnormal Uterine Bleeding During This Period. After Taking Detailed History And
Examination , Usg Was Done And The Patient Further Evaluated By Endoscopic Procedures (Laparoscopy, Hysteroscopy
Or Both The Procedures) And Histopathology. Data Recorded Was Analyzed Statistically To Find Out The Usg, Endoscopic
(Laparoscopy And Hysteroscopy ) Findings And Their Comparison With The Histopathological Findings.

Results :
Out Of 75 Cases, The Mean Age Of Patients Was 41.2 Years . 58.6 % Of Patients Were From Rural Background. The Most
Common Symptom With Which Patients Presented Was Menorrhagia (48 % ) , Polymenorrhagia (14.6 %) And
Metrorrhagia (13.3 %) And Others (24.1 %) . The Average Bmi Of These Patients Was Found To Be 27.45 . The Most
Common Abnormality On Histopathology Was Hyperplasia (14.6 %) , Followed By Submucous Fibroid (12 %). The
Relationship Between Results Of Usg And Endoscopic Findings And Usg With Histopathology With P Value 0.000 And
0.046 Respectively Was Significant , While Between Endoscopy And Histopathology With P Value 0.056 Was Not
Significant.

Conclusions : Laparoscopy Can Be Complimentary To Hysteroscopy In Evaluation And Management Of Patients With Aub
And These 2 Endoscopic Methods Together Have A Better Diagnostic Value Than Usg Especially In Case Of Structural
Lesions When Compared With Histopathology.

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Why Do Mothers Demand Cesarean Section In A Normal Healthy Pregnancy?

Author: Dr. Hafizur Rahman
Co Author:

Aims & Objectives: To Investigate The Psychological, Social And Demographic Factors Associated With Cesarean Section
On Maternal Demand.
Materials & Methods: It Was A Cross-Sectional Questionnaire Based Survey Conducted In The Department Of Obstetrics
And Gynaecology At Sikkim Manipal Institute Of Medical Sciences, Gangtok From January 2014 To September 2014
Among Full Term Pregnant Women Who Requested For Cesarean Section Without Any Medical Or Obstetric Indication.
Results: Mean Ages Of The Pregnant Women Were 25.4 Years And Most Were Primigravida Belonged To Urban Hindu
Family. The Rate Of Cesarean Section During The Study Period Was 56.2%. The Most Common Indication For Cesarean
Section Was Maternal Demand (47.2%) Followed By Fetal Distress. In Most (83%) Of The Cases Decision For Cesarean
Section Was Taken By Women Herself, Followed By Influence From Husband And Other Relatives. The Common Reasons
Offered For Demanding Cesarean Sections Were Fear Of Labour Pain (92%), Unpredictable Nature Of Normal Labour
(76.4%), Wanted To Deliver In Planned Date And Time; Cesarean Section Is Considered Safe For Baby And Easier To Get
Back To Sexual Activity. Most Of The Participants (69.7%) Were Not Aware Of Any Short Term Or Long Term Risks Of
Cesarean Section. Given An Enough And Adequate Explanation 53.3% Responded That They Would Not Change Their
Decision While 39.2% Responded That They Would Have Given A Thought For Trial Of A Normal Delivery While Rest
Were Unsure About It.

Conclusion: There Was High Rate Of Cesarean Section Among The Women Studied, The Most Of Which Contributed By
Maternal Demand. The Most Common Two Psychological Reasons Offered By The Women For Demanding Cesarean
Delivery Were Fear Of Labor Pain And Concern About Unpredictable Nature Of Normal Labour. This Is An Important
Finding And Should Be Taken In To Consideration While Counseling Women Regarding Mode Of Delivery.

***************

Safe Surgery Saves Lives A Good Initiative

Author: Dr. Rajani Sharma
Co Author:

Aims & Objectives:

Safe Surgery Saves Lives Is A Good Initiative To Reduce Number Of Surgical Deaths Across The World. Adverse
Events In Patient Who Have Undergone Surgery Constitute Large Proportion Of Iatrogenic Illness. Most Surgical Safety
Interventions Have Focused On The Operating Room.Since More Than Half Of All Surgical Errors Occur Outside Operating
Room, More Substantial Improvement In Outcomes Can Be Achieved By Targeting The Entire Surgical Pathway.
Aim: 1. To Use The Surgical Patient Safety System (Surpass) Checklist As A Tool To
Unnecessary Surgical Deaths & Complications.

Improve The Safety And Reduce

2. To Address Implementation Of Surpass Checklist To Improve Anaesthetic Safety

Surgery, Avoid Surgical Site Infections & Improve Communication Within The Team.

Practices, Ensure Correct Site

Materials And Methods:

We Examined Effect On Gynaecological Patient, Maternal & Foetal Outcome Of A Comprehensive,Multidisciplinary
Surpass Checklist,Including Items Such As Medication, Marking Of Operative Side, And Use Of Post Operative
Instruction.The Checklist Was Implemented In Our Institution With High Standards Of Care.
All Complications Occurring During Admission Were Documented Prospectively.We Compared Rate Of Complications
During A Baseline Period Of 1 Year With The Rate During A 1 Year Period After Implementation Of The Checklist While
Accounting For Potential Confounders. Similar Data Were Collected From Control Group.
Results:
In A Comparison Of 3560Patients Observed Before Implementation Of Checklist With 3620 Patients Observed After
Implementation, Total Number Of Complications Per 100 Patients Decreased From 27.3% To 16.7%, For An Absolute Risk
Reduction Of 10.6%. Mortality Decreased From 1.5% To 0.8%, For An Absolute Risk Reduction Of 0.7%.
Conclusion:
The Use Of This Comprehensive Surpass Checklist Is Associated With Reduction In Complications And Mortality Among
Patient Undergoing Surgery In Hospitals With High Baseline Standard Of Care.

***************

Prescription Event Monitoring (Pem) Study To Assess Safety Profile Of Oral Natural Micronized Progesterone
Sustained Release In India
Author: Dr. Meenakshi Ahuja
Co Author: Krishnaprasad K Dr1,

Aims & Objectives:

Early Pregnancy Loss Remains An Enigma Representing Tremendous Clinical Challenge Since Only 30% Of The Conceptions
Progress Towards Live Births. After Ruling Out Other Confounding Factors, Sustenance Of Pregnancy With Supplementary
Progesterone Represents Important Therapeutic Strategy. Once A Day Oral Administration Of Nmp Is Designed To
Improve Patient Compliance While Achieving Adequate Systemic (Sr. Prog Levels 14 Ng/Ml) And Therefore
Subsequent Local Concentrations As Suggested By Mhra (2008). A Pem Study Was Conducted To Further Understand The
Safety Profile Of Oral Nmp Sustained Release Formulation Especially Central Side Effects In The Out-Patient Settings Of
India.

Materials & Methods:

Pem Study Is A Method Employed Worldwide To Provide Useful Safety Information On The Drug When Prescribed In
Real-World Clinic Settings. Patients With Bad Obstetric History (Boh) Or Unexplained Infertility Were Prescribed
400 Mg Sr Once A Day With Sr. Progesterone Levels Assessed In All Patients On Day 22+/-1 Of Cycle. Safety Information
Related As Events Were Captured On The Study Questionnaire Sheet Provided To 20 Doctors Across India For
Hundred Patients Between January And March 14.

Results:

Data From 91 Patients Was Analyzed Representing Mean Of 29.8 Yrs & 61.3 Kgs. Sixty (66%) Had Unexplained Infertility
While Rest Had Boh (</=3 Abortions) Or Threatened Abortion. The Mean Sr. Progesterone Levels Achieved Was 38.9
Ng/Dl. Similarly Sr. Progesterone Levels Of 14 Ng/Dl Were Achieved By 100 And 96.1% Patients In Boh Or Stimulated
Iui Cycle Group Respectively. The Formulation Was Well Tolerated With Side Effects Including Drowsiness (N=1),
Giddiness (N=5) And Nausea (N=5) That Were Mild And Transient. Oral Nmp Sr 400 Mg Was Prescribed For 4 To 12 Weeks
Depending On The Outcome

Conclusion:

Clinical Use Of Oral Nmp Sr Offers Sustained Therapeutic Levels While Improving Patient Compliance In Patients With
Unexplained Infertility Or Boh.

***************

Fetomaternal Outcome In Cases Of Premature Rupture Of Membrane

Author: Dr. Sneha Sethy
Co Author: Dr Mamata Samal1, Dr Praniti Pradhan2, Dr Chintamani Mohanta3, Dr Mamata Soren4, Dr Kumudini
Pradhan5

Aims & Objectives: The Aim Of The Study Is To Detect The Premature Rupture Of Membrane Cases Promptly So That Early
Intervention Can Be Made To Minimise The Maternal & Perinatal Morbidity & Mortality.
Materials & Methods : The Present Study Was Undertaken In The Department Of Obstetrics & Gynaecology ,Vss Medical
College Hospital , Burla , Sambalpur, Odisha During The Period From December 2013 To July 2014. The Present Study
Comprised Of 104 Patients With Pregnancies After 37 Completed Weeks Of Gestation With Complain Of Watery
Discharge With At Least One Hour Of Latent Labour. After Admission To Indoor Or Labour Room A Detailed History &
Thorough General, Abdominal & Pelvic Examination With Routine Haematological Examination With Urine For Culture &
Sensitivity Was Sent. The Diagnosis Was Confirmed By Arborisation Test Of Vaginal Fluid.
Result : In This Controlled Prospective Study Maximum Patients Had A Latent Period Of 0 To 12 Hrs & The Most Important
Indication Of Caesarean Section Was Fetal Distress. There Was A High Incidence Of Perinatal Morbidity & Mortality Of
30.18% & 11.32% Respectively & Ill Effects Are Directly Proportional To The Latent Period.
Conclusion : Premature Rupture Of Membranes Is A Significant Obstetric Problem Hence All Cases Of Prom Should Be
Treated Early & Seriously To Minimise The Adverse Maternal & Fetal Effects.

***************

Fetomaternal Outcome With And Without Combined Spinal- Epidural Analgesia In Normal Labour
Author: Dr. Nishu Dhingra
Co Author: Dr Sujata Sharma1, Dr Upasana Oberoi2,

Aims & Objectives: The Purpose Of The Study Was To Compare The Maternal Outcome In Terms Of Duration Of Second
Stage Of Labour And Mode Of Delivery And Neonatal Outcome In Terms Of Apgar Score At 1,5 And 10 Minutes With And
Without The Combined Spinal-Epidural(Cse) Analgesia In Normal Labour.
Materials & Methods: In This Study,100Nullipara Patients With Singleton Pregnancy, Term Gestation, Cephalic
Presentation, Scheduled For Normal Vaginal Delivery Were Divided Randomly Into Two Groups A&B Of 50 Patients Each.
Groupa Received Combined Spinal-Epidural Analgesia At 3-5Cm Cervical Dilatation As A Method Of Pain Relief With
Levobupivacaine 2.5Mg And Fentanyl 25g While Group B DidnT Receive Any Analgesia. First Stage, Second Stage
And Total Duration Of Labour Were Noted. Mode Of Delivery Was Also Recorded In Both Groups. Patient Satisfaction
Was Assessed By Interviewing The Parturient After Delivery.
Results: In Group-A, Duration Of First Stage Of Labour Was 601.8097.38 Minutes And In Group-B, It Was 604.9869.08
Minutes,(P=0.858). Second Stage Of Labour In Groupa Was 135.0919.14 Minutes And In Group-B It Was
99.0417.21Minutes; (P=0.000).Total Duration Of Labour, In Groupa Was 743.02101.52 Minutes And In Groupb It
Was710.5973.769 Minutes,(P=0.085). Rates Of Normal Vaginal Deliveries Respectively In Group A And B Were 39/50
(78%) And 44/50 (88%) While Instrumental Deliveries In Both Groups Were 3/50 (6%) And 1/50 (2%) Respectively While
8 And 5 Patients Had To Be Taken Up For Caesarean In Groupa Group B Respectively,(P=0.369). None Of The Babies In
Both Groups Had Apgar Score<7.Patient Satisfaction Was Excellent In 96% Parturients Of Groupa.
Conclusion: Cse Is An Effective Method Of Labour Analgesia With No Harmful Effects On Mother And Fetus Except For
Slight Prolongation Of Second Stage Of Labour.

***************

Evaluation Of Adnexal Masses By Sonography And Mri In Postmenopausal Women: A Comparative Analysis
Author: Prof. Madhu Jain
Co Author: Shivi Jain1, Rc Shukla2, Ashish Verma3,

Aims & Objectives: To Compare The Diagnostic Accuracy Of Usg And Mri In Determining The Nature Of Adnexal Masses
In Post-Menopausal Women.
Materials & Methods: 180 Post-Menopausal Patients, With Clinically Suspected Adnexal Masses, Underwent Usg (Taus
And/Or -Tvus), Combined Usg & Doppler, And Mri With Their Categorization Into Benign, Malignant Or Indeterminate.
Chi-Square Test Was Used To Find Out Significant Association Between The Variables.The Final Diagnosis Was Established
By Per-Operative Findings And/Or Histopathology And Kappa Statistics Determined Agreement Between Each Imaging
Method & Final Diagnosis. The Data Analysis Was Done Using Spss-16 System.
Results: Out Of 230 Adnexal Masses (Bilateral In 50 Patients), 196 Were Benign And 34 Malignant. Accuracy Of Mri For
Characterizing Lesions As Malignant Was 95.1% Compared To That Of Usg Alone Which Was 82.5% And Of Combined
Usg & Doppler Which Was 90.3%.The Agreement With The Final Diagnosis Was poor For Usg Alone (= 11.5 )
Which Became good By Combining Doppler (= 59.0). However, excellent Agreement Was Seen With
Mri Alone (= 79.7).
Conclusion: Mri Is The Essential, Cost-Effective And Primary Imaging Modality In Evaluation Of Adnexal Masses In PostMenopausal Patients. It Alone Is Superior To Other Imaging Modalities In Determination Of The Nature Of Adnexal
Masses.

***************

Comparative Study Between Non Descent Vaginal Hysterectomy And Abdominal Hysterectomy
Author: Dr. Manpreet Kalra
Co Author: Mohi Manjit Kaur1, Balwinder Kaur2, Bansal Rosy3, Manjeet Kaur4, Sibia Preetkanwal5

Aims & Objectives: To Compare The Intra-Operative And Postoperative Observations Between Ndvh And Tah (For Benign
Conditions) And To Determine The Outcome Of Ndvh And Abdominal Hysterectomy. Material & Methods: 100 Cases With
Benign Uterine Disorders Were Included In The Study. Among Them 50 Cases Were Of Ndvh (Group A) And 50 Cases
Were Of Ah (Group B). It Was Conducted To Compare Intraoperative And Postoperative Observations Between Ndvh And
Abdominal Hysterectomy. Results: Mean Operating Time And Blood Loss Was Less In Ndvh Than Ah (86.6 Min V/S
137Min) And (98.8Ml V/S 240Ml) Respectively With P Value Of <O.Ooo1 Each. 2 Cases Of Bladder Injury Were Observed
In Group B (Which Were Cases Of Previous Lscs) And None In Ndvh. Mean Duration Of Hospital Stay Was Lesser In Ndvh
Than Ah (3.38 Days And 5.89 Days) P Value < 0.0001. Postoperative Fever (4% & 4%), Secondary Hemorrhage (6% & 6%),
Uti (8% & 6%) And Vault Infection (6% & 6%) Were Almost Same In Both The Groups, However The Incidence Of Paralytic
Ileus (0 & 2%) And Abdominal Wound Infection (0 & 8%) Was Higher In Group B. The Mean Pain Score On Lacc Scale Was
Statistically Significant (1.28 V/S 5.75) In Both The Groups With P Value Of <0.0001. Conclusion: It Can Be Concluded That
Ndvh Is Safe And Feasible And Provides More Comfort To The Patient Without Increasing Duration Of Surgery, Blood Loss,
Intraoperative And Postoperative Complications. It Is More Cost Effective Too.
***************

Demographic Profile Of Cervical Cancer Development- A Hospital Based Study

Author: Dr. Chandana Das
Co Author: Dr Manab Deka1, Dr Sujoy Bose2, Dr Purabi Deka Bose3, Dr Gokul Chandra Das4, Dr Ashish Bhattacharya5

Aims & Objectives: To Detect Human Papilloma Virus Infection Along With Its Genotype In Cancer Cervix And Its Relation
With Demographic Profile.
Materials And Methods: Cervical Cancer Cases Were Enrolled In Between Jan 2010 To Dec 2012. One Samples
Was Collected From Non Cancerous Area Of Cervix For Dna Extraction And Two Samples Were Collected From Cancerous
Area Of Cervix From Same Patient , One For Dna Extraction And Other One For Histopathological Examination To Confirm
Our Clinical Diagnosis. Extracted Dna Was Then Checked For Presence Of Hpv Dna By Pcr Amplification Method Using
My09/11 Primer. Hpv Genotyping Was Done By Using Specific Primer For Hpv 16 & Hpv18. The Cases Were Compared
With Their Corresponding Socio Demographic Profile.
Results: The Study Showed 88.88% Cases Found To Be Hpv Positive In Cancerous Area Compared To 7.4% Number In
Non Cancerous Area. Out Of Which 95.83% Cases To Be Hpv 16 And Only 4.16% Were To Be Hpv 18 In Cervical Cancer
Cases. There Were Other Significant Risk Factor Association Of Cervical Cancer With Early Marriage In 70.36% And High
Parity 87% Of Cases.
Conclusion: The Human Papilloma Virus Type 16 & 18 Are The Major Contributing Factor Along With Other Risk Factors
Like Early Marriage, Illiteracy And High Parity For Cervical Cancer In Our Region.

***************

Effect Of Prophylactic Isosorbide Mononitrate On The Incidence Of Preeclampsia In High Risk Women A Double
Blind Randomised Controlled Trial
Author: Dr. Ponmozhi Ganesan
Co Author: Ponmozhi1, Manikandan2, Jayanthi3, Anish Keepanasseril4,

Aims & Objectives: To Study The Effect Of Prophylactic Low Dose Isosorbide Mononitrate On The Incidence Of Gestational
Hypertension / Preeclampsia In High Risk Women And On The Maternal And Neonatal Outcome In High Risk Women.
Materials & Methods: It Was A Double Blind, Superiority; Randomised Controlled Trial. We Recruited 100 Women Who
Had High Risk For Preeclampsia.60 Women Were Analysed. After Informed Consent History And Baseline Characters Like
Height, Weight, Bmi, Blood Pressure Were Checked And Noted. Baseline Uterine Artery Pi And Tests For Endothelial
Dysfunction Namely Flow Mediated Vasodilatation Of Brachial Artery And Various Arterial Indices Like Brachial-Ankle
Pulse Wave Velocity, Ankle Brachial Index, And Arterial Stiffness Indices Were Performed. Participants Were Randomised
To Receive Either 20 Mg/Day Isosorbide Mononitrate Or Similar Looking Placebo From 14-16 Weeks Till Delivery. At 24
Weeks Uterine Artery Pi And Vascular Indices Were Repeated. They Were Followed Up Till Delivery.
Results: Compliance Was Good In Both The Groups. The Baseline Characters Did Not Differ Significantly In Both Groups.
The Rate Of Hypertensive Disorder Did Not Differ Significantly In Both Groups (33.3% In Ismn Group & 26.7% In Placebo
Group). The Severity Of Disease, Gestational Age At Diagnosis And Delivery, Maternal And Perinatal Morbidity And
Mortality Also Did Not Differ Significantly In Both Groups.
Conclusion: From The Interim Results Of Our Study We Conclude That In Women Taking Prophylactic Aspirin From Less
Than 16 Weeks, There Was No Significant Effect Of Low Dose Isosorbide Mononitrate On The Incidence Of Hypertension
And There Was No Significant Effect Of Low Dose Isosorbide Mononitrate On Disease Severity, Gestational Age At
Diagnosis Of Disease And On Maternal Perinatal Morbidity. However, Further Studies With Large Sample Size Are
Required To Confirm Our Results.

***************

Role Of Antenatal Health Education In Shortening The Duration Of Labor And Enabling Vaginal Delivery In
Primigravida
Author: Dr. Sadaranga Andal
Co Author: Dr. Prameela1, Dr. Swetha Gulabi2,

Aims & Objectives: To Study The Efficacy Of Antenatal Health Education In Making The Mother Relaxed And Confident
Resulting In Favorable Cervix And Shortening Of Labor.
Methods: In A Retrospective Study, 60 Primigravids Who Delivered Vaginally Were Analyzed. Health Education Regarding
Diet, Exercise And Positive Approach Was Offered To Antenatal Mothers From 2 Or 3Rd Month Onwards.
The Requirements For Easy Vaginal Delivery Were:
1)

Average Baby Weight - 2.8Kgs

2)

Favorable Head Station

3)

Cervix - 30% Effaced, 2-3Cm Dilated At The Time Of Admission.

4)

Spontaneous Onset Of Labor Pain.

Duration Of Labor Was Taken From Onset Of Active Labor Till Delivery.
Taking More Natural Diet (Fruits, Vegetables, Nuts And Seeds) Avoiding High Fat, Sugar, Refined Flour (Junk Food) To
Ensure Average Baby Weight.
Household Work, Walking, Climbing Of Stairs And Breathing Exercise; Pelvic Exercises (Kegels, Squatting, Cat Cow And
Butterfly) Were Advised From 34 Weeks For 2-3 Wks.
Positive Approach:- Favorable Cervix Depends On Diet, Exercise And Mind. Doubt And Fear Of Antenatal Mother Is Often
Unaddressed. It Is Said tense Mind Tense Cervix. Acceptance Of C-Section And Overcoming Fear Of Labor
Pain Help In Keeping Mother Relaxed. Friendly Behavior Of Staff During Pregnancy And Labor, One-To-One Interaction
With Delivered Mothers Increase The Confidence Of Antenatal Mother.
Results:
In Our Study 34 Mothers (56.7%) Had Average Baby Weight 2.5-2.9Kg And 26 Cases (43.3%) Had Baby Weight 3-3.5Kg.

46 Mothers (76.6%) Delivered In Less Than 6Hrs. 14Mothers (23.4%) Delivered In 6-12 Hrs.

Conclusion:
Antenatal Health Education Surely Helps In Shortening Labor And Easy Vaginal Delivery Possible By Making The Mother
Confident.

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Maternal Mortality At A Remote Medical College Of India: A Retrospective Study

Author: Dr. Pulak Kalita
Co Author:

Aims & Objectives: To Study The Incidence, Causes And Possible Prevention Of Maternal Deaths In A Remote Medical
College.
Materials & Methods: A Retrospective Study Of Hospital Records And Death Summaries Of All Maternal Deaths Over A
Period Of 5 Years From April,2009 To March,2014 At Silchar Medical College & Hospital Was Carried Out.
Results: There Were A Total Of 673 Maternal Deaths Out Of 39,797 Live Births Giving Maternal Mortality Ratio(Mmr) Of
1691 Per 100,000 Live Births. Common Causes Of Maternal Deaths Were Anaemic Heart Failure(24.22%),
Eclampsia(19.9%), Sepsis(16.8%) And Haemorrhage(10.5%). Most Of The Cases Were Unbooked And From Rural Area.
Majority Of Deaths Were In 24- 29 Years Of Age Group And Occurs Within 24 Hours Of Admission.
Conclusion: Mmr Is Very High. Anaemia Is The Leading Cause Of Death In This Remote Part Of Country. Improvement Of
Socio-Demographic Factors, Adequate Anc, Early Referral To Higher Centres And Timely Blood Transfusion Are Essential
To Reduce Incidence Of Maternal Deaths.

***************

A Comparative Study Of Termination Of Second Trimester Pregnancy With Misoprostol Alone And Mifepristone
Followed By Misoprostol Author: Prof. Chander Kiran
Co Author:

Aims & Objectives:

To Compare The Induction - Abortion Interval (I-A Interval) Of Misoprostol Alone &
Mifepristone Followed By Misoprostol In Second Trimester Pregnancy Termination.

Material & Method:

Fifty Women Of 13 -20 Weeks Pregnancy Were Randomized Into Two Groups (Gr. I & Ii). In Gr.I
600G Misoprostol Was Given Vaginally Followed By 400G 8 Hourly Up To A Maximum Of 48 Hours. In Gr.Ii
Mifepristone 200Mg Was Given Orally Followed 12 Hours Later By Misoprostol 600 G Vaginally. Misoprostol Was
Repeated Vaginally 400 G 8 Hourly Up To A Maximum Of 48 Hours. Induction Abortion Interval Was Studied And
Analyzed Using Paired-T Test.

Result :
Mean Induction Abortion Interval In Gr.I Was 28.86 6.32 Hours And In Gr.Ii 13.94 3.13 Hours
(P<0.0001). In Gr.I, 16% Aborted Within 24 Hours And 68% Within 36 Hours Whereas In Gr.Ii 84% Aborted Within 24
Hours And 92% Within 36 Hours.

Conclusion:
Priming The Uterus With Mifepristone Prior To Induction By Misoprostol In Termination Of Second
Trimester Pregnancy Shortens The Induction - Abortion Interval Significantly.

Key Words:

Mifepristone, Misoprostol, Second Trimester Termination Of Pregnancy.

***************

Emergency Obstetric Hystrectomies : A Retrospective Study

Author: Dr. Kiran Trivedi
Co Author:

Aims & Objectives:Emergency Obstetric Hysterectomies Are Done As A Life Saving Procedure To Save MotherS Life In Cases
Of Intractable Pph, Rupture Uterus And Severe Infection. All Cases Of Emergency Obstetric Hysterectomy Performed
Over A Period Of 2 Years Were Reviewed In Order To Evaluate The Incidence, Indications, Morbidity And Maternal
Mortality.
Materials & Methods:65 Patients Of Emergency Obstetric Hysterectomy Were Included In This Study From June 2012 To May 2014
In The Department Of Obstetric & Gynaecology, Rims, Ranchi.
Results:During This Study Period, Total Number Of Deliveries Were 12,409 And Total Number Of Emergency Obstetric
Hysterectomies Done Were 65 Giving An Incidence Of 0.52% , I.E. 1 In 191 Deliveries. 48 Patients Were Unbooked (73.8%)
. 24 Patients (36.9%) Were From Age Group 26-30 Years. Maximum Incidence Of Emergency Obstetric Hysterectomies
Were Observed In Women With Parity4 (36.92%). Emergency Obstetric Hysterectomies Were Performed For Many
Indications As For Rupture Uterus In 38 Patients (58.5%) , Atonic Pph 12 Cases(18.5%) , Placental Causes 15.4% (10 Cases),
Perforating Invasive Mole Presented As Haemoperitoneum In 2 Cases (3.07%) Septic Abortion In 2 Women(3.07%) And
1 Patient Was Of Ruptured Cornual Pregnancy(1.5%). It Was Seen That In This Study Maximum Patients Had Anemia
(58.5%) Followed By Febrile Morbidity (55.5%). 2 Patients Had Vvf And 1 Patient Had Acute Renal Failure. Uti And Wound
Infection Was Also Seen In Few Patients. Maternal Mortality Was Seen In 4 Patients Out Of 65 Patients Of Emergency
Obstetric Hysterectomy, Giving An Incidence Of 6.14% Mainly Due To Hemorrhage And Shock Along With Sepsis .
Conclusion:Emergency Obstetric Hysterectomy Is A Necessary Tool To Save MotherS Life. Clear Judgement, Timely
Intervention With Good Skill And Transfusion Facilities Can Reduce Maternal Morbidity And Mortality Significantly.

***************

Perimenopause Addressing And Analyzing The Transition

Author: Dr. Anjali P S
Co Author: Dr Anjali Ps1, Dr. Sareena Gilvaz2,

Aims & Objectives:

To Address And Evaluate The Symptoms And Complaints Of Women In The Perimenopausal Age Group.
This Is A Population Based Study, Aims To Assess The Quality Of Life And The Impact Of Hormonal Changes In
Perimenopausal Women And Health Strategies Which Will Help Them To Cope Up With The Transition

Materials And Methods :

This Is An Population Based Observational Study Done In 300 Women In Perimenopausal Age Group (42 - 52 Yrs)
Attending The Outpatient Department Of Obstetrics & Gynaecology At Jubilee Mission Medical College , Thrissur.
Women Who Were Receiving Hormonal Treatment ,Attained Premature/Surgical Menopause Or Having Any
Malignancies And Those Who Refused To Participate In The Study Were Excluded.
Using Structured Questionnaires, These Women Were Interviewed.
Information Regarding Their Complaints Both Physical And Psychological Were Analyzed.

Results :

Majority Of Women Felt That They Were Affected By The Symptoms In A Negative Manner.
Most Frequent Symptoms Were Fatigability And Lethargy, Poor Memory, Low Backache , Aches And Pains In Muscle
And Joints, Difficulty In Sleeping, And Vasomotor Symptoms.
The Menstrual Irregularity And Sexual Domains Were Also Found Disturbing To Many Of Them .

Conclusion :

Since This Is A Population Based Study Done In A Teritiary Care Institute , It Not Only Create Awareness But Also Help
Them In Educating And Planning Ahead For Challenges, That Can Make This Period As One Of The Most Rewarding And
Enriching Time Of Her Life.

***************

Evaluation Of Intraoperative Cytology Of Ovarian Tumours

Author: Dr. Kumudini Sardar
Co Author: Dr Kumudini Sardar1, Dr Sarita Tirkey2, Dr Meena Mehta3,

Aims & Objectives:

To Evaluate The Diagnostic Accuracy Of Imprint Cytology In Ovarian Tumours And To Compare It With
Histopathology

To Calculate The Incidence Of Various Types Of Ovarian Tumours.

Materials And Methods

In The Study Period Of 1 Year, From 1St May 2013 To 30Th April 2014, 75 Patients Underwent Surgery In Dept. Of
Obstetrics & Gynaecology, Rims, Ranchi For Ovarian Tumours. In This Prospective Study, Multiple Imprint Smears Taken
Peroperatively From The Fresh Samples From Various Representative Areas, Stained With H & E Stain And Papanicoulaou
Stain In Ethanol Fixed Smears And Later Examined Under Light Microscope. The Cytological Diagnosis Was Compared And
Correlated With Histopathological Diagnosis, Taking It To Be The Gold Standard.
Results
The Total Number Of Ovarian Tumours Studied Was 75. These Included 55(73.33%) Epithelial And 20(26.67%) NonEpithelial Ovarian Tumours. Out Of These 42(56%) Were Benign, 27(36%) Were Malignant And 6(8%) Were Borderline
Ovarian Tumours. In This Study, Serous Tumours Were Found To Be Most Common (31/75;41.33%) Followed By Mucinous
Tumours (24/75;32%) Followed By Germ Cell Tumours (13/75;17.33%). Imprint Smears Were Compared With
Histopathological Diagnosis And Correlation Was Found In 67 Cases (89.33%). The Diagnostic Accuracy Of Imprint
Cytology For Benign Tumours Was Found To Be 91.3% While Diagnostic Accuracy For Malignant Tumours Was 89.66%.
Conclusion
Imprint Cytology Can Be Used As An Adjunct To Histopathology For A Rapid And An Early Diagnosis In The Operation
Theatre, Particularly In Developing Countries Like Ours, Where Frozen Section Facility Is Not Available. Intraoperative
Imprint Cytology May Help The Surgeons To Plan The Extent Of Surgery While The Patient Is Still In The Operation Theatre
After The Preliminary Diagnosis Has Been Made.

***************

A Prospective Study Of Twin Deliveries And Its Perinatal Outcome In District Hospital
Author: Prof. Sapna I.S.
Co Author: Dr.Bhavya Jha1, Dr.Nuthakki Spandana2,

Aims & Objectives:

The Incidence Of Twins Has Increased Due To Widespread Use Of Advanced Art Techniques. There Is A Considerable
Perinatal/Maternal Mortality And Morbidity Associated, Thus, Antenatal Management And Safe Deliveries Of Twin
Pregnancy Are Important. Better Use Of Infertility Modalities, Early Diagnosis, And Prevention Of Preterm Birth, Close
Fetal Surveillance, And Atraumatic Labour Can Improve Perinatal Outcome In The Gestation.
This Study Is Aimed At Providing Data On Twin Deliveries In Chigateri District Hospital, Davangere, For A Period Of One
Year (January To December 2013) And An Insight On Their Fetal Outcomes, In Relation To Their Mode Of Delivery,
Gestational Age And Other Obstetric Complications.
Methods:
A 1 Year Prospective Study Of Twin Deliveries Was Conducted. The Perinatal Outcome In 78 Set Of Twins Was Compared
With That Of 156 Singleton Controls. Inclusion Criteria Were Twin Delivery, Gestational Age And Admission Compared
With No Admission To A Nicu. Variables Considered Were Fetal Gender, Obstetric & Labour Complication, Mode Of
Delivery & Newborn Status.
Results:

In Our Study, The Current Incidence Was 78 Per 7025 Singleton Deliveries (1 Per 100) Of Which 61 (78.20%)
Delivered Vaginally And 17 Underwent Lscs.41 Cases Were Preterm And 37 Were Term. Sex Ratio Was Almost F: M = 33:
35 ,13 Cases Had Associated Preeclampsia,

Low Birth Weight Babies Were 22 And 20 Very Low Birth Weights. While 23 Babies Had Rds & 11 Babies Suffered
Birth Asphyxia. Nicu Admissions Were 60 Of Which 31 Babies Survived
Conclusion:
This Study Indicated That Twin Pregnancy Being A High Risk Condition Entails Greater Neonatal Complications Compared
To Singleton Pregnancy. Thus It Is Recommended To Have A Greater Prenatal Care & Hospital Deliveries
Keyword: Twin Pregnancy, Perinatal Outcome, Preterm Delivery

***************

A Prospective Study Of Twin Deliveries And Its Perinatal Outcome In District Hospital
Author: Dr. Bhavya Jha
Co Author: Prof. Sapna I.S1, Dr. Nuthakki Spandana2,

Aims & Objectives:

The Incidence Of Twins Has Increased Due To Widespread Use Of Advanced Art Techniques. There Is A Considerable
Perinatal/Maternal Mortality And Morbidity Associated, Thus, Antenatal Management And Safe Deliveries Of Twin
Pregnancy Are Important. Better Use Of Infertility Modalities, Early Diagnosis, Prevention Of Preterm Birth, Close Fetal
Surveillance, And Atraumatic Labour Can Improve Perinatal Outcome In The Gestation.
This Study Is Aimed At Providing Data On Twin Deliveries In Chigateri District Hospital, Davangere, For A Period Of One
Year (January To December 2013) And An Insight On Their Fetal Outcomes, In Relation To Their Mode Of Delivery,
Gestational Age And Other Obstetric Complications.
Methods:
A 1 Year Prospective Study Of Twin Deliveries Was Conducted. The Perinatal Outcome In 78 Set Of Twins Was Compared
With That Of 156 Singleton Controls. Inclusion Criteria Were Twin Delivery, Gestational Age And Admission Compared
With No Admission To A Nicu. Variables Considered Were Fetal Gender, Obstetric & Labour Complication, Mode Of
Delivery & Newborn Status.
Results:
In Our Study

The Current Incidence Was 78 Per 7025 Singleton Deliveries

(1 Per 100) Of Which 61 (78.20%) Delivered Vaginally And 17 (21.79%)Underwent Lscs.41 (52.56%)Cases Were Preterm
And 37(47.43) Were Term

13 Cases Had Associated Preeclampsia.

Sex Ratio Was F: M = 33: 35

Low Birth Weight Babies Were 22 And 20 Very Low Birth Weights,While 23 Babies Had Rds & 11 Babies Suffered
Birth Asphyxia

Nicu Admissions Were 60 Of Which 31 Babies Survived .

Conclusion:
This Study Indicated That Twin Pregnancy Being A High Risk Condition Entails Greater Neonatal Complications Compared
To Singleton Pregnancy. Thus It Is Recommended To Have A Greater Prenatal Care & Hospital Deliveries .
Keyword:
Twin Pregnancy, Perinatal Outcome, Preterm

***************

Single Serum Progesterone Assay In Threatened Abortion As A Predictor Of Viable Pregnancy

Author: Dr. Priya Bansal
Co Author: Dr Anupama Dave1,

Aims & Objectives;

To Study Incidence, Etiological Factors & Outcome Of Pregnancy In Threatened Abortion
To Determine The Cut Off Level Of Serum Progesterone In Detecting Viability In Threatened Abortion.
Material &Methods
Prospective Study Conducted In Mgmmc Indore In Females Attending Opd With <13 Wk Gestation &Complaints Of
Abdominal Pain &Or Vaginal Bleeding.100 Threatened Abortion Cases Were Tested For Serum Progesterone & Usg. All
The Cases Were Under Follow Up Till The Termination Of Pregnancy And Results Analysed Statistically.
Results
58Cases Continued As Viable Pregnancy With Mean Progesterone Level-18.096. 42Cases Aborted With Mean Prog. Level
6.707.
As Per Roc Analysis Cut Off Level Of Serum Progesterone Came Out To Be 10.05Ng/Ml With A Sensitivity Of 93.1% &
Specificity Of 90.5%.
Conclusion
Serum Progesterone Measurement Is A Reliable Biochemical Test In Establishing The Diagnosis Of Early Pregnancy Failure
And A Predictive Test For Pregnancy Continuation.
***************

Social And Demographic Factors Associated With Eclampsia Related Maternal Mortality A Five Year
Retrospective Study At Jk Lon Hospital Kota
Author: Dr. Khushboo Jain
Co Author: Dr Mamta Sharma1, Dr Hitesh Mangal2,

Aims & Objectives-The Study Was Carried Out To Determine The Incidence Of Maternal Mortality Associated With
Eclampsia, To Assess The Mode Of Death In Eclampsia & To Determine The Socio Demographic Profile Of Women
Influencing The Maternal Death.
Material & Methods It Is A Retrospective Study Of 33 Eclampsia Related Deaths And This Study Was Conducted In J
K Lon Hospital ,Govt Medical College,Kota Rajasthan For A Period Of Five Years From 1St January 2009 To 31St December
2013.Total Deaths During The Period Was 131. Records Of Death & Their Demographic Profile Were Retrieved From
Medical Record Library.
Results-.Total No.Of Deliveries That Occurred In Our Institute Were 49961 With Total 805 Cases Of Eclampsia With An
Incidence Of 1.6% . Eclampsia Accounted For 25.1% Of Total Deaths (33 Cases) With Case Fatality Rate Of 4.09%.
Commonest Mode Of Death In Eclampsia Is Pulmonary Edema Which Accounted For 15 Cases ( 45.45%) Followed By
Cerebrovascular Accident With 7 Cases ( 21.21% ) Then Hellp Syndrome & Acute Renal Failure With 5 Cases Each (15.15%).
Eclampsia Death Commonly Occured In The Age Group 23-26 Years (12 Cases) , In Primi 24 Cases( 72.72 % ) & In Unbooked
,Lowersocioeconomic Status . Antepartum Eclampsia Contributes Most Of The Eclampsia Deaths (96.97 %).High Incidence
Is Explained By Late Referral Of Complicated Cases To Tertiary Centre.
Conclusion-Eclampsia Still Remains The Major Cause Of Maternal Mortality In India D/T Unsupervised Pregnancies &
Deliveries.We Must Continue Our Antenatal Vigilance To Detect The Signs Of Preeclamsia, And Timely Referral To Higher
Centre Would Prevent Maternal Morbidity And Mortality Due To Eclapmsia.

***************

Acute Abdomen Post Hysterectomy

Author: Dr. Archana Dwivedi
Co Author:

Aims &Objective :

Every Woman With Intact Ovaries, Despite Previous Hysterectomy Who

Presents With Abdominal Pain Should Be Screened For Pregnancy.

Discussion

Patient X Presented With Shock .History Of Hysterectomy 1.5 Years

Back .Ultrasound Shows Large Hemoperitoneum.B Hcg>12880

Emergency Laproscopic Ruptured Tubal Ectopic Removed Followed By
Both Side Salpingectomy.Pt Stood Operation Well And Discharged.
Conclusion

Salpingectomy With Hysterectomy Should Be Considered To Avoid

Such Emergencies.

***************

A Study On Reproductive Tract Infections Among Married Women In The Reproductive Age Group In A Railway
Population
Author: Dr. P Rajkumari
Co Author:

Aims &Objectives : To Find Out The Prevalence Of The Suggestive Symptoms Of Reproductive Tract Infections (Rti) And
The Relation Of These Symptoms With The Different Socio-Demographic Variables, Reproductive Characteristics, Use Of
Intrauterine Devices (Iuds) And Other Contraceptives Among The Study Population.
Materials & Methods: One Hundred Married Women In The Reproductive Age Group, With Complaints Of Abnormal
Vaginal Discharge, Residing In A Railway Set-Up Were Interviewed. Data Obtained Was Collated And Analyzed
Statistically.
Results: Out Of The Total 100 Women Surveyed, Statistically Significant Maximum Prevalence Of Rti Was Observed
Among The Low Socio-Economic Strata And Housewives. Among Oral Pill Users, 68.1% And Among Condom Users, 14.2%
Had Abnormal Vaginal Discharge. 62.54% Of The Intra-Uterine Device Users Had Abnormal Vaginal Discharge.
Conclusion: Prevalence Of The Suggestive Symptoms Of Rti Was Found To Be Quite High In The Low Ses Group And
Housewives. Symptoms Suggestive Of Rti Were Also Less In Condom Users Than In Those Using Ocps. Therefore, It Is
Necessary To Increase Awareness Regarding The Symptoms And Complications Of Rti/Sti Among Women.

***************

Expectant /Medical/Surgical Management Of Early Pregnancy Miscarriages -A Prospective Study

Author: Dr. Reshma Sajan
Co Author: Dr.Mumtaz. P,Mes Medical College,Kerala1, Dr.Abdul Vahab,Mes Medical College, Kerala2,

Aims &Objectives :
To Compare The Safety And Efficacy Of Expectant , Medical And Surgical Management Of Early Pregnancy Miscarriages
.
Materials And Methods :
The Prospective Study Conducted In Tertiary Care Centre For 5 Years, Included 312 Patients With Usg Confirmed
Pregnancy Miscarriage < 13 Weeks, Allocated By Patientpreference To Expectant Management (112 ),Medical
Management(100) And Surgical Evacuation (100 ).

Expectant Group : Managed As Out Patient Without Any Intervention Till Spontaneous Complete Miscarriage Was
Ascertained By Repeat Usg At The End Of 2 Weeks (Success ); In The Absence Of Which (Failure); Underwent Surgical
Uterine Evacuation. .
Medical Group:Managed By 600Microgram Vaginal Misoprostol Followed By 400 Microgram Vaginally After 48 Hours If
No Response.If Failure ,Managed By Planned Surgical Evacuation. Emergency Admission And Evacuation(Failure) Was
Done,If Symptomatic In The Waiting Period In Both Groups
Surgical Group : Underwent Planned Surgical Evacuation Once Diagnosed .
Followed Up For 6 More Weeks. Successrate And Complications Like, Vaginal Bleeding, Abdominal Pain, Emergency
Evacuation, Limitation Of Physical Activity And Patient Satisfaction Were Assessed And Compared.
Results:
(1)

Successrate In Cxpectant Group : 71% , Medical 85% , Surgical 96.56%.

(2)
Vaginal Bleeding,Amount Was Comparable In Expectant And Medical Groups,Duration Slightly More In
Expectant Group
(3)

Severe Abdominal Pain :Medical Group>Expectant>Surgical..

(4)
Unplanned Admissions , Emergency Evacuation And Limitation Of Physical Activity Were Comparable In Medical
And Expectant Group With Least In Surgical Group .
Conclusion:
Eventhough Surgical Management Is Definitive And Predictive,Medical And Expectant Management Miscarriage Offers
A More Natural And Cost Effective Method In Our Social Setup.Medical Management Eventhough Has A Comparatively
Higher Successrate Than Expectant Management,Has The Disadvantage Of Symptoms Of Abdominal Pain, Nausea And
Vomiting Necessitating Admission And Increased Cost. Expectant Management Successrate Can Be Improved With Much
Lesser Complication By Proper Patient Selection And Counseling.

***************

Prediction Of Early Pregnancy Failure By Use Of First Trimester Ultrasound Screening

Author: Dr. Sourav Sarkar
Co Author: Prof,Dr. Joydeb Roychowdhury1,

Aims &Objectives:

To Assess Early Pregnancy Developmental Changes In First Trimester Ultrasound Screening And To Identify & Correlate
Abnormal Ultrasound Findings With Clinical Outcome Of Pregnancy Up To 12 Weeks & Any Late Sequel As Pregnancy
Advances.

Materials & Methods :

A Prospective Observational Study Was Conducted In The Department Of Obstetrics & Gynecology Esi-Pgimsr,&Esic
Medical College, Joka From May 2012 To April 2013 Including 150 Patients With Uncomplicated Singleton Pregnancy
Within 5 To 12 Weeks Of Gestation.The Usg Parameters Like Crl, Yolk Sac Diameter, Mean Sac Diameter, Fetal Heart Rate,
Resistive Index Were Weekly Analyzed And Correlated With Pregnancy Outcome To Assess The Predictive Value Of
These Parameters.

Results & Analysis:

The Study Revealed 2-6% Pregnancy With Abnormal Usg Parameters. 4 Cases Of Yolk Sac Diameter Was Found >6Mm.
Among The 4 Cases 50% Miscarriages Occurred At 8 To 12 Weeks Which Is Statistically Significant (P<0.05) With A Positive
Predictive Value Of 50 %. 100% Abortion Occurred When Msd >25Mm With Ys But Absence Of Embryo And It Is
Statistically Significant (P<0.0001).Patients Having Embryo >9Mm With Absence Of Cardiac Activity Was Seen In
10(6.66%)Cases; All Of Them(100%)Aborted At 9To12 Weeks Which Is Statistically Significant.The High Incidence Of
Miscarriage In Slow Embryonic Heart Rate (<100Bpm) In Comparison To Normal Ehr Also Showed Statistical
Significance.The Study Also Found 33.33%Fetus Developed Iugr And 50% Pregnant Women Developed Gestational
Hypertension (Htn) With Raised Ri In First Trimester

Conclusion:

The Chronological Development And Growth Of Gestational Sac, Timely Appearance Of Yolk Sac, Crl, Its Cardiac Activity
And Heart Rate Can Be Very Well Assessed On Usg During The Period Of Organogenesis.Amongst The Different Usg
Parameters Growth Of Gestational Sac, Appearance Of Cardiac Activity And Ehr> 100Bpm Is The Most Important
Predictive Parameter Of Pregnancy Outcome

***************

Predicting The Reproductive Outcome In Endometriosis- A Comparison Between Afs And Efi Scores
Author: Dr. Niranjana Jayakrishnan
Co Author: Dr Krishnapillai Jayakrishnan1,

Aims And Objective- To Determine The Better Tool For Predicting The Reproductive Outcome Scored By Afs And Efi
(Endometriotic Fertility Index) Scores In Patients With Surgically Documented Endometriosis

Materials And Methods- The Patients Were Scored With Afs Intra Operatively And Post Operatively By Efi Scores And
Followed Up For 12 Months To Determine The Reproductive Outcomes Documented By Pregnancy Rates

Results- A Statistically Significant Variable Used To Create The Efi Was The Least Function Score (I.E., The Sum Of Those
Scores Determined Intra Operatively After Surgical Intervention That Describe The Function Of The Tube, Fimbria, And
Ovary On Both Sides). Sensitivity Analysis Showed That The Efi Was More Sensitive In Predicting The Reproductive
Outcomes

Conclusion-The Correlation With Efi Was A Better Prognosticator Of The Pregnancy Rates Compared To Afs Scores.. Its
Use Provides Reassurance To Those Patients With Good Prognoses And Avoids Wasted Time And Treatment For Those
With Poor Prognoses

***************

Study Of Maternal And Perinatal Outcome Following Prelabour Rupture Of Membrane.

Author: Dr. Ankita Mandal
Co Author:

Aims And Objective

1.To Study The Incidence And Causes Of Pre Labour Rupture Of Membranes.
2.To Study The Mode Of Delivery In Cases Of Pre Labour Rupture Of Membranes.
3.To Study Various Maternal Outcomes Following Pre Labour Rupture Of Membranes.
Chorioamnionitis
Puerperal Fever
Post Partum Haemorrhage
Other Morbidities Like Wound Infection Etc.
4.To Know The Fetal Outcome Like
Prematurity
Respiratory Distress Syndrome
Infection
Neonatal Mortality.
Methods And Materials
This Study Was Carried Out In The Department Of Obs And Gynae Of Rims, Ranchi During The Period Of One Year That
Is From August 2013 To July 2014.
A Total Of 200 Cases Who Were Attending Opd And Labour Room In Dep Of Obs And Gynae Of Rims Were Studied.
Results
1.Incidence Of Prom In Our Institution Turn Out To Be 7.2%
2.Maximum No. Of Cases Were Between 20-30 Age And Belonging To Low Socioeconomic Status.
3.Maximum No. Of Cases(80%) Were Of Term Prom.
4.37% Neonates Born After Prom Develop Morbidities Like Birth Asphyxia , Sepsis And Rds.
Conclusion
-Prom Remains A Significant Obestetric Problem.
-It Significantlly Contribute To Maternal Morbidity And Perinatal Morbidity.

***************

Health Education And Counselling: Its Role In Anemia In Antenatal Patients

Author: Dr. Nada Ahmed
Co Author: Dr.Seema Hakim1, Dr.Rehana2,

Aims And Objective(S): To Study The Role Of Imparting Health Education And Counselling To Antenatal Women And Its
Effect On Changing Hemoglobin Pattern.
Material And Method(S): A Total Of 100 Patients Were Selected For This Study Who Attended The Antenatal Clinic In
Jawaherlal Nehru Medical College Over A Period Of Two Years(2013-2014) Year. Their Hemoglobin Level Was Recorded
On The First Visit. Patient With Hemoglobin Level Less Than 7 Were Taken In The Study And Randomization Was Done.50
Patients Were Imparted Healh Education, Life Style Modification And Dietary Advice Alongwith Iron Supplementation.50
Patients Were Advised Oral Iron Tables(Ferrous Sulphate Or Fumarate) Only With No Focused Health Counselling . A
Comparative Data For Their Hemoglobin Pattern Was Evaluated At Subsequent Visits.
Result: Anc Patients With Health Education And Dietary Advice In Addition To Iron Supplementation Have A Significant
Rise In Haemoglobin Level And There Is A Significant Difference In Both The Groups Level Of Hemoglobin.
Conclusion: Imparting Health Education And Counselling Definitely Have A Role In Anemic Patients In Changing The Status
Of Hemoglobin Level And Improving The Quality Of Life In Antenatal Women.

Author-Dr.Nada Mushtaque,3Rd Year Pg Student M.S., Obs And Gynae,Dr.Seema Hakim, M.D,Ficog,Fimch,
Dr.Rehana,Phd Psychology
Fogsi Member
Number

***************

A Comparative Study Of Lipid Profile In Hypertensive And Normotensive Pregnant Women.

Author: Dr. Sonalika Singh
Co Author:

Aims And Objective:

1)To Compare The Lipid Profile Changes In Hypertensive And Normotensive Pregnant Women.
2)To Note The Maternal Outcome With Lipid Profile Changes.

Materials And Methods:

Source Of Data
Study Site: Jss Medical College And Hospital.Mysore
Study Period:This Study Will Be Carried Between December 2012 To April 2014.
Source Of Data: Antenatal Cases,Jss Hospital,Mysore.
Study Design: Comparative Study.
7.1 Methods Of Collection Of Data
Sample Size Prevalence Of Hypertension In Pregnancy Is 5%[12].
The Total Sample Size Is 140:
Hypertensive Pregnant Women(Study Group):70
Normotensive Pregnant Women(Control Group):70

Results:
In This Study Hypertensive Pregnant Females Have Been Found To Have Highly Significantly Decreased Levels Of Hdl Than
Normotensive Pregnant Females.
The Concerntration Of Total Cholestrol,Ldl,Vldl,Trigycerides Was Found To Be Significantly Increased With Hypertensive
Pregnant Females Than Normotensive Pregnant Females.

Conclusion:
In This Study Conducted Over A Period Of One And A Half Year,The Most Important Predisposing Factor That Came Up
Was The First Pregnancy(Primigravida) With Hypertension.

Different Lines Of Evidence Indicate That Abnormal Lipid Metabolism Is Not Mere A Manifestation But Is Also Involved In
The Pathogenesis Of Disease.

Thus Lipid Profile Can Be Used A As A Predictor For Hypertensive Disorders In Pregnant Females With De Arranged Lipid
Values.

***************

Leading Twin In Breech Presentation-Is Routine Caesarean Section Justified

Author: Dr. Lopamudra John
Co Author: Dr Seetesh Ghose1,

Aims And Objectives To Determine The Caesarean Section Rate In Twin Gestation For The Leading Twin In Breech
Presentation As Indication And To Find Out Whether Vaginal Delivery May Be Attempted In Such Cases.
Materials And Methods An Observational Study Conducted In Medical College Hospital Over A Period Of Two Years. All
Deliveries With Twin Gestations Were Included In The Study. The Overall Caesarean Section Rate Was Determined. Those
Who Underwent Lscs For The Indication Of First Twin In Breech Were Analysed For The Gestational Age, Parity, Baby
Weight And Apgar Score.
Results Out Of A Total Of 66 Twin Deliveries, 37 (56%) Underwent Caesarean Section And 32 (48.5%) Were Primary
Sections. 19 Had Breech Presentation In The Leading Twin, 2 Delivered Vaginally, Both In Multi, And The Remaining
17Underwent Section Out Of Which 14 Were Primary Sections ,11 In Primi And 3 In Multigravida. Both The Leading Twin
Breech Vaginals Were Term Gestations. There Were 19 2Nd Twin In Breech And After Excluding Previous Lscs And 1St
Twin Transverse, 17 Remained, Out Of Which 6 Delivered Vaginally And 11 By Lscs. In A Total Of 33 Breech Babies, 8
Delivered Vaginally And 25 By Lscs Out Of Which 10 Were The 2Nd Twin In Lscs Done For 1St Breech. The Average
Gestational Age Of The Vaginal And Lscs Breech Babies Were Comparable (36+2 Vs 36 Weeks) As Well As Their Weight
(2Kg) And Apgar. Probability Of Locked Twins Was Only In 6 Cases(42.8%).
Conclusion Trial Vaginal Is An Alternative For The Leading Twin In Breech Presentation Both In Multi As Well As In Primis
In An Attempt To Reduce The Section Rate In As Average Baby Weight Is Lesser In These Compared To Singleton
Gestations And Chance Of Locking Is Very Less.

***************

L-Arginine In Oligohydramnios And Iugr

Author: Dr. Poornima Mathur
Co Author: Dr. Sujata Sharma1, Dr. Madhullika Gambhir2,

Aims And Objectives To Study The Efficacy Of L Arginine In Treatment Of Oligohydramnios And Its Effect On
Fetomaternal Outcome.
Materials And Methods: The Study Was Conducted At Bebe Nanaki Mother And Child Care Centre, Amritsar. Randomly
Selected 60 Patients Presenting In The Out Patient Department With Singleton Pregnancy And Mild To Moderate
Oligohydramnios And Iugr Diagnosed On Ultrasound And Doppler Velocimetry Were Selected. The Patients Were Further
Divided Into Two Groups. One Group Was Administered L Arginine 3Grams Daily And The Other Group Placebo. Periodic
Ultrasound And Doppler Velocimetry Was Performed And The Fetomaternal Outcome Was Studied.
Results: Patients In The L-Arginine Study Group Showed Improvement In Doppler Velocimetry. In The Group Treated With
L-Arginine Higher Birthweight At Delivery, Gestational Age And Apgar Score At 1 And 5 Minutes As Compared To The
Placebo Group Was Observed. Neonates Delivered In The L-Arginine Study Group Also Had Lower Incidence Of Rds And
Nicu Admission.
Conclusion : Oral Treatment With L-Arginine Seems To Be Promising In Improving Fetal Outcome As Well As Accelerating
Fetal Growth In Pregnancies Complicated By Iugr.

***************

role Of Opportunistic Cervical Cancer Screening During Pregnancy

Author: Dr. Poonam Pawadi
Co Author: Dr. Shobha N Gudi1,

Aims And Objectives

Cervical Cancer During Pregnancy Is Relatively Uncommon. However, Pregnancy Represents A Unique Opportunity To
Screen Reproductive Age Women For Cervical Cancer. This Study Was Aimed To Find The Prevalence Of Abnormal Smears
For Cervical Cancer In Pregnant Women.

Material And Methods

This Prospective Study Was Done From September 2012 To November 2013. A Total Of 500 Pregnant Women Attending
Out Patient Department At Department Of Obstetrics And Gynaecology, St. Philomenas Hospital, Bangalore For Antenatal
Care Were Studied.

Results

In This Study 53% Of The Pregnant Women Were Aged Between 25 To 30 Years. The Mean Age Was 29.10 3.68 Years.
Of The 500 Women Studied, 56.6% Of The Women Presented With Gravida One. The Family History Of Cervical Cancer
Was Noted In 0.6% Of The Women. Per Speculum Examination Revealed Majority Of The Women (97%) Had Healthy
Cervix Os While White Discharge And Erosion Was Noted In 2.4% And 0.60% Of The Women Respectively. The Smear Was
Unsatisfactory In 0.4% Of The Women. Cytodiagnosis Was Found To Be Normal In 97% Of The Women And 0.2% Of The
Women Had Hsil And 2.4% Had Infection.

Conclusion

The Prevalence Of Abnormal Smear In This Study Was 0.2% Suggesting Cervical Cancer During Pregnancy Is Relatively
Uncommon.

Keyword

Cervical Cancer; Cervical Cancer In Pregnancy; High Grade Intraepithelial Lesion; Screening For Cervical Cancer;

***************

A Comparative Study Of Intravenous Labetalol And Oral Nifedipine In Hypertensive Emergencies In Severe
Preeclampsia
Author: Dr. Sandhya Kumari
Co Author: Dr. Shashi Bala Singh1, Dr. Atima Bharti2, Dr. Arti Jyoti3,

Aims And Objectives

To Compare The Use Of Intravenous Labetalol And Oral Nifedipine In Hypertensive Crisis In Preeclampsia In Terms Of
-

Efficacy

Feto Maternal Outcome

Side Effects And Safety Profile

Materials & Methods

Present Study Is A Randomized Controlled Trial Which Was Carried Out In Department Of Obs. & Gynae, Rims, Ranchi
From August 2013 To August 2015.
200 Cases Were Selected From Those Admitted In Labour Room And Were Randomised In Two Groups. The Study Was
Not Masked.
Target Bp Is To Achieve <= 150/100 Mm Of Hg.

Result
There Was More Significant Decrease In Systolic , Diastolic And Mean Arterial Blood Pressure At The End Of 15
And 30 Minutes In Labetalol Group.
In Labetalol Group 42% Cases Required Only Single Dose As Compared To Nifedipine Group In Which Only 16%
Cases Could Achieve Target Bp With Single Dose.
-

Average Dose Required To Achieve The Target Bp Was 2 In Labetalol Group And 3 In Nifedepine Group.

Infrequent Side Effects Like Tachycardia (6%) Was Seen With Nifedipine. Headache(2%) , Dizziness(2%) And
Nausea(2%) Was Seen In Labetalol Group.
-

Mode Of Delivery In

Labetalol Group- Spontaneous Vaginal Delivery(26%),Induced Vaginal (40%), Instrumental(8%), Lscs(26%).

Nifedipine Group- Spontaneous Vaginal(30%), Induced Vaginal(42%), Instrumental(6%), Lscs(22%)
-

In Our Study Groups 23% Babies Had Iugr.

Conclusion
-

Both Drugs Were Found To Be Effective Antihypertensive.

Labetalol Required Fewer Doses As Compared To Nifedipine To Achieve The Target Blood Pressure.

Only Infrequent Side Effects Was Seen With Nifedipine And Labetalol Group Indicating Both Drugs Can Be Used
Safely.
-

Maximum No. Of Cases(72%) Required Some Form Of Induction, Low Forceps Or Lscs.

***************

Screening For Gestational Diabetes Mellitus In First Trimester Of Pregnancy And Its Outcome
Author: Dr. Polaki Srilekha
Co Author: Dr. Priya Mohan Jayasingh1, Dr. Lal Mohan Nayak2, Dr. Atal Bihari Dandapat3, Dr. Nihar Ranjan Bhoi4,

Aims And Objectives :

The Aims Of The Present Study Are :

To Screen All The Pregnant Women In The 1St Trimester Of Pregnancy As Per Dipsi Guidelines I.E. Non-Fasting
75-G Oral Glucose Tolerance Test (Ogtt).

To Know The Prevalence Of Gdm In Our Community.

To Determine The Maternal And Fetal Outcomes Of Gdm.

Materials And Methods : The Present Study Was Carried Out In The Department Of O&G, Vss Mch, Burla During The
Period From December 2012 October 2014. All Pregnant Women Attending Antenatal Clinics Of The O&G
Department Of Vss Mch, Burla Who Are In First Trimester Of Pregnancy Were Taken As Cases. The Gtt Of All The Cases
Were Performed With 75 Gm Glucose As Per Dipsi Guidelines. The Cases Were Undergone Rescreening In The Later
Weeks Of Pregnancy If She Had Normal Glucose Tolerance In The First Trimester And Then All The Cases Were Followed
Up In Their Labour And Puerperium To Note The Pregnancy Outcome And Any Complication Associated. A Total Of 300
Cases Were Taken Into Study.
Results : Out Of 25(5%) Women With High 2 Hour Pgbs 16(3.2%) Cases Had Abnormal Gtt. Out Of These 16 Cases, 14(2.8%)
Cases Reverted To Normal Gtt During Puerperium. The Mean Birth Weight Of Baby In Abnormal Gtt Cases Was 3.43 Kg.
Due To The Standard Dietary Intervention There Was No Remarkable Difference In Apgar Score Of The Baby And In
Outcome Of Labour Between Abnormal Gtt And Control Cases.
Conclusion : Screening For Gdm Detects Not Only The Disease Before It Has Produced Any Deleterious Effect On Mother
And Foetus, But Also Rescue The Offspring In The Womb At Time And Also Warns Us About Its Long Term Unpleasant
Consequences.

***************

Relationship Between Early Second Trimester C-Reactive Protein And Adverse Pregnancy Outcome
Author: Dr. Tejaswi Nandan
Co Author:

Aims And Objectives :

Pregnancy Is Associated With Profound Inflammatory Changes During Early Phase, Resulting In Adverse Pregnancy
Outcomes Like Prom, Pih, Gestational Diabetes Mellitus, Preterm Birth, Iugr, Lbw Babies Etc. Objective Of This Study Is
To Evaluate The Role Of Early Second Trimester C-Reactive Protein For Prediction Of Adverse Pregnancy Outcomes.

Materials And Methods :

This Is A Prospective, Analytical Cohort Study Carried Out In The Department Of Obstetrics And Gynaecology, Katihar
Medical College And Hospital, Katihar. A Total Of 100 Women In Early 2Nd Trimester (14-18 Weeks Of Gestation)
Primigravida Were Analysed For Serum C-Reactive Protein Level And Followed Till Delivery. Patients With Increased Bmi,
Acute/Chronic Infections, Dm, Hypertension Were Excluded From The Study.

Result :
A Significant Correlation Was Found Between Elevated Serum C-Reactive Protein And Adverse Pregnancy Outcomes Like
Preterm Labour And Pih.

Conclusion :
Early Second Trimester C-Reactive Protein Can Help To Predict Adverse Maternal And Foetal Outcome And Timely
Preventive Prophylactic Therapies Can Prevent Morbidity And Mortality Due To Pregnancy.

***************

Evaluation Of Risk Factors Of Pelvic Inflammatory Disease

Author: Dr. Sowmya D
Co Author: Dr.Anita Simlot1, Dr.Nupur Hooja2, Dr.Nidhi Gupta3, Dr.Prakash Kumar M N4, Dr.Sowjanya5

Aims And Objectives :

Pelvic Inflammatory Disease Is Associated With Major Medical And Economic Consequences For Women Of Reproductive
Age. Identification Of The Risk Factors Associated With Pid Is Crucial To Efforts For Prevention Of These Consequences.
Objective Is To Evaluate The Risk Factors For Pid Women Attending Opd At Gangori Hospital.

Material And Methods: Hospital Based Analytic Type Of Observational Study .Conducted At Dept Of Obstetrics And
Gynaecology, Gangori Hospital.Sms Medical College, Jaipur. Risk Factors Were Assessed By 100 Women With Pid (Study
Group) And Then It Was Compared With 100 Controls Attending The WomenS Clinic. Significance Of Difference In
Proportion In Various Variables Of Pid In Both The Group Was Inferred By OddS Ratio And Chi-Square Test.

Results:
Cases Were Significantly Younger Than Controls (P<0.05). Risk Factors Identified By Bivariate Analysis Were Less Than
Secondary Level Education(Odds Ratio [Or] 4.429; (95% Confidence Interval: 11.816 To 10.802 ), Parity > 0[Or] 4.636
(95% Ci: 2.359 To 9.112 ), Spontaneous Abortion > 0[Or] 2.688 (95% Ci: 1.164 To 6.207), Lack Of A Birth Control Method
[Or] 4.846 (95% Confidence Interval: 2.497 To 9.406), Younger Than 18 Years At Age Of First Sex [Or] 2.496 (95% Ci:
1.383 To 4.505 ),Sex During The Previous Menses [Or] 4.959 (95% Ci: 2.353 To 10.449), With Multivariate Analysis To
Control For Confounders The Significant Risks Still Identified Were Spontaneous Abortion [Or 3.32], Lack Of
Contraception [Or 7.87].

Conclusion:
Certain Reproductive Behaviours Could Be Targeted For Public Health Attention And Risk Reduction Interventions To
Reduce Pid. Encourage The Use Of Condoms And Methods Of Contraception For Sexually Transmitted Disease Prevention
And Birth Control . Another Finding Was That It Is Probably Best To Avoid Sexual Intercourse During The Menses And
Have Single Partner.

***************

Application Of Palm-Coein Classification System In Cases Of Abnormal Uterine Bleeding

Author: Dr. Divya Shubham
Co Author: Anjali Kawthalkar1,

Aims And Objectives To Assess The Feasibility Of Palm-Coein Classification System For Cases Of Acute Uterine
Bleeding (Aub). To Study The Prevalence Of Various Causes Of Aub In Reproductive Age Group.
Material And Methods This Study Is A Cross-Sectional Study Done In A Lata Mangeshkar Hospital In Nagpur. The
Study Duration Was From January June 2014. A Total Of 80 Patients Were Studied. Patients In Reproductive Age
Group Who Came With Chief Complaint Of Abnormal Uterine Bleeding Were Included. Pregnant Subjects Or Patients
Presenting With Other Symptoms Were Excluded From The Study. Outcome Measures Included Age, Chief Menstrual
Complaint, Parity, History Of Any Hormonal Medication Intake And Histopathology Report.
Results Aub Is Most Commonly Found In Peri-Menopausal Age Group (40-50 Years). The Most Common Clinical
Presentation Was Represented By Menorrhagia Followed By Polymenorrhagia And Metrorrhagia. Chronic Aub Was More
Common Presenting Feature Than Acute Episode Of Aub. Transvaginal Sonography Revealed Various Structural Causes
Of Aub. Structural Causes Like Leiomyoma And Adenomyosis Were Found To Be More Common. Evaluation Of
Endometrium Revealed Various Patterns Of Histopathology.
Conclusion Palm-Coein System Of Etiological Classification Of Cases Of Abnormal Uterine Bleeding Is A Simple And
Easy To Apply System. It Helps In Correct Evaluation Of Cases Of Abnormal Uterine Bleeding When >1 Pathology Is Present
In A Patient. It Also Helps In Clearly Defining Various Menstrual Abnormalities.
***************

Role Of Modified B-Lynch Suture In Atonic Pph.

Author: Dr. Neena Somani
Co Author: Dr Neena Agrawal1,

Aims And Objectives To Evaluate Efficacy Of Modified B- Lynch Suture In Atonic Pph Encountered During Caesarean
Section.
Materials And Methods - A Prospective Study Was Conducted At Chl Hospital, Indore Which Is A Tertiary Referral Centre.
We Evaluated 150 Patients Of Atonic Pph During Lscs, Where Routine Uterotonics Did Not Work. This Study Included
Patients From 1St January 2009 Till 31St December 2013. In All These Patients We Used Modified B-Lynch Suture Using
No. 1 Chromic Catgut And A Straight Cutting Needle To Control Hemorrhage.
Results- After Application Of Modified B-Lynch Suture In 150 Cases Of Atonic Pph, Hemorrhage Was Controlled In 147
Patients Showing An Efficacy Of 98% And Only 3 Patients (2%) Required A Caesarean Hysterectomy.
Post Operative Period In All These Patients Was Uneventful Except For Fever And Wound Sepsis In 3 Patients Which Was
Treated With Antibiotics And Other Supportive Treatment.
Conclusion Modified B-Lynch Suture Was Successful In Controlling Atonic Pph During Lscs Where Other Measures
Like Pitocin, Carboprost, Ergometrine And Misoprost Failed To Control Bleeding And Uterus Remained Flabby. Obstetric
Hysterectomy Could Be Avoided In 98% Of Such Cases. Only 2% Patient Needed Hysterectomy After Application Of This
Suture. There Were No Major Post Operative Complications.
***************

Role Of 3D Ultrasound Versus Mri In Diagnosis Of Congenital Anomalies Of Uterus And Vagina
Author: Dr. Shelly Kushwah
Co Author: Madhu Jain1, Ashish Verma2,

Aims And Objectives This Study Aims To Assess The Role Of 3D Ultrasound And Mri In Diagnosis Of Congenital
Anomalies Of Uterus And Vagina And To Compare The Findings With Laparohysteroscopy,Laparotomy For Better
Assessment Of Results And Statistical Analysis Of Data.
Materials And Methods It Was A Prospective Cohort Study.145 Patients Having History Of Recurrent
Miscarriages,Spontaneous Abortion,Primary Amenorrhoea Were Included In The Study
Mri Was Done On A 1.5 Tesla (Siemens Avanto) System.3 D Ultrasonography Was Performed On (Andover ,Ma,Usa)
Installed With A Routine 3.5 Mhz Conex And A Multi Frequency 3D Transducer.3D Reformats Were Performed Using The
Baseline Data On A Virtual Organ Computer-Aided Analysis (Vocal) Software. The Anomaly Was Classified According To
Afs Classification 1988 And The Results Were Confirmed Per-Operatively In Symptomatic Ones.
Results- Mri Correctly Diagnosed 98( 96%) Patients Of Agenesis/Hypoplasia (Sensitivity-96.08%,Specificity-90.7%) While
3D Usg Diagnosed 91.16% Patients Correctly (Sensitivity-91.2%,Specificity-81.4%).4 Cases Were Not Detected By Both
Mri And 3 D Ultrasound.
Single Patient Of Unicornuate Uterus And 3 Patients Of Didelphys Uterus Were Diagnosed Correctly By Both 3D Usg And
Mri (Sensitivity-100%,Specificity-100%)
12(100%)Patients Of Bicornuate Uterus Were Diagnosed By Mri Accurately (Sensitivity-100%,Specificity-95.49%) But 3D
Usg Could Diagnose Only 9(75%)(Sensitivity-75%,Specificity-95.49%).
In Septate Uterus Mri Could Diagnose 6(33.33%) Cases With A Sensitivity-33.33%%,Specificity-100%) While 3D Usg Was
Better As It Could Correctly Diagnose 13(72.2%) Patients With A Sensitivity-72.2%,Specificity-100%).
9(100%) Cases Of Arcuate Uterus Were Diagnosed By Mri And 3D Usg Correctly With Mri Having A Sensitivity100%,Specificity-100%.

Conclusion -In Our Study Mri Was Overall Better Than 3 D Usg In Diagnosis Of Congenital Anomalies Of Uterus And Vagina
Except In Cases Of Septate Uterus.

***************

Estimation Of Maternal And Cord Blood Lead Levels And Its Correlation With Fetomaternal Outcome
Author: Dr. Ankita Fatnani
Co Author: Professsor Sujata1, Professor S.P. Jaiswar2, Dr. P.L. Sankhwar3, Professor A.A. Mahdi4,

Aims And Objectives- Estimation Of Maternal Blood Lead Levels And Cord Blood During Delivery And To Find The CoRelation Between Them And Fetomaternal Outcome.
Materials And Method- The Study Was Conducted In The Department Of Obstetrics And Gynaecology In Collaboration
With Department Of Biochemistry, Kgmu, Lucknow Over A Period Of One Year On 110 Paired Samples. ( Maternal And
Cord Blood)
Results- Baseline Lead Levels In Maternal Blood Lies Below 5 g/Dl. Five Subjects Had Maternal Blood Lead Ranging
Between 5-10 g/Dl, Two Of Then Had Lead Levels Between 10-20 g/Dl And One Had Lead Levels Above 20 g/Dl.
7.2% Of Mothers And 1.7% Of Babies Are Having Lead Levels >5 g/Dl, Crossing The Cdcs Intervention Levels Of Lead
Concentration. Positive Co-Relation Was Observed Between Maternal And Cord Blood Lead Levels. Higher Blood Lead
Levels Among Hypertensive Subjects And Elevated Cord Blood Lead In Babies Of Low Birth Weight.
Conclusions- Positive Co-Relation Was Seen Between Maternal And Cord Blood Lead Levels.

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Hysteroscopic Septal Resection Using Unipolar Resectoscope Versus Bipolar Resectoscope: A Prospective,
Randomized Study.
Author: Dr. Yamini Kansal
Co Author:

Aims And Objectives- To Compare The Operative Parameters (Operative Time, Fluid Absorption, Hyponatremia,
Complications) And Reproductive Outcome Of Hysteroscopic Septal Resection Using Unipolar Resectoscope Versus
Bipolar Resectoscope.
Materials & Methods- Twenty One Women Underwent Hysteroscopic Septal Resection Using Either Unipolar
Resectoscope (With 1.5% Glycine) Or Bipolar Resectoscope (Normal Saline). Intraoperative Parameters (Operative Time,
Uid Deficit And Complications) And Post Operative Serum Sodium Levels Were Compared Between The Two Groups.
A Second Look Hysteroscopy Was Performed After 6 Weeks. All Pregnancies Occurring During The Follow Up Period Were
Recorded.
Results- A Significant Negative Correlation Was Seen Between The Volume Of Fluid Deficit And The Serum Sodium Levels
(R= -0.796; P<0.001) In Group A (Unipolar). No Significant Correlation Was Found In Group B (Bipolar).Mean Serum
Sodium Levels Were Significantly Lower In Group A Compared To Group B. No Significant Difference Was Found In The
Operative Time And The Fluid Deficit Between The Two Groups. There Was Significant Decrease In The Abortion Rate
And A Significant Increase In The Full Term Delivery Rate Post Metroplasty In Both The Groups. Comparing The Two
Groups, No Significant Difference Was Observed In The Reproductive Outcome Or In The Post-Operative Remnant
Septum And Adhesions Rate.
Conclusion-The Safety And Efficacy Of The Bipolar Resectoscope Has Been Reconfirmed In Our Study. This Research Was
The First Attempt To Evaluate The Effect On Serum Electrolytes After Hysteroscopic Septal Resection. A Larger Similar
Randomized Controlled Trial Will Be Needed To Have A More Conclusive Comparison Of The Unipolar And Bipolar
Resectoscopes.

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Adverse Maternal And Foetal Outcomes In Severe Anaemia During Pregnancy

Author: Dr. Arpana Das
Co Author: Prof Dr Robin Medhi1,

Aims And Objectives- To Study The Adverse Maternal And Foetal Outcomes In Severe Anaemia During Pregnancy.
Materials And Methods- Our Study Was A Prospective Observational Study Conducted At Silchar Medical College And
Hospital From June 2013 To May 2014. In Our Study, 79 Pregnant Women With Severe Anaemia(Hb% < 7Gm/Dl) Were
Compared With 90 Pregnant Women With Mild To Moderate Anaemia( Hb% 7-11 Gm/Dl) And 150 Pregnant Women
With Normal Haemoglobin(Hb% > 11 Gm/Dl). Adverse Maternal Outcomes Analyzed Were Preterm Delivery, Postpartum
Hemorrhage, Puerperal Sepsis, Wound Gaping And Maternal Mortality. Adverse Foetal Outcomes Analyzed Were
Preterm Birth, Low Birth-Weight And Perinatal Mortality.
Results- In Our Study, We Found That Pregnant Women With Severe Anaemia Had Increased Risk Of Preterm Labour( P
Value < 0.001,Or 6.9 With 95% Ci: 3.50- 13.49), Preecclamsia( P Value < 0.05, Or 2.8 With 95% Ci: 1.13-6.98), Post Partum
Haemorrhage(P Value < 0.001, Or 6.8 With 95% Ci 2.56-18.09), Puerperal Sepsis ( P Value < 0.001, Or 8.8 With 95% Ci:
2.39-32.13) And Wound Gaping ( P Value < 0.001,Or 9.8 With 95% Ci: 2.06-45.56). Maternal Death Occurred Only In The
Severe Anaemia Group (7.6%). There Was Also Increased Incidence Of Preterm Birth(P Value < 0.001, Or 6.6 With 95%
Ci: 3.32-13.46), Low Birth Weight Babies (P Value < 0.001, Or 9.7 With 95% Ci: 4.93-19.11) And Perinatal Death ( P Value
< 0.001, Or 13.7 With 95% Ci: 4.50- 41.65) Among The Babies Born To The Severe Anaemia Group.
Conclusion- Severe Anaemia In Pregnancy Is A Risk Factor For Poor Pregnancy Outcomes And Results In Complications
That Threaten The Life Of Both Mother And Foetus. Proper Implementation Of Government Policy, Social Awareness,
Early Detection And Prompt Management Of Anaemia During Pregnancy Can Prevent This Entirely Preventable
Complication.

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Lactate Dehydrogenase (Ldh), A Biochemical Marker For Maternal And Fetal Outcome In Preeclampsia And Eclampsia
Author: Dr. Sameetha Pallem
Co Author:

Aims And Objectives

To Compare Serum Lactate Dehydrogenase (Ldh) Levels In Normotensive Pregnancy And In Women With
Preeclampsia And Eclampsia And To Correlate The Severity Of The Disease, Maternal And Perinatal Outcome With Serum
Lactic Dehydrogenase (Ldh) Levels.
Methods
This Is A Prospective Comparative Case Control Study Conducted In The Department Of Obstetrics And Gynaecology In
Collaboration With Department Of Biochemistry, Government General Hospital, Kakinada, Andhra Pradesh. Total Of 150
Women Were Studied, Of Which 50 Were Normotensive Women, 30 Were Of Mild Preeclampsia, 20 Were Of Severe
Preeclampsia And 50 Were Of Eclampsia. Serum Ldh Levels Were Estimated And Grouped As <600 Iu/L, 600800 Iu/L
And >800 Iu/L. All Women Were Followed Through Delivery And Postpartum Period And Babies Till Early Neonatal Period
(<7Days). The Statistical Analysis Was Done By Chi-Square Test Analysis Of Variance And Paired t Test.
Results
Ldh Levels Were Significantly Elevated In Women With Preeclampsia And Eclampsia ( P<0.001). Systolic And
Diastolic Bp Were Significantly Higher In Patients With Higher Serum Ldh Levels (P < 0.001) And Had Poor Maternal And
Perinatal Outcome.

Conclusion
High Serum Ldh Levels Have Significant Association With The Severity Of The Disease And Poor Outcomes In Patients Of
Preeclampsia And Eclampsia And Can Be Considered As A Supportive Prognostic Tool From Early Third Trimester.

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Pre Surgical Assessment Of P.O.D By Tv Usg

Author: Dr. Govindarajan Dharani Bai
Co Author:

Aims And Objectives

Endometriosis, In Reproductive Years Has An Incidence Of 6-10 %. Though Symptoms Vary With Location Of Active
Endometriosis, Pelvic Pain Is Constant With Infertility.Though Laparoscopy Is The Gold Standard In Definitive Diagnosis
Of Endometriosis, It Is Invasive. Transvaginal Ultrasound Scanning Is Useful To Confirm Or Rule Out Endometriosis ,
Specifically In Deep Infiltrating Endometriosis. Evidently, Success Of Surgical Treatment Of Deep Infiltrating Endometrosis
Depends On Obtaining Detailed Information About The Lesion Prior To The Procedure.
Material & Methods.
This Prospective Study Conducted At Oyster Clinic, 30 Patients Aged 25-38Yrs With Need For Pelvic Ultrasound
Suspecting Endometriosis And Those Needing Serial Follicular Evaluation Were Included. Ultrasound Evaluation Was
Performed With Voluson S-6 Machine.Trans-Abdominal Sonographic Evaluation Was Followed By Tvs. All Scans Were
Performed By The Same Sonologist Who Has Gynaecological Expertise, Each Examination Was Interpreted In Real Time
And Videotaped For Video Review.
The Uterosacral Ligaments, Vagina /Cervix And The Rectosigmoid Colon Were Systematically Analysed During Each
Sonographic Examination. Partial Or Complete Obliteration Of Pod And The Presence Of Fluid Were Recorded. Unilateral
Or Bilateral Ovarian Involvement By The Presence Of Cysts With Diffuse Low Level Internal Echoes Noted.
Results.
Of The 30 Cases Analysed Finding Of Hypoechoic Linear Thickening Of Bowel Wall Noted In One Case, Unilateral Cyst
With Low Level Internal Echoes In One Case And Multi Loculated Bilateral Cysts In Two Cases.
Conclusion.
Typical Sonographic Video Clips For Die Of The Rectum Integrated In Tvs Training Courses Could Help To Improve The
Diagnostic Accuracy And Shorten Diagnostic Delays. Standard Evaluation Of Painful Symptoms Is Useful In Screening
Women For The Presence Of Endometriotic Nodules Reaching The Muscular Layer Of The Rectum, Allowing The Surgeon
To Discuss The Best Surgical Strategy With The Patient And To Assemble A Multidisciplinary Team.

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Fetal Outcome Of Hiv Positive Pregnant Women Screened In Various Chandigarh Health Setups
Author: Dr. Swapan Kular
Co Author: Dr. Swapanjeet Kaur1, Dr. Amber Aggrwal2, Dr. Jaydeep Kale3,

Aims And Objectives

Study On Hiv +Ve Pregnant Women Screened Out Of Approximately 75,000 Pregnant Women Over 3 Year Period(2011
To 2014).

Material And Methods

Pregnant Patients At Various Health Setups Approximately 75,000 Were Screened (Pgi, Gmch-32, Gmsh-16) For Hiv.
Positive Patients Approx. 154 Were Put On Arv Prophylaxis (Single Drug 2011 To 2013, Multiple Drug In 2014) To Reduce
Pptct. Infants Born Were Tested With Dbs Within 2 Months. Infants Were Put On Replacement Feed Without Breast Feed.
Infants Were Retested At 18 Months.

Results

Out Of 154 Hiv Positive Pregnant Women About 111 Received Arv Prophylaxis. Approx 123 Infants Were Put On
Replacement Feeds And Out Of Which 118 Infants Had Hiv Testing Through Dbs Within 2 Months Of Birth. 2 Infants Were
Positive After Above Test. After 18 Months Follow Up Only 1 Infant Was Positive.

Conclusion

Arv Prophylaxis Is Very Effective In Preventing Mother To Child Transmission. Now Arv Prophylaxis Has Been Changed
From Single Drug To Multiple Drug Regime And Results Have Improved (No Positive Case Reported In 2014).

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Pulmonary Edema Complicating Preeclampsia: Timely Cesarean Saves Lives: A Prospective Observational Study.
Author: Prof. Kiran Aggarwal
Co Author:

Aims And Objectives

I)To Study The Clinical Profile Of Pregnant Women With Pulmonary Edema Complicating Preeclampsia.
Ii)To Study The Obstetric Outcome In These Patients With An Early Decision Of Cesarean Section
Material And Methods: 21 Patients Admitted To Icu With Pulmonary Edema Complicating Preeclampsia (Jan 2011- Feb
2014) Were Included. Clinical Characteristics, Severity Of Hypertension, Biochemical Profile, Management And Outcome
Of Pregnancy Were Studied. 50 Patients Of Severe Preeclampsia Without Pulmonary Edema Were Taken As Control.
Results: 53 Women Admitted Due To Hypertensive Disorders Out Of Which Pulmonary Edema Complicated 21/53
(39.6%). 50% Were Multigravida In Age Group 20-30 Years. 55% Were 30-34 Wks Gestation And 40% > 36 Wks. 16 Were
Antenatal,9 Presented With Pulmonary Edema And 7 Went Into Pulmonary Edema In Hospital. 4 Were Intrapartum, 1
Postpartum.
Mean Systolic Pressure Were170+/- 4 Mm Of Hg, Mean Diastolic Pressure 108+/-2 Mm Of Hg, 75% Had Generalized
Anasarca, With Serum Albumin <3. Moderate Anemia Seen In 60%, Liver Enzymes Twice Normal In 50%. Rest Of The
Biochemical Profile And Coagulation Was Normal. Those Who Developed Pulmonary Edema In Hospital Had Sudden
Accelerated Hypertension. In Severe Preeclampsia Without Pulmonary Edema 30% Were Multigravidas (P<0.005), 25%
Had Generalized Edema(P<O.001), Anemia In 20%(P<0.001).
14/16(87.5%) Antenatal Patients, Who Did Not Respond To Conservative Medical Therapy, Werw Intubated And
Emergency Lscs Done, Inspite Of 3 Patients Having Intrauterine Death. 13 Recovered One Died After 35 Days In Icu
Because Of Multiorgan Dysfunction. 2 Patients Came Gasping And Died In Casualty Immediately.
Perinatal Mortality Was 50%.
Conclusion:Accelerated Hypertension, Anemia, Generalized Anasarca( Increased Capillary Permeability), Decreased
Serum Proteins, Combination Of Drugs Like Steroids, Magnesium Sulphate Predisposes To Pulmonary Edema. Gravid
Uterus Causes A Cardiopulmonary Compromise And Difficult Resuscitation.Immaculate Fluid Management And Once
Intubated Decision In Favor Of Lscs Helps Drastically In Improving Maternal Outcome.

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Pregnancy Outcome In Women With Previous One Spontaneous Abortion

Author: Dr. Devi R
Co Author:

Aims And Objectives

Spontaneous Abortion Is A Common Phenomenon. But Adequate Research Material Is Not Available To Prove Whether
One Spontaneous Pregnancy Loss Is Associated With Adverse Pregnancy Outcomes. The Purpose Of This Study Is To Find
Out The Association Between One Spontaneous Pregnancy Loss And Adverse Pregnancy Outcomes In The Subsequent
Pregnancy.
Materials And Methods
This Is A Hospital Based Cohort Study. 100 Women Who Had One Spontaneous Abortion Preceding The Current Pregnancy
Were Included In The Case Group. Control Group Included 101 Women Who Had One Full Term Live Birth Preceding The
Current Pregnancy And No History Of Spontaneous Abortions. The Incidence Of Adverse Pregnancy Outcomes Like
Preterm Labour, Pprom, Prom, Iugr And Oligohydramnios And Neonatal Outcomes Like Poor Apgar Score, Low Birth
Weight, Nicu Admissions And Neonatal Complications Were Compared And Analysed Between The Two Cohorts.
Results
Comparing The Pregnancy Outcomes Of The Case And Control Groups, We Found That The Case Group Consisting Of
Women With Previous One Spontaneous Abortion Had A Higher Number Of Instances Of At Least One Adverse Pregnancy
Or Neonatal Outcome, Compared To The Control Group (P Value = 0.05). 39% Of The Women In The Case Group Had At
Least One Adverse Pregnancy Or Neonatal Outcome, While In The Control Group Only 26% Had The Same. The Adverse
Outcomes Which Were Independently Associated With Initial Spontaneous Abortion Were Pprom (P = 0.03), Prom (P =
0.04), Iugr (P = 0.03), Low Birth Weight (P = 0.03), Low Apgar Scores (P = 0.01) And Babies Requiring Nicu Care (P = 0.002).
Conclusion
This Study Is A Pointer That Pregnancies Following A Spontaneous Abortion, Rather Than Considering Them Low Risk
Pregnancies, Should Be Taken Care Of Expecting This High Risk For Adverse Outcomes.

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Role Of Transcervical Amnioinfusion In Labour Complicated With Thick Meconium Stained Liquor
Author: Dr. Usha Dasari
Co Author:

Aims And Objectives

To Evaluate The Effectiveness Of Amnioinfusion In Cases Of Thick And Particulate Meconium Stained Liquor To Reduce
The Incidence Of Fetal Distress And Meconium Aspiration Syndrome In Neonates And Compare Neonatal Outcome With
Control Group.

Methods
A Prospective Comparative Case Control Study Was Conducted In The Department Of Obstetrics And Gynecology,
Government General Hospital, Kakinada. A Total Of 100 Cases Of Labour Complicated With Thick Meconium Stained
Liquor Were Studied Of Which In 50 Cases Transcervical Amnioinfusion Was Given And Remaining 50 Cases Without
Amnioinfusion Were Taken As Controls. The Statistical Analysis Of Neonatal Outcome Was Done By Chi Square Test
Analysis Of Variance And Paired T Test.

Results
Operative Interventions For Fetal Distress Were Significantly Less In Infusion Group ( P<0.01 ). Apgar Scores At 1Min,
5Min And 10Min Of >7 Were Observed In More Cases Of Infusion Group With Significant Difference In Control Group.
Use Of Resuscitative Measures For Neonates Were Relatively More In Control Group With Higher Incidence Of Meconium
At And Below Vocal Cords( P<0.01 ). In Infusion Group, Admissions In Nicu Were Less ( P<0.01 )

Conclusion
Transcervical Amnioinfusion During Labour Is A Safe, Simple, Inexpensive And Effective Procedure In Improving The
Obstetric And Perinatal Outcome In Patients Labouring With Thick Meconium Stained Liquor.
***************

Study Of Heart Disease Complicating Pregnancy And Maternal And Fetal Out Come Authors
Dr Shobha, Dr Sunanda, Dr Rajini,
Author: Dr. Shashi Parlapalli
Co Author:

: Drshashi Jyothsna,

Aims And Objectives

To Study 100 Cases Of Heart Disease Complicating Pregnancy And Maternal And Fetal Outcome
Introduction
Heart Disease Complicating Pregnancy Is Considered As High Risk Situation. Increased Cardiac Demands During
Pregnancy Potentially Increase Morbidity And Mortality In Women With Heart Disease
Materials And Methods
Observational Study Of 100 Cases Of Pregnancy Complicated By Heart Disease, Reporting To Tertiary Care Hospital For
Delivery, Was Carried Out To Find Out Antepartum, Intrapartum And Postpartum Complications And Maternal And Fetal
Outcome
Results
Rheumatic Heart Lesions Constitute54% . Mitral Stenosis Is The Commonest Lesion Constituting 27% .65 Women
Delivered Vaginally At Term Of Which 56 Delivered Spontaneously And 9 Delivered By Outlet Forceps. 15 Delivered
Prematurely.Cesarean Section Performed In 35 Cases Of Which 2 Cases Done For Pulmonary Edema With Ventillatory
Support With Poor BishopS Score To Decrease Work Load On Heart .There Are 10 Maternal Deaths, 4 Were Mitral
Stenosis,5 Were Peripartum Cardiomyopathy And 1 Case Was Severe Pulmonary Stenosis With Interatrial Aneurysm,Of
Which 6 Died Due Of Pulmonary Edema, 3 Died Due To Congestive Heart Failure And One With Ccf With Atrial
Fibrillation.9 Died After Delivery And One Case Died During 32Wks Due To Pyrexia With Ccf. 10 Went Into Pulmonary
Edema And 4 Cases Recovered. 6 Went Into Ccf And 2 Recovered . 1 Case Had Pph, 2 Had Wound Gaping And 1 Had
Postpartum Psychosis. Perinatal Mortality Is 11%
Coclusion
Early Diagnosis, Regular Antenatal Checkup, Institutional Delivery At Tertiary Care Hospitalcan Reduce Maternal And
Perinatal Morbidity And Mortalityassociated With Heart Disease. Nyha I And Ii Should Be Monitored In Obstetric Icu.,
Need To Improve Obstetric Icu. All Obstetricians Must Be Trained In Cardiac Unit For 3 Months To Tackle Cardiac Cases
***************

Evaluation Of Perinatal Morbidity And Mortality In Antepartum Haemorrhage(Aph) In A Tertiary Care Center
Author: Dr. Monika Rajput
Co Author: Ruchi Hooda1, Nilu Kumari2, Gunjan Gulati3, Nikita Kumari4, Banashree Das5

Aims And Objectives: Aim Of The Present Study Was To Analyze Perinatal Morbidity And Mortality In Patients With
Antepartum Haemorrhage ( Aph)
Method: It Is A Retrospective Study Carried Out In Vmmc & Sjh, Delhi Over A Period Of One Year, July 2013 To June 2014.
All The Patient Admitted To The Department Of Obstetrics And Gynecology With Diagnosis Of Antepartum Haemorrhage
Were Included In The Study. All The Women Were Followed Till Delivery And Outcome Was Noted And Analyzed.
Result: The Incidence Of Aph Was 2.08%, Out Of Which 67% Were Due To Placenta Previa And 32% Were Due To Placental
Abruption. Majority Of The Patients (62.3%) Had Inadequate Or No Antenatal Care In This Indexed Pregnancy. Perinatal
Mortality Was As High As 20% Of Which 17 % Was Still Birth And 3 % Was Neonatal Death. Perinatal Mortality Was Very
High With Placenta Previea (49.6%) Than In Patients With Abruptio ( 5.9%) Nicu Admission Needed In 28.79 % Of Babies.
25.8 % Babies Delivered Prematurely. Birth Asphyxia Was Diagnosed In 13. 6%. Congenital Malformation Was Detected
In 1.5 % Of Babies.
Conclusion: Antepartum Haemorrhage ( Aph) Is A Major Cause Of Perinatal Mortality And Morbidity. Adequate
Antenatal Care May Prevent Many Mortality And Morbidity.

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Adverse Obstetrical And Perinatal Outcomes In Adolescent Pregnancies Associated With First Birth.
Author: Dr. Banani Das
Co Author: Proff Dr Robin Medhi1,

Aims And Objectives: To Evaluate Adverse Obstetrical And Perinatal Outcomes Among Adolescent Mothers Of Age
Group 15 -19 Years Associated With First Birth .

Materials And Methods: This Was A Prospective Cross-Sectional Study Done At Silchar Medical College And Hospital
Over A Period Of June 2013 May 2014. Adverse Obstetrical And Perinatal Outcomes Of All Adolescent Mothers Of
Age 15-19 Years With Singleton Pregnancy Above 28 Weeks Of Gestation Attending In The Department Of Obstetrics And
Gynecology Were Compared With Matching Older Mother Of Age Group 20-29 Years. For Each Adolescent Mothers Two
Simultaneous Older Primigravidae Were Studied. The Adverse Outcomes Like Pre-Eclampsia, Eclampsia, Pre-Term
Delivery, Mean Birth Weight ,Nicu Admission And Perinatal Mortality Along With Contraceptive Awareness Among The
Adolescent Mothers Were Evaluated.

Results :

The Adolescent Mothers Had Higher Risk Of Pre-Eclampsia [Or 2.572 ,95% Ci(1.0743-6.149)] And Eclampsia [Or 2.609,
95% Ci(1.0457-6.4829)]. Adolescent Mothers Intended To Deliver Earlier [ Mean Gestational Age 36.5Weeks Vs
37.7Weeks]. Mode Of Delivery In Adolescent Mothers DidnT Differ From Control Group. Babies Of Adolescent
Mothers Had Increased Risk Of Prematurity [Or 1.98, 95% Ci (1.12-3.49)], Low Mean Birth Weight [2444.4Gms Vs
2701.6Gms; P Value- 0.0003], And Higher Rates Of Nicu Admission [Or 2.51,95% Ci(1.303-4.83)]. There Was No Significant
Difference Found In Perinatal Mortality. There Was Lack Of Knowledge And Wrong Belief About Contraception Among
The Adolescent Mothers[Or 8.33,95% Ci(4.71-14.74)] .
Conclusion: Adolescent Mothers Have More Adverse Outcomes As Compared To Older Mother(20-29Years). Effective
Contraceptive Education And Safe Sex On The One Hand And Provisions For Quality Pregnancy Care, If Pregnancy Occurs,
Should Be Provided To Adolescent Girls To Reduce These Poor Outcomes.

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Study On Comparison Of Transvaginal Cervical Length And Bishop Score In Predicting Successful Labour Induction
Author: Dr. Ranjana Atal
Co Author: Dr. Madhubala Chouhan1,

Aims And Objectives:

1. To Compare The Predictive Value Of Trans Vaginal Ultra Sonographic Measurement Of Cervical Length Versus Bishop
Score Prior To Induction Of Labor In Predicting The Mode Of Delivery And Maternal And Fetal Outcome.
2.To Estimate The Most Useful Cutoff Points For The Two Methods.
Material And Methods: The Study Was Conducted At Department Of Obs & Gynae At Pannadhay Rajkiya Mahila
Chikitsalaya Rnt Medical College , Udaipur.This Study Is A Prospective Observational Study. In This Study 100 Patients
With Gestational Age Between 37-42 Weeks With Singleton Pregnancy Admitted For Induction Of Labor Are Enrolled.
After Informed And Written Consent Of Patients,The Cervical Length Was Measured By Trans Vaginal Ultrasound And
Then Bishop Score Was Assessed By Digital Examination. Induction Of Labor Done By Tab Misoprostol 25Microgram
Per Vaginally .Predictive Values For Successful Labor Induction Within 24Hrs Was Detected And Compared Between
Bishop Score And Cervical Length Measured By Tvs.
Results: Tvs
Cervical Length And Bishop Score Have Significant Correlation In Predicting The Success Of Induction Of Labor. Cervical
Length Is The Better Predictor Of The Likelihood Of Vaginal Delivery Within 24Hrs. Out Of 100 Enrolled Patients, 80(80%)
Patients Delivered Vaginally And 20(20%) Patients Delivered By Caesarean Section . In The Receiver Operating
Characteristic Curves,The Best Cutoff Points For The Prediction Of Successful Induction Was 28Mm For Cervical Length
And 5 For The Bishop Score.
Conclusion : Trans Vaginal Sonographic Measurement Of Cervical Length Is A Better Predictor Of The Likelihood Of
Vaginal Delivery Within 24Hrs Of Induction When Compared To Bishop Score.

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correlation Of S. Estrogen Level And Hyperlipidemia As A Predictor Of Cardiac Risk In Peri And Post Menopausal
Women
Author: Prof. Yashodhara Pradeep
Co Author: Dr.Renu Singh1, Babita Devi2, Ayush Chandra3, V, S, Narayan4,

Aims And Objectives:

Estimation Of S. Estrogen And Lipid Profile In Peri And Post Menopausal Women

Correlation Of S. Estrogen And Lipid Profile In These Two Groups For Prediction Of Cardiac Risk

Material And Method:

Study Design: Cross Sectional Observational
Study Population : Women Attending Gopd Dept Of Obgyn Kgmu Lucknow Up
Sample Size: 100 With 10% Drop Out Rate
Inclusion And Exclusion Criteria Were Taken Into Account
Detail History ; Clinical Examination; Routine Investigation
Specific Examination:
Bmi, Waist Hip Ratio, Blood Pressure
Specific Investigation:
S. Lipid Profile After 10 Hours Fasting, S. Estradiol,
Criteria For Abnormal Range; S. Estrogen < 40Pg/Ml, Bmi<25, Whr<0.81, Sbp140/Dbp90, Total Cholesterol<200,
Ldl <100, Hdl<51, Tg<150.
Statistical Tool:
Mean, Sd, Chi Square Test; Student T Test; Bivariate Correlations; Linear Regression; Roc Curve; Level Of
Significance P Value<0.05
Results : The Peri And Post Menopausal Women With S. Estrogen < 40 Pg/Ml, Have Shown Presence Of 2Cardiac
Risk Factor.P0.02; On Bivariate Analysis Significant And Mild Inverse And Moderate Inverse Correlation With Dbp,
S.Cholesterol, S.Ldl And S. Triglyceride (R=-0.3 To 0.5);Sbp,Vldl,Cho/Hdlands.Ldl/Hdl(R=-0.5 To 0.7) Respectively; Strong
Positive Correlation Of S.Estradiol With S. Hdl (R=- 0.768 ); On Multivariate Analysis A Significant Correlation Of S.Estradiol
With Age, Duration Of Menopause, Whr, S.Hdl And S.Cholesterol/Hdl Were Found. Roc Did Show The Sensitivity And
Specificity Of S. Estradiol <40 Pg/Ml To Predict S.Hdl <51 Is78.7 And 74.2% Respectively
Conclusion: The S. Estroggen >40Pg/Ml Is Associated With Significantly Higher Risk Of Chd In Peri And Pmw

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Prevalence Of Chlamydia And Gonorrhea In Hiv Positive And Hiv Negative Outpatients
Author: Dr. Shilpa Agrawal
Co Author: Prof. N. R. Agrawal1, Dr. Jaya Chakravarty2, Dr. Uma Pandey3,

Aims And Objectives:

Assess And Compare Prevalence Of Gonorrhea And Chlamydia Infections In Hiv Positive And Hiv Negative Individuals

Methods And Materials:

Rct Was Done In Department Of Obstetrics & Gynecology, Ims Bhu From July, 2012 To July, 2014. A Total Of 80 Hiv
Seropositive Were Taken As Cases And 20 Hiv Seronegative Patients As Controls. All Subjects Were Asked About Sti
Symptoms, Sexual Behavior, Physically Examined And Samples Were Taken From Both Ectocervix And Endocervix For
Detection Of Chlamydia, Gonorrhea, Hpv And Trichomoniasis Using T.Vaginalis/N.Gonorrhoeae/C.Trachomatis Real
Time-Pcr Kit. The Difference In Prevalence Were Assessed For Stastical Significance.

Results:
The Mean Age Was 36 And 29 Yrs ( P Value <0.001) In Cases And Controls, Respectively. Among Cases, 40(50%) Had
Symptoms/Signs And 30(37.5%) Had Sti. All 20 Controls Were Symptomatic But Only 1(5%) Had Sti. Among Cases, The
Prevalence Of Chlamydia, Trichomonas, Syphilis, And Hpv Was 5%(4/80), 8.8%(7/80), 3.8%(3/80) And 27.5%(22/80),
Respectively, While Gonorrhea Was Absent. Only One Control (Hiv Negative) Tested Positive For Std That Was
Trichomonas. The Mean Cd4 For Std Positive Patients Was 386.55282.5 And That Of Std Negative 442.57243.6.
There Is Statistically Significant Association Of Low Cd4 With Presence Of Any Sti(P-Value: 0.007).

Conclusion:
It Is Concluded From The Study That The Prevalence Of Chlamydia, Syphilis, Trichomonas, And Hpv Is Higher In Hiv
Seropositive Population And, That Low Cd4 Counts Increases The Risk To Acquire Sti. However, Surprisingly, Gonorrhea
Infections Were Not Found To Increase In Hiv Patients In Our Study. Clinical Symptoms Alone Can Be Unreliable In
Specifically Predicting Infections With C.Trachomatis And N.Gonorrhea And Hence There Is A Need For Adopting A Specific
Strategy For Screening Of Std Patients In India To Reduce Overall Rate Of Sti, Which Would In Turn Reduce Risk Of Hiv
Infection.

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The Efficacy Of Cefazolin/Cephalexin And Erythromycin In Prolonging Pregnancy Upto 34 Weeks In Preterm
Premature Rupture Of Membranes
Author: Dr. Navya Chandrakumar
Co Author: Dr Grv Prasad1, Dr Rashmi Bagga2, Dr Praveen Kumar3, Dr Vikas Gautam4,

Aims And Objectives:

To Observe The Efficacy Of Cephazolin/ Cephalexin And Erythromycin In Terms Of Prolongation Of Pregnancy Upto 34
Weeks And In Reduction Of Maternal Morbidity And Perinatal Morbidity And Mortality Following Pprom.
Materials And Methodology:
50 Women With Singleton Pregnancy With A Live Fetus Between 26-33 Weeks Of Gestation With Pprom Were Included
And Given Cefazolin (1G Iv Q6H) And Erythromycin (250Mg Po 6H) For Initial 48 Hrs Followed By Oral Cephalexin( 500 Mg
Po 6H) And Erthromycin(250 Mg Po 6H) For 5Days With A Total Course Of 7 Days Based On Local Sensitivity Pattern Of
Organism To Antibiotics. Maternal Infectious Morbidity, Delivery Details, The Duration Of Expectant
Management(Latency Period), Indication For Delivery, Method Of Labour Induction, Mode Of Delivery And Neonatal
Outcome Were Noted.
Results :
Latency Period Ranged From 1-64 Days. Mean Latency Period Was 14.70 Days (26-30 Weeks Was 20.58 Days, Between
301/7-32 Weeks Was 11 Days And Above 32 Weeks Was 6.9 Days). There Is Apparent Gain In Latency Period Seen At
Each Gestational Age From Onset Of Pprom (P=0.012). No Antepartum Fever In Mothers. Postpartum Fever Was Seen In
8% . The Neonatal Morbidity In The Form Of Early And Late Onset Neonatal Sepsis Was 35.4%. Perinatal Mortality Was
12% And Neonatal Survival Rate Was 88%. Other Morbidities Like Rds (47.9%), Bpd (0.08%), Pvlm (0.04%) , Nec And Ivh
Each In 0.02%.
Conclusion :
Cefazolin/Cephalexin With Erythromycin Is A Good Alternative Antibiotic Regimen To Standard Ampicillin/Amoxicillin
With Erythromycin Combination In Terms Of Increase In Mean Latency Period Following Pprom Which In Turn Reduces
Death Due To Prematurity In The Neonate, And Also Reduces Neonatal Morbidities And Maternal Infectious Morbidity
Associated With Pprom.

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Effect Of Vitamin C And E In Prevention Of Preeclampsia And Newborn Outcome: A Case Control Study
Author: Dr. Sushama Surve
Co Author:

Aims And Objectives: 1.To Study The Combined Effect Of Vitamin C And E Supplements During Pregnancy On The
Incidence Of Preeclampsia. 2. To Study The Effect Of Vitamin C And E Intake In Pregnant Women And On Newborn
Outcome.
Materials And Methods: This Case Control Study Was Conducted In Goa Medical College, From March 2010 To June 2011
After The Approval From Ethical Committee. Cases And Controls Were Taken Randomly From Antenatal Patients
Attending Our Hospital Opd, 16 Week Onwards. Cases Included 100 Women Who Received Oral Vitamin C In Dose Of
500Mg And Oral Vitamin E In Dose Of 400Iu Per Day. Control Group Included 100 Women Who Did Not Receive Vitamin
E And Vitamin C. Observation Of Relative Benefit On Incidences Of Preeclampsia And Newborn Outcomes In Both Groups
Was Made.
Results: The Incidence Of Preeclampsia In This Study Was 7% In Cases And 13% In Controls (Rr- 0.54%, 95% Ci-0.33-0.87,
P Value < 0.05). The Incidence Of Severe Preeclampsia In Cases Was 2% And In Controls Was 7% (Rr-0.28, 95% Ci- 0.120.63, P Value <0.05). The Study Also Showed That Significant Number Of Antenatal Patients Developed Preeclampsia In
The Age Group 25-30 Years And Most Were Primigravidas. There Was 12% And 22% Risk Of Preterm Delivery In Cases
And Controls Respectively (Rr-0.54, 95% Ci-0.37-0.79, P Value <0.05). Controls Were 1.26 Times More Prone For Lscs As
Compared To Cases.
Conclusion: Hence We Recommend Routine Vitamin C And E Intake In All Pregnant Women.

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Ovarian Tumours Associated With Pregnancy- A Five Year Retrospective Study In A Tertiary Care Hospital
Author: Dr. Vineetha R
Co Author: Dr.Sunanda N1,

Aims And Objectives: Pregnancy With Ovarian Tumours Was Reviewed Over A 5 Year Period To Determine The Types Of
Tumours Associated With Pregnancy In Patients Undergoing Surgery And The Maternal And Fetal Outcome.
Materials And Methods: This Retrospective Study Was Carried Out At Cheluvamba Hospital Between June 2009 And
2014.There Were 67,745 Deliveries And 17 Women Were Operated Upon For An Ovarian Tumour Diagnosed In The
Antepartum, Intrapartum Or Postpartum Period. Information Of The Patients Regarding Their Age, Parity, Clinical
Presentation, Gestational Age At Diagnosis And Surgery, Ultrasound Features, Treatment, Maternal, Fetal Outcome And
The Histopathology Of The Tumours Were Noted.
Results: The Overall Incidence Of Ovarian Tumor In Pregnant Woman Underoing Surgery Was 1 In 1693 (0.025%)
Deliveries. 52.87% Tumors Were Diagnosed In The First And Second Trimesters Of Pregnancy. Ten (58.82%) Presented
As An Emergency At Different Periods Of Gestation With Torsion Being The Most Common Cause Of Surgery. Serous
Cystadenoma(23.52%) And Dermoid Tumour(17.64%) Were The Most Common Types Of Ovarian Tumors Found In The
Study. The Incidence Of Malignant Tumors Was One (5.88%).Maternal Outcome Was Uneventful In All Patients. Abortion
Rate Was 100% In First Trimester.Outcome In Second Trimester Is Inconclusive As Few Patients Lost To Followup. Patients
Diagnosed In Third Trimester Had An Uneventful Fetal Outcome.

Conclusion: Ovarian Tumours Are Encountered With Greater Frequency, Most Being Benign And Self Resolving With
Malignancy Occuring In A Small Minority Of Cases. Removal Of Persisting Or Enlarging Ovarian Masses As Soon As Possible
Is Important To Obtain A Final Histologic Diagnosis And Rule Out Malignancy.

Key Words: Histopathology. Ovarian Tumours . Pregnancy . Surgery

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Comparative Study Of Labor Analgesia And Its Outcome Using Combined Spinal Epidural And Epidural Analgesia
Author: Dr. Namratha S
Co Author:

Aims And Objectives: Regional Analgesia Tends To Be The Most Effective Method Of Pain Relief During Labour. One Of
Them Being Combined Spinal Epidural(Cse) Block Has The Added Advantage Of Both Epidural And Spinal Analgesia But
The Day To Day Application Is On The Lower Side. Hence This Study Aims At Comparing The Efficacy Of Epidural With
Combined Spinal Epidural Blockade In Different Aspects Of Labour Analgesia.

Materials And Methods: The Data For Study Was Collected From Healthy Term Primigravida With Cephalic Presentation
With Singleton Pregnancy In First Stage Of Labour Opting For Painless Labour After Taking The Written Informed Consent
Belonging To Asa I And Ii. The Study Population Consisted Of 60 Parturients. They Were Divided Into 2 Groups Of 30
Each.Group I Received Combined Spinal Epidural Analgesia And Group Ii Received Epidural Analgesia.
The Study Was Conducted Using 20 Mcg Fentanyl Deposited Intrathecally Followed By 8 Ml Of 0.125% Bupivacaine Given
Epidurally In Cse Group And 8 Ml Of 0.125% Bupivacaine With 20 Mcg Fentanyl Given Epidurally In Epidural
Group.Supplemental Doses With 5 Ml 0.125% Bupivacaine Depending On Patients Requirement..
Continuous Monitoring Of Vitals Of The Subjects And Intrapartum Fhs Monitoring Was Done In The Post Procedure
Period And Labour Was Managed Accordingly.

Results: The Quality And Duration Of Analgesia, Mode Of Delivery , Neonatal Outcome Were Comparable For Both
Groups. The Onset And Peak Of Analgesia Was Faster In Cse Than Epidural Analgesia. .There Was No Motor Blockade In
Either Of Groups.Duration Of Labour Of 1St And 2Nd Stages Was Comparable In Both The Groups .3Rd Stage Of Labour
Was Signficantly Shorter In Cse Group Compared To Group Ii. Higher Incidence Of Pruritis Was Noted In Cse Group .

Conclusion:Both Cse And Epidural Group Were Comparable With Respect To Quality And Duration Of Analgesia , Mode
Of Delivery , Neonatal Outcome. The Onset And Peak Of Analgesia Was Faster In Cse Than Epidural Analgesia With Higher
Incidence Of Pruritis In Cse Group.

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A Retrospective Study Of Maternal Mortality Ratio

Author: Dr. Aruna Chinta
Co Author: Dr.D.Rajya Laxmi Md Dgo1, Dr.A.Shyamala Ms2, Dr.Y.Anuragamayi Ms3, Dr.Ch.Karuna Kumari Ms4,
Dr.B.Aruna Kumari Ms5

Aims And Objectives: To Analyse The Causes, Epidemiological Aspects Of Maternal Deaths, To Improve The Standards Of
Obstetric Services, To Suggest Ways To Reduce Mmr.
Materials And Methods: A Retrospective Study Conducted At Rangaraya Government General Hospital, Kakinada For A
Period Of 5 Years From January 2007 To December 2011. Material Was Collected From The Records. Deaths Were
Analysed With Respect To Age, Parity, Residence, Nature Of Delivery, Causes, Admission Death Interval And Booking
Status.
Results: During The Study Period 159 Maternal Deaths, 46,751 Live Births Occurred With Mmr 340/1, 00,000 Live Births.
67.3% Deaths Were Unbooked, 81.1% Were From Rural Areas, 61% Were In Age Group 21-24 Years, 45.91% Were Primi,
38.36% Deaths Occurred Within 24 Hours, Direct Causes 71.03% With Leading Cause Toxaemia 28.93%, Followed By
Haemorrhage 23.89%, Sepsis 15.8%. Indirect Causes Accounted For 28.8%, With Leading Cause Anaemia 11% And Heart
Disease 11%. Deaths Due To Abortion 8.8%, 29.5% Were Antepartum And 61.6% Were Postpartum Deaths.
Conclusion: In The Present Study The Rate Was High Due To The Fact That Hospital Receives High Risk, Moribund Cases
From Peripheral Hospitals, Private Clinics Around. There Is Need For Improvement In Educating The Women For Seeking
Antenatal Care, Improving Transport Facilities. Extension Of Antenatal Care To Villages And Health Education Of Pregnant
Women And Problems Of Multiparity Should Be Stressed. Maternal Deaths Can Be Prevented By Improving Health Care
Facilities In Rural Areas By Availability Of Basic Drugs Like Inj. Magnesium Sulphate And Tab.Misoprostol As Deaths Are
Still Due To Eclampsia And Postpartum Haemorrhage. Early Detection Of High Risk Pregnancy And Referring Them To
Tertiary Care Hospital At Earliest Can Reduce Complications. Nrhm Plays A Role In Reducing Maternal Mortality By
Advocating Institutional Deliveries And Timely Referral Of High Risk Cases.

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Metabolic Syndrome In Postmenopausal Indian Women And Its Correlation To Mrs And Luts Score
Author: Dr. Latha Lakshmi
Co Author: Latha Lakshmi K1, Aruna Kekre2, Phijam3,

Aims And Objectives: To Assess The Prevalence Of Metabolic Syndrome, In Postmenopausal Women And To Correlate It,
To The Menopausal Rating Scale (Mrs) And Lower Urinary Tract Symptoms (Luts) Score, In Postmenopausal Women With
Natural And Surgical Menopause.
Materials & Methods: It Is A Prospective Cross Sectional Study, Of Women Attending The Menopause Clinic, In A Tertiary
Hospital, India, From April 2014 To September 2014. Metabolic Syndrome Was Diagnosed Using The New International
Diabetic Federation (Idf) Definition. Menopausal Symptoms Were Assessed Using Validated Menopausal Rating Scale And
The Lower Urinary Tract Symptoms Were Assessed Using The Bristol Female Lower Urinary Tract Symptom Questionnaire.
A Total Of 196 Women Were Studied, Which Included 159 Women With Natural Menopause And 37 Women With Surgical
Menopause. 110 Women With Natural Menopause And 24 Women With Surgical Menopause Were Diagnosed To Have
Metabolic Syndrome. The Mrs And The Luts Scores Were Also Evaluated.
Results: The Non Parametric Method Of Wilcoxon Two Sample Test Was Used For Analysis. The Prevalence Of Metabolic
Syndrome Among Those With Natural Menopause Was 69% And Those With Surgical Menopause Was 65%. There Was
A Significant Difference, Between Women With And Without Metabolic Syndrome Attaining Natural Menopause With
Regards To The Flow Score (P= 0.0012), The Total Luts Score (P=0.0315) And The Quality Of Life Score ( P= 0.0314). There
Was No Significant Difference In Mrs And Bfluts Scores, Between Women With And Without Metabolic Syndrome, Having
Surgical Menopause.
Conclusion: The Prevalence Of Metabolic Syndrome Is 69% In Natural And 65% With Surgical Menopause. Women Who
Attained A Natural Menopause With Metabolic Syndrome Had Significantly Higher Flow Score, Total Luts Score And
Quality Of Life Score (P< 0.05), Than Women Without Metabolic Syndrome. This Study Emphasizes The Need To Identify
Metabolic Syndrome In Postmenopausal Women And Offer Appropriate Treatment.

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Ectopic Pregnancy A Five Year Retrospective Study In A Tertiary Care Hospital

Author: Prof. Sunita Goyal
Co Author: Dr Arti Gupta Tuli1,

Aims And Objectives: To Study The Clinical Profile Of Ectopic Pregnancy In A Tertiary Care Hospital.
Material And Methods: It Was A Retrospective Study Conducted At Christian Medical College & Hospital, Ludhiana From
1St June 2009 To 31St May 2014. A Total Of 108 Patients With Ectopic Pregnancy Were Analysed On Clinical Presentation,
Clinical Findings, Investigations, Operative Findings And Outcome.
Results And Analysis: A Majority Of Women (44.44%) Were In The Age Group Of 26-30 Years And 50% Were Multigravida.
Risk Factors Were Identifiable In 71.29% Patients. Amenorrhea (91.6%) And Pain Abdomen (92.82%) Were The Most
Common Presenting Symptoms. Twenty (18.51%) Women Had Laparoscopy, 72 (66.67%) Underwent An Exploratory
Laparotomy And Sixteen (14.81%) Women Received Medical Management.There Was Tubal Rupture In 73 (78.49%),
Chronic Ectopic In 10 (10.75%), Tubal Abortions In 5 (5.37%) And Un-Ruptured Tubal Pregnancy In 5 (5.37%) Women .
There Were No Maternal Deaths And Post Operative Morbidity In The Form Of Febrile Illness (11.11%), And Wound
Sepsis(4.62%) Was Seen.
Conclusions: Ectopic Pregnancy Still Remains One Of The Major Cause Of Maternal Morbidity And Mortality. Early
Diagnosis And Referral In Hemodynamically Stable State Along With Use Of Minimal Access Surgery Or Medical
Management Can Change The Scenario Of Ectopic Pregnancy In The Developing World.
Key Words: Ectopic, Pregnancy, Amenorrhoea.

***************

Maternal And Neonatal Outcome Of Early Versus Delayed Cord Clamping At Term Gestation
Author: Prof. Pushpa Dahiya
Co Author: Ranjita Bains1,

Aims And Objectives: To Study The Effect Of Umbilical Cord Clamping At 3 Minutes On Duration Of Third Stage Of Labor,
Amount Of Blood Loss, Neonatal Haemoglobin, Bilirubin At 24 Hours And After 6 Weeks
Material And Methods: In This Prospective Randomized Study 113 Women At Term Gestation With No Antenatal
Complication Were Included At Pgims, Obstetrical Ward Rohtak.Women Were Divided Into 2 Groups. In Study Group
Umbilical Cord Was Clamped 3 Minutes After Delivery Of Baby While In Control Group Cord Was Immediately Clamped.
In Both Groups The Duration Of Labour , Effect On Blood Loss, Haemoglobin And Bilirubin Level At Birth And After 6
Weeks Were Compared.
Results: In Both The Groups The Mean Age, Gestation, Literacy Were Comparable. Mean Duration Of Third Stage Of
Labour In Group I And Ii Was 4.74 1.41 Minute And 5.32 1.73 Minutes Respectively. Mean Blood Loss Was Also
Comparable. 16% Women In Control Group Required Additional Uterotonics While 12% In Study Group Needed
Uterotonics. There Was No Retained Placenta, Pph In Either Group. The Cord Hemoglobin Was Significantly Higher In
Study Group. Mean Neonatal Hb On Day1 In Study Group Was 16.21 1.36G/Dl While In Control Group It Was
14.190.82G/Dl. Mean Bilirubin Level On Day 1Was 2.66 1.15Mg% And 3.35 1.42Mg% In Control And Study Group
Respectively. One Minute Apgar Score Was Comparable In Both Groups.
There Was A Statistically Significant Difference In Hemoglobin Of Babies Who Had Delayed Cord Clamping After 6 Weeks
Follow Up.
Conclusion: Delayed Cord Clamping Is A Feasible Low Cost Intervention To Decrease The Incidence Of Anaemia In New
Born And Infants At 6 Weeks In Poor Resource Settings.Hence, Whenever Possible It Should Be Included In Routine
Practice In Third Stage Of Labour.

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Fetomaternal Outcome In Cases Of Oligohydramnios After 28 Weeks Of Pregnancy

Author: Dr. Veena Vidyasagar
Co Author:

Aims And Objectives: To Study The Fetomaternal Outcome In Cases Of Oligohydramnios Admitted In The Labour Room
For Delivery.
Materials And Methods: A Prospective Hospital Based Study Was Conducted At Sharda Hospital, School Of
Medical Sciences And Research, Sharda University, Greater Noida. The Study Was Undertaken Over A Period Of Two Years
From April 2012 To March 2014. Cases Of Oligohydramnios (Afi Less Than 5 Cms) Detected Ultrasonographically At The
Time Of Admission For Delivery Were Included In The Study. The Inclusion Criteria For The Purpose Were: 28 Completed
Weeks Of Gestation With Singleton Live Pregnancy, Intact Membranes And No Foetal Anomalies. Data Regarding BioSocial Characteristics, Maternal And Perinatal Outcome Were Collected And Results Were Analysed.
Results: There Were 1342 Deliveries During The Study Period. 41 Cases Were Detected To Have Oligohydramnios.
Majority Of The Cases (81.39%) Belonged To The Age Group Of 20-30 Years And Maximum (24.39%) Were Of Gestational
Age 37-38 Weeks. Incidence Of Associated Maternal And Foetal Complications Was Higher In Cases With
Oligohydramnios. Incidence Of Hypertensive Disorders Of Pregnancy Was 17.07% And Intrauterine Growth Restriction
(<10Th Percentile For Gestation) Was 46.34%. Lscs Was Performed In 48.78 Percent Cases. Perinatal Mortality Was 9.76%.
Fetal Heart Rate Abnormalities Were Observed In 19.51% Cases At The Time Of Admission And In Additional 7.3% Cases
During Monitoring. Low Apgar Score Was Seen In 19.51% Neonates, 36.59% Neonates Were Admitted In Nicu And 9.76%
Cases Had Meconium Aspiration Syndrome..
Conclusion: Oligohydramnios Is Being Detected More Often These Days, Due To Routinely Performed Obstetric
Ultrasonography. In The Present Study, Cases With Afi Of <5 Presenting For Delivery (After 28 Weeks Of Gestation), Were
Studied. Babies Were Relatively More Prone For Complications, Like Intrapartum Fetal Distress, Meconium Aspiration
Syndrome And Birth Asphyxia.

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Study Of Twin Pregnancy With One Twin Demise-Management, Maternal And Perinatal Outcome
Author: Dr. Akhila M V
Co Author: Dr S Radhamani1,

Aims And Objectives: To Study The Incidence, Management And Determine Maternal And Perinatal Outcome In Cases Of
Twin Pregnancy With One Twin Demise In The Second Half Of The Pregnancy.
Materials And Methods: This Retrospective Study Was Carried Out At Cheluvamba Hospital Between September 2009
And 2014. We Studied 924 Twin Deliveries Out Of A Total Of 71,704 Deliveries.19 Twin Pregnancies Complicated By Single
Iufd After 20 Weeks Of Gestation Were Identified From The Hospital Records.Data Collected Included Maternal Age,
Parity, Antenatal Complications,Cause Of Iufd, Gestation At At Diagnosis, Time Interval Between Diagnosis Of Iufd And
Delivery, Mode Of Delivery, Birth Details, Type Of Placentation And Neonatal Complications.

Results: The Incidence Of Twin With One Twin Demise Was 2.056%. Mean Gestational Age At Presentation Was 33.86
Weeks Out Of Which 14(73.68%) Presented In Labour. Among The Rest, Mean Interval Between Diagnosis To Delivery
Was 4 Days. Cause Of Death Was Growth Discordance In 7 Cases, Placental Insufficiency In 4 Cases, Severe
Oligohydramnios In 3 Cases, Twin To Twin Transfusion Syndrome And Anomalous Baby In One Case With 3 Having No
Recognisable Cause. Eleven(57.89%) Out Of 17 Cases Had Monochorionic Type Of Placentation. Neonatal Course Involved
Eleven Icu Admissions, Majority Due To Prematurity Out Of Which 4 Deaths Occurred. Maternal Course Was Uneventful
In Majority (63.157%) Of Cases. There Were Two Maternal Deaths Due To Intravascular Coagulopathy Sequale.

Conclusion: Single Fetal Death Occurs More Often In Monochorionic Twins. The Main Problem For The Surviving Twin Is
Prematurity. It Is Very Important To Identify The Chorionicity By Ultrasound Examination In Early Pregnancy And
Implement Specific Surveillance Of Monochorial Pregnancies.
Key Words: Chorionicity. One Twin Demise. Twin.

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Reversal Of 'A' Wave In Ductus Venosus Doppler With Normal Nuchal Translucency In First Trimester: Benign Or
Omnious?
Author: Dr. Sushmita Namdeo
Co Author: Dr Indrani Suresh1,

Aims And Objectives: To Study The Outcome Of Reversal Of A Wave (Raw) In Ductus Venosus (Dv) Doppler, In
Fetuses With Normal Nuchal Translucency I.E. (Nt) < 99Th Centile During First Trimester Scan (Fts)

Material And Methods: Retrospective Case Control Study

The Study Population Consisted Of The Women Who Presented For The Fts From January 2010 To December 2013. The
Total Number Of Women Presenting For Fts During This Period Was 32828.
Inclusion Criteria: Pregnant Women With Raw In Dv Doppler With Nt < 99Th Centile Or 3.5 Mm On Fts. Exclusion Criteria:
Nt > 99 Th Centile Or 3.5 Mm And Obvious Anomalies (Eg. Non Immune Hydrops, Omphalocele)
Twenty Two Cases Were Found. The Control Group Was Selected And Controlled For Crl.

Results: The Incidence Of Raw In Dv With Nt < 99Th Centile Was 0.7/1000 Pregnancies. Adverse Outcome Included
Cardiovascular Defects (N = 10; 45%), Fetal Growth Restriction (N = 2; 9%), Perinatal Death (N=3; 13%), Multisystem
Anomalies (N=1; 4%) And Aneuploidy (N = 1; 4%) In A Total Of 17/22 Cases (77%).

Conclusion: Abnormal Dv Doppler Findings At Fts Appear To Predict Adverse Outcome Independently Of Normal Nt.
These Patients Need Detailed Mid-Trimester Assessment Of Fetal Anatomy With Echocardiography, And Subsequent
Follow-Up.

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Association Of Genetic Polymorphism Of Cyp1A1 (T6235C) With Polycystic Ovary Syndrome.

Author: Dr. Suchi Sinha
Co Author: Priyanka Pandey1, Madhu Jain2, Kiran Singh3,

Aims And Objectives: To Test The Association Of Cyp1A1 Gene T6235C Polymorphism With Pcos In Indian Women.
Materials And Methods: In A Case Control Study,150 Women With Pcos (Rotterdam Criteria) And 150 Age Matched
Healthy Controls Were Enrolled And Compared With Respect To Cyp1A1 T6235C Polymorphism. Women With Pcos,
Having Sonographic Presence Of Polycystic Ovaries(Pco, N=120) Were Again Compared With Control Group. Results:
There Was 1.39 Times Increased Frequency Of Tc Genotype [Odds Ratio(Or) 1.393; P=0.17] And 3 Times Increased
Frequency Of Cc Genotype [Or 3.0; P=0.06] In Women With Pcos As Compared To Controls. However, When Pco Group
Was Compared With Controls, There Was 1.92 Times Increased Frequency Of Tc Genotype (Or 1.928 ; P=0.01) And 4.5
Times Increased Frequency Of Cc Genotype (Or 4.05; P=0.008).Conclusion: The Study Shows Association Between Pcos,
Especially Those With Sonographic Presence Of Polycystic Ovaries And Cyp1A1 Gene T6235C Polymorphism. Cyp1A1
Gene Polymorphism May Have An Effect On Estrogen Metabolism And Folliculogenesis Leading To Formation Of
Polycystic Ovaries, Which Along With Other Contributory Factors Can Lead To Full Fledged Polycystic Ovary Syndrome.

***************

A Comparative Study Of Ovulation Induction With Clomiphene Versus Clomiphene And Bromocriptine In Follicular
Phase In Normoprolactinemic Pcos Patients
Author: Dr. Gayathri S R
Co Author: Dr.Muthulakshmi M1, Dr.Saswati Tripathi2, Dr.Anjalakshi Chandrasekar3,

Aims And Objectives:

1. To Determine The Follicular Size, Endometrial Thickness And Ovulation On Induction Of Ovulation
With Clomiphene And Clomiphene + Bromocriptine In Follicular Phase.
2. To Compare The Follicular Size, Endometrial Thickness, Ovulation And Pregnancy Rates In Both
The Groups.

Materials And Methods:

On The Basis Of Inclusion And Exclusion Criteria, 70 Pcos Patients With Normal
Prolactin(<20Ng/Ml) And Age <35Years Were Randomly Assigned Into Two Groups.
One Group (N=35) Received 50 Or 100Mg Of Clomiphene From Day3 To Day7. Other Group
(N=35) Received 50 Or 100Mg Of Clomiphene From Day3 To Day7 And Bromocriptine 1.25Mg Twice Daily From Day5 To
Day14. Both Groups Were Followed For Three Cycles. The Outcomes Studied Were Follicular Size, Endometrial Thickness,
Ovulation And Pregnancy Rates.

Results:
There Was No Significant Difference In Age, Body Mass Index, Serum Prolactin, Basal Fsh, Lh, Estradiol Levels
Between Both The Groups. Follicular Size In Clomiphene + Bromocriptine In Follicular Phase Group (Mean= 18.40Mm)
Was Significantly Larger Than In Clomiphene Group (Mean=16.70Mm) With P Value Of 0.0031. The Average Endometrial
Thickness, Ovulation And Pregnancy Rates Were Higher In The Clomiphene + Bromocriptine In Follicular Phase Group
Than Clomiphene Alone But Values Didnot Reach Statistical Significance.

Conclusion:
The Addition Of Bromocriptine To Clomiphene In Follicular Phase Has An Advantage Of Improving Follicular
Size, Endometrial Thickness, Ovulation And Pregnancy Rates In Pcos Patients, Though Larger Studies Are Needed To
Demonstrate Statistical Significance.
***************

Transdermal Nitroglycerin In Patients With Preeclampsia With Placental Insufficiency: Effect On Uterine And
Umbilical Artery Indices
Author: Dr. Akshaya Doddamani
Co Author: Dr. Rajrani Sharma1,

Aims And Objectives:

To Evaluate The Effect Of Transdermal Nitroglycerin On Maternal Systolic Blood Pressure, Diastolic Blood
Pressure.
To Evaluate The Effect On Doppler Velocity Waveforms Of Uterine And Umbilical Arteries In Patients With
Preeclampsia.
Materials And Methods:
The Study Was Conducted At Dept. Of Obs And Gynae, Rnt Medical College, Udaipur. 50 Women With Singleton
Pregnancies Complicated By Preeclampsia With Placental Insufficiency With Gestational Age Between 27-34 Weeks Were
Enrolled In The Study After Taking Written And Informed Consent. All Women Underwent Doppler Study At The Start Of
Treatment. 5 Patients Had Termination Of Pregnancy. Each Patient Received Trans Dermal Nitroglycerine Patch 10Mg For
14 Hours Daily For 3 Days. Doppler Study Was Done On Day 3 With The Patch. Patch Was Removed After 3 Days And
Doppler Study Done On Day 4. Resistance Index, Pulsatility Index, Sd Ratio, Amniotic Fluid Volume Noted Each Time And
Were Compared Using Anova Tests. Blood Pressure Was Compared Before And During Treatment.
Results: Trans Dermal Nitroglycerine Patch Application Resulted In Very Highly Significant Reduction In Systolic And
Diastolic Blood Pressures(P<0.001). Doppler Study Revealed Resistance Index, Pulsatility Index And Sd Ratios Of Left
Uterine Artery, Right Uterine Artery, Umbilical Artery Were Significantly Reduced During Treatment. Values Reverted
Back To Pre- Treatment Values After Stopping The Treatment With The Patch. Amniotic Fluid Volume Increased
Significantly After Treatment(P<0.001).
Conclusion:
The Use Of Transdermal Nitroglycerin In Preeclampsia With Placental Insufficiency Is Associated With A Significant
Decrease In Resistance Index, Pulsatility Index And Sd Ratios Of Uterine And Umbilical Arteries. There Was A Significant
Reduction In Maternal Blood Pressure During Treatment. Afi Was Also Found To Increase With The Treatment. No Fetal
Bradycardia Or Tachycardia Or Change In Cardiotocographic Tracings Occurred During The Treatment. Headache Was
Complained By All The Patients.
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The Effect Of Antenatal Education On Maternal Behaviour During Labour - A Study

Author: Dr. Smruthi Cheluvaraj
Co Author: Dr.Srinivas K1,

Aims And Objectives:

To Study The Effect Of Antenatal Health Education On The Maternal Behavior During Labour And Puerperium.

Materials And Methods:

This Is An Ongoing Study At Vanivilas Hospital, Bmcri, Bangalore.

Period Of Study:

Jan 2014 On Wards-

Out Of 411 Patients Recruited, 201 Were In The Study Group And 210 Were Controls. The Unbooked Cases Who Came
To The Hospital For Delivery Were Taken As Controls. They Were Matched With Respect To Age Parity, Se Status, Medical
Complications Etc.,

Expecting Mothers At Term Who Attended The Antenatal Clinic Regularly Were Given Health Education With The Help
Of Iec Materials Regarding Maternal Changes During Pregnancy, Pregnancy Complications, Warning Signs During
Pregnancy And At Term, Labour Events,Advantages Of Vaginal Delivery, Episiotomy, Breast Feeding Etc., Data Were
Tabulated In Simple Tables And Analysed.
Results:

Mothers Spent A Mean Average Time Of 7.2 Hours In The Active Phase Of Labour In The Study Group Unlike 11 Hours
In The Control Group. 63% Of Women In The Study Group Were Ambulatory Till The Late First Stage Of Labour Whereas
The Control Group Were Confined To Bed. False Labour Pains Noted In 11% Of Study Group And 30.2% In Controls. Study
Group Women Showed Better Bearing Down Efforts. Instrumental Deliveries Were Very Less In The Study Group. No
Much Difference Observed In The Cesarean Rates, Birth Weights, Stillbirth Rate Or Medical Complication Rate. Need
For Induction And Augmentation Was More In Controls With No Statistical Significance. Most Mothers In The Study Group
Breast Fed Their Children Within Half An Hour Of Birth. Labour Pains Better Tolerated By Study Group. Contraceptive
Acceptance Was More In The Study Group.

Conclusion:

Health Education Regarding Labour Should Become An Integral Part Of Antenatal Care.

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Intracaesarean Ppiucd: Increasing Acceptance In Rural Rajasthan

Author: Dr. Urmila Porwal
Co Author: Urmila Porwal1,

Aims And Objectives:

1. To Contribute To National Population Stabilization Programme By Strengthening Ppiucd Programme Of Goi.
2. To Reduce Maternal Morbidity And Mortality By Avoiding Complications Of Short Birth To Birth Interval Following
Caesarean-Delivery.
Materials And Methods:
This Prospective Study Was Conducted At Government Amritkaur Hospital, Beawar, Rajasthan: June 2011- June 2014.
Women Undergoing Caesarean-Section (Cs) And Their Family Members Were Counseled Regarding Intra-Caesarean
Ppiucd. 465 Women Consented For The Procedure. Primi And Repeat Cs Cases Were Included.
During Cs, After Removal Of Placenta And Membranes Uterine Cavity Was Cleaned With Sterile Gauze. Coppert-Cu380A
Was Inserted Using Ring Forceps Through The Uterine Incision By Non-Touch Technique And Placed High At The Fundus.
Uterus And Abdomen Closed In Usual Way. Routine Post-Operative Care Was Given.
All Women Were Followed Up By History-Taking And Physical-Examination At 2 Weeks, 6 Weeks And 6 Months.
Ultrasonography Was Done At 6-Week Follow Up.
Results:
100% Women Returned For 2 Weeks And 6 Weeks Follow-Up While 80% Returned For 6 Months Follow-Up. One Woman
Had Spontaneous Expulsion. None Of The Women Had Infection, Perforation Or Failure. Strings Were Missing In 90%
Women At 6 Weeks Follow-Up. 9 Cases Required Removal: Prolonged Irregular Bleeding Pv (6), Husband Went Abroad
(1), Wanted Second Issue (2).
An Increasing Trend Of Acceptance Was Observed: June 2011- May 2012 (39), June 2012- May 2013 (130), June 2013 June 2014 (296).
Conclusion:
Intra-Caesarean Ppiucd Is A Safe, Effective, Convenient, Long-Term And Reversible Method Of Contraception. Device Is
Supplied Free Of Cost By Goi.
The Acceptance Is High And An Increasing Trend Is Observed Over The Years Probably Due To Less Side Effects And
Complications.
***************

A Hospital Based Prospective Study Of 40 Cases Where Myomectomy Is Done Along With Caesarean Delivery
Author: Dr. Prerna Khandelwal
Co Author: Dr. Arun Gupta1,

Aims And Objectives:1.

To Determine The Safety, Cost Effectiveness And Complications Of Myomectomy At The Time Of Caesarean
Delivery And Perioperative Morbidity.
2.
To Compare Our Findings With Published Results Of Other Studies That Advocate Routine Caesarean
Myomectomy.
Materials And Methods:Study Center- The Study Was Conducted At The Department Of Obstetrics And Gynaecology , Panna Dhay Rajkiya Mahila
Chikitsalya ,Rnt Medical College,Udaipur.
Subjects For Study:-Study Included 50 Patients Who Underwent Caesarean Section Along With Myomectomy. A
Prospective Study Where All Patients Underwent Myomectomy During June 2013 To November 2014.
Results:-The Mean Gestational Age Was 36 Weeks. Most Of The Patients Were Primiparous. The Gestational Age Varied
From 21 Years To 38 Years. In Total Cases Size Of Fibroid Varied From 1*1 Cm To 12*10 Cm. Most Of The Fibroid Removed
Were Subserosal And Intramural In Nature. Regarding Hemoglobin Differences, There Was Hardly Any Difference
Between Pre-Op And Post-Op Hemoglobin Levels. No Patient Required Blood Transfusion. None Of The Patient Required
Hysterectomy. The Duration Of The Hospital Stay Was 5-7 Days. Neonatal Outcome Was Good In All Patients.
Conclusion:-Caesarean Myomectomy Has Traditionally Being Discouraged Due To Theoretical Risk Of Hemorrhage And
Postoperative Morbidity. But Now Caesarean Myomectomy Can Be Safely Done By Experienced Hands. Fibroids
Obstructing The Lower Uterine Segment Or Accessible Subserosal, Intramural And Pedunculated Fibroids Can Be Safely
Removed By Skilled Surgeons.Cesarean Myomectomy Should Be Strongly Recommended At Well Equipped Tertiary
Centers Which Could Also Have A Positive Bearing On Future Reproductive Outcomes.
***************

Colposcopic Evaluation Of Cervix With Persistent Inflammatory Pap Smear: A Prospective Analytical Study.
Author: Dr. Sapna Waghmare
Co Author: Dr.Waghmare Sapna1, Dr.Nalini.K.S2,

Aims And Objectives:

Inflammatory Pap Smear Is The Most Common Report Received By A Gynaecologist.The Cervical Screening Algorithm For
Benign Cellular Changes On The Pap Smear Recommends Treatment Of Infection If Indicated And A Repeat Pap Smear In
4 To 6 Months Time. If The Inflammatory Changes Still Persist, Subject The Patient To Colposcopy. However, In Practice,
This Is Not Followed, Especially In Developing Countries Due To Non Compliance Of Patients. Hence, A Good Number Of
Patients In The Premalignant Stage Are Being Missed. This Study Was Undertaken To Evaluate Patients With Inflammatory
Pap Smears Without Atypia Using Colposcopy.

Methods:
A Prospective Analytical Study Of 50 Gynecologial Patients With Persistent Inflammatory Pap Smear Between 2013 And
2014 In An Out-Patient Setting. All Of Them Were Subjected To Colposcopy And Biopsy From The Abnormal Areas. The
Incidence Of Cervical Intraepithelial Neoplasia (Cin)/Invasive Carcinoma Was Calculated By Proportions/Percentages.
Results:
The Incidence Of Pre-Malignant Lesions (Cin) Was High (6.38%). Cin 2/3 Were Present In 4.25% Of The Cases.
Conclusions:
Patients With Persistent Inflammatory Pap Smears Can Harbour A High Proportion Of Cin And Hence These Patients Will
Need Further Evaluation

***************

Intravenous Iron Sucrose Therapy For Moderate To Severe Anemia In Pregnancy

Author: Dr. Swadesh Chatterjee
Co Author: Dr.Swadesh Ranjan Chatterjee1,

Aims And Objectives:

Iron Deficiency Anemia (Ida) Is The Most Common Nutritional Deficiency In Pregnancy, Pregnant Woman With Moderate
Anemia Are To Be Treated With Parentral Iron Therapy . This Study Was Undertaken To Evaluate The Response And Effect
Of Intravenous Iron Sucrose Complex (Isc) Given To Pregnant Women With Ida.
Material And Methods:
A Prospective Study Was Conducted In The Dream Land Nursing Home And Sudha Well Women Clinic, Durgapur, West
Bengal From July 2013 To June 2014. 100 Pregnant Women With Hemoglobin Between 5-9 G % With Diagnosed Iron
Deficiency Attending Antenatal Clinic Were Given Intravenous Iron Sucrose Complex In A Dosage 200Mg Twice Weekly
Schedule After Calculating The Dosage Requirement.
Results:
The Mean Raised From 7.63 0.61 To 11.20 0.73 G% (P< 0.001) After Eight Week Of Therapy . There Was Significant
Rise In Cerium Ferritin Levels (From 11.2 4.7 To 69 23.1 g/L) (P< 0.001). Reticulocyte Count Increase Significantly
After Two Weeks Of Starting Therapy (From 1.5 0.6 To 4.6 0.8%).
Conclusion:
In Conclusion , My Result Showed That , Intravenous Iron Sucrose Therapy Was Effective To Treat Moderate Anemia In
Pregnant Women . Intramuscular Preparation Are Known To Be Associated With Local Side Effects . Iron Sucrose Complex
Iv Therapy Was With Negligible Side Effects . The Author Is Recommended To Use It At Peripheral Level To Make
anemia Free India

***************

Lactic Dehydrogenase : A Biochemical Marker For Preeclampsia - Eclampsia

Author: Dr. Amulya Swati
Co Author: Dr Pushpa Roy1, Dr Rajkumari2,

Aims And Objectives:

To Compare Serum Lactic Dehydrogenase (Ldh) Levels In Normal Pregnant Women And In Women With Preeclampsia
And Eclampsia.
To Correlate The Severity Of The Disease , Maternal And Perinatal Outcome With Serum Ldh Levels In Patients Of Pre
Eclampsia And Eclampsia
To Improve Fetomaternal Outcome.
Material And Methods:
A Comparative Study Was Conducted In Department Of Obstetrics And Gynaecology, Pmch , Patna From October 2013
To September 2014 .
100 Patients Were Studied. 25 Normal Pregnant Women , 25 Were Mild Preeclampsia , 25 Severe Preeclampsia And 25
With Eclampsia. Statistical Analysis Was Done.
Results:
Ldh Levels Were Significantly Elevated In Women With Preeclampsia And Eclampsia.
Higher Ldh Levels Had Significant Correlation With Higher Blood Pressure Both Systolic And Diastolic.
Younger Women And Primi Para Had More Severe Disease With Correlating Higher Ldh Levels.
Mean Gestational Age At The Time Of Delivery Was Earlier With Higher Ldh Levels Along With Preterm Births.
Maternal Complications Were Statistically Significant With Increasing Ldh. Abruption Placentae, Hellp Syndrome With
Renal Failure, Pulmonary Oedema, Embolisms, Renal Failure, Cerebrovascular Accidents Were Reported In Severe
Preeclampsia And Eclampsia Group.
Chances Of Mortality Was More With Higher Ldh Levels.
There Were Many Neonatal Complications As Well.
Intrauterine Growth Retardation, Preterm Births, Low Birth Weight Babies Were Commonly Associated. There Were More
Perinatal Deaths With Increasing Levels Of Ldh And Severe Disease When Compared With Normal Pregnant Women.
Conclusion:
Higher Ldh Levels Correlate Well With The Severity Of The Disease And Poor Outcomes In Patients Of Pre Eclamsia And
Eclampsia

***************

Hyperhomocysteinemia As A Risk Factor For Iugr

Author: Dr. Lopamudra Pradhan
Co Author: Dr K.R.Mohapatra1,

Aims And Objectives:

To Compare Fasting Plasma Homocysteine Levels In Normal Pregnant Women And In Women With Iugr And Find The
Association Between Homocysteine And Iugr.

Materials And Methods:

The Present Clinical Study Is A Case Control Study Carried On Pregnant Women In Term Pregnancy Attending Opd Or
Admitted To Labor Room In Obstetrics And Gynaecology Department At Scb Medical College, Cuttack From 2012 To 2015
.Controls Pregnant Women Without Any Complications , Between Gestational Age 37 Weeks And 42 Weeks . Cases
Pregnant Women With Iugr Without Any Other Complications, Between Gestational Age 37 Weeks And 42 Weeks .
Results:
The Mean Fasting Plasma Total Homocysteine Concentration Was 6.32Mol Per Liter In The Study Group And 4.1 Mol
Per Liter In The Control Group With A P Value Of 0.000 Which Is Significant.
Conclusion:
These Results Indicate That Mothers Of Infants With Intrauterine Growth Retardation Do Not Have Elevated Plasma Total
Homocysteine Concentrations. The Homocysteine Concentration In The Case Group Was Comparatively Higher Than In
The Control Group.

***************

Oral Nifedipine Versus Iv Labetalol In Hypertensive Emergencies Of Pregnancy: A Randomised Trial .

Pregnancy
Author: Dr. Jamuna R
Co Author: Dr. Dhananjay B S1,

Aims And Objectives:

To Compare The Efficacy Of Oral Nifedipine And Iv Labetalol In Hypertensive Emergencies Of Pregnancy.

Methods And Materials

Out Of 60 Consenting Pregnant Women With Blood Pressure(Bp) >160/110 Mm Hg, 30 Each Were Randomised To Oral
Nifedipine And Iv Labetalol. The Patients Randomised To Oral Nifedipine Had Received 10Mg Orally Every 15 Mins For A
Maximum Of 5 Doses Or When Target Bp Of <150/100Mm Hg Is Achieved. Patients Randomised To Iv Labetalo Had Been
Administered 20Mg Initially And Followed By Escalating Dose Of 40Mg, 80Mg,80Mg,80Mg Every 15 Mins For A Maximum
Of 300Mg. The Time Required, Number Of Doses Required To Achieved Target Bp And Adverse Effects Were Measured.
The Statistical Level Of Significance Was Taken At P<0.05.

Results:
The Patients Who Came In The Inclusion Criteria Were Treated With Either Nifedipine Or Iv Labetalol.It Was Found Oral
Nifedipine Required 22.55+/-9.02 Mims Whereas Iv Labetalo Required 38.43+/-17.23 Mins To Achieve Target Bp Which
Was Significant (P<0.05). It Was Found That Nifedipine Required Fewer Doses Than Labetalol To Achieve Target Bp.
Adverse Effects Observed Were Very Few And Of Minor Degree And They Were Statistically Not Significant In Both The
Groups.

Conclusion:
Both Oral Nifedipine And Iv Labetalol Are Effective In Reaching The Therapeutic Goal In Hypertensive Emergencies Of
Pregnancy But Nifedipine Achieved The Target Bp More Rapidly And With Fewer Doses Than Iv Labetalol. Iv Labetalol Is
More Effective In Sustaining The Therapeutic Level Than Oral Nifedipine.

***************

A Study Of Perinatal Outcome Of Pregnancy Induced Hypertension And Intrauterine Growth Restriction By Using
Colour Doppler In Third Trimester Of Pregnancy At A Rural Hospital
Author: Dr. Raidu Deepthi
Co Author: Dr. Ramesh . G1,

Aims And Objectives:

To Identify Early , Quickly And Accurately High Risk Foetuses By Changes In Doppler Flow Velocity Waveforms.
To Study S/D Ratio , Ri And Pi Of Umbilical Artery And Fetal Middle Cerebral Artery In Pih And Iugr
Materials And Methods :
Singleton Pregnancies With Vertex Presentation Between 28-42 Weeks Of Gestation Complicated By Pih And Iugr In One
Year Both Admitted To The Rural Hospital
Results :
50 Patients Were Taken For Analysis , Out Of 50 Patients 20 Patients Developed Preeclampsia, 10 Patients Developed
Iugr . Umbilical Artery Doppler Was Abnormal In 16 Cases Who Developed Preeclampsia And 7Patients Who Developed
Iugr.
Conclusion:
Colour Doppler Is A Promising Tool In Prediction Of Pih And Iugr
***************

Knowledge, Attitudes And Practices Regarding Hpv Vaccination Among Postgraduate Gynecology Residents In A
Municipal Medical College In India
Author: Dr. Madhva Prasad S
1,
Co Author: Michelle Fonseca Deepali Kharat2, Nilesh Mhaske3, Pooja Chandak4, Aditi Joshi5

Aims And Objectives:

To Study The Knowledge, Attitudes And Practices Regarding Hpv Vaccination Among Postgraduate Gynecology Residents
In A Medical College In India
Materials And Methods:
With Existing Knowledge And Lacunae Regarding Hpv Vaccination, A Relevant Questionnaire Was Developed And
Validated. Ethics Committee Approval Was Obtained. Validated Questionnaire Comprising Of Questions Testing Each Of
The Knowledge, Attitudes And Practices Regarding The Use Of Human Pappilomavirus Vaccine Was Administered To
Postgraduate Residents, After Administration Of Due Consent For Participation In The Study. The Responses To The
Questionnaire Were Tabulated, Intergroup Comparison Was Done Based On Number Of Completed Years Of Residency
And Statistical Methods Applied For Assessment Of The Various Parameters.
Results: Total Of 46 Postgraduate Residents Were Administered The Questionnaire. All Consented For Participated. The
Knowledge Of The Participants Was Found To Be Adequate In Basic Information, But Lacked In Relatively Recent Advances
In The Topic, But Showing An Improvement With Increased Duration Of Residency. The Attitudes Of The Participants
Varied Widely, With No Significant Differences Between The Levels Of Seniority. A Very Small Number Of The
Postgraduate Trainees Have Actually Been Exposed To Hpv Vaccine Administration And Counseling. This Practice Of The
Participants Was Fairly Consistent Among The Different Groups, Reflecting The Consensus Protocol Prevalent Among
Government-Run Institutions.

Conclusion: There Is A Vast Scope For Improvement Of The Knowledge, Refinement Of Attitudes And Promotion Of
Quality Of Practices Regarding Hpv Vaccination Among The Postgraduate Gynecology Trainees. Given The Success Of Hpv
Vaccination Program Elsewhere, Large Burden Of Disease In India, Huge Scope For Preventing Oncology Services, And
TodayS Postgraduate Trainees Being The Torchbearers Of The Future, It Is Imperative That They Be Well Aware Of All
Aspects Regarding Hpv Vaccination.

***************

To Study The Prevalence Of Thyroid Dysfunction And Autoimmune Status In Pregnancy In India And Its Impact On
Obstetrical Outcome.
Author: Dr. Khushbu Tewary
Co Author:

Aims And Objectives:Thyroid Disorders Are Common In Pregnancy And Treatment Of Overt Hypothyroidism Clearly
Improves Outcomes In Pregnant Women.Even Subclinical Hypothyroidism Especially Those With Thyroidperoxidase
Positive Status Has Adverse Effects On Pregnancy.There Are A Few Data From India About The Prevalence Of
Hypothyroidism In Pregnancy.With This Viewpoint This Study Aims To Find The Prevalence Of Thyroid Dysfunction In
Pregnancy And Its Impact On Obstetrical Outcome.
Materials And Methods:The Study Comprised Of 200 Pregnant Women In Any Gestational Week Attending The Antenatal
Clinic In Nmch,Patna.Free T4,Serum Tsh And Tpoab Were Estimated In Addition To Routine Investigations.Patient In Any
Gestational Week And Singleton Pregnancy Were Enrolled For Study.Exclusion Criteria Included Patients With Known
Chronic Disorders-Diabetes,Hypertension,Bad Obstetric History With Known Cause And Multifoetal Gestation.Patients
With Deranged Thyroid Function Were Treated And Followed Every 6 Weeks Till Termination Of Pregnancy.
Results:Patients With Low Ft4 And Tsh>Trimester Specific Range[2.5 For First And 3.0 For Second And Third Trimesters]
Were Considered Overt Hypothyroid;Those With Normal Ft4 And Increased Tsh Were Considered Subclinical
Hypothyroidism.Prevalence Of Overt Hypothyroidism Was 3%[N=6] And Subclinical Hypothyroidism Was
9%[N=18].Among Overt Hypothyroids,Prevalence Of Preeclampsia Was 16.7%,Abruptio Was 16.7%.Spontaneous
Abortions Were Noted In 16.7% Whereas Preterm Births Were Seen In 33.3%[N=2].Among Subclinical Hypothyroids
Preeclampsia Was Noted In 22.2%[N=4],Whereas Spontaneous Abortions Were Seen In 5.6%[N=1].Lscs For Foetal
Distress Was Done In 66.7%[N=4] Of Overt Hypothyroid And 33.3%[N=6] Of Subclinical Hypothyroid
Patients.Autoimmune Status Was Seen In 12.5%[N=25] Of The Population.
Conclusion:There Is A High Prevalence Of Thyroid Dysfunction In Pregnancy And Obstetrical Complications Are Also High
Thus Universal Screening Should Be Done So That Cases Are Diagnosed As Early As Possible And Obstetrical Catastrophe
Be Avoided.

***************

Effect Of Anti-Tubercular Treatment On Endometrium, Fallopian Tubes And Ovaries In Genital Tuberculosis
Author: Dr. Sneha J
Co Author: Dr Sneha J1, Dr J B Sharma2, Prof Sunesh Kumar3, Prof K K Roy4, Dr Neeta Singh5

Aims And Objectives:To Assess The Effect Of Att On Endometrial Function By Endometrial Aspiration Studies And
Hysteroscopic Findings And On Fallopian Tubes And Ovaries By Laparoscopic Visualisation.
Materials And Methods:This Is An Interventional Study Carried Out At Department Of Obstetrics And Gynaecology, All
India Institute Of Medical Sciences, New Delhi. A Total Of 50 Infertile Patients Aged 20 To 45 Yrs With Genital Tuberculosis
Were Recruited From Gynaecology Opd. The Effect Of 6 Months Course Of Anti-Tubercular Treatment (Dots Regime) On
The Status Of Ovaries, Fallopian Tube And Uterus Was Assessed.
Results: On Endometrial Sampling Pre Att, Histopathology, Afb And Pcr Was Positive In 3(0.06%), 2(0.05%), 47(94%)
Patients Respectively. After Att,No Patient Had Histological Evidence Of Tuberculosis On Ea And Pcr Was Positive In
16(33%)Patients.
At Pre Att Laparoscopy, Tubercles Were Noted On The Surface Of The Tube, Ovary Or Pelvic Peritoneum In 27(54%)
Patients, Pelvic Adhesions In 21(42%) Patients, Casseous Nodules And Encysted Ascitis In 4(8%) Patients Each.Post Att,
Tubercles Were Noted In 1(0.02%) Patient, Pelvic Adhesions In 20(41.6%), Hydrosalpinx In 16(33%) Patients, Tubes Not
Visualized In 10(20%) Patients. Normal Findings Were Seen In 2(4%) And 15(31%)Patients Pre And Poat Att Respectively
.Pre Att, Chromotubation In Right And Left Tube Showed Free Spill In 18(36%) And 20(41%) Patients, Delayed Spill In
4(8%) And 5(10%) Patients And No Spill In 28(56%) And 25(52%) Patients Respectively.Post Att, Free Spill And No Spill
Was Noted In 25(50%) And 23(47.9%) Patients From Right Tube And In 24(48%) Patients Each From Left Tube
Respectively.Pre And Post Att Hysteroscopy Showed Various Grades Of Intra-Uterine Adhesions In 31(62%) And
14(29.1%) Patients Respectively. 2 Women Conceived During Att.
Conclusion: Att In Women With Female Genital Tb Suppresses The Active Disease. The Damage Already Caused Is Not
Reversed And Hence, Fertility Rates Remain Low.
***************

Comparative Clinical Study Of Laproscopic Assisted Vaginal Hysterectomy And Non Descent Vaginal Hysterectomy
Author: Dr. Shobha Shiragur
Co Author: Rajammal B1,

Aims And Objectives:To Study And Compare The Indications And

The Intraoperative And Post Operative Events Of Ndvh And Lavh
Materials And Methods :
The Study Was Undertaken In The Department Of Obstetrics And Gynecology , Amrita Institute Of Medical Sciences,
Kochi. From September 2006 To September 2007. A Total Of 50 Women In Each Group Undergoing Lavh & Ndvh For
Benign Pelvic Conditions Were Included In The Study. Lavh & Ndvh Done For Endometrial Carcinoma And Prolapsed
Uterus Were Excluded From The Study.
Results :

Majority Of Study Subjects In Both The Groups Belonged To The Age Group 40-50 Years. The Commonest Indication For
Surgery In The Present Study Is Fibroid Uterus In 35 (70%) Lavh And 42 (84%) Ndvh Group. 26 (52%) In Lavh And 22 (44%)
In Ndvh Group Had Abdominal Surgery For Various Reasons. 26(52%) In Lavh Group Completed The Surgery In 200-300
Minutes , While The Majority 35 (70%) Cases In Ndvh Group Completed In 100-200 Minutes. Average Weight Of The
Specimen In Lavh Was 330 Gms And Ndvh 307 Gms. Mean Operative Blood Loss In Lavh Was 187Ml And In Ndvh Was
184 Ml.

Conclusions:
Lavh Took A Long Time To Perform, There Was No Statistically Significant Difference In Post-Operative, Hospital Stay,
Recovery Milestones Or Complication Rates Between The Two Groups. In The Clinical Situations Such As Dense Pelvic
Adhesions Laparoscopic Approach Had The Added Advantage In Preventing Laparotomy.

***************

Stillbirths-A One Year Retrospective Study In Government Maternity Hospital,Tirupati

Author: Dr. Sharmista Kadi
Co Author:

Aims And Objectives:To Study The Most Common Causes Of Stillbirth And Identify Preventable Factors Of Stillbirth.
Methods:A Retrospective Study Conducted On All Cases Delivered At Government Maternity Hospital,Tirupati From April
2013 To March 2014.
Results:Out Of 12,931 Deliveries Conducted Over A Period Of One Year At Government Maternity Hospital,Tirupati, 335
Stillbirths Were Registered.Among Those Women Who Delivered Stillborn 47.7% Had Received Regular Antenatal Care
While 52.3% Had Not.91% Women Belonged To The Age Group 20-30 Years,6% Were Above 30 Years And 2% Below 20
Years.42.6% Stillbirths Were Of Term Gestation,52.4% Were Preterm Deliveries And 5% Were Post Dated Pregnancies.
48.6% Were Primipara,30% Second Para,17.4% Third Para And 4.6% Multipara.Among 335 Stillbirths,3% Were Twin
Gestation.83.8% Of Cases Were Delivered By Vaginal Delivery And 16.2% Delivered By Caesarian Section With C-Section
Being Done Mainly For Obstetric Complications In Safer Interest Of The Mother.Major Causes Contributing To Stillbirth
Are Unknown Causes(24%),Hypertensive Disorders In Pregnancy(20%),Antepartum Haemorrhage(9%),Malpositions And
Malpresentations(11%),Congenital Anomalies(8%),Polyhydramnios,Oligohydramnios And Premature Rupture Of
Membranes(8%),Rupture Uterus(2%),Bad Obstetric History(1.7%),Rh Negative Pregnancies And Hydrops
Fetalis(1.8%),Fetal Distress(2.9%),Anemia(6.5%) And Other Medical Illnesses.
Conclusion:Majority Of The Causes Of Stillbirth Are Preventable.Interventions Directed Towards Mothers Before & During
Pregnancy And Childbirth May Reduce Stillbirths.Interventions Needed Are Proper Antenatal Care,Protein Energy
Supplementation,Early Identification Of High Risk Pregnancies,Birth Planning,Emergency Obstetric Care,Prevention Of
Preterm Deliveries And Safe Labor Induction Practices In High Risk Cases,Counselling Mother For Safe Institutional
Delivery And Providing Acceptable Family Planning Services.
***************

The Effect Of Combined Therapy Myoinositol And D- Chiroinositol On Lipid Profile In Pcos Patients
Author: Dr. Monisha Sagar
Co Author: Dr Swetnisha1, Dr Sweta2, Dr Rajsree3, Dr. Kumudini Jha4,

Aims And Objectives-The Combined Therapy Myoinositol And D- Chiroinositol Have Been Shown To Improve Insulin
Resistance,Hyperandrogenism And To Induce Ovulationin Pcos Women. However Their Effect On Dyslipidemia Are Less
Clear. The Aim Of This Study Is To Evaluate Whether The Combined Therapy Myoionositol Plus D-Chiroinositol(In A
Physiological Ratio Of 40:1) Improve The Profile , Therefore, Reducing Cardiovascular Risks In Pcos Patients.
Material And Methods- This Is A Prospective Study Done On 14 Pcos Patients (Bmi>30Kg/M2) During Oct 2013 To Sep
2014 In Darbhanga Medical College,Laheriasarai,Bihar. The Lipid Profile Was Assessed By Measuring Total
Cholesterol,Ldl,Hdl And Triglycerides Before And After 6 Months Treatment With The Combined Theray.
Result- As Per Protocol, Data Was Analysed And Was Found That Patients On Combined Therapy Myoionositol And DChiroinositol Haveimproved Hdl Levels,Ldl Levels And Triglycerides Levels.
Conclusion- The Combined Administration Of Myoinositol And D-Chiroinositol Improves The Lipid Profile Of Pcos Women,
Therefore, Reducing The Cardiovascular Risks
***************

Comparision Of Ferric Carboxymaltose Injection With Oral Iron In Treatment Of Postpartum Iron Deficiency Anaemia.
Author: Dr. Aprajita Kumari
Co Author: Dr Geeta Sinha1,

Aims And Objectives-To Compare The Safety And Efficacy Of Ferric Carboxymaltose Injection With Oral Iron In Treatment
Of Postpartum Iron Deficiency Anaemia-By Estimating Haemoglobin Rise And Changes In Serum Iron Parameters.To
Assess And Compare The Side Effects.
Material And Methods-The Study Was Carried Out In The Department Of Obstetrics And Gynaecology ,Patna Medical
College And Hospital From August 2013 To August 2014.Total 230 Postpartum Women Within 10 Days Of Delivery
Having Haemoglobin 5- 9 Mg/Dl, Were Randomized In A Ratio Of 1:1. Patients Were Undergo Detailed History And Clinical
Examination.Total Dose Of Intravenous Fcm Were Calculated By Ganzoni Formula. Total Iron Dose-Body Weight In Kg X
[14-Baseline Hb]X2.4 Plus 500.Where 2.4 = Unitless Conversion Constant 500=Target Iron Store In Mg.14= Target Hb
G/Dl. Fcm Was Given As Slow Intravenous Infusion Maximum Single Dose Was Not Exceed 15 Mg/Kg Or 1000Mg/Dose
In 250 Ml Of 0.9 Percent Normal Saline Over 15 Minutes.Fcm Was Repeated Weekly Up To Calculated Dose S.Second
Group Of Patients Were Given Ferrous Sulphate Tablet 200 Mg [60 Mg Elemental Iron] Thrice Daily For 6 Weeksall
Patients Were Followed At 3 And 6 Weeks.
Results: Ferric Carboxymaltose Treated Subjects Were Achieved A Haemoglobin More Than 11 Gm/Dl In A Very
Short Time Period With Sustained Haemoglobin Greater Than 11Gm/Dl On Day .Achieved Haemoglobin Rise 3 Gm/Dl
Or Greater More Quickly.Attain Higher Serum Transferrin Saturation And Ferritin Level.Drug Related Adverse Effects
Occured Less Frequently With Ferriccarboxymaltose
Conclusion-Intravenous Ferric Carboxymaltose Were Safe And Well Tolerated With An Efficacy Superior To Oral
Ferrous Sulphate In The Treatment Of Postpartum Iron Deficiency Anaemia.

***************

Optimizing Surgical Strategies In Placenta Accreta - To Improve The Maternal Outcomes

Author: Dr. Aruna Suman
Co Author: Dr .A.Padmaja1, Dr.Sandhya Rani2,

Aims- To Optimize The Surgical Techniques In Placenta Accreta Cases - To Improve The Maternal Outcome And To Save
The Life Of The Mothers In Lower Resources Settings

Materials And Methods - A Prospective Study Designed At Tertiary Care Center At Hyderabad , At Modern Government
Maternity Hospital From 2012 June To 2014 June , This Was Compared With Maternal Outcome In Previous Years Ie 2010
To 2012 .There Were About 16 Cases Of Placenta Accreta From 2012 To 2014 June,, 9 Cases During 2010 To 2012 Which
Were Compared.
A Surgical Protocol Was Developed That Matched Our Set Up , Following The Nice Guide Lines And Rcog G Uide Lines To
Minimize The Surgical Complications And Reduce Maternal Morbidity And Mortality Which Is Very High.
The Protocol That Was Followed Was - After Diagnosis Of Placenta Accreta ,Elective Surgery Was Planned At 37Wks,
Maping Of Edge Of Placental Insertion Is Done Before Taking Incision That Is Above The Edge , Delivery Of Fetus, Cord
Clamping And Ligation ,No Attempt To Separate The Placenta Is Made, Total Hysterectomy Is Done With Placenta In Situ
.
Results -There Is Decrease In Maternal Morbidity And Mortality When A Planned Elective Surgery Was Performed With
Available Multidisciplinary Approach ,The Mortality Dropped From 63% To 37% Comparatively In Our Set Up.
There Was Decreased Necessity Of Blood Transfusions Also .
Conclusion- Optimization Of Safe Surgical Techniques And Following The Protocols According To The Evidence Will
Reduce The Morbidity And Mortality In Cases Of Placenta Acreta In Low Resources Settings , The Safe Surgery Will Save
Life .

***************

Prevalence Of Vitamin D Deficiency And Its Role As The Predictor Of Insulin Resistance In Pcos.
Author: Dr. Saumya Prasad
Co Author: Dr. Pratima Mittal1, Dr. Jyotsna Suri2,

Aims:
1.

To Compare The Vitamin D Level In Pcos And Non Pcos Groups

2.

To Determine Correlation Between Vitamin D3 And Insulin Resistance In Pcos.

Material And Methods: 50 Pcos Women And Age Matched 50 Non Pcos Women Were Recruited. Serum Estimation For
S. Vitamin D3, Fasting Insulin, And Fasting Glucose Was Done And Homa- Insulin Resistance Was Calculated. Correlation
Of Vitamin D And Insulin Resistance Was Determined.
Result: Vitamin D Deficiency (<20Ng/Dl) Was Highly Prevalent Among Women With Pcos (63.3 %). The Difference In The
Mean Value Of The 2 Groups Was Found To Be Significant, 10.38 Ng/Ml And 19.2Ng/Ml Respectively (P=0.002). The
Difference In The Mean Insulin Resistance In These Women Is Statistically Significant, 20.6 Ng/Ml And 11.41 Ng/Ml,
Respectively, (P< 0.0001).A Negative Correlation Was Found Between Vitamin D Deficiency And Insulin Resistance (R= 0.3009).
Conclusion: There Is A Negative Correlation Between Vitamin D Deficiency And Insulin Resistance. Serum Levels Of
Vitamin D3 Are Lower Both In Pcos And Non- Pcos Women. Mean Levels Of Vitamin D Are Significantly Lower In Pcos
Group. The Role Of Vitamin D Supplementation Can Be Explored In Case Of Pcos.
***************

Abuse Of Mtp-Pill Without Proper Prescription: an Analytical Study

Author: Dr. Parneet Kaur
Co Author: Dr Balwinder Kaur1, Dr Khushpreet Kaur2, Dr Manjit Kaur Mohi3, Dr Lavinder Mann4,

Aims: An Analytical Study Of Abuse Of Mifepristone/Misoprostol I.E. Mtp-Pill For Abortion Without A Proper Prescription
Material & Methods: The Study Was Conducted In Department Of Obstetrics And Gynecology, Government Medical
College And Rajindra Hospital Patiala From January 2010 To December 2012. Pregnant Females Who Reported To Family
Planning Opd With History Of Intake Of Mifepristone/Misoprostol For Purpose Of Abortion Were Enrolled.
Results: 131 Cases Reported With H/O Intake Of Pills For Abortion. Mean Age Came Out To Be 29.4 Years. The Subjects
Were Almost Equally Divided Between Urban And Rural Areas. The Gestational Age At The Time Of Reporting Was
Between 5Weeks To 14 Weeks. No Patient Underwent Per Vaginum Examination Before Intake Of Drugs To Know Size Of
Uterus Or To Rule Out Ectopic Pregnancy. The Tests Done Before Intake Of Pills Were Upt In 76.3% And Usg In 3.8%.
Among 131 Subjects 53.4% Had Taken Drug On Recommendation Of Chemist And 33.6% Took On Advice Of Rmp,
Whereas 6.1% Administered The Pills By Themselves. Others Took It From Anm (3.8%), Gynecologist (1.5%), Dia (0.8%)
And On Advise By A Neighbor (0.8%). Only 15.3% Subjects Had Taken Drugs According To Who Recommended Schedule.
Pregnancy Outcomes Were Continuation Of Pregnancy, Incomplete Abortion, Complete Abortion, Missed Abortion,
Ectopic Pregnancy And Septic Abortion In 44.3%, 38.3%, 12.2%, 2.2%, 1.5% And 1.5% Of Cases. None Of The Patients
Were Aware About The Side Effects Of The Drugs Or Importance Of Follow-Up.
Conclusion: As Patients Had Easy Access To These Drugs For Termination Of Pregnancy, They Should Not Be Available
Over The Counter But Only On Prescription Of Qualified Medical Practioner So That Misuse Is Avoided. More Focus Should
Be On Use Of Contraception Practices For Avoiding Pregnancy Rather Than Thinking Undergoing Abortion.

***************

Maternal Morbidity Due To Unsafe Second-Trimester Medical Abortion: Current Scenario In Rural Practice
Author: Dr. Meena Armo
Co Author:

Aims: To Determine The Frequency Of Women Who Underwent An Unsafe Second-Trimester Medical Abortion And
Attended A Tertiary Care Center, Government Medical College Bilaspur Chhattisgarh (Chhattisgarh Institute Of Medical
Sciences) With Complications.
Material And Methods: A Retrospective Record Based Data Analysis Was Performed On Patients With History Of Unsafe
Second-Trimester Medical Abortion Carried Out At Location Other Than Our Centre, During The Period Of June 2009 To
May 2014.
Result: Out Of 400 Cases Of Unsafe Medical Abortion Observed Over The Period, 123(30.75%) Patients Underwent An
Unsafe Second-Trimester Medical Abortion And Admitted In Obstetrics & Gynecology Department With Complications.
Majority Of Patients Were Rural, Illiterate, From Very Low Socioeconomic Background. Most Frequent Complain For
Admission Observed Was Severe Bleeding, Seen In 77(62.60%) Cases. The Most Common Reason For The Termination
Was Unintended Pregnancy In 100 (81.30%) Cases. Majority Of Provider 112(91.05%) Were Either Paramedics Or Quacks.
Complications Observed In 86(69.91%) Cases, Of Which Severe Anemia Seen In 65(52.84%) And Shock In14
(11.38%).Majority Of Patients 101(82.11%) Required Either Medical Or Surgical Intervention. Unfortunately 4 (3.25%)
Patients CouldnT Survive Despite Of All Resuscitative Measures.
Conclusion: It Is Very Unfortunate That More Than 40 Years Following Legalization Of Abortion, The Right Of Abortion
And Mtp Law Is Little Known To The Females Of Our State. However Measures To Reduce Unsafe Abortion And Its
Consequences Include, Strengthening Of Existing Government Health Services, Provision Of Drugs At Low Cost At Primary
Health Care Centers Specially In Difficult To Reach Areas, Improving Access To Family Planning Services, Making Policy To
Reduce Sale Of Otc Drugs And Most Important Is, To Educate People About Safe Abortion, Abortion Rights, Mtp Law,
Through Print And Electronic Media.

***************

To Study The Impact Of Progesterone(Dydrogesterone) On Proinflammatory ( Il-6 And Tnf-Alpha) And AntiInflammatory (Il-10) Cytokines In Threatened Abortion
Author: Prof. Reena Yadav
Co Author: Dr Simpy1, Dr Anju Jain2,

Aims:- To Study The Impact Of Progesterone (Dydrogesterone) On Proinflammatory And Anti-Inflammatory Cytokines
Concentrations In Threatened Abortion. Material And Methods:-It Was A Randomised Interventional Study.100 Women
Admitted With Threatened Abortion Were Randomly Divided In Two Groups-Cases And Controls. Fifty Women In Each
Group. Initial Ultrasonography Was Done To Assess The Cardiac Activity In All The Subjects. The Serum Levels Of Il-6 ,TnfAlpha And Il-10 Were Measured In All At The Time Of Admission. The Cases Were Given Tab Dydrogesterone In The Dose
Of 30Mg Per Day And Controls Were Not Given Any Progesterone Preparation. Serum Levels Of Il-6, Tnf-Alpha And Il-10
Were Again Measured After 10Days And Also At 14Weeks Of Gestation In Both Cases And Control Group And The Values
Were Compared. Results:-Serum Values Of Il-6 Showed Fall After 10Days And At 14 Weeks Of Gestation In Both Cases
And Controls .The Mean Value In Cases At Admission, After 10 Days And After 14 Completed Weeks Were 44.6924.69,
39.7118.75 And 29.268.48 Respectively .Corresponding Values For Controls Were 50.7625.16,36.8212.46 And
32.515.26Respectively. Mean Serum Concentration Of Il-10 At Admission, After 10 Days And At 14 Weeks Of Gestation
In Cases Were 66.6824.46,59.3111.62 And 44.769.90. The Corresponding Values For Control Groups Were
61.2523.34, 56.5210.53 And 59.0413.14 Respectively. The Mean Values When Compared In Cases And Controls
,The P Value Was Not Significant.Tnf-Alpha Was Not Detectable In Both Cases And Control Group.19 Out Of 50 Women
Aborted In Case Group And 15 Out Of 50 Women Aborted In Control Groups. Conclusion:- It Is Concluded That
Dydrogesterone Has No Effect On Proinflammatory And Anti-Inflammatory Cytokines Levels In Threatened Abortion. The
Number Of Women Who Aborted In Cases And Control Group Were Comparable Thereby Indicating That There Is No
Role Of Dydrogesterone In Threatened Abortion .
***************

Teen Moms'- A Dual Risk And A Public Health Crisis

Author: Dr. Rachna Dubey
Co Author:

Aims:
A Comparative Study Of Medical Complications Amongst Adolescent & Nonadolescent Pregnancies And Their Foetal
Outcome.

Methodology:

This Hospital Based Study Is In Government Hospitals Of Indore (M.P.) Providing Obstetrics And Gynaecological Care With
Facilities Of Integrated Counselling And Testing Centres For Hiv & Sti Clinics Under Nacp-Iii Program

1.

District Hospital .

2.

Mgm Medical College.

3.

Hukumchand Hospital.

Study Aims To Examine The Incidence Of Adolescent Pregnancies And Identify The Health Problems Specific To Them.
This Study Spanned From 1St October 2011 To 1St September 2012.

Results:

1.The Percentage Of Teenage Pregnancies Was Found To Be 12.05% Of Total Deliveries. Amongst Adolescent Mothers
86.93% Were Primigravida.
2.Total 28.69% Delivered Low Birth Weight Babies. The Lbw Proportion Was Much Higher In Adolescent Mothers I.E.
36.36% Compared To Control 21.02%.
3.Amongst Adolescent Group, 78.98% Had Moderate And 5.68% Had Severe Anaemia Compared To 65.34% And 3.41%
In Control Group.
4.Contraceptive Use Was 11.08%. Out Of These 1.99% Were
Contraceptive Use Was 4 Times Higher In Controls.

Adolescents Compared To 9.09% Control. Thus,

5.Sti Prevelence Was Observed More In Muslims (31.82% Positive) As Against Hindus (16.28% Positive).
6. 19.89% Of Adolescent Mothers Delivered Pre Term Babies Compared To 9.09% In Control Group And Lscs Is More I.E.
30.68% In Control Group As Compared To Adolescent I.E. 14.77%. Forceps Delivery Was Higher I.E. 3.41% In Adolescent
V/S 0.57% In Control.
7. 37.50% Adolescent And 23.30% Non-Adolescent Had One Or More Pregnancy Complications. Iugr 15.15%, Cpd 12.88%
And Mal Presentations 18.18% Respectively Are Amongst The Commonest Pregnancy Risk Factors In Adolescent Age

Group As Compared To Control Group I.E.10.98%, 10.98% And 14.63% Respectively. Prolonged Labour Was Also Higher
In Adolescent Pregnancy 3.79% As Compared To Control Group 2.44%.
8.Ecplemsia And Precplemsia Was 18.18% In Adolescents, Whereas In Control Group Only 9.66% Had Pih.

***************

Study Of Congenital Malformations At Birth- A Prospective Study

Author: Dr. Neha Madurwar
Co Author: Neha Madurwar1, Shyama Kanungo2,

Aim-To Study Incidence Of Clinically Detectable Congenital Malformations At Birth In Scb Medical College
Material And Method-All The Babies Delivered From 1St January 2013 To 30Th June 2014 Was Examined For Congenital
Malformation.
ResultsCongenital Malformations Were Studied Prospectively From January 2013 To June 2014 Covering 13736 Consecutive
Deliveries With 12933 Live Birth And 803 Stillborns. Of All Deliveries The Total Number Of Congenital Malformations
Were 159 (1.03%) With 103 Of Them In Live Births (0.7%) And 48 In Stillborn (5.9%). Of All The Most Common Congenital
Malformation Was Found To Be Of Central Nervous System 53 (33.33%) Followed By Gastrointestinal Tract System 36
(22.64%),Musculoskeletal System 30 (18.86%),Genitourinary System 24(15.09%) Least Common In Cardiovascular System
14 (8.81%) & 3 Cases Of DownS Syndrome.Musculoskeletal And Genitourinary Malformations Were More Common
Among Live Births While Central Nervous System And Gastrointestinal Defects Were More Common In
Stillborns.Congenital Malformations Were More Common In Males(83) Than In Females(56) Births,2 Had Ambiguous
Genitalia.They Were More Common In Preterm (77) Than Term (64) Babies,18Abortions.Most Of Congenital
Malformations Had Birth Weight Of 1.5- 2.49 Kg (72 Babies);49 In 2.5-3.5Kg; 21 In 0.5- 1.49Kg&3 In>3.5Kg.Among
Maternal Factors Maximum Number Of Congenital Malformations(I.E 64 Patients) Were In Age Group 24- 29Yrs,47
Among 20-24Yrs,26 In 30-34Yrs&19 Had >34Yrs. In Parity 76 In Primi, 42 Had Previous One Or More Abortions.Most Of
The Patients Belonged To Low Socio- Economic Status. None Of The Patients Took Pre-Natal Folic Acid Supplementation.
Conclusion-In My Study Total Number Of Congenital Malformations Were 159 (1.03%) With 0.7% In Live Birth And 5.9%
In Iud. Most Common System Involved Was Cns. Cns > Git > Gus > Musculo- Skeletal System > Cvs. Congenital
Malformations Were Found To Be More Common In Males, Preterm,Low Birth Weight Babies, In Age More Than
25Yrs,Primi&Low Socio- Economic Status Patients
***************

An Interesting Case Of Post Caesarean Urinary Incontinence

Author: Dr. Kokilavani Moorthy
Co Author: Prof. Dr.Sridevi1, Dr.Maya Menon2, Dr. Ramachandhiran, Urologist3,

An Interesting Case Of Post Caesarean Urinary Incontinence

Background: An Iatrogenic Ureterovaginal Fistula Following Caesarean Section Is Very Rare Reported Incidence Is Around
0.01-0.027%.The Mechanism Of Injury Resulting In Iatrogenic Postoperative Ureterovaginal Fistula Includes Ureteral
Laceration Or Transection, Bunt Avulsion, Crush Injury, Partial Or Complete Suture Ligation, And Ischemia Due To
Operative Devitalization Of The Ureteral Vascular Supply Or Cautery Injury During Surgery.
Case: 29 Year Old Women Underwent An Emergency Caesarean Section For Second Stage Cephalopelvic Disproportion.
Intraoperatively Small Uterine Extension About 1.5 Cm Near The Left Angle Of Uterus Noted. Haemostatic Sutures Were
Taken. On Her Sixth Postoperative Day She Complained Urinary Incontinence .She Was Able To Void Normally In Between.
Examination Showed Pooling Of Urine In The Vagina. No Obvious Fistulous Tract Visualized. Ultra Sonogram Showed Left
Significant Hydroureteronephrosis With Proximal Hydroureter, Distal Ureter Obscured And No Evidence Of Calculus.
Intravenous Pyelography Showed Contrast Filling In The Lower End Of Left Distal Ureter And In Vagina Suggestive Of Left
Ureterovaginal Fistula.
Patient Counselled And Planned For Cystoscopy And Proceed With Retrograde Pyelogram And Double J Stenting Or
Uretero-Ureterosotomy /Uretero Neocystotomy. Cystoscopy Showed Normal Urinary Bladder And Ureteric Orifices. No
Evidence Of Fistulous Tract In Bladder. Retrograde Pyelogram Showed Extravasation Of Contrast In Left Distal Ureter,
Double J Stent Was Inserted From Pelvis To Bladder. Patient Became Asymptomatic. Stent Removed After 6 Weeks.
Conclusion: Ureterovaginal Fistula Is An Uncommon Complication Of Emergency C-Section .Prompt Diagnosis Is Made By
Vigilance Post Operative Care The Treatment Aims At Resolution Of The Urinary Leakage, Prevention Of Urosepsis, And
Preservation Of Renal Function .Minimally Invasive Surgical Treatment Is The Best Initial Approach In Selected Patients,
With A Success Rate Of 71%.

***************

Analysis Of Near-Miss And Maternal Mortality At Tertiary Referral Center Of Rural India
Author: Dr. Archana Rathod
Co Author: Dr. Vijay Bhagat1, Dr. Sandhya Pajai2,

Analysis Of Near -Miss & Maternal Mortality At Tertiary Referral Center Of Rural India
Authors: Dr Archana D.Rathod, Dr. Vijay Bhagat, Dr. Sandhya Pajai.
Department Of Obstetrics And Gynaecology, Shri Vasantrao Naik Govt. Medical College & Hospital, Yavatmal 445001,
Maharashtra , India.
Abstract:
Objective:
1) To Determine The Incidence Of Near Miss, Maternal Death & Mortality Index.
2) To Compare Near Miss Cases As Per Who Criteria With That Of Maternal Mortality.
3) To Study The Causes Of Near Miss & Maternal Deaths.
Study Design: Retrospective Cohort Study
Setting: Shri Vasantrao Naik Govt. Medical College, Yavatmal, India.
Study Population: All Cases Of Near Miss As Per Newer Who Criteria & Maternal Deaths.
Methodology: A Cohort Of Emergency Obstetric Admission In The Study Setting During The Study Period Was Followed
Till 42 Days After Delivery, Cases Fulfilled Who Set Of Severity Markers For Near Miss Cases For Acute Severe Maternal
Morbidity And Mortality (Samm). All Maternal Deaths During The Same Period Were Analysed & Compared With Near
Miss Ones.
Results: During The Study Period , There Were 29,754 Emergency Obstetric Admission, 21,992 (73.91%) Total Deliveries
With 18,630 (84.71%) Vaginal Deliveries And 3,360 (15.28%) Caesarean Deliveries. There Were 161 Near Miss Cases And
66 Maternal Deaths Occurred. The Maternal Near Miss Incidence Ratio Was 7.56/1000 Live Births, While Maternal
Mortality Ratio Was 2.99/1000 Live Births. Mortality Index Was 29.07; Lower Index Indicative Of Better Quality Of Health
Care. Maternal Near Miss To Mortality Ratio Was 3.43: 1.Amongst Near Miss Cases, Haemorrhage (26.70%), Anaemia
(18.63%) And Pih (9.31%) Were Leading Causes. While Causes For Maternal Mortality Were Sepsis (18.18%), Pih (18.18%),
Anaemia (16.16%) & Hepatitis (16.66%).
Conclusion: Despite Of Improvements In Health Care; Haemorrhage, Pih, Sepsis And Anaemia Remain The Leading
Obstetric Causes Of Near Miss And Maternal Mortality. All Of Them Are Preventable. The Identification Of Maternal Near
Miss Cases Using New Who Set Of Severity Markers Of Samm Were Concurrently Associated With Maternal Death.
Definite Protocols & Standards Of Management Of Samm Should Be Established, Especially In Rural Indian Settings.

***************

Anca Positive Vasculitis- A Rare Cause Of Maternal Mortality

Author: Dr. Sharadhi C
Co Author: Dr Sharadhi C1, Dr Suchitra Thunga2,

Anca Positive Vasculitis- A Rare Cause Of Maternal Mortality

Dr Sharadhi. C1 ,Dr Suchitra Thunga2,Dr Prabha Adhikari 3,Dr Arun Rao4.

1. Junior Resident, 2. Professor, 3.Professor, 4. Hod
Department Of Obstetrics And Gynecology
Kasturba Medical College
Abstract
Background: Pregnancy Is A Hypercoagulable State . Common Causes Of Dvt Associated With Acute Renal Failure In
Pregnancy Include Auto Immune Diseases Like Sle , Apla. Here We Describe An Interesting Case Of A Primigravida At 19
Wks Period Of Gestation Who Presented With Dvt , Progressed To Have A Missed Abortion , Arf And Pulmonary
Hemorrhage Which Led To Maternal Mortality Which Was A Complication Of Anca Associated Vasculitis.
Case: A 29 Yr Old Primigravida With A Nasal Twang Came With Complaints Of Pain And Swelling In Right Lower Limb Since
One Month Which Was Aggravated And Associated With Low Grade Fever Since 1 Day. On Examination Patient Had
Extensive Subcutaneous Edema Of Right Lower Limb Associated With Tenderness And Palpable Purpura. Doppler
Evaluation Showed Dvt Extending To Right External Iliac Vein. Patient Was Started On Heparin Infusion. Rft Was Altered
At Admission. Next Day Usg Showed Missed Abortion. After Reserving Adequate Blood And Blood Products, Termination
Of Pregnancy Was Done By Vaginal Misoprostol. Patient Was In Arf. Ana, Apla, Anti Ds Dna Were All Negative With Anca
Positivity. She Developed Breathlessness And Features Of Ards And Was Promptly Intubated And Put On Mechanical
Ventilation. At The Time Of Intubation She Was Found To Have Pulmonary Hemorrhage. She Was Taken Up For
Plasmapheresis, But The Patient Succumbed To The Illness Despite Two Sessions Of Plasmapheresis.
Conclusion: Patients Should Be Throughly Investigated For The Causes Of Dvt In Pregnancy With An Open Mind
Considering Rare Possibilities Of Vascultis Like Wegeners Granulomatosis And Treated Aggressively.
Keywords: Dvt, Arf, Anca Associated Vasculitis

***************

Androgen Insensitivity Syndrome In Two Sisters ( An Unusual Case Report)

Author: Prof. Surinder Bhupal
Co Author:

Androgen Insensitivity Syndrome (Testicular Feminisation Syndrome) In Two Sisters

Case Report)

( An Unusual

Bhupal. K. Surinder, K.Arvinder , Bhupal J.P.S, Singh Beant, Richa, Santosh

Abstract
Androgen Insensitivity Syndrome (Ais) Is A Rare X Linked Recessive Condition. It Is A Disorder Of Androgen Receptor
Function And Represent The Most Common Detectable Cause Of Male Pseudohermaphroditism. This Condition Involves
Genotypic Males Present With Phenotypic Characteristics Of Females. Complete Androgen Insensitivity Syndrome Is Rare
Form Of Ais And Prevalence Is Estimated As One In 20000 Live Male Birth And One In 60000 Live Births.Because Of Its
Rarity, I Report A Case Of Cais Diagnosed In A Female Who Came With H/O Infertility. Material And Methods:I Report A
Case Of 30 Year Old Married Female Who Presented With Chronic Abdominal Pain With H/O Primary Amenorrohea, With
H/O Similar Complaints In Her Elder Sister. On General Physical Examination Patient Was Well Built With Absent Axillary
And Pubic Hairs And Well Developed Breast With Stable Vitals. All Routine Investigations Were Within Normal Range.
Buccal Smear Reveals No Barr Body. Patient Was Not Willing For Karyotyping. Hormonal Profile Reveals Normal Lh, Fsh
And Testosterone Levels. Ultrasonography Revealed Unilateral Adnexal Mass Of Size 9*8*8Cm ?Teratoma With Absent
Uterus. On Laparotomy Left Adnexal Mass About 8*8*6Cm Removed And Right Gonadectomy ( 4*2*1) Done. Hpe Shows
Presence Of Seminiferous Tubules And Ovarian Stroma With Absence Of Graffian Follicles In Left Gonad And Right Gonad
Reveals Seminiferous Tubules Without Any Ovarian Stroma. Gross And Histopathological Finding Fits Into Ais. Patient
Put On Hormonal Replacement Therapy. Conclusion: Ais Although Rare, Is Distressing And Requires Expert And
Sympathetic Handling. Patients Can Achieve An Excellent Quality Of Life As A Female By Multispeciality Approach
Including Gonadectomy, Surgical Correction And Psychological Counselling Along With Estrogen Replacement.
Keywords: Ais, Primary Amenorrohea, Androgen Receptor

***************

Applicability Of NaegeleS Rule On Expected Date Of Delivery

Author: Dr. Shashi Roopa
Co Author: Professor And H.O.D Dr.T.Bharathi Mbbs,Ms(Obg),Phd1,

Applicability Of NaegeleS Rule On Expected Date Of Delivery

Author Dr.Shashi Roopa
Guide Prof. & H.O.D Dr.T.Bharathi
Abstract
Introduction
Naegele'S Rule Is A Standard Way Of Calculating The Due Date For A Pregnancy. The Rule Estimates The Expected Date
Of Delivery (Edd) By Adding One Year, Subtracting Three Months, And Adding Seven Days To The First Day Of A Woman'S
Last Menstrual Period (Lmp).
Or
By Adding 9 Months + 7 Days To The First Day Of Last Menstrual Period.
The Result Is Approximately 280 Days (40 Weeks) From The Lmp.
Aims And Objectives
1. To Study The Applicability Of NaegeleS Rule On Expected Date Of Delivery.
2.Factors Contributing For The Actual Date Of Delivery.
Methodology A Retrospective Study Over A Span Of 4 Months Of Pregnant Women In Government Maternity Hospital
, Tirupati Analyzing The Expected Date Of Delivery And Their Actual Date Of Delivery And Some Of Factors Contributing
To Date Of Delivery.
Results- NaegeleS Rule Gives Approximate Date Of Delivery Which Is Based On First Day Of Last Menstrual Period
But As It Is Not Based On Ovulation Date , It Varies In Pregnant Women With Irregular Menses And From Woman To
Woman. Date Of Delivery Also Depends On Many Factors Like Maternal Health Status, Disease Conditions, Multiple
Gestation,Fetal Health Etc.,. Which Are Some Factors To Be Considered.
Conclusion- The Actual Date Of Delivery Varies Depending Upon The Health Status Of Women,Associated Diseases,High
Risk Factors,Multiple Gestation Etc.,.Having Knowledge Of These Factors Can To Some Extent Help To Know The Actual
Date Of Delivery. NaegeleS Rule Is Very Useful For Calculating Expected Date Of Delivery In Pregnant
Women.Depending On Above Factors Date Of Delivery Can Be Expected To Occur Before Or After The Expected Date Of
Delivery.
***************

Aberrations, Apt Interventions And Restored Fertility

Author: Dr. M. Subbulakshmi
Co Author:

Are Congenital Aberrations GodS Deliberations To Showcase, His CreationS Potential To Rectify?
A 13 Year Old Schoolgirl From A Rural Area Presented With Acute Retention Of Urine With Catheter
In-Situ.
Menstruating Regularly Since Menarche. Stable Vitals. Clinically A Palpable Tender
Firm Mass In The Left Iliac Fossa
Extending Into The Pelvis. Usg Abdomen & Pelvis - Bicornuate Uterus With A Left Sided Distended Vagina, Corpus And
Salphinx - Probable Haematocolpos, Haematometra And Haematosalphinx With Absent Left Kidney. Revisited Local
Examination Revealed A Vaginal Swelling On The Left Side With A Drawn Up Cervix On The Right.
Under General Anaesthesia, Incision And Drainage Of The Vaginal Swelling Septotomy Of The Longitudinal Septum
With Catheter Placement For Drainage Of Haematometra Done. Diagnostic Laparoscopy Did Reveal A Double Uterus
With The Distended Left Corpus And Salphinx.
Literature Search Reveals The Unique Clinical Syndrome Double Uterus With Obstructed
Hemivagina And
Ipsilateral Renal Agenesis Due To Embryologic Arrest At 8 Weeks Of Pregnancy Simultaneously Affecting The Mullerian
And Metanephric Ducts.
Our Patient Was Counseled Regarding The Possible Endometriosis Risk And Subfertility. She Got Married After 4Years,
Conceived And Delivered By Emergency Caesarean Section In Our Hospital Due To Arrest Of Descent.
Aberrations Aptly Intervened AllS Well That Ends Well.

***************

Assessment Of Knowledge And Practice Of Safe Handwashing Techniques Amongst Health Service Providers
Author: Dr. Neha Garg
Co Author: Dr. Rakesh P. Khuteta1,

Assessment Of Knowledge And Practice Of Safe Handwashing Techniques Amongst Health Service Providers
Dr. Neha Garg, Dr. Rakesh P. Khuteta
Introduction: Handwashing Is Like A Do-It-Yourself Vaccine. Various Factors Influencing Adherence To
Recommended Hand Hygiene Practices Assessed.
Materials & Methods: This Was A Cross Sectional
Descriptive Type Of Observational Study Conducted In Department Of Obstetrics And Gynaecology Amongst 200 Health
Service Providers. Structured Interviewer Administered Questionnaire Was Used To Collect Their Knowledge. Also They
Were Observed Regarding Their Practice Of Proper Handwashing.
Results: A Wide Gap Was Found
Between The Knowledge And The Actual Practice Of Safe Handwashing Among Different Health Service Providers. Three
Sets Of Group Observed. Those With Lack Of Knowledge And Practice; Secondly Those With Proper Knowledge But Lack
Of Practice & Lastly With Both Proper Knowledge And Practice Of Handwashing.
Conclusion: Intensive
Education, Monitoring And Conscious Involvement Of Health Personnel Into The Mandatory System Of Patient Welfare
Will Be Of Imminent Help In Reducing The Iatrogenic Morbidity.
***************

Umbilical Cord-A Screening Tool To Indicate Towards Complications

Author: Dr. Athira Narayanan
Co Author: Priya Ballal1, Nikil Shetty2,

Athira Narayanan, Priyaballal, Nikil Shetty

Department Of Obstetrics And Gynecology, Kasturba Medical College, Mangalore, Manipal University, India.
Address For Correspondence: Dr.Athira Narayanan, Junior Resident, Department Of Obstetrics And Gynecology, Kasturba
Medical
College-Mangalore,
Lighthouse
Hill
Road,
Mangalore-575001,
Karnataka,
India. E-Mail:
Drathirashaji@Gmail.Com

Aim And Objectives

To Assess The Role Of Umbilical Cord Thickness And Coiling Index By Sonography As Predictors Of Meconium Staining
And Perinatal Outcome After 34 Weeks Period Of Gestation
Methodology
One Hundred Singleton Pregnant Women Were Subjected To Ultrasound After 34 Weeks Period Of Gestation. In These
Patients, Thickness And Coiling Index Were Measured In A Free Loop Of Umbilical Cord. The Pregnancies Were Followed
Till Delivery, When Fetal Heart Rate Abnormalities, Meconium Staining, Birth Weight, Apgar Score And Nicu Admission
Were Recorded. Ultra Sonogram Findings And Clinical Findings Were Analyzed To Determine Any Correlation. Statistical
Analysis Was Done By Chi Square Test, Using PearsonS Correlation Co-Efficient.

Results
Mean Cord Thickness Was 1.62 0.26. Lean Cord(<1.3) Was Associated With More Number Of High Risk
Cases{Fgr,Oligohydramnios,Polyhydramnios,Pih,Gdm (P = 0.04)}. Thicker Cord(>1.9) Was Associated With Macrosomia (P
= 0.01). No Significant Association Was Found Between Cord Thickness And Msaf, Low Apgar Score And Nicu Admissions.
Mean Coiling Index Was 0.42 0.08.Hypercoiled Cord(>0.5) Was Associated With More Number Of High Risk Cases (P =
0.00). Hyper Coiled Cord Was Associated With Polyhydramnios (P = 0.02). More Number Of Primigravidas Was Seen To
Have Hypercoiled Cord (P = 0.04). No Significant Association Was Found Between Coiling Index And Msaf, Low Apgar
Score And Nicu Admissions.

Conclusion
Sonographic Assessment Of The Umbilical Cord Can Be Used In Triaging The Labouring Into High Risk And Low Risk Cases.

***************

Study Title- Success Of Ppiucd Current Scenario At Deptt. Of Obstetrics & Gynaecology, Pmch, Patna
Author: Dr. Ranu Singh
Co Author:

Auther -Dr. Ranu Singh, Chief Medical Officer (Incharge -Rch) Deptt. Of Obg, Pmch,Bihar.
Aim- To Find Out The Compliance And Complications Of Immediate Postpartum Iucd In Intracesarean Post Placental &
Postpartum Insertion, From April 2010 To September 2014.And Follow Up . Material And Methods - Total 2303 Women
Were Enrolled For The Study 1593 Ppiucd Insertion Were Intracesarean, 463 Post Placental & 247 Post Partum, All
Together 710. A Long KellyS Forcep Was Used For Post Placental & Post Partum Insertion Where As Ppiucd Was
Applied Manually In Intracesarean Cases. The Women Were Counseled A/C To Mec Criteria. Screening Was Done In The
Antenatal As Well As Immediate Prior To Insertion. Total No Of Normal Delivery Were 12049 & Cesarean Section Was
5773. Result- 2303 Women Were Enrolled For Study. Intracesarean Ppiucd Was Inserted In 1593 Clients (36.2%) Post
Placental & Post Partum Was 710 (5.80%). In All The Three Groups Effectiveness Was Same. The Data Revealed That Total
No Of Follow Up Was 1414. In Which There Was Expulsion In 20 Cases, Removal 85 Cases, Infection 28 Cases, Missed
Strings 276 Cases, Others 229 Cases And All Together Satisfied Client Were 775. Conclusion- Immediate Ppiucd Insertion
Is Safe & Effective, But It Requires Effective Counseling Both In Antenatal ,First Stage Of Labour,And Postpartum .

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Long Term Follow-Up Of Patient Satisfaction And Quality Of Life Following Cystocele Mesh Repair
Author: Dr. Smithy George
Co Author: Dr.Smithy Sanel George1,

Author- Dr.Smithy Sanel.Senior Consultant, Dhanya Mission Hospital.Potta Kerala

Aim To Assess Relationship Between Long Term Patient Satisfaction ,Quality Of Life And Pelvic Organ Prolapse
Quantification (Popq) Score Following Cystocoel Mesh Repair
Methods- Study Included All Women Who Underwent Cystocoel Mesh Repair By A Single Surgeon Between March 2011October 2013.Patients Were Assessed At 1 Year And 2 Years Using Qol Questionnaire And Also Anatomical Correction
Assessed With Popq Score.Post Surgery Point Ba<1 Was Taken As Cure.
Results- 88 Patients Underwent Cystocoel Mesh Repair.Mean Age Was 55+/- 9( 50- 75)And Follow Up Was Between 1236 Months.Two Patients Lost To Follow-Up At 12 Months ,4 Patients At 24 Months.There Was 1 Case Of Mesh Erosion
,Which Was Surgically Corrected.At 12 Months Cure Rate Was 90% And Patient Satisfaction Was 85%.Younger Patients
I.E.. Between 50-60 Age Group Reported Better Satisfaction.At 24 Months , Anatomical Cure Was 85% And Patient
Satisfaction Was 80%.At 36 Months ,The Anatomical Cure And Patient Satisfaction Remained Same.
Conclusion Long Term Follow- Up Of Women With Cystocoel Mesh Repair Showed Reduced Failure Rates,Good
Patient Satisfaction And Very Few Complications.

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Comparitive Study Of Ashok Anand Stitch V/S Internal Iliac Ligation In Cases Of Placenta Praevia
Author: Dr. Dhruv Gohil
Co Author:

Author
Dr.Dhruv Gohil (Assistant Professor, Ggmc And Jj Group Of Hospitals, Mumbai)

Introduction
Massive Pelvic Hemorrhage Is A Feared Complication During Obstetric Surgery. It Can Occur Anytime During Surgeries
Due To A Number Of Reasons Ranging From Uterine Atony To Vascular Injuries. In Cases Of Placenta Previa, More So In
Cases Of Morbidly Adherent Placenta, It Can Be Life Threatening. Within Minutes You Can Lose A Life.
Methods
In This Study We Are Comparing The Efficacy Of Ashok Anand Stitch (An Effective Method Discovered, Practiced With
Surprisingly Successful Results) With Internal Iliac Ligation In 35 Cases Of Placenta Previa Operated At Our Centre. It Was
In Terms Of Blood Loss, Need For Blood Transfusion And Uteri Salvage. These Parameters Were Compared To That In
Other Studies Where Internal Iliac Ligation Was Done For Such Cases.
Results
The Data Was Analysed And Results Of The Two Methods Were Compared
Conclusion
In Developed Countries And At Well-Equipped Centers Where Facilities Of Blood And Blood Products, Intensive Care And
Skilled Surgeons Are Available, Such Complications Can Be. In Underdeveloped And Developing Countries With Scant
Resources And Sometimes Even In Developed Countries With Resources, It Can Become A Nightmare For Everyone. Ashok
Anand Stitch Has A Very Low Learning Curve, Doesnot Require Any Special Instruments Or Suture Material. It Can Be
Performed Easily And Safely And Has Life Saving Efficacy Especially In Remote Rural Areas Where Thousands Of Motalities
Occur Due To Placenta Previa At The Same Time Also In Tertiary Care Centres Like Medical Colleges Which Receive A Lot
Of Referred Cases. Clearly Ashok Anand Stitch Is A Better Modality In Management Of Such Cases.

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Geriatric Gynecological Problems Among Elderly Women In A Tertiary Care Hospital

Author: Dr. Mriganka Mouli Saha
Co Author: Abhijit Rakshit1, Dipnarayan Sarkar2, Gourisankar Kamilya3, Subhash Chandra Biswas4,

Author: Mriganka Mouli Saha, Abhijit Rakshit, Dipnaryan Sarkar, Gourisankar Kamilya, Subhash Ch Biswas

Aim & Objectives: Geriatric Gynecology Deals With Gynecological Conditions Encountered In Postmenopausal Women At
And Above 60 Years With Intent To Early Diagnose And Manage Those Conditions And To Create A Sense Of Wellbeing.
A Major Challenge For The World In The Twenty First Century Is The Elderly Population Due To Rise In Life Expectancy.
Morbidity Related Geriatric Gynecological Problems Are On Rise. According To Official Population Projections, The
Number Of Elderly Persons Will Rise To Approximately 130 Million In India By The Year 2015. This Study Was Taken Up
To Analyze Prevalence, Diagnosis, Treatment Given To The Females Aged 60 Years And Above, Having Gynecological
Disorders In A Tertiary Care Centre.

Materials & Methods: It Was An Prospective Observational Study Of Female Patients Aged 60 Years And Above Admitted
In The Department Of Obstetrics And Gynecology, Ipgmer Over A Period Of One Year (February 2012 To January 2013).
90 Patients Were Aged 60 Years Or More Amongst Total Admission Of 811 Comprising Prevalence Of 11.09%. The Mean
Average Age Of Admission Was 64.19 Years. Age Distribution, Spectrum Of Gynecological Disorder, Type Of Surgeries
Performed Were Noted And Analyzed.

Results: In Our Study 45.56% Of Them Were Between 60 To 65 Years Of Age Group. Uterovaginal Prolapse (51.1%) Was
The Commonest Problem Followed By Genital Malignancy (26.7%). Among The Total 15 Urinary Incontinence Patients,
Nine Cases Were Diagnosed As Stress Urinary Incontinence & Seven Of Them Managed By Tvt/Tot, Two Of Them
Underwent Burch Colposuspension. Remaining Six Patients Of Urinary Incontinence Suffering From Overactive Bladder
(Oab) & Urge Incontinence, Managed Conservatively.

Conclusion: In Future Geriatric Gynecology Will Be Going To Play An Important Role In India, As The Size Of Elderly
Population Is Increasing Over Time.

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Maternal And Fetal Outcome In Pregnant Women With Takayasu Arteritis In Govt.Rajaji Hospital,Madurai
Author: Dr. Vinotha M
Co Author: Dr.Vinotha M.S.O.G Pg1, Professor Dr.Mahalakshmi Md.Dgo2, Dr.Sivapriya M.S.O.G Pg3,

Author:-Dr.M.Vinotha M.S.O.G Pg
Co-Authors:-Professor Dr.N.K.Mahalakshmi Md.Dgo
Dr.Sivapriya M.S.O.G Pg
Takayasu Arteritis Also Known As Pulseless Disease/Aortic Arch Syndrome.
Introduction
Takayasu Arteritis Is A Non Specific Granulomatous Inflammation Of Vessls.The Etiologies May Be
Genetic,Autoimmune,Infective,And In Some Cases ,The Cause Is Still Not Understood.Angiographic Classification Depends
On The Site Of Involvement Namely Branches From Aorta,Ascending Aorta ,Aortic Arch,Desc.Thoracic,Abdominal
Aorta,And Renal Arteries.The Clinical Classification Devised By Ishikawa Has Typei,Type Iia,Type Iib,Typeiii
Though It Is A Rare Disease With Incidence Of 1 In 2Lakhs,5 Cases Being Reported In Our Tertiary Care
Hospital(Grh,Madurai),From Dec 2013 To Sep . 2014.
Case Discussion
40%(2 Cases) Were Primigravidae,60%(3 Cases) Were Multigravidae And All Of Them Had Disease Duration From 2 To
10 Years.Age Group Ranged From 20 To 35 Yrs.60%(3 Cases )Were Admitted At 32 To 34 Weeks And 40%(2 Cases) At
Term Gestation.Among Multigravidae,2 Had Underwent Lscs In Previous Pregnancy.All Women Were On
Multidisciplinary Approach By Cardiologist,Rheumatologist,Physician,Neonatologist.All Were Investigated With Echo
&Mri Angiography(80% Had Aortic Regurgitation Secondary To The Disease)And Were Treated With
Prenidsolone,Antihypertensives,Aspirin,Digoxin,Diuretics.
60%(3 Cases) Underwent Lscs,20%( 1 Case) Labour Natural And 1 Had Instrumental Delivery.Among 5 Cases,2 Maternal
Deaths Were There,One Belong To Ishikawa Type Iii Classification And Other Type 2.Both Women Expired In Their
Immediate Postpartum Period Due To Acute Encephalopathy.
Conclusion
Prenatal Counseling, Multidisciplinary Approach ,Early Antenatal Registration,Grading Depending On The Clinical
Classification,Low Dose Aspirin,Low Dose Prednisolone,Antihypertensives,Thromboprophylaxis,Will Help To Reduce The
Maternal Morbidity And Mortality In These Women.

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- Changing Trends And Determinants Of Caesarean Section In A Tertiary Care Hospital

Author: Dr. Supriya Dankher
Co Author: Dr Sakshi Goel1, Dr Sumitra Bachani2, Dr Vijay Zutshi3,

Authors Dr Supriya Dankher , Dr Sakshi Goel , Dr Sumitra Bachani , Dr Vijay Zutshi

Abstract
Objective - 1. To Study Changing Trends And Determinants Of Caesarean Section In Last Five Years In A Tertiary Care
Hospital .
2. To Infer And Suggest Steps For Controlling Caesarean Section Rates.
Materials And Methods
This Is A Retrospective Analysis Of Caesarean Section(Lscs) Cases Done Between 2008-2009 And 2013-2014 At
Safdarjung Hospital, Delhi. Comparision Between Indications For Lscs Was Done . There Was A Gap Of Four Years Between
The Two Groups.
Results
Rates Of Caesarean Section Has Risen From 12% To 16.30% In Last Five Years. Major Determinant Has Remained
Same I.E Foetal Distress . Rates Of Lscs Contributed To Previous Caesarean Section Has Increased From 23.19% To 30.12%.
Among Cases Of Previous Caesarean Section, Major Causes Of Repeat Caeserean Section Are Features Of Scar Dehiscence
.

Conclusion

There Has Been An Increase In The Caeserean Section Rates From 2009 To 2014 . The Share Contributed By
Previous Caesarean Section With Features Of Scar Dehiscence Has Increased From 23 To 30% . Major Determinant Of
Caesarean Section In Remains Fetal Distress. Despite Of Increasing Rates Of Caesarean Section, Perinatal Morbidity And
Mortality Remains Same Which Is More Worrisome. Hence, In Cases Of Foetal Distress Decision Of Caesarean Section
Needs A Second Thought. Also , There Should Be Designated Departmental Audits To Review Indications Of Caesarean
Section .

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To Study Maternal And Fetal Outcome In Cases Of Acute Febrile Illness In Pregnancy.
Author: Dr. Shrutika Shah
Co Author: Drarun H Nayak1, Dr Meenal Sarmalkar2,

Authors Dr Shrutika Shah(2Nd Year Resident)

Dr Arun H Nayak (Professor And Hou)
Dr Meenal Sarmalkar (Assistant Professor)
Although Maternal Fever Has Been Implicated As A Human Teratogen In Several Studies , No Prospective Study Has
Addressed The Outcomes Following Such Exposures In Pregnancy.
Title To Study Maternal And Fetal Outcome In Cases Of Acute Febrile Illness In Pregnancy.
Aims And Objectives:-1)To Determine Maternal Outcome With Respect To Operative Intervention,Induction,Icu
Admission Maternal Mortality.2)To Determine Whether Or Not Maternal Fever Is Associated With Increased Risk Of
Structural Malformations , Prematurity, Growth Retardation Or Pregnancy Loss
Materials And Methods:- A Prospective Study Was Done At Ltmgh Sion For Period Of 1 Year 2014.50 Cases Were Selected
And Followed Up Till Delivery And Their Outcomes Noted.
Results :-Out Of 50 Patients Selected 20 Patients Had High And 30 Had Low Grade Fever.Patients With High Grade Fever
In Early Pregnancy Were Associated With Structural Malformations And Higher Rate Of Still Birth As Compared To Low
Grade Fever Group.
Conclusion:-High Grade Maternal Fever Early In Pregnancy Is Associated With Adverse Fetal Outcome.

***************

Anti Mullerian Hormone - A New Hormone Marker Of Ovarian Reserve

Author: Dr. Radha V
Co Author: N.Sanjeeva Reddy1, Anjalakshi Chandrashekar2, Nalini Ganesan3,

Authors
Dr V. Radha, Prof N. Sanjeeva Reddy, Prof Anjalakshi Chandrashekar, Prof Nalini Ganesan, Sri Ramachandra University,
Chennai

Aim
To Determine The Accuracy Of Serum Anti Mullerian Hormone (Amh) As A Marker Of Ovarian Reserve In Patients
Undergoing Ivf-Icsi

Objectives
1. To Compare Serum Amh, Antral Follicle Count (Afc) With Maternal Age
2. To Predict Ovarian Response With Serum Amh, And Afc In Patients Undergoing Ivf-Icsi.

Material And Methods:

A Total Of 246 Women Enrolled For Ivf-Icsi Fulfilling The Selection Criteria Were Recruited For The Study At Smart, Sri
Ramachandra University. On Day 3 Of The Cycle Serum Amh, Was Assayed Along With Fsh, Lh, Estradiol, Tsh And Prolactin.
On The Same Day Afc Was Measured By Trans Vaginal Ultrasound. Within 3 Months They Were Subjected To Ivf-Icsi.
Serum Amh Levels And Afc Were Compared With Age And Oocytes Retrieved.

Results
All The 246 Women Enrolled In The Study Were Analysed By Pearson Correlation With Significant P Value < 0.01.The
Mean Age Of The Women Was 30.8 4.5Years, Duration Of Infertility Was 7.8 3.9, Bmi Was 26.5 4.7. Average
Number Of Oocytes Retrieved Was 13.7 8.6. There Was A Negative Correlation Of Amh And Afc With Age (R= - .30, &
- 0.33 Respectively). With Regard To Retrieval Of Oocytes, Amh And Afc Showed A High Positive Correlation Of R= .76
And .73 Respectively Which Is Statistically Significant
(P=0.000)
Conclusion
Serum Amh Levels Robustly Correlated Well With Afc As A Marker Of Ovarian Reserve. So Can Be A New, Promising
Hormonal Marker Of Ovarian Reserve And Predictor Of Ovarian Response.

***************

Comparitive Study Of Low Dose Asperin With Low Dose Aspirin And Low Molecular Weight Heparin In Recurrent
Miscarriages
Author: Dr. Shrikant Ohri
Co Author: Dr Shrikant Ohri1, Dr Manisha Laddad2,

Authors
Dr.Shrikant Ohri, Postgraduate Student, Kims Karad
Dr.Manisha Laddad, Associate Professor, Kims Karad

Abstract:
Background: Recurrent Miscarriage Is A Major Women'S Health Problem. Aspirin And Heparin Have Been Shown To Have
Potentially Beneficial Effects On Trophoblast Implantation. No Significant Side Effects Of The Treatments Could Be
Evidenced In Patients Or Newborns With Both Drugs.
Methods: An Open Clinical Trial Was Conducted At The Department Of Obstetrics And Gynecology At Kimsdu, Karad From
January 2013 To July 2014 To Investigate The Effects Of Treatment With Low Dose Aspirin (Lda) Versus Treatment With
Low-Molecular-Weight-Heparin (Lmwh) In Combination With Lda On Patients With A History Of Recurrent Miscarriages.
A Total Of 150 Women Were Enrolled In The Study. Women Were Eligible For The Study If They Had A History Of Three
Or More Consecutive Miscarriages. Participants Were Randomly Assigned To Receive Either Lda (75 Mg Daily) Alone Or
A Combination Of Lda And Lmwh (75 Women Per Treatment Group).
Results: The Group Received Lmwh And Lda Had Significantly Lower Number Of Miscarriages (24/75 [32%] Vs. 41/75
[54%], P < 0.001) And Significantly Higher Number Of Live Births (52/75 [69%] Vs. 31/75 [41%], P< 0.001). In Comparison
With Group Receiving Lda Only . There Were No Significant Differences In The Mean (Sd) Birth Weights Of Neonates Born
In Either Group (2950.4 565 Vs. 3000 540 G For The Lda And Combination Groups, Respectively, P = 0.444).
Conclusion: The Combination Of Lda And Lmwh Is Better Than Lda Alone For The Maintenance Of Pregnancy In Patients
With Recurrent First Trimester Miscarriage.

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Clinico Pathological Study On Primary Fallopian Tube Carcinoma (Pftc):10 Yrs Experience At A Tertiary Cancer
Hospital
Author: Dr. Ashok Padhy
Co Author: Dr M R Mohapatra1, Dr J Mohapatra2, Dr B L Nayak3, Dr J Parija4, Dr S K Giri5

Authors: Ashok Kumar Padhy,M R Mohapatra,J Mohapatra , B L Nayak ,J Parija, S K Giri

Place: Acharya Harihar Regional Cancer Centre(Ahrcc),Cuttack,Odisha
Objectives: The Aim Of The Study Was To Evaluate The Incidence Of Various Histological Types Of Primary Fallopian Tube
Carcinoma (Pftc) ,Incidence As Per Age ,Parity,Clinical Presentations,Pre Operative Evaluations,Surgical Staging, Nodal &
Omental Positivity,Adjuvant Therapy , Follow Up & Survival Of Patients.
Methods: Retrospective Analytical Study Of 16 Cases Of Primary Fallopian Tube Carcinoma During A Span Of 10 Years
(2004 Jan To 2013 Dec) At The Dept Of Gynecology Oncology, Ahrcc Basing On Hospital Records With Due Permission Of
Ethical Committee.
Results: Out Of 16 Cases, 10 Cases Were Operated At Our Centre ,6 Cases Outside & Referred To Our Centre. Out Of 6
Referred Patients 3 Patients Underwent Revision Staging At Our Centre.

Average Age At Presentation Was 46 Yrs (Min. Age: 38 Yrs & Max Age: 65 Yrs).

Pain Abdomen Was The Commonest Symptom Followed By Discharge Per Vaginum

Typical Latzko Triad Of Symptoms (Pain+Discargepv+Mass) Found In 3 Patients (18.7%)

In About 81% Cases It Was Surprise Diagnosis In Patients Undergoing An Exploratory Laparotomy For Ovarian
Malignancy

Majority (50%) Presented In Stage I And Ii Disease, Whereas 37.5% Presented In Stage Iii

The Histopathology Report Was Papillary Serous Adenocarcinoma In Most Of The Cases (81%).

Primary Surgery (Tah+Bso +Omentectomy+ Bilateral Pelvic And Pa Lymphadenectomy) Was Done In 60% Of
Cases & Revision Staging Was Done In 18.7% Of Patients.

Nodal Positivity Was Observed In 18.7% Of Cases And Omental Involvement Also Was Noticed In 18.7% Of
Patients.

Carboplatin Based Chemotherapy Was Most Common Adjuvant Chemotherapy

Overall 5 Yrs Survival Was 37.5%.

Conclusion: Pftc Is A Rare Malignancy Where Preoperative Diagnosis Is Always Deceptive So Majority Present In Advanced
Stage. Papillary Serous Adenocarcinoma Is The Most Common Histological Type. It Carries Poorer Prognosis Compared
To Ovarian Malignancy. Surgery Is The Primary Modality Of Treatment & Surgical Principles Are Similar As Used For
Ovarian Cancer. Aggressive Adjuvant Chemotherapy With Platinum & Traxol Is Required Except Stage I & Grade I.As The
Incidence Is Very Low, Multicentric Trial Is The Call Of The Day & Every Case Has To Be Reported In Detail.

***************

Post Placental Iucd Insertion Have We Come A Full Circle?

Author: Dr. Kavya Hs
Co Author: Dr Archana Bhosale1, Dr R V Mayekar2, Dr Y S Nandanwar3,

Authors: Dr. Kavya Hs

Co-Authors: Dr. Archana Bhosale-Asst Prof. Dr. Rahul Mayekar-Assoc Prof. Dr. Y. S. Nandanwar Prof. And Hod
Aims And Objectives: To Assess The Efficacy And Feasibility Of Iud(Cut 380-A) Insertion Immediately After Delivery Of
Placenta.To Assess The Post-Insertion Side-Effects , Complications & Expulsion Rate.
Materials And Methods: For Most Women, Including Women Who Want To Have Children, Contraception Is Not An
Option; It Is A Basic Health Care Necessity.A Study Was Conducted Over A Period Of 1.5 Years In A Tertiary Care Institute
In Mumbai. Open Label, Prospective, And Longitudinal Study. Out Of A Total Of 16483 Patients Who Delivered 506
Patients Opted For A Post Placental Iucd Insertion. Out Of 506, 41 Were Intracesarean Insertions . The Patients With Post
Placental Intrauterine Contraceptive Insertion Were Followed Up At 6 Weeks And For A Period Of 6 Months.
Inclusion Criteria:
1.) Any Normal, Vertex, Full-Term Vaginal Delivery Eligible For Ppiucd.
2.) Any Ftlscs With No Other Medical Contraindications
Exclusion Criteria:
1.)Assessment During Anc Period -Distorted Uterine Cavity (Uterine Septum, Fibroid Uterus, Etc.)
2.) Acute Purulent Discharge.
3.) Malignant Or Benign Trophoblastic Disease .
4.) Suffering From Aids And Neither Clinically Well Nor On Antiretroviral Therapy .
5.) During Labour -Chorioamnionitis , Prom>18 Hrs, Unresolved Postpartum Hemorrhage.
Results: New Advances And New Understanding About Ppiucd Led It To Be Safe And Effective & With Good Retention
Rates,Serves As Useful Method For Family Planning. Expulsion Rates In Our Study Were 2.3%.Out Of 72 Expulsion, Partial
Expulsion Was The Main Reason For Expulsion In 46 Patients. 90 Patients Had Cut In Situ At The Time Of Follow Up
Conclusion: Ppiucd Is A Right Choice, When Inserted With Right Technique ,Right Instrument,Right Time. . Expulsion Rate
Minimal If Correct Insertion Technique And With Trained Hands.

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Prevalence Of Pcos And Diabetes In Women With A History Of Preterm Birth- A Case Control Study
Author: Dr. Chinmayee Kar
Co Author:

Authors: Dr. Chinmayee Kar1, Dr. Ananya Agrawal1, Dr. Babita Ramani2, Dr. Sharmila Pradhan3, Dr Ojaswini Patel3, Prof.
Dr. S.K Behera4
1: Pg Student; 2: Senior Resident; 3: Assistant Professor; 4: Professor
Corresponding Author: Dr. Chinmayee Kar
Objective:
To Test The Hypothesis That Endocrine And Metabolic Factors Predispose To Preterm Birth.
Material And Methods:
A Cross-Sectional, Case-Control Study Done In Vss Medical College , Burla For A Period Of 2 Years ( Jan 2013- Aug
2014).
Population: Women With Previous Preterm Births (N = 100) Were Compared With Matched Controls With Term Births
(N = 108).
A Clinical Examination Including Transvaginal Ultrasound Was Performed. Fasting Blood Samples Were Collected And An
Oral Glucose Tolerance Test Was Performed.
Main Outcome Measures: The Prevalence Of Polycystic Ovary Syndrome (Pcos) Diagnosis (Rotterdam Criteria) And Serum
Levels Of Androgens, Glucose And Insulin In The Preterm Group.
Results:
24 Of 100 Women (24%) Met The Pcos Criteria Among Women With Preterm Birth, Compared With 15 Of 108 (13.8%)
Among Controls . 5 (5%) Women With Preterm Birth Were Diagnosed With Diabetes Compared With None In The Control
Group (P < 0.01). Hirsutism Was Present In 30 (30%) Women With Preterm Birth Versus 7 (6.4%) In The Control Group (P
< 0.01).
Conclusions:
The Prevalence Of Pcos, Diabetes And Hirsutism Are Increased Among Women With A History Of Preterm Birth. This
Indicates That Endocrine And/Or Metabolic Factors May Be Involved In The Pathogenesis Of Preterm Birth. Women
Experiencing Preterm Delivery May Have An Increased Risk Of Developing Diabetes And Pcos Later In Life.

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Meconium Stained Amniotic Fluid And Perinatal Outcome : A Prospective Cross Sectional Study.
Author: Prof. Kamal Prakash Patil
Co Author: Dr. M.K.Swamy - Professor1, Dr. Shubha Rao - Post Graduate2,

Authors: Dr. Kamal Patil Professor, Dr. M.K.Swamy Professor, Dr. Shubha Rao Post Graduate Student.
Department Of Obstetrics And Gynaecology
Jawaharlal Nehru Medical College, Belgaum, Karnataka (Kle University)

Objective: To Evaluate The Mode Of Delivery And Perinatal Outcome In Meconium Stained Amniotic Fluid.

Methods:

This Prospective Cross-Sectional Study Was Conducted In Kle Dr. Prabhakar Kore Charitable Hospital Between January
2013 To October 2013. A Total Of 340 Pregnant Women Meeting The Inclusion Criteria Were Evaluated. The Mode Of
Delivery And Perinatal Outcome Was Studied And Results Were Analyzed By Chi Square Test.

Result:

The Incidence Of Msaf Was 8.5%. Fetal Heart Rate Abnormalities Were Seen More In Cases With Thick Meconium Stained
(73.60%) Than With Thin Meconium (23.40%) (P<0.001). There Were Increased Rates Of Lscs In Thick Meconium (79.5%)
Than In Thin Meconium (20.5%). Lower Apgar Scores At 1 And 5 Mins Were Seen More In Thick Meconium Stained
(68.42%, 77.27%) Than In Thin Meconium Stained (31.58%, 22.73%) (P=0.004). Nicu Admissions Were Found In 31.1% Of
Thick Meconium As Compared To Thin Meconium (10.4%). Mas Was Seen In 5% Of Thick Meconium Stained And 0.6% Of
Thin Meconium Stained. Neonatal Deaths Were Seen In 1.5% Of Thick Stained Liquor And None In Thin Meconium.

Interpretation And Conclusion:

We Conclude That The Rates Of Cardiotocography Abnormalities, Caesarean Section, Lower Apgar Scores And
Nicu Admissions, Were Observed More In Thick Meconium Stained Than In Thin Meconium Stained Liquor. More Number
Of Babies With Thick Meconium Liquor Developed Mas And Birth Asphyxia. However The Perinatal Outcome In Both
Groups Were Not Statistically Significant

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Successful Management Of Traumatic Post-Partum Haemorrhage With Internal Iliac Artery Embolization In A Patient
With Dic: A Case Report
Author: Dr. Megha Jindal
Co Author:

Authors: Dr. Megha Jindal, Dr. Sangeeta Gupta, Dr. Sudha Prasad

Background: Conventionally, The Management Of Pelvic Hematoma Has Been Laparotomy With Ligation Of Specific
Bleeding Sites Or Internal Artery Ligation. Patients With Coagulopathy Pose A High Risk Of Anaesthesia And Massive Blood
Loss During Surgery. Drastic Improvements In Coagulation Has Been Noted After Embolization.

Case: 30 Year Old Primigravida At 36 Weeks Of Gestation With Jaundice And Intra Uterine Foetal Death Presented With
Disseminated Intravascular Coagulation. After Correction Of The Coagulation Profile, Labour Was Induced. Just After
Delivery, The Patient Had Traumatic Post-Partum Haemorrhage With Vaginal And Cervical Tears Along With Broad
Ligament Hematoma Formation. Empirically, Bilateral Internal Iliac Artery Embolization Was Performed Considering The
High Risks Of Surgery. The Patient Was Monitored Intensively Postoperatively.

Conclusion: With A Team Of Obstetrician, Anaesthetist, Interventional Vascular Surgeon And Radiologist Mortality Can
Be Avoided In A Patient With Liver Dysfunction With Coagulopathy. Minimally Invasive Procedure-Embolization Avoids
The Operative Morbidity In Patients Who Are Poor Surgical Candidates Like In Coagulopathies. In Selected Cases,
Embolization May Be Introduced In The Treatment Algorithm Before Proceeding To Surgical Procedures Weighing The
Risks And Benefits.

***************

A Study Of Neurological Disorders In Pregnancy

Author: Dr. Rama Lakavath
Co Author:

Authors: Dr. Ramadevi , Dr. Shobha Md, ,Dr.Sunanda , Dr.Aruna

Aims And Object: To Study Maternal And Fetal Outcome In Neurological Disorders Complicating Pregnancy Gandhi
Hospital, Secunderabad, Telangana State, India.
Materials And Methods: Observational Study Of Pregnancy Outcome Of Neurological Disorders In Pregnancy For A Period
Of 1 Year In Gandhi Hospital Tertiary Health Care Center From Case Records.
Results: Total Number Of Deliveries During Study Period Was 9457. Eclampsia (324), Maternal Complications Dic (12),
Aki (8), Hellp Syndrome (12), Abruption (4), Postpartum Psychosis (4), Cerebral Venous Thrombosis (20), Maternal Deaths
(6). Fetal Complications Preterm(34), Iugr (21), Iud (32).
Epilepsy(40). Juvenile Myoclonic Epilepsy (1). Other Cases Noted Are Infections- Gbs (8), Tubercular Meningitis
(4), Hepatic Encephalopathy (1), Cerebral Venous Thrombosis . Traumatic Quadriparesis (1), Hypoglycemia (3), Hypoxic
Seizures (7). Posterior Cerebellar Tumour (1) (Hemangioblastoma).FriedreichS Ataxia (1)
Conclusion
Eclampsia Is The Most Common Cause Of (Pregnancy Related) Neurological Disorders In Pregnancy Which Can Be
Prevented By Early Diagnosis And Management Of Preeclampsia. Second Most Common Cause Is Epilepsy.
Preconceptional Counselling And Control Of Convulsions Before Pregnancy And Initiating Treatment With Non
Teratogenic Drug With Modification Of Dosage During Pregnancy And Supplementation Of Folic Acid Preconceptionally
Is Best Way To Ensure A Safe Pregnancy Outcome. Before Labeling As Eclampsia Thorough Neurological Examination To
Rule Out Other Causes Of Convulsions. Mortality With Intracranial Tumour Is High. First Episode Of Seizure During
Pregnancy Needs Thorough Evaluation And Management.
***************

Obstetric Hysterectomy For Morbidly Adherent Placenta- A Night Mare, Need To Expertise To Save The Life.
Author: Dr. Sandhya Sanda
Co Author:

Authors: Dr. Sanda Sandhya Rani, Professor & Hod( Obgy), Mgmh, Petlaburz, Hyd .
Dr. S.Hima Bindu , Asst Professor.

Objective: To Study Obstetric Hysterectomy For Pathologically Adherent Placenta In 2 Yrs Period In Our Teaching Hospital
From 2012 Oct 2014 Sep.
Aim: To Reduce Material Mortality By Proper Pre Operative Diagnosis, Volume Replacement, Expertise Surgical Skill &
Good Team Work.
Material & Method: All Antenatal Women With Usg Showing Grade 3&4 Placenta Previa & Previous Lscs With Anterior
Low Lying Placenta Are Evaluated With Doppler And Mri To Diagnose Morbidly Adherent Placenta And Planned For
Elective Surgery With Proper Blood Reservation And Counseling. Consent For Hysterectomy Was Taken.
Results: We Have Encountered 18 Morbidly Adherent Placenta. Accreta 10, Increta 7, Percreta 1. There Is History Of 1
Previous Lscs In 6, 2 Previous Lscs In 8 And 3Previous Lscs In 4 Cases. Case With Percreta Has History Of 2 Previous Lscs.
Total Hysterectomy Done In 15 Cases. Subtotal Hysterectomy In 3 Cases Where Placenta Is Not Covering The Os.
Bicornuate Uterus Is Seen In 1 Case. Emergency Surgeries In 6 Cases In View Of Severe Bleeding And Irritable Uterus.
Elective Surgery Done In 12. Blood Loss Ranged From 1200Ml To 2700Ml. Blood Transfusion Required In All From 2 8
Units. Ffp Transfused In Between 2 - 6 Units. 3 Had Bladder Injury. Mortality In 6 Cases Which Were Done In Emergency.
Conclusion: There Is Rise In Morbidly Adherent Placenta Due To Increase In Caesarean Rate. Antenatal Diagnosis Is
Possible With Doppler & Mri. When Done As A Team Work And Planned Surgery, Caesarean Hysterectomy Saves Lives In
Morbidly Adherent Placenta.

***************

Testicular Feminization Syndrome-2 Different Situations.

Author: Dr. Himabindu Sangabathula
Co Author: Dr Sandhya Rani1, Dr Nagalaxmi2,

Authors: Dr.Hima Bindu Sangabathula, Assistant Professor Mgmhpetlaburz,Hyd.

Co Authors:,Dr.S.Sandhya Rani Professor & Hod Osmania,,Dr.M.Nagalaxmi Asst Professor.
Background: Testicular Feminizing Syndrome Is Rare And Seen In 1:20,000 Male Births, There Is Failure Of
Masculinization Of External Genitalia In Genotypically Male . They Will Be Reared As Females.And,Usually Investigated &
Diagnosed In Later Life.
Case Report 1:A 24 Year Married Individual Came With Complaint Of Unattained Menarche .On Examination Breast Are
Well Developed,Scanty Pubic&Axillary Hair.Blind Vaginal Pouch Of 6 Cm Admitting 1 Finger Noted. Usg :Uterus And
Ovaries Not Seen .Hypo Echoic Oval Solid Areas Of 34X15 Mm In External Inguinal Ring On Both Sides. Mri: Oval Altered
Signal Intensity Lesion Iso Intense On T1W1 Hyper Intense Ot2W1 Noted In Bilateral Inguinal Areas-Suggestive Of Testes.
Karyotyping 46 Xy .Diagnostic Laproscopy :Uterus, Ovaries Not Found..Gonads Not Visualized.
Treatment.Counselling Done. Sister Screening Advised. Karyotyping Not Revealed To The Patient To Avoid Psychological
Trauma. Due To Risk Of Malignancy.Bilateral Gonadectomy Done.
Case 2:A 25 Year Old Female Came With Irregular Cycles And Found To Be 20 Weeks Pregnant .She Took Medications For
Withdrawal Bleeding In The Past 4 Months.She Continued The Pregnancy And Delivered A Live Child Having Genitalia Of
Female Pattern. As She Took Medications For Withdrawal Examined Thoroughly And,Sent For Neonatologist Opinion .In
Usg Bilateral Inguinal Testes Found .Karyotyping 46 Xy.
Conclusion :If There Is Any Doubt Of Gender At Birth It Is Best To Not To Guess But Offer An Answer After Full
Investigation .The Choice Of Gender Should Not Be Governed By The Chromosomal Make Up But Should Depend On
Functional Ability Of The External Genitalia For Coitus After Surgery As Well As Considering Future Fertility Potential .It
Is Easier To Reduce Clitorial Size And Create Vagina ,Making Female Gender Preferable In Most Cases.

***************

Is The Elderly Expectant Mother At Higher Risk In Pregnancy?

Author: Dr. Shilpa Adki
Co Author: Dr. Nozer Sheriar1,

Authors: Dr.Shilpa Adki And Dr.Nozer Sheriar

Aim And Objective: To Evaluate Pregnancy Outcome In Women Over 38 Years Of Age.
Materials And Methods: A Prospective Case-Control Study Comparing 85 Women Over 38 Years With A Control Group Of
Women Aged 21-37 Years Over A Period Of Ten Years.
Results: The Mean Age Of Women In The Study Group Was 39.6 Years And That In The Control Group Was 31 Years. The
Average Weight Gain In Pregnancy Was 10.10 And 11.64 Kilograms Respectively. The Incidence Of Primigravidae Was
34.1% Vs 52.9% And Multigravidae Was 65.9% Vs 47.1% Respectively; P=0.006. The Study Group Had A Higher Rate Of
Art Pregnancies (P=0.003) And Pre-Existing Medical Disorders Like Thyroid Disorders (14.1% Vs 9.4%). There Was
Statistically Significant Difference In The Rates Of Pih (14.1% Vs 5.9%; P=0.037), Iugr (10.6% Vs 3.5%; P=0.036), Fibroid
Uterus (23.5% Vs 8.2%; P=0.003) And Threatened Preterm Labor (10.6% Vs 2.4%; P=0.014). The Difference In The
Incidence Of Multiple Pregnancies (3.5% Vs 3.5%, P=0.66), Gestational Diabetes Mellitus (4.7% Vs 1.2%; P=0.18) And
Preterm Deliveries (14.1% Vs 7.1%; P=0.067) Was Not Statistically Significant. The Rate Of Cesarean Deliveries Was Higher
In The Study Group (68.2% Vs 48.2%; P=0.004). The Mean Birth Weights Were 2895 Grams And 3034 Grams In The Study
And Control Groups Respectively. In The Study Group, Four Women Had Missed Abortions And Three Women Underwent
Second Trimester Termination Of Pregnancies For DownS Fetus, Abnormal Karyotype (Aneuploidy For Sex
Chromosome) And Ultrasound Scan Showing A Complex Cardiac Anomaly.
Conclusion: Pregnancy At Advanced Maternal Age Belongs To A High-Risk Category. However, The Expected Medical And
Obstetric Complications Can Be Minimized And Even Prevented With Good Antenatal Care And Strict Vigilance To Achieve
A Safe And Successful Obstetric Outcome.
Key Words: Cesarean Deliveries, Elderly, High-Risk, Pregnancy Outcome.

***************

Evaluation Of The Alcazar Scoring System In Differentiating Benign From Malignant Ovarian Tumors A Case
Series
Author: Dr. Nathasha K
Co Author: Dr Sahu Mahija1, Dr Padhy Ashok2,

Authors: H.K.Nathasha, Sahu Mahija, Padhi Ashok Kumar.

Aims & Objectives: To Evaluate Prospectively The Diagnostic Performance Of Alcazar Scoring System To Differentiate
Benign From Malignant Ovarian Tumors Using Gray Scale Ultrasonography And Colour Doppler.
Materials & Methods: The Prospective Cohort Study Was Conducted From January 2014 To August 2014 In The Dept Of
Obstetrics And Gynecology, Scbmch, Cuttack. The Study Includes 54 Patients With Ovarian Tumors And All Were
Subjected To Ultrasound And Colour Doppler. The Data Obtained Was Used To Score According To Alcazar System And
The Probability Of Malignancy Was Determined. The Efficacy Of The Scoring System Was Evaluated By Histopathological
Examination Of The Tumor And The Ascitic Fluid Cytology As Gold Standard.
Results: Of The 54 Cases, Alcazar Scoring System Identified 22 Out Of 25 Malignant Tumors And 27 Out Of 29 Benign
Tumors. The Sensitivity And Specificity Of The Scoring System For Diagnosing Malignancy Are 88% And 93.1%
Respectively. The Positive Predictive Value And Negative Predictive Value Are 91% And 90% Respectively.
Conclusion: Alcazar Scoring System Is More Specific As A Diagnostic Tool To Rule Out Malignancy And Can Be Used To
Differentiate Benign From Malignant Ovarian Tumors. The Main Disadvantage Being, It Is Operator Dependent.
Keywords: Ovarian Mass, Ultasonography With Colour Doppler, Alcazar Scoring System And Histopathology.

***************

Study Of Prolactin In Cervicovaginal Secretion In Women With Preterm Labour And Normal Pregnancy
Author: Dr. Seema Mehrotra
Co Author: Urmila Singh1, Sm Natu2, Shilpi Chauhan3,

Authors: Seema Mehrotra, Urmila Singh, Sm Natu, Shilpi Chauhan

Institution: Department Of Obstetrics And Gynecology & Department Of Pathology, Kgmu, Lucknow

Aims: To Study The Levels Of Prolactin In Cervicovaginal Secretion In Normal Pregnancy And To Evaluate Its Diagnostic
Value In Women With Preterm Labour
Methods: Total 225 Women Between 24-36 Weeks Of Gestation With Labour Pains And Without Labour Pains Were
Enrolled. After Obtaining Their Demographic Data, Clinical Assessment, Cervicovaginal Secretion Sample Were Obtained
During P/S Examination, But Before P/V Examination For Prolactin Estimation. All The Women Were Followed Till Delivery
And They Were Divided Into Control Group (N=150)-Women With Normal Pregnancy, Delivered At Term, Study GroupWomen Who Came With Preterm Labour (N=75).Study Group Was Further Subdivided Into Study Group 1A (N=50)Women Who Delivered Preterm And Study Group 1B (N=25) Threatened Preterm Labour And Delivered At Term.
Result-In This Study Mean Prolactin Levels In The Study Group 1A Was Significantly Higher Than The Study Group1B And
Control Group (11.81+9.3Ng/Ml Vs.4.61+6.2 Vs. 2.15+5.1 Ng/Ml ) (P=0.000). The Mean Prolactin Was Significantly Higher
In Study Group Ib (Threatened Preterm Labour) As Compared To Control Group (P=0.000)
Conclusion: Prolactin In Cervicovaginal Secretion Can Be Used As A Predictor For Preterm Delivery

***************

Study Of Saliva Estriol To Progesterone Ratio In Normal Pregnancy And Preterm Labour
Author: Prof. Urmila Singh
Co Author: Seema Mehrotra1, Aa Mahadi2, Ranjana Singh3, Richa Yadav4,

Authors: Urmila Singh, Seema Mehrotra , Aa Mahdi, Ranjana Singh, Richa Yadav
Institution: King George Medical University, Lucknow

Objective: To Study Levels Of Saliva Estriol To Progesterone Ratio In Preterm Labour And Normal Pregnancy

Method: A Prospective Study On 100 Antenatal Women With Gestational Age Between 28 And < 37 Weeks With Labour
Pains Or Without Labour Pains In Department Of Obstetrics And Gynaecology, Kgmu, Luck Now. Saliva Was Collected And
Tested For Unconjugated E3 And Progesterone By Enzyme Linked Immunosorbent Assay. All Women Were Followed Till
Delivery.
Results: Ratio Of E3 To Progesterone Was Significantly Higher In Preterm Labour As Compared To Patients Without Labour
Pains. A Cut Off Value Of > 0.79 Of Estriol To Progesterone Predicted For Preterm Delivery With Sensitivity Of 85.4% And
Specifity Of 66.1%. In Women Who Presented With Preterm Labour 63.6 % Delivered Preterm Using Threshold Of 0.79

Conclusion: Increased Estriol To Progesterone Ratio Is Associated With Increased Risk Of Preterm Birth

***************

Obstetric Emergency -A Daunting Challenge In Rural Medical College&Analysis Of Barriers Preventing Access To
Emoc In Rural India
Author: Dr. Priya Nallaiyan
Co Author: Dr.Mahendra .G1, Dr.Prof.Vijayalakshmi2,

Authors:
1.

Priya N

2.

Mahendra G

3.

Vijayalakshmi S

1.

Junior Resident ,2. Assistant Professor , 3.Professor And Hod ,Department Of Obg, Aims ,Karnataka.

Aims And Objective:

To Evaluate The Incidence Of Obstetric Emergency Cases ,Its Maternal And Fetal Outcome.

To Analyse The Barriers Preventing Access To Emoc In Rural India.

Methods:
This Prospective Study Includes 121 Cases Of Obstetric Emergency Admitted And Treated In Critical Care Unit Of
Adichunchanagiri Institute Of Medical Sciences During The Study Period From August 2013- 2014.Personal Interview With
Each Patient Done Regarding Barrier Prevented Her From Early Access To Emoc.

Results
Out Of 121 Patients Admitted In Critical Care Unit (9%) ,Post Partum Hemorrhage Is The Leading Cause Of Emergency
Contributing 47.93%. Only 34% Had Regular Anc Check Up With Nil Maternal And Perinatal Mortality Ratio,Whereas 65%
Had <2 Anc Visits With Mmr Of 0.75 & Pnmr Of 9 Per 1000 Live Births.
Regarding Analysis Of Barriers,16% Of Women Are Unaware Of Emergency Situation.21% Of Women Were
Aware But Delay Was Made In Decision Making .20%,4% &14% Of Women Were Referred By Health Care Staff Due To
Nonavailability Of Obstetricians,Anaesthetists & Blood Bank Respectively.23% Got Delay Due To Nonavailability Of
Transport.
Conclusion
Prevention And Proper Intervention Of Obstetric Emergencies Is The Foremost Goal Of Modern Obstetrics, Since It Is The
Critical Situation Most Women Faces With Least Prediction And Most Prevalence.Expanding The Roles Of Available Health
Care Staff By Emergency Obstetric Care Training (Emoc) Plays A Pivotal Role To Bridge The Gap Due To Nonavailability
Of Experts At Rural Level.

Theme
Let Us Promise Emoc For Rural India ,Rather Than Being A Star In The Sky
But A Candle In Her Home.

***************

Comparision Of Predictive Values Of Diagnostic Parameters For Ovarian Masses

Author: Dr. L Rama Devi Pasumarthy
Co Author:

Authors:1. L Rama Devi Pasumarthy (Pg-Ms-Obg-Amc)

2. Dr. T Radha Mddgo., (Professor-Obg-Amc)
3. Dr.I Vani (Associate Professor-Obg-Amc)
4. D V G Radhika (Pg-Ms-Obg-Amc)
Institution: Andhra Medical College & King George Hospital-Visakhapatnam

Aim: To Compare Sensitivity And Specificity Of Ca-125, Ultrasonography, Ct And Rmi(Risk Of Malignancy Index) In
Distinguishing Benign And Malignant Tumours By Correlating With Post Operative Histopathology Report.
Materials And Methods: It Is An Observational Study Consisted Of 30 Women Admitted With Clinically Diagnosed Ovarian
Masses In King George Hospital Visakhapatnam From August 2013 -July 2014. Pre Operatively Cases Are Evaluated By Ca125 With A Cutoff Of 35 Iu/Ml, Ultrasonography, Ct And Rmi Scoring Was Calculated By Ultrasonic Evaluation Of Ovarian
Mass, Menopausal Status And Ca-125 Levels. Post Operatively Histopathology Of The Resected Tumour Was Done To
Confirm The Diagnosis.
Results: Out Of 30 Cases 23(77%) Were Benign And 7(23%) Were Malignant As Per Histopathology. Ct Scan Has Sensitivity
Of 90% And Specificity Of 91%. Rmi Has Sensitivity Of 87.5% And Specificity Of 90.4%. Ca-125 Has Sensitivity Of 71% And
Specificity Of 78%. Usg Has Sensitivity Of 76% And Specificity Of 85%.
Conclusion: Ct And Rmi Have Similar Sensitivity And Specificity And Are Better Diagnostic Markers Compared To Ca-125
And Usg Individually In Evaluation Of Ovarian Masses. But Rmi Is Cost Effective Than Ct In Evaluation Of Ovarian Masses
And Can Be Used In Gyneacological Practice In Suspicious And High Risk Cases.

***************

A Comparative Study Between Use Of Fetal Pillow And PatwardhanS Technique During Cesarean Section In
Deeply Engaged Head
Author: Dr. Snigdha Kumari
Co Author: Dr Snigdha Kumari1, Dr Ramprasad Dey2, Dr Subhas Chandra Biswas3,

Award Paper For Fogsi- C L Jhaveri Prize

TopicA Comparative Study Between Use Of Fetal Pillow And PatwardhanS Technique During Cesarean Section In Deeply
Engaged Head
Dr. Snigdha Kumari (Presenter), Dr Ramprasad Dey, Dr Subhas Chandra Biswas, Department Of Obstetrics & Gynaecology,
Chittaranjan Seva Sadan, Kolkata
Objective: To Compare The Maternal And Fetal Outcome By Using Fetal Pillow With PatwardhanS Technique During
Cesarean Section In Second Stage Of Labour
Study Design: This Study Was Conducted In The Department Of Obstetrics & Gynaecology, Chittaranjan Seva Sadan,
Kolkata From January 2013 To June 2014, Among The 101 Mothers With Single Fetus In Cephalic Presentation And Deeply
Engaged Fetal Head. Fetal Pillow Technique Was Used In 51 Cases And Results Were Compared With PatwardhanS
Technique In 50 Cases.
Results And Analysis: Both The Groups Were Matched In Terms Of Obstetric Features And For Indications Of Cesarean
Section. Delivery Of Fetal Head Was Nearly 7 Times Easier In Fetal Pillow Cases Than In PatwardhanS Technique. Total
Time Taken For Caesarean Section Was Approximately 35Min In Fetal Pillow Group Versus 42 Min In PatwardhanS
Technique Group. Intraoperative Complications Like Uterine Artery Tear, Extension Of Uterine Angle, Blood Loss And
Need For Blood Transfusion Were Comparable In Both The Groups. Delivery Of Fetus Required Less Time With The Use
Of Fetal Pillow Technique. Favorable Apgar Score At 1 Min And 5 Minutes With Less Incidence Of Nicu Admission Was
Noted In Fetal Pillow Group Than PatwardhanS Technique Group.
Conclusion: - Application Of Fetal Pillow During Cesarean Section Leads To An Easy Delivery Of Deeply Engaged Fetal Head
And Thereby Reducing Selective Maternal And Neonatal Complications.

***************

A Rare Case Of Partial Vaginal Agenesis With Mental Retardation

Author: Dr. Yoginadra Kumar Kabadi
Co Author: Dr Ravi Nemagouda1, Dr Bharat Kshatri2,

Back GroundVaginal Agenesis Is Quite Rare And Association Of Mental Retardation Is Much More Rarer.
This Association Affects The Management Significantly
Case-14 Year Old Girl Presented With Cryptomenorrhoea With Haematocolpos And Haematometra. She Was Mentally
Retarded. It Was Associated With Partial Vaginal Agenesis. She Was Managed With Drainage Of Haematometra,
Haematocolpos And Vaginoplasty. After Two Menstrual Cycles She Returned With Repeat Situation In Spite Of Teaching
Her Mother Vaginal Dilatation. Repeat Vaginoplasty Was Not Successful But Resulted In Opening Of Bladder Which Was
Corrected And Discharged. She Landed Up With Hysterectomy Finally.
Conclusion
-- When Vaginal Agenesis Is Associated With Mental Retardation Should Hysterectomy Be The Primary Mode Of
Treatment?

***************

Interstitial Pregnancy A Case Study

Author: Dr. Ramgopal Pillai
Co Author: Dr. Sathy M Pillai1, Dr. Parvati R Pillai2,

Back Ground:- An Interstitial Pregnancy Is A Uterine But Ectopic Pregnancy; The Pregnancy Is Located Outside Of The
Uterine Cavity In That Part Of The Fallopian Tube That Penetrates The Muscular Layer Of The Uterus. Interstitial Pregnancy
Constitutes 2% - 4% Of All Ectopics, But Have 7-10 Times Higher Mortality Than Ectopics In General. Incidence Is Rising
With Increasing Use Of Assisted Reproductive Technologies.

Case:- 30 Year Old Lady, G3A1E1 With History Of Laparoscopic Right Salpingectomy For Right Tubal Ectopic Following Ivf
In 2013, Presented With Twin Gestational Sacs At Left Interstitial Region, Following Ivf In 2014. An Ultrasound Confirmed
A Left Interstitial Dcda Pregnancy. She Underwent Laparoscopy For Confirmation. Ultrasound Guided Local Injection Of
Methotrexate Was Given Into Both Sacs, After Which She Was Followed Up On Hcg Values. She Showed A Falling Titre
Of Hcg And Became Urine Pregnancy Test Negative Within 4 Weeks Of Procedure.

Conclusion:- Diagnosis Of Interstitial Pregnancy Is Difficult To Make And Requires Accurate Ultrasound Interpretation And
May Require Laparoscopic Evaluation. Choice Of Treatment Is Decided By Clinical Situation. Ruptured Interstitial
Pregnancy Is A Medical Emergency Requiring Surgery. In A Stable Patient, Conservative Measures Like Laparoscopy Or
Medical Management May Be Used. Future Fertility Is Possible, Although Cases Of Uterine Rupture Are Increased. This
Concern Applies To Both Medically And Surgically Treated Patients.
***************

Effectiveness Of Via Vili In Screening Cin Between Tertiary And Primary Care Level
Author: Dr. Sujatha Alagesan
Co Author: Sujathaalagesan1,

Back Ground:
Cancer Cervix Is A Leading Cause Of Mortality And Morbidity Among Women. Many Studies Have Proved That
Via And Vili Has Sensitivity Comparable To Papsmear Not Only In A Resource Poor Setting But In A Well Equipped Centre
Also. Present Study Compares The Effectiveness Of Via-Vili Done In Two Centers With Low Resource Setting.
Aim:
To Compare The Efficacy Of Our Via-Vili Test With Other Centers Test.
Methodology:
During 1 Year, 5285 Mothers Have Undergone Via-Vili Screening Test At Our Hospital. Only 430 Were Positive. Same
Period 778 Via-Vili Positive Cases Were Referred From Surrounding Phcs For Further Management. The Two Groups Were
Confirmed Colposcopy And Biopsy. Results Were Compared Between Two Groups. Data Were Analyzed And Interpreted
By Z Test Of Proportions At 5% Significance.
Results:
Tkmch, Out Of 430, Colposcopy Positive Was 262 (60.9%) And Among Colposcopy Positive 35 (13.4%) Were
Biopsy Positive. Among 778 Referred Positive Cases Colposcopy Positive Was 318(40.8%) And Biopsy Positive Was 28
(8.8%). The Confirmation Of Via-Vili By Colposcopy Was Statistically Significant (Z=6.802 And P<0.001). But Confirmation
Of Colposcopy Positive By Biopsy Was Not Statistically Significant (Z=1.745 And P>0.05).
Discussion:
The Confirmatory Colposcopy Positive 60.9% Of Our Hospital Was Significantly Greater Than The Referred
Confirmatory 40.9%. It Shows That Our Via-Vili Test Was Stringent And Effective Than The Referred. The Biopsy
Confirmations (13.4% And 8.8%) Were Not Statistically Significant Since It Was Performed At Our Hospital.
Conclusion:
The Statistically Significant Difference In Via-Vili Outcome Between Rural And Urban Population Needs Further
Detailed Study. The Via-Vili Screening Test May Be Improved At Primary Health Centers Still More To Minimize The
Expenditures Of Govt. As Well As Individuals.
Key Words:
Via-Vili Screening Test, Efficacy, Comparison, Confirmation, Colposcopy, Biopsy,

***************

Abdominal Aproach For Genital Prolapse Case Series

Author: Dr. Sangamesh Mathapati
Co Author: Dr Suyajna Joshi D.1, Dr Veerendtrakumar C.M.2,

Back Ground: Genital Prolapse Is One Of The Most Common Problems Encountered By Gynaecologists In Day To Day
Practice. 11% Per Cent Of All Women Experience Some Type Of Prolapse Surgery During Life Time And 30% Of These
Cases Will Undergo Another Operation For Recurrence Of Prolapse Or A Complication Related To Surgery.
Choosing Correct Operation For Prolapse Is Critical For Success. The Conventional Method Is Vaginal Approach With Site
Specific Repair. The Abdominal Approach Is Useful In Some Cases In Which One Or More Pelvic Support Operation Have
Failed. Abdominal Sacrocolpopexy Is Not A Site Specific Repair However It Provides Substantial Proximal Support And
Protects Vaginal Length.
Restricting An Operative Procedure To The Repair Of A Single Dominant Or Symptomatic Site Of Prolapse Transfer The
Physical Stress To A Different Vaginal Segment
Case: We Have A Small Series Of Genital Prolapse Cases At Obg Vims Bellary Managed With Abdominal Surgery As Primary
Mode Of Treatment. The Abdominal Approach Provided Better Understanding Of Anatomy, Easy Operability With Proper
Restoration Of Axis, Length And Function Of Vagina. The Postoperative Outcome Was Satisfactory.

Conclusion: Abdominal Approach For Genital Prolapsed Provides Good Success Rate With Less Chances Of Recurrence. It
Avoids Morbidity Of Vaginal
***************

A Case Of Bladder Extrophy Renal Agenesis Tranverse Veginal Septum -Decherney`S Syndrome
Author: Dr. Desamala Anupama
Co Author: Dr.Aruna Ramaiah1, Dr.Mahitha Reddy2,

Back Ground:This Is A Rare Case Of Urogenital Anomaly In A Post Extrophy Bladder Repaired Pubertal Girl Presenting As Pain & Mass
Abdomen.
Case Report:Ms.Xxxx ,13Year Old Female Presented With Severe Lower Abdominal Pain To Gynaec Opd.She Gave A Past History Of
Undergoing Surgery For Bladder Extrophy &Umbilical Hernia At The Age Of Two &Half Years.Physical Examination
Revealed A Tall Lean Girl With Severe Lower Abdominal Tenderness & Suprapubic Mass More Towards Rightside.
External Genitalia--Anatomy Distorted Due To Scarring.Bladder Extrophy Repaired Scar Present On Monspubis .Leftside
Labia Not Well Differentiated Due To Scar Tissue.Rightside Upper Labia Well Differentiated.Urethral Orifice Noted In The
Midline,Hymen Intact ,No Bulge Noted.
Usg-Absent Left Kidney.Rightside 9.8&4.8 Torcheous Tubular Elongated Anechoic Structure Noted--Ovarian Cyst
Ct Abdomen:-Chronic Hydrosalpix Ovarian Cyst.Absent Left Kidney
Mri:-Renal Anomaly Confirmed.Uterus Bicornuate,Bicolis With Collection Noted In Vagina More On Rightside Measuring
4.9 Mm-Haematocolpos, Rightside Haemotosalpix
Transperineal Usg:-Disproportionate Distension Of Cervix & Vagina.Transverse Septum Of 3.3 Mms
Haemotometrocolpos.In View Of Dilemma In Diagnosis Due To Different Opinions Given In Usg/Ct/Mri Case Was Posted
For Examination Under Anesthesia.On Examination Low Transverse Septum Noted Incised By Vertical Incision &
Haemotocolpos Drained.
Conclusion:-This Is A Rare Case Of Extrophy Bladder With Unilateral Renal Agenesis With Bicornuate Uterus With
Transverse Vaginal Septum -A Genetic Syndrome Known As "Decherny Syndrome."
Clinical Relevance:Prenatal Usg Detection Of Renal Anamolies Should Arouse Suspicion Of Genital Anamolies I.E Of Uterus, Ovaries &
Vagina.Early Detection Of Urogenital Anamolies Help In Planning Their Management.
***************

Laparoscopy In Complicated Ectopic Pregnancy

Author: Dr. Sanghamitra Dash
Co Author:

Backgroud:. The Technical Advancement In The Field Of Laparoscopic Surgery Has Greatly Enhanced The Possibility Of
Both Diagnosing And Treating Ectopic Pregnancy Effectively.

Case Studies: A Retrospective Analysis Of 28 Cases Of Ectopic Pregnancy Admitted To Our Hospital Between January 2012
To June 2013. The Mode Of Presentation, Hospital Stay, Duration Of Surgery, Enteral Feeding, Ambulation And
Conversion To Laparotomy Were Analyzed Between 12 Complicated Cases And 16 Uncomplicated Cases. Of The 12
Complicated Cases 5 Patients Had Previous Lscs With Adhesions, 4 Cases Were In Shock , 2 Cases Previously
Salpingectomy Was Done And One Case Had Undergone Resection & Anastomosis For Abdominal Tuberculosis. In The
Complicated Group Tubal Rupture Was Seen In 7 Cases With Stable Vitals In 3 Cases And 4 Cases Were In Shock. Of Rest
5 Cases: 2 Cases Had Chronic Ectopic, 2 Cases Had Un-Ruptured Ectopic And 1 Case Had Abortion. In The Uncomplicated
Group Rupture (Stable) Was Seen In 2 Cases, Unruptured In 3 Cases, Tubal Abortion In 6Cases, At Fimbrial End In 4 Cases
And In 1 Case It Was Of Unknown Location. The Mode Of Presentation Was Pain In 10/12Cases Vs 12/16 Cases, Spotting
9/12Cases Vs 8/16 Cases, Delayed Period In 3/12Cases Vs 4/16 Cases And Giddiness In 10/12 Cases Vs 11/16 Cases In 1St
Group Vs 2Nd Group Respectively. The Hospital Stay Was 48Hrs Vs 36Hrs, Duration Of Surgery Was 50Mins Vs 25 Mins,
Enteral Feeding Was Started After 24Hrs Vs 14Hrs, Ambulation Was After 40Hrs Vs 24Hrs In 1St Group Vs 2Nd Group
Respectively And Conversion To Open Procedure Was Nil In Either Group.
Conclusion : This Procedure Is, However, Vastly Dependent On The Experience And Expertise Of The Surgeon, The
Equipment And Facilities Available. There Seems Little Doubt That Laparoscopic Management Should Be The First Line Of
Treatment

***************

Case Report Of Rupture Of Gravid Uterus

Author: Dr. Varshitha.R Gowda
Co Author: Prof Shobha Dhananjaya1, Prof Sapna I S2, Prof Shukla Shetty3,

Background
A Case Of G4P3L2 With 39 Weeks Of Gestation With Vertex Presentation Was Referred From Phc Due To Prolonged Iind
Stage, And Was Diagnosed As Rupture Uterus In Our Government District Hospital, Davangere.
Case
G4P3L2 Was Referred From Primary Health Centre In View Of Failure To Progress Of Labor. Her Complaints Were Labor
Pains 7 Hours Prior And Leaking Per Vagina 5Hrs Prior Admission.
She Had Regular Antenatal Check Up At Primary Health Centre & All Three Trimesters Were Uneventful.
She Gives History Of 7Yrs Married Life With Previous 3 Vaginal Deliveries Among Them The First Delivery Was At Home
And The Next Two Were Institutional Deliveries. The First Baby Died 9Months After Birth Due To Respiratory Infection.
There Was No Other Significant Medical, Past, Family History.
On Examination:
She Was A 25 Yr Old Pregnant Woman Moderately Built And Nourished And Conscious, Co-Operative,
But Pallor Was Present, With A Pulse Rate Of 168 Bpm, Blood Pressure-108/60.
Cardio Vascular System Revealed Tachycardia
Abdomen Was Tense & Uterine Contour Was Altered With Fetus Being In Longitudinal Lie With Head At The Lower Pole
Of The Uterus. Fetal Heart Sound Was Not Heard.
On Pv Examination Cervix Was Fully Dilated With Vertex At -3 Station.
Under Ga Laparotomy Proceeded With Peripartum Total Abdominal Hysterectomy Was Done.
Operative Findings: There Was Hemoperitonium Of 400Ml; Baby & Placenta Were In The Abdominal Cavity. Also
Complete Left Lateral Uterine Wall Rupture Extending From The Peritoneum Beyond The Infudibulo Pelvic Ligament Up
To The Vaginal Vault.
Patient Was On Ventilator Support For 3 Days & Was Stable Throughout The Postoperative Period.
Conclusion:
Rupture Uterus, Being Preventable, Still Remains A Dreaded Complication. It Causes Catastrophe To The Mother & Fetus.
High Parity, Injudicious Use Of Induction Methods & Vbac Are Important Cause.

***************

Chylous Ascites: A Rare Laparoscopic Finding In Cases Of Infertility

Author: Dr. Shreenivas Badiger
Co Author: Garimakachhawa1, Monica Gupta2, Vidushi Kulshrestha3, Mayur Tosar4, Kriplani Alka5

Background : Chylous Ascites Is The Extravasation Of Milky Chyle Into The Peritoneal Cavity Defined As The Presence Of
Ascitic Fluid With High Fat (Triglyceride) Content (>200 Mg/Dl). It Is Usually An Incidental Finding Occurring In 1:11,584
Abdominal Surgeries Or Can Be Secondary To Certain Pathologies Including Malignancies, Infections, Cirrhosis, Trauma.
Case Description: A 25 Years Old Woman With Primary Infertility Of 5 Years With Normal Regular Menstrual Cycles And
History Of Att For Pulmonay Tuberculosis. There Was H/O Hydrotubation, Followed By Ovulation Induction For 3 Cycles.
Ultrasound Revealed A Normal Uterus, Endometrial Thickness Of 5Mm And Normal Bilateral Ovaries With No Free Fluid.
Endometrial Aspiration Showed Late Secretory Endometrium, Pcr Positive For Tb While Afb Was Negative.
Hysterosalpingography Showed Normal Uterine Cavity, Left Fimbrial Block, Right Cornual Block For Which Diagnostic
Laparoscopy With Chromotubation And Hysteroscopy Was Performed. There Was Incidental Intraoperative Finding Of
Around 100 Cc Of Milky White Fluid Present In Peritoneal Cavity Suggestive Of Chylous Ascites. Uterus With Bilateral
Ovaries Was Normal. Both Tubes Were Rigid, Short With Dilated Ampulla And Cornual Block. Hysteroscopy Showed
Normal Uterine Cavity With Mild Peri-Ostial Adhesions. Cytology Analysis Of The Chlous Fluid Showed Numerous
Macrophages With Lipid Laden Material, Increasded Cellularity, With No Evidence Of Malignancy. Gram Staining And Afb
Staining Was Negative And Culture Was Sterile. Biochemistry Showed Triglycerides 243 Mg/Dl. Patient Was
Discharged In Stable Condition On Low Fat Diet And Antitubercular Treatment Was Started. She Was Counseled For In
Vitro Fertilization.
Clinical Relevance: Although Tuberculosis Is Common In Infertile Women In Our Country, Chylous Ascites Is A Rare Finding.
We Suggest That Presence Of Chylous Ascites In Infertility Should Raise Suspicion Of Tuberculosis In Absence Of Other
Findings.

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Myiasis- The Aftermath Of Clumsiness

Author: Dr. Goldy Selwyn Jemima
Co Author: Dr.Ramalakshmi, M.D.,O.G.,1,

Background
Myiasis Is The Infestation Of Mankind With Dipterous Larvae. Presence Of Maggots In External Parts Is Relatively
Common , But On Covered Parts Like External Genitalia It Is Extremely Rare . We Describe A Case Of Vulval Myiasis To
Stress The Aftermath Of Unhygienic Practices In Rural India .
Case
A 26 Years Old Postnatal Mother Who Delivered 10 Days Back Was Referred To Our Hospital With Vulval Pain ,
Itching And Larvae Coming Out Of The Vulva . She Was Neither Immunocompromised Nor Mentally Challenged . Her
Delivery And Sterilisation Procedures Were Uneventful . She Had No Sexually Transmitted Diseases. She Had No Other
Genital Lesion Or Ulcers . The Only Risk Factor She Had Was Her Unhygienic Lifestyle.Her Household Had Conditions Of
Poor Hygiene , Which Were Compatible With A High Risk Of Disease. Her Unhygienic Common Toilet Attracted Many
Flies . A Lack Of Underwear , Using Dirty Ragged Clothes During Menstruation And Drying Clothes In Soil Are The
Predisposing Factors For Myiasis In This Case . The Larvae Were Removed Manually Followed By Thorough Wound
Debridement And Irrigation With Turpentine Oil.The Patient Was Treated With Parenteral Antibiotics , Antihistamines
And Serratiopeptidase.On Discharge She Was Instructed To Adopt Clean Sanitation .
.Clinical Relevance
Very Few Cases Of Urogenital Myiasis Are Reported In The Literature . The Rarity Of Reports Is Due To Under
Reporting Due To Social Stigma . This Case Report Is Presented For Its Rarity And To Emphasise That Health Education Is
The Primary Prevention Of Myiasis . A Differential Diagnosis Of Vulval Myiasis Should Be Entertained In Suspicious Genital
Lesions Of High Risk Individuals.

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Congenital Adrenal Hyperplasia And Pregnancy - A Case Report

Author: Dr. Nithya Jagadeesan
Co Author: Karpagam Murali, Dept Of Obstetrics And Gynecology1, Ravikumar Vr, Division Of Pediatric Surgery2, Ahila
A, Division Of Pediatric Endocrinology3,

Background
Congenital Adrenal Hyperplasia (Cah) Is An Autosomal Recessive Disease Affecting Cortisol Biosynthesis. Although
Treatable With Steroid Replacement And Corrective Surgery, The Fertility Rate Is Low Due To Anovulation , Luteal Phase
Defect And Secondary Ovarian Hyperandrogenism. Pregnancy With Cah Is Relatively Uncommon.
Case Report:
We Report A Case Of 21 Year Old Female With Classic Cah Diagnosed At 2 Months Of Age, Treated With Steroid
Replacement And Genital Surgery , Who Conceived Spontaneously And Had A Successful Pregnancy Outcome. She Was
Born Of Consanguineous Parents. Serum Hormone Analysis Confirmed The Diagnosis. Ultrasound Revealed Normal
Uterus And Ovaries. She Was Treated With Hydrocortisone And Fludrocortisone And Was Followed With Hormones To
Adjust Medication Dosage. At 18 Months Of Age Reduction Of Clitoral Hypertrophy And Vaginal Reconstruction Was
Performed. She Developed Huskiness Of Voice And Hirsutism Just Prior To Menarche .She Had Regular Scanty Periods .
She Reached Adult Height Of 134 Cm . She Had Repeat Vaginoplasty At 20 Years Of Age. She Conceived Spontaneously
Five Months After Marriage. Dating Ultrasound Revealed Male Fetus. Antenatal Care Was Continued In Liaison With An
Endocrinologist. Anomaly Scan Revealed Incompetent Cervix Which Necessitated Cervical Encerclage . Steroids Were
Increased To Maintain Serum Hormonal Levels Within The Range . She Went Into Preterm Labor At 32 Weeks And Had
Caeserean Section In View Of Previous Vaginoplasty. She Delivered A Boy Baby Weighing 1920G With Good Apgar. Baby
Was Screen Negative For Cah. Baby Is Now 18Months Old And Has Normal Physical And Mental Development.
Conclusion.
Ovulation And Pregnancy Is Possible In A Female With Cah If Diagnosed Early In Life And Treatment Instituted To
Control Excess Androgens. The Complexity Of Issues Highlights The Need For Multidisciplinary Team Approach.
***************

Case Presentation On Rarely Occuring Female Hypospadiasis

Author: Dr. Priyadarsini Pakkala
Co Author: Dr.M.Syam Mohan Rao1, Dr.K.Vandana2, Dr.K.Ramesh(Urologist)3,

Background
Hypospadias Is A Rare Congenital Malformation Where In Urethra Opens In Anterior Vaginal Wall. In Females
Hypospadias Is Much Less Common Than In Males. Incidence In Females Is One In Five Lakh Live Births Where As In Males,
It Is One In Three Hundred Live Births.
Case
Patient Aged Nineteen Years Married For Six Months, With Complaint Of Pain Abdomen, Dyspareunia And Constipation.
She Had Occasional Pain Abdomen In The Past Which Was Relieved By Foleys Catheterisation, According To History. Her
Menstrual Cycles Were Regular. On Local Examination, A Transverse Vaginal Septum Is Present. Urethra Is Not Visualised
Separately. Ultrasound Revealed A Separate Bladder And Uterus. Upon Examination Under General Anaethanesia With
The Help Of Cystoscope, Urethral Opening Is Seen On Anterior Vaginal Wall. Thus, Hypospadias Which Is A Rare Congenital
Anamoly Was Diagnosed Accidentally.
Conclusion
Diagnosis Of A Female Hypospadias Is Accidental In Our Case As Her Period Are Regular And There Is No Problem During
Micturition. In This Condition Due To Inadequate Length Of Urethra, It Exits In An Abnormal Location That Is Surgical
Repair Is Technically More Complicated. If Surgery Is Not An Option, It May Be Allowed To Persist. Usually Females Lead
A Normal Life Including Conceiving And Bearing Children.

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Uterine Necrosis Following Devascularization Procedures For Postpartum Hemorrhage

Author: Prof. Jyoti Chandran
Co Author: Dr Jyoti Ramesh Chandran1, Dr V Rabia Bi2, Dr Sumangala Devi D3,

Background
Stepwise Devascularisation And B Lynch/HaymanS Sutures Are The Main Surgical Procedures Performed For
Management Of Atonic Postpartum Hemorrhage. Some Degree Of Uterine Necrosis Is An Acceptable Complication But
Massive Uterine Necrosis May Occur Due To Non Adherence Of Basic Principles Of The Procedure Or Patient Factor
Warranting Hysterectomy.
Case 1: Mrs X, 23 Year Old P3L1 Was Referred On Post Operative Day 51 As A Case Of Puerperal Sepsis. She Underwent
Stepwise Devascularization And B Lynch Procedure Following Atonic Postpartum Hemorrhage ( Pph) After Vaginal
Delivery.8 Pint Of Blood And Blood Products Were Transfused. On Admission She Was Febrile And Uterine Size
Corresponding To 30 Weeks.She Was Started On Broad Spectrum Antibiotics And Ct Scan Diagnosis Of Hematopyometra
Was Made. Drainage Of Same Attempted But Failed Hence Laparotomy With Subtotal Hysterectomy Done As The Uterus
Was Found To Be Completely Necrosed.
Case 2:Mrs Y,30 Year Old P3L3 Was Referred On Post Operative Day 37 As A Case Of Puerperal Sepsis. She Underwent
Caesarean Section For Fetal Distress And Had Pph For Which HaymanS Sutures Were Applied Using Vicryl As Suture
Material. One Pint Of Blood Was Transfused. On Examination Patient Was Stable With Fundal Height Corresponding To
18 Weeks And Profuse Foul Smelling Vaginal Discharge. Ultrasound With Doppler Revealed Air Pocketing In The Anterior
Uterine Wall With Reduced Vascularity Of Uterus Suggestive Of Uterine Necrosis. Patient Was Given Broad Spectrum
Antibiotics . Laparotomy With Total Hysterectomy Was Done As Uterus Was Friable And Necrosed .
Conclusion:Moribund Condition Of Patient Following Postpartum Hemorrhage May Affect The Healing Process Following
Stepwise Devascularization Which Led To Uterine Necrosis
The Use Of Delayed Absorbable Suture Material ( Vicryl) In Place Of The Recommended No. 2 Chromic Catgut Can Cause
Damage To Uterine Musculature Affecting Vascularity Of Myometrium Leading To Necrosis.

***************

Pregnancy In Uterine Didelphus With Pre Eclampsia ,Iugr ,Oligohydramnios

Author: Dr. Sirisha Bevunapalli
Co Author: Dr.M.Sasikala, Md1, Dr.B.Usharani,Md2, Dr.D.Ushasree,Md3,

Background
The Diagnosis Of Uterine Anomalies Is Important In Infertility Patients And Also In Pregnant Woman Because Of The
Association With Obstetrical Complications Such As Abortion, Cervical Incompetence, Dystocia, Ectopic Pregnancy,
Intrauterine Growth Restriction, Premature Labor And Malpresentation Of The Placenta.
The Most Common Congenital Uterine Malformations Arise From Defects In Paired MLlerian Duct Development,
Fusion Or Resorption Which Were Estimated To Occur In 5% Of Women.Uterus Didelphys Represents A Uterine
Malformation Where The Uterus Is Present As A Paired Organ . There Is A Double Uterus With Two Separate Cervices,
And Often A Double Vagina. Each Uterus Has A Single Horn Linked To The Ipsilateral Fallopian Tube That Faces Its Ovary.
The Uterus Is Formed During Embryogenesis By The Fusion Of The Two Paramesonephric Ducts (Also Called MLlerian
Ducts),Which When Fails To Fuse, Causes Didelphic Uterus. The Cause Of The Fusion Failure Is Not Known. Associated
Defects May Affect The Vagina, The Renal System And, Rarely The Skeleton. It Has Been Estimated To Occur In 1/3,000
Women.
Case
A Female By Name D.Devaki F/20Yrs Diagnosed As Primi With Didelphus Uterus With Pre Eclampsia , Iugr And
Oligohydramnios At 28 Wks Gestational Age And Was Maintained On Tab Labetalol 200 Mg Bid,Tab Nefidipine 10 Mg
Tid,Tab Isoxsuprine 10 Mg Tid,L-Arginine Sachets Bid,Hospitalization And Bedrest,4Th Hrly Bp Monitoring,Prophylactic
PritchardS Regimen When Required, Till 36 Completed Weeks Where She Landed In Preterm Labour And Was
Subjected To Emergency Lower Uterine Segment Caeserean Section.Baby Was 1.8 Kgs With Apgar 8-10 And Was Kept In
Nicu.Mother And Baby Safe By 10 Th Postnatal Day
Conclusion
Congenital Uterovaginal Anamolies Can Have Adverse Effects On Pregnancyoutcome.It Is Still Worse If Associated
Pregnancy Induced Hypertension Exists.Early Diagnosis ,Aggressive Evaluation And Appropriate Management Can
Prevent Pregnancy Wastage And Maternal And Fetal Morbidity.

***************

omental Prolapse Through Vaginal Vault Rupture A Case Study

Author: Dr. Hema Kaushik
Co Author: Dr. Shukla Shetty1, Dr. Sarvamangala2, Dr. Madhu K N3,

Background
Vaginal Evisceration Following Hysterectomy Is A Rare Occurrence With Only A Few Cases Being Documented Worldwide
. It Is A Potentially Life Threatening Complication Of A Very Common Gynaecological Operation Which Should Be
Recognized And Treated Without Delay. We Report A Case Of Spontaneous Vault Rupture, 5 Years After Abdominal
Hysterectomy Without Any Known Etiological Risk Factors .
Case
A 43 Year Old Woman, P2L2 Presented With Mass Per Vagina Since 2 Days. She Underwent Abdominal Hysterectomy 5
Years Back For Abnormal (Dysfunctional) Uterine Bleeding. There Was No History Of Coitus, Constipation, Chronic Cough,
Heavy Manual Work Or Trauma.
On Examination, Her Vitals Were Stable. General Physical Examination And Systemic Examination Were Normal. On
Abdominal Examination There Was Vague Tenderness In Lower Abdomen And Hernial Orifices Were Free. Vulval
Examination Revealed A Fleshy Reddish Mass Measuring 12X4Cms Protruding Through The Vagina. A Rent Of 4 Cms Was
Seen In The Vaginal Vault With No Signs Of Infection. Abdominal X Ray Was Unremarkable. Patient Was Taken Up For
Examination Under Anaesthesia And Surgery.
The Prolapsed Omental Mass Was Excised And Peritoneum And Vaginal Vault Were Closed With No.1 Vicryl.
Histopathological Examination Of The Mass Confirmed It As Omentum. Her Postoperative Period Was Uneventful.
Conclusion
Vaginal Evisceration Is A Rare Emergency Complication Requiring Prompt Surgical Intervention. Incidence Is Higher After
Laparoscopic Hysterectomy Compared With Abdominal And Vaginal Hysterectomy. In Premenopausal Cases, Evisceration
Appears To Be Rarer And Tend To Be Associated With Either Sexual Or Obstetric Trauma. In Post Menopausal Women,
Risks Include Older Age, Increase In Intra Abdominal Pressure, Inadequate Wound Healing . This Case Is Reported
Because Of Its Rarity And To Emphasize The Need For An Adequate Closure Of The Vault Following Hysterectomy. During
Follow Up Patient Needs To Be Examined To Check Integrity Of The Vaginal Vault.

***************

Emergency Cesarean - Incidental Diagnosis Of Velamentous Cord Insertion

Author: Dr. Aishwarya Jagan
Co Author: Dr. Rani Reddy M.D.,1,

Background : Emergency Cesarean Section After The Onset Of Labor Is Done In About 2% Of Low-Risk Pregnant Women
And Half Of These Cases Are Associated With Placental And Umbilical Cord Abnormalities. Pregnancies Complicated With
Vci Are At Greater Risk For Adverse Perinatal Outcome Like Fetal Growth Restriction, Placental Abruption, Previa,
Abnormal Intrapartum Fetal Heart Rate (Fhr) Pattern And Neonatal Death. During Intrapartum, Variable Decelerations
And A Non-Reassuring Fhr Pattern Are Frequently Observed In Cases With Vci.
Case Report : Here We Present A Primigravida At 38 Weeks And 5 Days Of Gestation With Severe Oligohydramnios With
Late Onset Iugr Admitted To Our Hospital For Labor Induction With Intravaginal Dinoprostone. Fetal Heart Rate Was
Monitored Continuously. After 6 Hours Of Induction, Cardiotocography Reveals Variable Decelerations And Vaginal
Examination Showed An Uneffaced Cervix At Mid Position, 2Cm Dilatated With Membranes. Emergency Caesarean
Section Was Planned And An Alive Term Male Baby Of Weight 2.18 Kg With 1 And 5 Min Apgar Of 8 And 9 Was Delivered.
Intraoperatively A Posterior Placenta With Velamentous Cord Insertion Of Around 15Cm Of Vessels Traversing The
Membranes Was Observed.
Conclusion: The Present Case Report Signifies The Importance Of Close Fhr Monitoring And Antenatal Usg Diagnosis Of
Placental And Cord Abnormalities In At Risk Pregnancies.

***************

Placenta Percreta Successfully Managed By Cesarean Hysterectomy A Case Report

Author: Dr. Kapila Deepti
Co Author: Kapila Suguna Deepti1, R K Panigrahi2,

Background : Placenta Percreta The Rarest And The Most Severe Form Of Placenta Accreta Is A Potentially Life
Threatening Condition. The Incidence Has Increased And Seems To Parallel With The Increasing Cesarean Delivery Rate.
We Are Presenting A Case Of A 28 Year Old Gravida 2, Para 1 , Living 0 With A History Of Previous Cesarean Who Attended
The Labor Room With A Complaint Of Pain In The Lower Abdomen For 1 Day.
On Examination, She Had Tachycardia And Scar Tenderness. She Underwent An Emergency Cesarean Section And A
Healthy Male Child Was Delivered. Spontaneous Placental Separation Failed, There Was Torrential Bleeding From The
Uterus. Placenta Was Percreta Type Posteriorly Perforating The Uterus And Adherent To The Bowel Loops Which Were
Separated Carefully And A Subtotal Hysterectomy Was Performed. Post Operative Period Was Uneventful And Patient
Was Discharged After 7 Days In A Good Condition.
Conclusion: A Gross Increase In The Placenta Accreta Syndromes Has Been Noted With The Increasing Rates Of Cesarean
Sections. Diagnosis Of Placenta Accrete Syndromes Antenatally Allows A Multidisciplinary Planning In An Attempt To
Minimize Potential Maternal Or Neonatal Morbidity And Mortality. In General, The Recommended Management Is
Planned Preterm Cesarean Hysterectomy With Placenta Left In Situ Because Attempts At Removal Of The Placenta Are
Associated With Significant Hemorrhagic Morbidity. However, Surgical Management May Be Individualized.

***************

A Rare Case Of Mid Trimester Fundal Rupture In An Unscarred Uterus

Author: Dr. Punyashree Ranganna
Co Author: Dr Veerendra Kumar C M.1,

Background : Spontaneous Uterine Rupture Is More Likely In Women With High Parity. Rupture Is More Common In
Scarred Or In Unsupervised Neglected Obstructed Labour . Uterine Rupture Is A Life Threatening Condition For Mother
And Fetus Occurs In <0.01% Of Pregnant Women And<1% Of Women Attempting Vbac.
Case: A 20Yr Old G3P1L0A1 With 28Weeks Of Twin Gestation Was Reffered After Attempted Termination Using Oxytocics
For Intra Uterine Fetal Demise Of Both Twins In Shock .Uterine Contour Could Not Be Made Out With Evidence Of Fluid
In Peritoneal Cavity. Under Ga Emergency Laparotomy Was Done , Irregular Irrepairable Extensive Fundal Rupture Seen.
Both Babies Were Dead And Found In Peritoneal Cavity With Placenta Inside The Uterine Cavity. Haemoperitoneum Of
1000Ml Seen, Subtotal Hysterectomy Was Done.
Conclusion :Mid Trimester Uterine Rupture Is Rare. The Possible Causes In This Case Could Be Inherent Weakness Of
The Myometrium , Over Distention Due To Multiple Pregnancy , Possible Injudicious Use Of Oxytocic Agents Elsewhere
. Previous Vigorous Curretege Might Have Weakened The Fundal Myometrium. Her Obstetric Career Ended Due To
Irrepairable Fundal Rupture.

***************

End Points Of Samm Hurdles To Tertiary Care

Author: Dr. Audimulapu Sujatha
Co Author: Dr Sujatha1, Dr Aruna Ramaiah2,

Background : The Concept Of Severe Acute Maternal Morbidity Emerged In Response To The Need For A More Sensitive
Marker Of Quality Of Obstetric Care.
Nearmiss : A Woman Had A Near Brush With Death. She Would Have Died Were Good Fortune And Medical Care Not On
Her Side. This Refers More To The Risk Management. Samm Refers To The Morbidity Of A Women Actually Suffers.
Retain The Concept Of Harmed Or Damaged Mother.
Case Presentation Of Nearmiss :
Patient Lakshmi G4 P3 L2 D1 With Term Gestation Were Referred To The Mgmh, Hyderabad With Obstructed Labour
Followed By Rupture Of Uterus. Emergency Laparotomy, Cesarean Hysterectomy Done With The Blood Loss Of 2000Ml
5 Points Of Blood Transfuse 2 Ffps Given And Mother Could Be Revived.
Near Miss To Mortality :
Mrs. Nusrat Fathima P3 L3 A2 With 20Th Post Operative Day Lscs Admitted With Severe Secondary Pph With Anemia And
Referred From Peripheral Hospital, Emergency Laparotomy And Hysterectomy Done, Patient Could Not Be Revived .
Conclusion :
Prevent Ability Of Events Along The Continuum Of Severe Morbidity To Near Miss To Death And Concluded That The
Same Factors Contributed To The Outcome In All Categories
Patient Factors (13-20%), System Factors (33-47%), Provider Related Factors (90%).
Since Samm Is A Prevalent Throughout The World. Mostly Due To Treatable Conditions Like Hemorrhage Contributing To
The 80% Of The Causes By Achieving Clear Definitions Of The Samm, Registering Samm Would Be Valuable Way To
Monitor And Improve The Quality Of Maternal Services And Decreasing Mortality To Morbidity Ratios And Mortality
Index.

***************

Ruptured Uterus Didelphys Misdiagnosed As Ruptured Ectopic Pregnancy A Case Report

Author: Dr. Nidhi Jha
Co Author: Dr. Pushpa Jha1,

Background : The True Incidence Of Obstructive MLlerian Anomalies Is Unknown But Is Believed To Be Between 0.1%
And 3.8% . Uterus Didelphys Represents A Uterine Malformation Where The Uterus Is Present As A Paired Organ. There
Is Presence Of Double Uterine Bodies With Two Separate Cervices, And Often A Double Or Septate Vagina As Well.
Pregnancy With Uterine Anomalies Are Rare In Clinical Practice And Only Few Cases Are Reported In Literature.
Case: 24Year Old Woman With History Of 1-1/2 Months Of Amenorrhoea Presented With Acute Abdominal Pain. Urine
Pregnancy Test Was Positive. Menarchae Was Achieved At 13 Years With History Of Dyspareunia. Tenderness Was
Present In Right Iliac And Lumbar Region Otherwise Abdominal Examination Was Unremarkable. Per Speculum
Examination Was Normal And Pelvic Examination Showed Fornicial Tenderness.Usg Showed Haemoperitoneum
Suggestive Of Ruptured Ectopic Pregnancy. Emergency Laparotomy Revealed A Uterus Didelphys With A Ruptured
Intrauterine Pregnancy In One Of The Uterus.
Conclusion :Rupture In Such Cases Occurs Because Of Inability Of Malformed Uterus To Expand As A Normal Uterus. The
Walls Of The Anomalous Uteri Tend To Become Abnormally Thin As Pregnancies Advances, Thickness Can Be Inconsistent
Over Different Aspects Of The Myometrium, And The Placenta Does Not Adhere Properly. Patients With Uterus Didelphys
Sometimes Seen With Pain Severe Enough To Mimic An Acute Abdomen. It Is Important To Keep This Unusual Congenital
Malformation In Mind In The Differential Diagnosis Of Pelvic Mass And/Or Abdominopelvic Pain In Young Women So As
To Avoid Inappropriate Surgical Procedures.

***************

Laparoscopic Myomectomy:A Rare Case Of Uterine Tumor Resembling Ovarian Sex-Cord Tumor
Author: Dr. Amiti Agrawal
Co Author: Dr.Amiti Atulkumar Agrawal1, Dr.Rakesh Sinha2,

Background : Utrosct Currently Defined As The Neoplasm Predominantly Composed Of Sex Cord-Like Elements And
Generally Behaves In A Benign Fashion.To Date, Only 77 Cases Have Been Reported In Literature.1 In The Landmark
Publication By Clement And Scully In 1976,14 Cases Of Utrosct Were Described As : Group I(Estscle) Endometrial Stromal
Tumors With Sex-Cord Like Elements,Which Behaves Like A Low Grade Endometrial Stromal Sarcoma & Group Ii(Utrosct)
Cells With Proliferative Pattern Resembling Ovarian Sex Cord Tumors.2,3 The 2 Most Common Symptoms Are
Postmenopausal Bleeding(44.2%) And Abnormal Menstruation(39.5%).4 Out Of The Plethora Of Immunohistochemical
Stains,Calretinin,Inhibin,Cd 99 And Melan A Are The Most Characterestic Sex Cord Markers.5Differential Diagnosis
Include Epitheloid Variant Of Leiomyosarcoma,Adenosarcoma,Perivascularepitheloid Cell Neoplasms And Synovial
Sarcoma.
Case Report : A 30 Year Old Unmarried Woman Presented At Womenshospital,Mumbai With Heavy Menstrual Bleeding
And Dysmenorrhea Since 1 Year.On Examination Uterus Was Just Palpable.Usg Showed An Enlarged Uterus(7.8X7.4X4.8
Cm) With 1Subserosal Fibroid Of Size 6.2X6.2X5.9 Cm Reaching Till Mucosal Layer Of Endometrial Cavity Displacing It
Anteriorly.Et-4.4 Mm,Right Ovary 11.1 Cm And Left Ovary 10.2 Cm(Pco).Intraoperatively A Large 16 Weeks Uterus With
Single Large Fibroid In The Fundus Was Seen Which Was Degenerated.Laparoscopic Myomectomy Was Done And The
Fibroid Was Retrieved By Morcellation.Histopathology Showed Utrosct And Tumor Cells Expressed Cd-10,Sma,Desmin
And Calretinin.
Discussion :Due To Difficulties In Diagnosis On Hematoxylline-Eosin Stain,Immunohistochemistry Is Mandatory For
Diagnosis.6 Diagnosis Is Incidental On Examination Of Surgical Specimens.Endometrial Stromal Component Determines
Clinical Behavior And Its Prognosis.In Young Patients Fertility Sparing Surgery (Resection Of The Tumor With Preservation
Of Remainder Of Uterus For Subsequent Pregnancies) With Long Term Follow Up Is Acceptable With Excellent
Prognosis.For Group I Tumors Total Hysterectomy With Bso Or Simple Hysterectomy Is The Gold Standard Treatment.7,8
Successful Medical Treatment With Anastrazole Has Been Reported.9

***************

Chemoresistant Choriocarcinoma Of Uterus

Author: Dr. Hemalatha Dangeti
Co Author:

Background :
Choriocarcinoma Is A Highly Malignant Tumour Arising From Chorionic Epithelium. About 3-5% Of All Patients With
Molar Pregnancies Develop Choriocarcinoma; 50% Develop Following Hydatidiform Mole, 30% Following Miscarriage Or
Ectopic Pregnancy And 20% Following Normal Pregnancy.
Case :
A 20Yrs Old Nulliparous Lady Presented In Our Opd On 8-10-2012 With A History Of 3Months Amenorrhea Associated
With Pain Abdomen. One Year Ago, She Underwent Suction Evacuation For Molar Pregnancy At 4 Months Gestation. She
Did Not Come For Follow Up; Used Oral Contraceptive Pills For One Year. Per Vaginal Examination Uterus Bulky,
Mobile, Fornices Free; No Evidence Of Metastasis. Her Blood Counts, Liver, Renal And Thyroid Function Tests Were
Normal. Serum Hcg 600Miu/Ml.
Usg Showed A Heterogeneous Lesion Of 3.2Cms1.8Cms, Seen On The Anterior Uterine Wall With Increased
Vascularity. Mri Revealed A Highly Vascular Invasive Mole. Chest X Ray Normal. D&C Report Ischaemic Necrosis
With Inflammatory Cells.
Management : 2 Cycles Of Single Agent Chemotherapy With Methotrexate Were Given Following Which Her S.-Hcg
Was 585Miu/Ml. As There Was No Improvement, Chemotherapy Was Changed To Emaco. After 8 Cycles Of Emaco, Her
S. Hcg Dropped To 152Miu/Ml. Chemotherapy Changed To Cisplatin And Etoposide. After 8 Cycles, S. Hcg Dropped To
50.1Miu/Ml. Her Blood Biochemistry During Chemotherapy Remained Within Normal Limits. Case Was Dicussed With
Radiotherapist Who Suggested Hysterectomy.
Repeat Pelvic Ultrasound And Color Doppler Revealed A Highly Vascular Lesion On The Anterior Wall, Extending Upto
Serosa. Ct Abdomen Revealed Bulky Uterus With No Evidence Of Secondaries And No Lymphadenopathy. She Underwent
Tah On 25-2-2014. Hpe Report Was Choriocarcinoma.
One Week Later, S. Hcg Was <0.1Miu/Ml.
Conclusion :
This Case Comes Under The Category Of Non Metastatic Malignant Gtd. As The Tumor Was Chemoresistant To Single
Agent And Multi-Drug Regime, Hysterectomy Was Done.

***************

Something Fishy About Dermoids

Author: Dr. Venus Dalal
Co Author: Prof. Sunesh Kumar1, Prof. K K Roy2, Prof. Lalit Kumar3, Dr. D N Sharma4,

Background :

Mature Cystic Teratoma (Dermoid) Is A Common Benign Adnexal Tumour In Females. Malignant Transformation In A
Mature Cystic Teratoma Of The Ovary Is Rare. The Most Common Malignancy Is Squamous Cell Carcinoma, Which
Consists Of About 75% Of Malignant Transformations. Because Of The Lack Of Specific Symptoms And Signs, Preoperative
Diagnosis Is Difficult. In The Present Report, We Describe 2 Cases Of Squamous Cell Carcinoma Arising In A Mature Cystic
Teratoma.

Case 1:

A Postmenopausal 50-Year-Old Women With Incidently Diagnosed Right Complex Ovarian Cyst On Ultrasound And Ca
125- 79.6. She Underwent Total Abdominal Hysterectomy And Bilateral Salpingo-Oophorectomy And Infracolic
Omentectomy . Ovarian Mass With Hair, A Tooth And Putty-Like Material Was Present. Histopathology Showed Right
Ovarian Teratoma With Squamous Cell Carcinoma. The Patient Was Categorized As Figo Stage Ia. She Is Presently Under
Follow-Up.

Case 2 :

46 Yr Old Female Underwent Laparotomy + Right Ovarian Cystectomy In Pvt Hospital In Etawah, U.P For Right Ovarian
Mass And Was Diagnosed As Squamous Cell Carcinoma In Mature Cystic Teratoma On Histopathology. The Clinical
Evaluation Was Done With Ultrasound, Computed Tomography (Ct) Scan And Serologic Marker Serum Ca125. She Was
Then Posted For Complete Surgery. Intraoperative, Left Ovarian Mass With Multiple Metastatic Deposits On Omentum
And Small Intestine Was Found . Subsequently, She Was Given Chemotherapy And Is Now, On Regular Follow-Up .
Conclusion :
Malignant Transformation In Dermoid Is A Rare Event. Adequately Staged Patients With Disease Confined To The Ovary
Have A Much Better Prognosis With 5-Year Survival Rates Approaching 95%. Purpose Of This Case Report Was To Create
Awareness Among Physicians While Dealing With Dermoid Cysts Of Large Size In Older Patients.

***************

A Comparative Study Between Intramuscular Oxytocin And Intramuscular Methyl Ergometrine In The Active
Management Of Third Stage Of Labour
Author: Dr. Deepa Rajendran
Co Author:

Background And Objectives:

Aimed At Comparing The Efficacy Of Prophylactic Intramuscular Methylergometrine 0.2Mg And Intramuscular Oxytocin
10U In Reducing Blood Loss In The Third Stage Of Labour.
Method:
One Hundred Low Risk Pregnant Women At Term With Spontaneous Onset Of Labour Who Met With The Inclusion
Criteria Were Included In The Study. They Were Randomly Allocated Into Two Groups Of 50 Each And Were Managed
Actively In Third Stage With 10 Units Oxytocin Im Immediately After The Delivery Of The Baby, Cord Was
Clamped And Cut Immediately After The Delivery Of The Baby. Controlled Cord Traction Of The Umbilical Cord
Was Done.
The Main Outcome Measures With Respect To Third Stage Of Labour Were Difference Between The Two Groups With
Regard To; Duration, Blood Loss By Volume, Difference In Haemoglobin And Hematocrit, Any Changes In Blood Pressure,
Need For Additional Oxytocin And Side Effects.
Results:
The Mean Duration Of Third Stage And Blood Loss In Third Stage Between The Two Groups Were Significantly Less.
There Was A Reduction In Haemoglobin And Hematocrit Values At 24 Hours Postpartum But Were Clinically
Insignificant. The Need For Additional Oxytocics Was 12% Among The Oxytocin Group.
There Was No Need For Further Blood Transfusion In Either Of The Two Groups. In This Study 8 Women Who Received
Methergine Had Vomiting And 9 Had Rise In Blood Pressure. While Those Who Were Given Oxytocin Alone Did Not Have
Any Significant Side Effect.
Conclusion:
Intramuscular Oxytocin Results In Less Blood Loss With Least Side Effects And Can Be Used Safely In All Cases In The
Third Stage Of Labour To Prevent Postpartum Haemorrhage When Compared To Intramuscular Methylergometrine.

***************

Archaeology In Gyneacology
Author: Prof. Dr Rajeshwari Khyade
Co Author: Dr Rajeshwari Laxman Khyade1, Dr Kirti Bendre2, Dr Geeta Niyogi3,

Background -Intrauterine Retention Of Fetal Bones Is A Rare Complication Of Abortion Causing Menorrhagia And
Secondary Infertility. Hysteroscopic Removal Of Fetal Bones Resulted In Resumption Of Normal Menstrual Cycle With
Better Chances For Conception.
Case A 25Yr Old Lady P1L1 With Previous History Of Mtp At 1 1/2Months Followed By Check Curettage Came To Our
Clinic With History Of Menorrhagia And Secondary Infertility, Ultrasound Revealed Presences Of Foreign Body.
Hysteroscopic Removal Of Fetal Bones Was Done. Patient Resumed Normal Menstrual Cycle With Normal Flow And Was
Subjected For Ovulation Induction With Follicular Monitoring.
Conclusion Intrauterine Retention Of Fetal Bone May Result In Abnormal Uterine Bleeding, Secondary Infertility And
Chronic Pelvic Pain. Recognition Of Foreign Body In The Uterine Cavity Is Of Great Clinical Importance For Successful
Treatment Of Secondary Infertility.

***************

Alarming Rise In Cases Of Peripartum Hysterectomy For Placenta Accreta- Our Experience At A Tertiary Care Center
Author: Dr. Devyani Misra
Co Author: Dr. Pushplata Sankhwar1,

Background- Peripartum Hysterectomy Is An Important Life-Saving Procedure In Cases Of Severe Obstetric Haemorrhage
And Is Associated With High Morbidity. Despite Advances In Medical And Surgical Management Of Obstetric
Haemorrhage, It Continues To Be The Leading Cause Of Maternal Mortality Worldwide. Aim- The Aim Of This Study Was
To Evaluate The Incidence, Risk Factors, Indications, Complications And Change In Trends Of The Indications For
Peripartum Hysterectomy In Recent Years. Methodology- A Retrospective Analysis Of The Medical Records Of Patients
Who Underwent Peripartum Hysterectomy At The Department Of Obstetrics And Gynaecology, Kgmu, Lucknow, Between
1St January 2004 And 31St December 2013 Was Done. Maternal Characteristics, Details Of Pregnancy And Delivery,
Indications For Ph, Intraoperative Findings, Postoperative Complications, Maternal And Neonatal Outcomes Were
Recorded. The Data Was Analysed To Assess The Outcome. Results- A Total Of 49,979 Deliveries Occurred During The
Study Period Of 10 Years At This Center, During Which 502 Cases Of Peripartum Hysterectomies Were Performed. The
Incidence Of Peripartum Hysterectomy Was 1.00%. A Higher Incidence Of The Need For Hysterectomy Was Observed
With Increasing Parity And Prior Uterine Surgeries. Morbidly Adherent Placenta Was Noted To Evolve As The Primary
Etiology For Peripartum Hysterectomy Over The Duration Of This Study Taking Precedence Over Atonic Postpartum
Haemorrhage And Rupture Uterus. Maternal Mortality Associated With Peripartum Hysterectomy Was 27.49%.
Conclusion- Anticipation Of Risk Factors And Prompt Management Can Help Avoid A Large Number Of Peripartum
Hysterectomies. Judicious Decision For Indication Of Primary Caesarean Sections Has To Be Practiced To Avoid Later
Complication Of Morbidly Adherent Placenta.
***************

Small Bowel Ischemia In Pregnancy

Author: Dr. Bala Selvi
Co Author: Asst Professor Dr.Valarmathy M.D.D.G.O1, Asst Professor Dr.Vijayalakshmi.M.D.D.G.O2, Professor
Dr.Umadevi.M.D.D.G.O.3,

Background- Small Bowel Ischemia Due To Superior Mesentric Vein Thrombosis Is Rare During Pregnancy.However
Additional; Precipitating Factors Should Usually Be Identified.After Searching The Medline Only 16 Cases Of Small Bowel
Ischemia Are Reported To Have Occured In Pregnancy.
Case-An 18 Old Primi With Ho 6 Month Of Amenorrhoea With Lmp On 22-12-13 Was Reported Gandhigram Kasturba
Hospital As Perforation Peritonitis.An Emergency Exploration Revealed Right Para Duodenal Hernia With Gangrenous Sall
Bowel From 15 Cm Distal To Dj Flexture 2 Feet Proximal To Ileocaecal Junction.Resection Of Gangrenous Bowel
Done.Viability Of Rest Of Bowel Normal. Hence Proceeded To Jejunoileal Anastomosis (Side To End).Based On Operative
And Pathological Findings ,Small Bowel Ischemia Might Be Attributed To Superior Mesentric Vein Thrombosis.
At Term She Delivered By Lscs Without Complication Intra Operatively And Post Operatively.
Conclusions-Hypercoagulation State Normally Found In Pregnancy Is Believed To Lead To This Catastrophic Condition
With Out Other Precipitating Factors.
***************

A Case Report Of Twin Twin Transfusion Syndrome

Author: Dr. M Lipika
Co Author: Sahoo Sasmita1, Panigrahi R.K.2, Kar T.3,

Background- Ttts Is A Serious Condition That Can Complicate 8-10% Of Twin Pregnancies With Monochorionic Diamniotic
Placentation.The Diagnosis Of Ttts Requires 2 Criteria:(1) The Presence Of A Mcda Pregnancy(2) The Presence Of
Oligohydramnios In One Sac, And Of Polyhydramnios In The 2Nd Sac.The Quintero Staging System Appears To Be A Useful
Tool For Describing The Severity Of Ttts .
CaseA 27 Yr Hf ,G2P1 At 29 Weeks Gestation With Twin Pregnancy Was Admitted To The Labour Room On 24/10/12 With
Complaints Of Pain In Lower Abdomen For 1 Day .Usg On 24.10.12 Revealed Monoamniotic-Monochorionic Twin Live
Intrauterine Fetuses ,Afi-40.Placenta-Single, Anterior & Fundic, Grade Ii, Membrane Separating Both Twins Not Seen.1St
Twin Aga 31 Weeks.Efw 1880 Gm Is Enlarged In Size Showing Fetal Ascites And Scalp Swelling Evidence Of Fetal Hydrops
And Recipient 2Nd Twin Aga-28 Week Efw 1217 Gm, Small In Size.Findings Suggest Twin-Twin Transfusion
Syndrome.Amnioreduction Done.Patient Went To Spontaneous Labour.The First Twin, A Live Preterm Female Baby
Delivered Vaginally By Assisted Breech At 1.20 Pm/27.10.12 /2.3 Kg.Baby Was Plethoric With Subcutaneous
Oedema,Facial Puffiness,Parietal Oedema,Cyanosis Of Both The Legs.The Second Twin, A Live Preterm Female Baby Was
Delivered By Vertex Presentation At 1.25 Pm/27.10.12/ 800 Gms And Small For Ga.Both The Babies Were Asphyxiated
And Did Not Cry After Resuscitation And Transferred To Sncu. Placenta Was Monochorionic-Diamniotic.1St Twin Died
After 10 Hours Of Delivery Due To Cardiac Failure& 2Nddied After 19 Hours Of Delivery.
Conclusion-Many Patients With Stage I Ttts Managed Expectantly And Advanced (Eg, Stage Iii) Ttts Perinatal Loss
Rate Of 70-100%, Particularly When It Presents <26 Weeks. Fetoscopic Laser Photocoagulation Of Placental Anastomoses
Is Considered By Most Experts To Be The Best Available Approach For Stages Ii, Iii, And Iv Ttts With A Perinatal Mortality
Rate Of 30-50%.

***************

An Unusual Case Of Gestational Thrombocytopenia Superimposed By Viral Infection

Author: Dr. Priyanka Budania
Co Author: Dr. Kusum Lata Meena1, Dr. B.S. Meena2, Dr. Mohan Lal Meena3,

Background
Thrombocytopenia Is Classically Defined As A Platelet Count Of Less Than 150,000/L. It Affect 6-10% Of All
Pregnancy And Second Only To Anemia As The Most Commonly Encountered Blood Disorder In Pregnancy. It May Result
From Diverse Etiology-Gestational Thrombocytopenia, Idiopathic Thrombocytopenic Purpura, Von Willibrand Disease,
Viral And Bacterial Infections, Preeclampsia Complicated By Hellp, Hemolytic Uremic Syndrome, Thrombotic
Thrombocytopenic Purpura Etc.

Case
A 24 Yr Old G1 Female Was Diagnosed With Thrombocytopenia In The Third Trimester Of Gestation. Her Platelet
Count Were 39,000/L At Time Of Admission. Rest All Investgations Including Hb, Tlc, Dlc, Rfts, Lfts, Coagulation Profile,
Reticulocyte Count, Coombs Test, Viral Markers, Ana, Thyroid Profile Were Normal. Patient Also Had History Of Chicken
Pox 1 Month Back . So The Patient Was Diagnosed As Gestational Thrombocytopenia Superimposed By Viral Infection. 12
Units Of Blood Components Were Transfused. She Was Also Treated With Steroids. In The 38Th Week Labour Was
Induced. She Gave Birth To A Healthy Male Child Of 3.4 Kg. Breast Feeding Was Established. On The 4Th Postpartum Day
Platelet Counts Were 44000 /L, Both The Patient And Healthy Baby Were Discharged On Request . On First Follow Up
PatientS Palatelate Count Were 1,09,000/L.

Conclusion
Pregnancy Complicated With Thrombocytopenia Is A Relatively Common Occurrence And Challenge To The
Obstretician. The Myriad Of Disease Processes, Either Pregnancy-Induced Disorders Or Preconception Medical
Conditions, Can Cloud The Correct Diagnosis. The Great Majority Of Patients With Gestational Thrombocytopenia Have
A Benign Condition, But A Minority Of Patients Who Have A More Serious Disease Are At Risk For Serious Morbidity And
Mortality. With A Thorough History, Physical Examination, Focused Laboratory Evaluation, And Multidisciplinary
Approach Including Physician And Hematologists, These Patients Uniformly Have Favorable Outcomes And Can Be Safely
Managed.
***************

Twin I Says To Twin Ii- Are We With An Alien? A Rare Case Of Complete Mole With Viable Twins.
Author: Dr. Vaishnavi
Co Author: Dr. Umashanthi Md, Dgo1,

Background
Complete Mole With Co Existent Viable Pregnancies Is Uncommon. It Is Very Rare Incidence, Less Than 20
Cases Of Complete Mole With A Co Existent Singleton Viable Pregnancy Is Being Reported In Literature. A Complete Mole
With Co Existent Viable Twins Is Further Less.
Case Presentation
35 Years G4A3, Married Since 16 Years, Conceived After Ivf Treatment Came To Our Opd With Usg Showing
Tcta Triplets, One Being A Complete Vesicular Mole. Her Ga Was 13 Weeks . She Was Admitted In September 2013. She
Was A Known Case Of Hypothyroidism And On Tablet Thyroxin 100 Mcg 1 Od. She Had Mildly Increased Bp And So Was
Put On Tablet Labetalol 100Mg Bd And Tablet Ecospirin 75Mg 1Od Since Then. Pih Investigations Were Normal. Usg At
Iog Confirmed The Diagnosis With Vesicular Mole Lying Close To The Os. Patient Was Carefully Monitored Daily And Was
Discharged At Request On December 2013. She Again Came To Our Opd With C/O Mucoid Discharge At 30 Weeks
Gestation. She Was In Early Labour. She Was Kept Under Vigilant Observation. On 16.1.14, She Delivered Two Alive
Preterm Babies With Outlet Forceps And The Mole Was Adherent To The The Placenta Of Twin 2. Hpe Report Confirmed
The Diagnosis Of Complete Vesicular Mole.
Conclusion
Incidence Of Complete Mole With Viable Pregnancies Is Extremely Rare. Presence Of Mole With A Viable
Pregnancy Is Not An Indication For Termination Of Pregnancy But Requires Extreme Care And Caution.

***************

A Novel Approach To Krukenberg Tumor 2 Case Reports

Author: Dr. Danu C
Co Author: Dr.Betsy Thomas1,

Background
Krukenberg Tumor Is A Rare Metastatic Tumor To Ovary; Usually From A Primary Gastrointestinal Or Breast
Malignancy. It Accounts To Only 2% Of Ovarian Tumors And Is 80% Bilateral. It Is Usually Not Discovered Until The Primary
Disease Is Advanced And Therefore Most Patients Die Within 1 Year Of Diagnosis. No Literature Defines An Optimal
Treatment For Krukenberg Tumor. Whether A Surgical Approach, In An Advanced Malignancy Like Krukenberg Tumor,
Improves The Quality Of Life And Survival Rate Is Yet To Be Answered.
Case
Case 1 29Year Old P1L1A3 With Abdominal Pain, Easy Fatigability And Irregular Periods Was Found To Have
Carcinoma Of Stomach With Bilateral Krukenberg Tumor. A Whole Body Pet-Ct Scan Ruled Out Metastasis Elsewhere.
Considering Her Young Age And Possibility Of Complete Resection Of The Tumor, We Did A Primary Debulking
(Gastrectomy+Bilateral Ovariectomy) Followed By Adjuvant Chemotherapy Instead Of Subjecting Her For A Palliative
Treatment Alone. Now After 5 Cycles Of Chemotherapy She Is Doing Well And Is On Follow Up.
Case 2 43Year Old P4L4 With Abdominal Pain,Dyspepsia,Constipation,Single Episode Of Bleeding Per Rectum
And No Menstrual Irregularities. Uss Revealed Right Ovarian Mass. Ca125-9.23. Underwent Right Ovariotomy. Hpr
Showed Scattered Signet Ring Cells. Possibility Of Metastasis From Adenocarcinoma. Further Investigations Revealed
Carcinoma Of Stomach And Rectosigmoid With Ovarian Malignancy. Pet-Ct Showed No Other Metastasis. She Underwent
Gastrectomy+Anterior Resection+Tah+Left Ovariotomy. Completed 8Cycles Of Chemotherapy And Is On Follow Up.
Conclusion
Krukenberg Tumor Is A Stage4 Disease Which Otherwise Mandates Palliative Chemotherapy. Whether A
Primary Debulking Can Increase The Response To Chemotherapy And Prolong Life Is Still Debated. Literature Shows That
Ovarian Metastasectomy Is Beneficial If Gross Residual Disease Can Be Thoroughly Eradicated. More Prospective Studies
Are Needed To Set A Therapeutic Approach For Krukenberg Tumor In The Hope Of Improving Survival Rate Of Such Young
Patients.

***************

Sub Septate Uterus With Transverse Lie

Author: Dr. Basudev Marandi
Co Author: Dr. T.Kar . S.C.B. Medical College,Cuttack1, Dr. R.K.Panigrahi .S.C.B. Medical College,Cuttack2, Dr. U.Naik.
S.C.B. Medical College,Cuttack3,

Background
Congenital Uterine Malformations Are Known To Have A Higher Incidence Of Infertility, Repeated First Trimester
Spontaneous Miscarriages, Fetal Intrauterine Growth Restriction, Fetal Malposition, Preterm Labor, Retained Placenta
And Increased Cesarean Section Rate.
Mullerian Anomalies Are The Consequence Of Four Major Disturbances In The Development Of The Female Genital
System During Fetal Life:
1.

Failure Of One Or More Mullerian Ducts To Develop (Agenesis, Unicornuate Uterus Without Rudimentary Horn)

2.

Failure Of The Ducts To Canalize (Unicornuate Uterus With Rudimentary Horn Without Proper Cavitation)

3.

Failure To Fuse Or Abnormal Fusion Of The Ducts (Uterus Didelphys, Bicornuate Uterus)

4.

Failure Of Resorption Of The Midline Uterine Septum (Septate Uterus, Arcuate Uterus).

Case
A 25Years G3P2L1 At Ga 39Weeks 4Days Came To S.C.B.Medical College, Cuttack On 05.09.14 At 12.30Pm With Complaint
Of Leaking P/V Since 12Hr & Intermittent Mild Pain Lower Abdomen Since 1Day.
On Examination P/A- Uterus Term Size, Transverse Lie, Lower Pole Empty. Contraction-1-2 In 10Min Lasting For 1015 Sec. Relaxation Good. Fhr- 138/Min
P/S-Frank Leaking (+).P/V- Cx-Fully Effaced, Os-4Cm Dilated.
Usg Finding-Single Live Intra Uterine Fetus At Ga-32 Weeks 6 Days. Transverse Lie, Placenta-Fundal, Grade3 Maturity,
Amniotic Fluid 10Cm.
Pt Was Diagnosed As G3P2L1At Ga 39Weeks 4Days With Transverse Lie With Prom>12Hrs. Hence Lscs Decision Was
Taken.
Lscs- A Live Term Mch Weighing 2.25 Kg Delivered By Breech Extraction At 04.02Pm On 05.09.14. Uterus Was Found To
Be Sub-Septate. Rest Of Intra-Op & Post-Op Period Was Uneventful.
Conclusion
Abnormal Lie With Preterm Labour Cases Can Be Suspected Of Any Congenital Uterine Anomaly And Imaging Methods
Like Usg Can Aid In Diagnosis But The Final Diagnosis Can Be Made During Caesarian Section.

***************

HashimotoS Thyroiditis In Pregnancy

Author: Dr. Muhammed Mahenoor
Co Author:

Background
Hypothyroidism Occurs In 2.5% Of All Pregnancies Including Both Clinical And Subclinical Cases. 0.05% Of All
Pregnant Women Have Overt Hypothyroidism. Hashimoto'S Is The Leading Cause Of A Declined Thyroid Level Due To
Autoimmunity And The Major Cause Of Hypothyroidism In Developed Countries And Second In Developing Nations Next
To Iodine Deficiency During Pregnancy. 10-20% Of All First Trimester Gestations Are Euthyroid With Positive Antibody
Profile And 16% Of Them Develop Subclinical Hypothyroidism By 3Rd Trimester (Tsh > 4 Miu/Ml). Most Of Them Are
Failed To Be Recognized By Clinicians Due To Lack Of Screening For Antibodies.One Such Case Was Diagnosed As
HashimotoS Thyroiditis.
Case Report
A 22 Year Old Primi Of 6 Weeks Gestation Showed Tsh Value As High As 17 Miu/Ml While Ft3 / Ft4 Being Within
Normal Range. Patient Showed Diffuse Goitre And Gives A Positive Family History Of Hypothyroidism In Her Mother For
5-6 Years Yet, Was Subjected To Repeat Profile In Addition To Testing Antibodies Against The Gland. To Our Surprise
Though The Repeat Tsh Was 4.03 Miu/Ml, The Antibodies Were Abnormally High With Tpoab 359.29 Iu/Ml [< 35
Iu/Ml] And Tg Ab 701.91 Iu/Ml [<20 Iu/Ml]. American Thyroid Association (Ata) Recommends Only 2.5 Miu/Ml As The
Acceptable Limit For Tsh In I Trimester And 3 Miu/Ml During Ii/Iii Trimester.
She Was Started On 25Mcg Levothyroxine And Was Found To Develop Upper Abdominal Pain. Reassured And
An Endocrinologist Opinion Was Sought To Incur The Fact That Her Dosage Needed To Be Stepped-Up To 75Mcg Despite
Her Symptoms That, Shall Abate As Time Passes. Astoundingly, She Fared Well Without Any Further Complaints. 4 Weekly
Follow Up Of Tsh Was Done And Dosage Was Adjusted Accordingly.
Clinical Relevance
Pregnancy Is A Stress Test For Thyroid Function Leading To Hypothyroidism Due To Increase Iodine Deficiency
And Demand Upto 50% More Than Usual. Hypothyroidism Is Associated With Increased Risk Of Miscarriage, PreEcclamsia, Preterm Labour, Still Birth, Fetal Distress During Labour, Lbw, Cardiac Failure, Pph, Postpartum Depression.
Uncontrolled State During Gestation Leads To Poor Psychomotor Development And Lower Iq In The Offsprings. Thyroxine
DoesnT Cause Fetal Thyrotoxicosis As Placenta Metabolises Most Of It And No Known Lethal Congenital Disorders
Too. Though Labour DoesnT Warrant Special Management In The Optimally Treated Ones, 25% Cases Develop
Postpartum Thyroditis And About 10-20% Subclinical Cases Progress To Overt Hypothyrodism Within 1-4 Years
Accounting For Screening Later. The Indian Thyroid Society (Its), Thyroid Dysfuntion And Pregnancy Guidelines
Recommends Screening For Hypothyroidism With Tsh During 1St Antenatal Visit. This Patient Was A School Dropout
During Childhood Owing To Slow Learning And Could Be A Victim Of Unevaluated Disease In Her Mother While She Had
Been A Recipient Intrauterine Then. High Prevalence Of Thyroid Disorders (11%) In India With Low Quality Of Life Is Due
To Minimal Diagnosis, Low Awareness And Low Involvement Of Doctors In Treatment. Lets Contribute Our Part With
Humanitarianism In Order To Avoid Avertable Incompetence In Our Contemporaries And In The Future Generation.

***************

Effect Of Lamivudine Treatment In The Third Trimester In Hepatitis B Positive Pregnant Women In Decreasing The
Viral Load And Subsequent Fetal Transmission.
Author: Dr. Beena Guhan
Co Author: Dr. Smitha D.S1,

Background

Hepatitis Infection Is Most Commonly Acquired Through Either Perinatal Or Horizontal Transmission. The Risk Of Perinatal
Transmission Of Hbv Increases As The MotherS Viral Load Increases. This Study Was Aimed To Stop Such Transmission
From Highly Viremic Mothers By Giving Them Lamivudine Antenatally.

Objectives

To Study The Effect Of Lamivudine Treatment To Decrease Hbv Dna Viral Load In The Third Trimester In Hbsag Pregnant
Positive Women And Its Effect On Mother To Child Transmission Of Hepatitis B.

Methodology

Hbsag Pregnant Women Satisfying The Inclusion Criteria Were Selected For This Prospective Case Control Study Of 30
Each In Case And Control Group. Hepatitis B Viral Dna Load Was Seen At 28Weeks And Lamivudine Started At 32 Weeks
In The Case Group. Both Groups Were Followed Up Till 1Month Postpartum And Babies Till 6Months For Hbsag Positivity.

Results

Prevalence Of Hepatitis B Infection Was More In The Peak Reproductive Age Group Of 25-30 Years. Transmission Rate Of
36.1% Was Observed In Hbeag Positive Mothers. A Significant Fall Was Seen In The Dna Viral Load In The Range Of 10Log
4 To 10 Log 6 In The Case Group (P Value 0.000). 48.3% Hbeag Positive Mothers In The Case Group Became Hbeag
Negative At The End. A Significant P Value 0.001 Was Observed. 46.7% Babies In The Control Group Versus 16.7% In The
Case Group Turned Out To Be Hbsag Positive At The End Of The Study. P Value Was Significant (0.012).

Interpretation And Conclusions

By This Study It Stands To Reason That If The MotherS Viral Load Can Be Reduced At The Time Of Birth, The Risk Of
Perinatal Transmission Can Be Reduced. Studies In This Field Were Sparse And This Was A Seminal Attempt To Encourage
More Studies In This Direction, To Save Babies From A Deadly Chronic Infection.

***************

Prophylactic Uterine Artery Catheterization Before Caesarean Section In High-Risk Pregnancy

Author: Dr. Priyanka K
Co Author: Dr. Aruna Muralidhar1, Dr. Shama Rao2, Dr. Padmalatha Venkataram3,

Background
Abnormal Placentation Broadly Comprising Of Placenta Previa, Accreta, Increta, And Percreta, Is A Leading Cause Of
Massive Peripartum Hemorrhage With Blood Loss Varying From 3,000 To 5,000Ml. Pregnancy With Lower Uterine
Segment Fibroid Requiring A Caesarean Section For Obstetric Indications Has Also Been Associated With Peripartum
Hemorrhage. There Seems To Be An Increasing Trend In The Incidence Of These Conditions Which Could Be Due To A
Significant Increased Rates Of Caesarean Sections In Our Country.

We Report A Case Series With The Use Of Intra-Arterial Balloon Catheters Introduced Preoperatively. This Procedure Is
Performed Under Fluoroscopic Guidance By An Interventional Radiologist Prior To The Caesarean Section, With Occlusion
Catheters Placed In The Bilateral Uterine Arteries. These Catheters Are Inflated Immediately In Case Of Peripartum
Hemorrhage, Thus Minimizing Maternal Complications.

Cases
We Present A Case Series Of Three Patients - Previous Lscs With Central Placenta Previa, Large Anterior Wall Fibroid
Occupying More Than Half Of The Lower Segment And Placenta Previa With Increta. All Three Cases Had Intra-Arterial
Balloons Placed Preoperatively. In The Last Case The Balloon Was Inflated To Give Occlusion Support For 50 Mins And
Was Deflated At The End Of Surgery When The Haemostasis Was Satisfactory. All Three Cases Did Not Have Post
Operative Bleeding And The Catheters Were Removed The Next Day After Overnight Observation. All Three Mothers And
Babies Have Been Followed Up And Are Doing Well.

Conclusion/ Clinical Relevance

Postpartum Hemorrhage Is A Leading Cause Of Maternal Mortality In Developing Countries. In Recent Years, There Has
Been Significant Interest In The Potential Role Of Interventional Techniques In Obstetrics, Specifically In The Control Of
Peripartum Hemorrhage And Avoidance Of Caesarean Hysterectomy. The Importance Of Referral To Tertiary Care Centre
For The Management Of High Risk Cases Is Essential And Cost Effective In Improving Maternal Outcomes.
***************

Polycythemia Vera In Pregnancy - A Case Report

Author: Dr. Harmanpreet Kaur
Co Author: Dr Ripan Chanana1, Dr Madhu Nagpal2,

Background
Association Of Polycythemia Vera In Pregnancy Is Rare, Estimated Incidence Being 0.004 Per 100000 In Women Aged 2034 Years And 0.25 Per 100000 In 35- 39 Yrs Age Group.
Case
29 Year Old Patient Was Referred To Sgrdimsr Amritsar At 36Wks Gestation With Proven Diagnosis Of Polycythemia
Vera(Pv). At Admission Her Haematocrit Was Normal, So Was Categorized As High Risk Pregnancy With Low Risk Pv.
She Was First Diagnosed At Age Of 25 Years When She Developed Pain Abdomen, Paraesthesia, Aquagenic Pruritis,
Erythromelalgia. Investigations Revealed Hb 17.5Gm Tlc 20500/Cumm, Platelet Count 432000/Cumm, Serum Iron
54Mcg/Dl, Tibc310Mcg/Dl. Diagnosis Was Confirmed After Testing For Jak2V617F Mutation. She Was On Aspirin(75Mg),
Itopride, Zolpidem, Propranolol, Alprazolam And Fluoxetine. Three Phlebotomies Were Performed To Bring Her Hb Below
12Gm%
She Gave History Of Menorrhagia (Mf 15/28Days) 2Yrs After Marriage With Endometrial Hyperplasia (On Usg), Controlled
On Cyclical Progestogens For Two And Half Years.
She Remained Asymptomatic (2Yrs), Till She Presented With Pain Abdomen And Vomiting (Amenorrhoea Eluded). Usg
Revealed Viable Fetus With 12 Wks Gestation. She Underwent Regular Antenatal Care, Aspirin Continued Till 36 Wks.
Before Referral Usg Revealed Fetus With Estimated Weight 3210 Gms, Afi 20, Transverse Lie With Anterior Upper
Placenta. Emergency Lscs Was Done, Live Male Baby (3Kg) Was Delivered. Intra/Post Operative Period Were Uneventful.
Patient Was Discharged On Day 9 With No Evidence Of Disease In Newborn.
Clinical Relevance
Pv Is Most Commonly Due To Cytogenetic Abnormality Of Jak2Gene. The Risks With Pv In Pregnancy Are Unclear. Only
50 Pregnancies Have Been Reported So Far. Treatment Varies With Severity Of Disease. Adverse Outcome Of Pregnancy
Are Early/ Late Pregnancy Loss, Iugr, Preterm Labour, Maternal Morbidity And Mortality. Prepregnancy Diagnosis And
Preconceptional Stability With Aggressive Management Is The Key Stone.

***************

Successful Management Of A Scary Case Of Caesarean Scar Pregnancy With Combined Treatment Using
Methotrexate ,Uterine Artery Embolisation And Suction Evacuation
Author: Dr. Priyanka Mehta
Co Author: Prof Usha Vishwanath1, Prof Santosh Joseph2, Dr Anita Manoharan3,

Background
Caesarean Scar Pregnancy (Csp) Is The Rarest Type Of Ectopic Pregnancy Implanted In The Myometrium At The Site Of
The Previous Caesarean Section Scar. It May Lead To Catastrophic Complications Like Uterine Rupture And
Uncontrollable Haemorrhage4. Early Diagnosis Can Offer Treatment Options Of Avoiding Uterine Rupture And
Haemorrhage, Thus Preserving The Uterus And Future Fertility.
The Conservative Treatment Can Be By Local And/Or Systemic Administration Of Methotrexate , Dilatation And Curettage
, Excision Of Trophoblastic Tissues (Laparosopy/ Laparotomy) And Uterine Artery Embolisation 7 Combined With
Curettage And/Or Methotrexate .

Case
A 36 Year Old Female Gravida 3 Para 1 Abortion 1 At 11 Weeks Of Gestation Diagnosed With Caesarean Scar Pregnancy
Was Referred To Our Tertiary Care Institute For Further Management. She Had A Previous Caesarean Section With
Serosal Bladder Injury, Which Was Repaired In Layers In 2009. She Had Open Myomectomy In 2006 For Fundal
Intramural Fibroid . She Had Spontaneous Miscarriage In 2005 For Which Check Curettage Had Been Done. She Was A
Known Diabetic On Insulin For 5 Years.
We Did Successful Treatment Of A Viable Caesarean Scar Pregnancy By Systemic Injections Of Methotrexate Followed
By Selective Uterine Artery Embolisation In Combination With Dilatation And Curettage.
Conclusion
Caesarean Scar Pregnancy Is One Of The Rarest Forms Of Ectopic Pregnancy. Little Is Known About Its Incidence And
Natural History .With Increasing Incidence Of Caesarean Section Worldwide, More And More Cases Are Diagnosed And
Reported
Keywords : Caesarean Hysterectomy, Caesarean Scar Pregnancy,
Maternal Morbidity, Placenta Accreta, Uterine Rupture

***************

Non Classical Congenital Adrenal Hyperplasia: An Unusual Cause For Primary Amenorrhea With Virilization
Author: Dr. Deepthi Nuthalapati
Co Author: Dr. P.Chandrasekhar1, Dr.C.Anuradha2, Dr.V.A.A.Lakshmi3, Dr.P.Jayanthi4, Dr.Jhansi Vani5

Background
Congenital Adrenal Hyperplasia Due To 21-Hydroxylase Deficiency Is One Of The Most Common Autosomal Recessive
Hereditary Diseases. The Impairment Of Cortisol Synthesis Leads To Excessive Stimulation Of Adrenal Glands By
Adrenocorticotrophic Harmone, Adrenal Hyperplasia, And Excessive Androgen Synthesis. Clinical Manifestations Of
Milder Forms Of Enzyme Deficiency Result From Hyperandrogenism Such As Menstrual Disturbances, Infertility And
Hirsutism.

Case

An Unmarried Female Presented At 18 Years Of Age With Primary Amenorrhea, Masculine Voice And Excessive Hair All
Over The Body. On Examination : Height -131 Cm ,Weight-31 Kgs, Arm Span-136 Cms, Breast-Tanner Stage 1, Pubic HairTanner Stage 4, Voice- Coarse Deep Voice, Masculine Type Of Distribution Of Hair Present
Local Examination
Labia Majora-Posteriorly Fused, Clitoromegaly With Clitoral Index Of 250Mm2
Per Rectal- Hypoplastic Uterus
Investigations
Karyotype- 46,Xx- Normal Female Karyotype
Usg-Uterus. 4.2X 1.5 X2.7 ;Ovaries Normal
Ct Abdomen -Showed Bilateral Adrenal Hyperplasia
Hormonal Assays
17-Hydroxyprogesterone--550Ng/Ml, Fsh-5.25 U/L, Lh-2.23 U/L, Estradiol-131.6Pg/Ml, Testosterone-475.6 Ng/Dl, Dhea.
1.99 , Dheas 66.17, Cortisol-0.01Microg/Dl , T3,T4 ,Tsh-Normal
Serum Electrolytes:Normal

She Was Diagnosed As Non Classical Late Onset Congenital Adrenal Hyperplasia Due To 21-Hydroxylase Deficiency.
Treatment Advised: Hydrocortisone-10 Mg ;One Tablet In The Morning ,Half Tablet In The Evening . Patient Was Advised
For Monthly Follow Up With Harmonal Assays To Asses Regression Of Symptoms With Treatment.

Conclusion

With Adequate Medical And Surgical Treatment The Prognosis Is Good. Patient Has To Be Provided With Stress Doses Of
Glucocorticoids In Times Of Illness, Trauma Or Surgery. The Principal Goal Of Treatment Is To Improve Quality Of Life ,

Ensure That They Remain Fertile, Reduce The Manifestations Of Hyperandrogenism And Minimise The Adverse Effects Of
Glucocorticoid Therapy.

***************

Lymphangioma Circumscriptum: A Great Mimicker

Author: Dr. Varnit .
Co Author: Prof. K K Roy1, Prof. Sunesh Kumar2, Dr. J B Sharma3, Dr. Neeta Singh4, Dr. Latika Chawla5

Background
Lymphangioma Circumscriptum (Lc) Is A Developmental Defect Of Lymph Channels Present In The Skin And Subcutaneous
Tissues. It Can Be Developmental Or Acquired. Axilla, Adjacent Chest Wall, Oral Cavity And Tongue Are Common Sites Of
Lymphangioma Circumscriptum And Vulva Being An Extremely Uncommon Site Of Occurrence.

Case

65Yr Postmenopausal Woman Presented With C/O Bilateral Lower Limb Edema For 20Yrs, And Growth On Vulva For 15
Yrs. There Is H/O Pain And Occasional Blood Tinged Discharge From The Mass. On Examination Of Vulva, There Was A
Large Irregular Warty Growth Involving Both Labia Majora, Resembling Frog Spawn. There Were Also Multiple Small
Satellite Lesions On The Mons Pubis. Lymphangiography Of Bilateral Lower Limbs Was Normal. Mantoux Test, Filarial
Antigen, Chlamydia Antibody Test Were Negative. She Received Treatment Multiple Times In Past. She Is Also A Known
Case Of Ulcerative Colitis Since 10 Yrs. She Underwent Wide Local Excision And Hpe Was Reported As Lymphangioma
Circumscriptum. She Is Currently Under Follow Up.

Conclusion

Our Aim Is To Highlight An Unusual And Extremely Rare Case Of Vulval Growth. Vulval Lc Poses A Diagnostic Challenge To
The Treating Gynaecologist Because Of Various Clinical Mimics. It Affects Quality Of Life Of Women, As The Large Vulval
Growth And Pedal Oedema Causes Difficulty In Walking, And Negatively Affects Sexual Image.. With Proper Treatment
Quality Of Life Can Be Improved, Though No Permanent Cure Is Available.

***************

Chronic Non Puerperal Inversion -Unravelling Mystery

Author: Dr. Aishwarya Parthasarathy
Co Author: Aishwarya Parthasarathy1, Latika Chawla2, Sunesh Kumar3, K.K.Roy4, J.B.Sharma5

Background
Non Puerperal Inversion Is An Extremely Rare Phenomena . It'S Variable Presentation Poses A Clinical Challenge In The
Diagnosis And Management
Case
Two Cases Presented In The Outpatient Department Of Aiims, New Delhi. First Case Was A 56 Year Old Post Menopausal
Woman With Post Menopausal Bleeding And Discharge Per Vaginum . Examination Revealed A 7 Cm Growth In Vagina
Which Bled On Touch And Cervix Could Not Be Felt. Usg Revealed A Large Polyp In Vagina. Polypectomy Was Attempted
Thrice. Laparotomy Was Done That Revealed A Inversion Of Uterus With A Multiple Polypoidal Mass On The Fundus.
Inversion Was Corrected By Huntington'S Technique And Total Abdominal Hysterectomy And Bilateral
Salpingoopherectomy Was Done. The Histopathology Revealed Adenofibroma , A Rare Benign Mesenchymal Tumour .
Second Patient Was A 35 Yr Old Female With Polymenorrhagia , Intermenstrual , Post Coital Bleeding And Foul Smelling
Disharge Per Vaginum . Per Speculum Revealed A 7 *7 Cm Irregular Growth In The Vagina With Blood Stained Discharge,
Cervical Rim Could Not Be Felt. With The Suspicion Of Cancer Cervix, Biopsy Was Taken Twice And Necrotic Tissue Was
Obtained Both The Times. Mri Report Revealed A Growth In The Uterus And Extending To The Adnexa , Suggestive Of A
Mixed Mullerian Malignant Tumor . Laparotomy Was Done That Revealed Inversion Of Uterus With A Growth Arising On
Fundus. Histopathology Reavealed Leiomyosarcoma, A Malignant Tumor .
Conclusion
A Bulky Growth In The Fundus Can Cause Uterine Inversion And Present With Varied Symptoms. It Can Present In Both
Pre And Post Menopausal Women And Can Be Due To A Benign Or Malignant Pathology. Though Rare , It Is A Differential
Diagnosis In The Case Of Mass Felt Per Vaginum . Imaging Can Be An Aid But Not Supplement Clinical Suspicion.

***************

Ohss - A Case Study

Author: Dr. George Paul
Co Author: Dr Mary Daniel1,

Background
Ovarian Hyper Stimulation Syndrome Is A Rare Iatrogenic Life Threatening Complication Of Ovulation Induction That
Occurs In The Luteal Phase With Exogenous Gonadotrophins And Rarely With Clomiphene . This Condition Characterised
By Cystic Enlargement Of The Ovaries And A Fluid Shift From The Intravascular Space To The Third Space Due To Increased
Capillary Permeability Is Generally Self Limiting.
In Severe Form Of Ohss, Patient May Have Hemo Concentration, Thrombosis, Oliguria, Ascites, Pleural Effusion, Rarely
Pericardial Effusion,Respiratory Distress And Ards. Hereby Presenting One Such Case Of Severe Ohss Which Presented
With Respiratory Distress
Case
A 29Years Old Nullipara Married For 8 Months Presented With Complaints Of Sudden Onset Of Breathlessness Associated
With Abdominal Distension And Decreased Urine Output Following Ovulation Induction. Ultrasound Showed Bilaterally
Grossly Enlarged Ovaries With Bilateral Pleural Effusion And Gross Ascites. She Underwent Therapeutic Paracentesis
Draining 1.5L Of Fluid. She Was Transfused With 20% Human Albumin To Correct Hypoproteinemia. Patient Improved
And Repeat Ultrasound After A Week Of Admission, Showed Decrease In Size Of The Ovaries And No Appreciable Pleural
Effusion Or Ascites.

Conclusion/ Clinical Relevance

Patients With Severe Ohss Should Be Admitted, Monitored And Treated Under Intensive Care With Multidisciplinary
Approach To Tackle The Various Complications Associated With This Condition. Adequate Fluid Management Should Be
Titrated Depending On The Hemoconcentration And Urine Output To Restore An Effective Plasma Volume, Improve Renal
Function And Prevent Thrombosis. Correction Of Hypo Proteinemia With 20% Human Albumin Is Very Effective. If
Required, Therapeutic Thoracocentesis Or Paracentesis Maybe Performed In Cases Of Severe Respiratory
Distress/Collapse Of Lung Or Painful Ascites.
Patients Undergoing Ovulation Induction Should Be Thoroughly Evaluated And Monitored With Strict Guidelines For
Diagnosis Of Ohss, Thereby Preventing Thrombosis, Organ Failure And Ards.

***************

A Deceptive Infection In The Garb Of A Pelvic Tumour

Author: Dr. Ramya Sundaram
Co Author: Dr Anjalakshi Chandrasekhar1,

Background
Pelvic Actinomycosis Is An Extremely Rare Disease That Can Result In Serious Complications And Is Usually Seen To Be
Associated With Long Term Iucd Usage. However, The Correct Diagnosis Can Seldom Be Established Before Surgery
Because The Disease Often Mimics Ovarian Tumours. Here We Report A Case Of Pelvic Actinomycosis Without A History
Of Iucd Usage.
Case Study
35 Year Old Parous Woman, Sterilized, Presented To Our Outpatient Department With The Complaints Of Lower
Abdominal Pain For 2 Weeks And Polymenorrhagia For 2 Months. She Was Diagnosed As A Diabetic After Admission And
Started On Insulin. On Examination ,There Was An Infraumbilical Mass 56 Cm, Firm But Tender Along With An
Enlarged Uterus And An Adnexal Mass Of 55 Cm. Ct Abdomen Showed An Enhancing Lesion In The Pelvis Indenting
The Dome Of Bladder With Linear Extension To The Infraumbilical Region, Probably Endometriosis Or A Urachal Remnant
Malignancy. Further, Mri Showed Hyperdense Lesions With Cystic Areas In Bilateral Adnexa ,Possible Endometriosis.
Tumour Markers Were Within Normal Limits, Hence A Fnac Of The Infraumbilical Mass Was Done Which Suggested A
Soft Tissue Lesion With Infection. Cystoscopy Was Normal. Laparotomy Revealed A Subcutaneous Mass Extending
Intraperitoneally Upto The Dome Of The Bladder But Not Invading It And Bilateral Hemorrhagic Adnexal Masses Densely
Adherent Anteriorly To The Bladder And Posteriorly To The Bowel. Total Abdominal Hysterectomy With Bilateral Salpingo
Oopherectomy With Excision Of The Subcutaneous Mass Was Done.Histopathology Confirmed Actinomycosis Involving
Tubes, Ovaries And The Subcutaneous Tissue. Patient Was Started On Penicillin Therapy And Responded Well.
Conclusion
The Clinical Presentation Of Actinomycosis Often Simulates Gynecological Malignancies. Non Specific Imaging Findings
Render The Disease Undiagnosable. Correct Diagnosis And Appropriate Antibiotic Therapy Would Go A Long Way In
Preventing Complications.

***************

Social And Obstetrical Background In Association With Perinatal Birth Asphyxia -An Analysis In A Rural Tertiary Care
Centre
Author: Dr. Surajit Hazra
Co Author: Tanmay Mandal1, Taraknath Ghosh2,

Background
Perinatal Birth Asphyxia Is One Of The Leading Causes Of Neonatal Mortality Of Our Country. Who Estimates In
Developing Countries 3% Of All Infants Suffer From Mild To Moderate Birth Asphyxia Of Which 23% Die And
Approximately The Same Number Develop Serious Sequelae.
Aims And Objectives
Little Can Be Done For Babies Affected By Birth Asphyxia. So Prevention Is Unquestionably Desired. Our Goal Is To
Evaluate The Social Factors And Obstetric Causes (Both Ante Partum And Intra Partum ) In Association With Birth Asphyxia
To Make An Outline Preventive Strategy For Prevention Of Such Disaster.
Material And Methods
This Case Control Study Was Conducted At Labour Room And Got Of Department Of Gynaecology And Obstetrics,
Burdwan Medical College And Hospital. The Data Was Collected Prospectively On Day To Day Basis. Cases Were Baby
Born With Asphyxia And Control Were Baby Born Without Asphyxia.100 Cases And 100 Control Were Analysed.
Identification Of Risk Factors Were Done By Retrospective Comparison Of Both The Cases And Control Group.
Results
After Going Through Analysis Of Data Various Factors Have Been Identified To Be Associated With Birth Asphyxia.
Identified Social Factors Are Illiteracy(71% Vs 42%) ,Low Family Income (64% Vs 38%) ,Irregular Antenatal Checkup (82%
Vs 46%).Antenatal Risk Factors Are Hypertension And Eclampsia (46 % Vs 13%),Anaemia(58% Vs 33%),Multiple
Pregnancy(38% Vs 11%),Preterm Delivery (48% Vs 6%).Intra Partum Risk Factors Include Prolonged Second Stage Of
Labour (68% Vs 23%) Meconium Stained Liquour (84% Vs 6%),Breech Presentation(33% Vs 4%).All The Values Are
Statistically Significant (P<.05)
Conclusion
Most Of The Identified Risk Factors Are Either Preventable Or Can Be Managed With Timely Intervention. So Early
Prevention And Quick Diagnosis Of These Risk Factors Can Minimise The Incidence Of Birth Asphyxia.

***************

Placenta Percreta - Conservative Management

Author: Dr. Sivapriya R
Co Author: Prof.Dr. K.S.Chithra1, Prof.Dr. C. Shanthi2, Prof. Dr. Umadevi3,

Background
Placenta Percreta Defined As Abnormal Deep Invasion Of Placenta Into The Myometrium, Incidence Of 1 In 7000.
Incidence Is Dramatically Increased Due To Increasing Caesarean Section Rates.Maternal Morbidity And Mortality
Associated With Placenta Percreta Mainly Caused By Massive Haemorrhage Or Emergency Hysterectomy. The
Conservative Management Of This Condition Allows The Patient To Retain Her Fertility And Avoids The Problem Of
Massive Haemorrhage. We Are Presenting A Case Of Placenta Percreta Which Has Been Managed Conservatively.
Case
34 Yrs, Multigravida, 38 Wks Gestation, 2 Previous Lscs, Diagnosed As Case Of Central Placenta Previa By Usg, And Mri
Showed Invasion Into The Bladder. After Delivering The Baby By Elactive Classical Cs, Since No Separation Of Adherent
Placenta And Taking Into Invasion Of Bladder, Placenta Was Left In Situ. Post Operatively Inj. Methotrexate 4 Doses On
Alternate Days With Inj. Folinic Acid Given. Serial Monitoring Of Serum Beta Hcg, Usg Done, Which Showed Decreasing
Trend In Hcg Levels And Placental Volume Over 2 Weeks.Patient Discharged And Is On Close Follow Up.
Conclusion
Studies Suggest That Leaving Placenta In Situ Lowers The Risk For Subsequent Hysterectomy And Hence Be An Alternative
Line Of Management In Hemodynamically Stable Or Fertility Needs To Be Preserved. This Is Our Experience Regarding
Conservative Management After Thorough Counseling . It Decreases The Need For Massive Blood Transfusion And The
Morbidity And Mortality Associated With Caesarean Hysterectomy.

***************

Thrombotic Events In Pregnancy And Puerperium-Case Series & Review Of Literature

Author: Dr. Indira Ramya Swetha Kondeti
Co Author: Dr Venkata Sujatha Vellanki1, Dr Sajana Gogineni2, Dr Ushanag3, Dr Eswar G4, Dr Sasisekhar V5

Background
Pregnancy And Puerperium Are Most Prevalent Prothrombotic States.Cortical Venous Sinus Thrombosis May Present
With Headache,Cerebral Irritation&Neurologic Deficit And Arterial Thrombosis May Present With
Edema,Pallor,Coldness,Calf Muscle Tenderness&Decreased Pulses.Cvst May Occur In Conjuction With Hypertention,Pre
Eclampsia,Reversible Posterior Leucoencephalopathy&Dehydration.Added Risks For Thrombosis Include
Infections,Prolonged Immobility,Obesity,Smoking,Instrumentation&Caesarean Delivery.Complete/Partial Recovery Is
Possible Even With Severe Initial Presentation With Early Diagnosis And Treatment.
Case Reports
20Years P2L1D1 On Her12Th Postnatal Day Presented With Seizures, Headache And Involuntary Urination.She Was
Normotensive During Antenatal Period And Had A Preterm Vaginal Delivery.She Was Unconscious With Blood Pressure
Of 180/120Mmhg.Mri Showed Features Of Pres(Posterior Reversible Encephalopathy Syndrome) With Cortical Venous
Sinus Thrombosis. She Was Treated With Antihypertensives, Anticoagulants(Heparin For One Week),
Anticonvulsants&Antibiotics And Was Discharged On 12Th Day On Treatment With Oral Anticoagulants With Regular
Follow Up.
19Years
Primi
Gravida
With
24Weeks
Gestation
With
H/O
12Hr
Journey
Came
With
Breathlessness,Cough,Oliguria,Pedaledema Upto Hips With Pain In Right Leg And Absent Fetal Movements.Had H/O
Fever 1Wk Prior.Her Bp130/110, Pr110/Min&Rr40/Min.B/L Basal Crepitations Present.Right Lower Limb Was
Pale,Cold&Tender With Edema&Decreased Peripheral Pulses.Usg Showed Iud With B/L Pleural Effusion&Grade1Renal
Parenchymal Changes.Lowerlimb Doppler Showed Right Arterial Thrombosis Extending From Right External Iliac Artery
To Superficial Femoral Artery.She Was Treated With Antibiotics,Ivfluids,Analgesics And Diuretics.Labour Was Induced
With Misoprostol.She Was Referred To Vascular Surgeon Where She Underwent Thrombectomy And Was On Regular
Followup.
22Years P2L2 On Her12Th Day Of Caesarean Delivery Presented With Headache,Altered Sensorium,Seizures&Involuntary
Urination.Mri With Mrv Showed Features Of Acute Venous Sinus Thrombosis Of Superior Sagital Sinus.She Was Treated
With Heparin&Phenytoin For One Week&Discharged On Oral Anticoagulants With Regular Followup.
Conclusion
Pregnancy And Puerperium Are The Major Leading Causes For Thombosis.Cvst And Arterial Thrombosis Can Be Diagnosed
Clinically.Mri&Mrv Are Efficient For Early Diagnosis Of Cvst And Doppler For Arterial Thrombosis.Anticoagulation With
Heparin Is The Key To Good Prognosis In Cvst And Thrombectomy For Arterial Thrombosis.

***************

Pregnancy In Non Communicating Horn Of Bicornuate Uterus-A Rare Case Report

Author: Dr. Monalisa Peter
Co Author: Dr Lopamudra Jena1, Dr Ravi Narayan Satapathy2, Dr Sujata Swain3, Dr Purna Chandra Mahapatra4,

Background
The Incidence Of Pregnancy In Non Communicating Horn Is 1/76000-1/1,50,000.Pregnancy Occurs Via Transperitoneal
Migration Of Sperm Or Zygote.Variable Thickness Of Rudimentary Horn Musculature,Poor Distensibility Of Myometrium
Lead To Rupture.This Complication Is Usually Seen In 2Nd Trimester Resulting In Shock And Hemoperitoneum.
Case Report
21Yr G2A1 Female With Five Months Amenorrhoea Was Referred From Dhh With Chief Complaint Of Pain Abdomen
Which Was Gradual In Onset Associated With Vomiting , Syncope.Her Previous Menstrual Cycles Were Normal.She Was
Married For 3Years With H/O One First Trimester Abortion.On Admission Her Vitals Were Stable.P/A Examination Showed
Generalized Tenderness With 20Week Size Uterus.P/S Exam Showed No Vaginal Bleeding.On P/V Exam Uterus Was 20
Weeks,Cervix Was Long And Os Closed.She Was Managed Conservatively With Injectable Antibiotics And Iv Fluids. Usg
Was Done That Showed Single Live Extrauterine Fetus Of Aga18Weeks 5Days Placenta Grade 0 And Free Fluid In
Peritoneal Cavity. Laprotomy Was Planned Which Showed Partially Ruptured Non Communicating Horn On Left Side.B/L
Tubes Ovaries Were Healthy.Fetus With Placenta Were Inside Noncommunicating Horn Which Were Removed Intoto
With Ipsilateral Salpinx.Postop Period Was Uneventful And Patient Was Discharged.
Discussion
90% Of Rudimentary Horn Horns Are Non Communicating To Main Uterine Cavity.Rupture Occurs In 80%Cases Before
20Weeks.Sensitivity Of Usg Is 26% That Decreases With Advancing Gestational Age.Laproscopy Is Most Accurate For
Diagnosis.Laprotomy Is Must After Diagnosis.Neonatal Survival Is Very Poor.

***************

An Intresting And Rare Case Of Vulvar Varicosities With Vulvar Hematoma

Author: Dr. Sridevi Yadlapalli
Co Author: Dr.Vellanki Venkata Sujatha1, Dr.Sajana Gogineni2, Dr. Prashanthi Vemulapalli3, Dr.Sowjanya4,

Background
Vulvar Hematomas Are Uncommom Complication Of Pregnancy And Usually Result From Traumatic Injury In Non
Pregnant Women Or As A Complication Of Delivery Of The Baby Or Episiotomy And Rupture Of Varicose Veins Of The
Vulva. Other Associated Risk Factors Such As Pre-Eclampsia, Clotting Disorders, Multiple Gestation, Operative Vaginal
Delivery, Nulliparity And Genital Tract Varicosities.

Case Report
A 24 Year Old G4P1L1A2 With 40 Weeks 4 Days Period Of Gestation With Prom, Came For Safe Confinement. Labour Was
Augmented And She Developed A 4X5 Cm Size Swelling On Right Side Of Labia Majora In The Lower Aspect And Gradually
Extended In To Upper Part Of Labia Majora After 7 Hours Of Augmentation During Second Stage Of Labour. On Vaginal
Examination A Size Of 10X8 Cm Of Tense Cystic Vulvar Hematoma Developed, Vaginal Packing Was Attempted,
Hematoma Ruptured Spontaneously And Around 200Ml Blood Was Drained. She Was Posted For Emergency Lscs And
Delivered A Live Male Child With Birth Weight Of 3.6 Kg. Vulvar Hematoma Explored, Clots Were Removed And Bleeders
Was Ligated. Total Blood Loss Was 1500Ml And She Was Transfused With 2 Units Of Packed Red Blood Cells And 2 Units
Of Fresh Frozen Plasma And Discharged On Seventh Post Operative Day Without Any Complications.

Conclusion
The Spontaneous Vulvar Intrapartum Haematoma In This Case Occurred As A Result Of Rupture In A Vulvar Varicosity.
Early Diagnosis And Prompt And Appropriate Management Of The Patient Allowed Good Recovery Without Any Further
Complications.
***************

A Rare Interesting Case Of Caesarian Scar Pregnancy

Author: Dr. Birra Rao
Co Author: Dr B.Venkateswara Rao1, Dr J Sandhya2, Dr S Shamshad Begum3, Dr M Madhavi4,

Background:
Caesarian Scar Pregnancy Is The Rarest Of The Ectopic Pregnancies Which Carries Significant Maternal
Morbidity And Mortality. The Incidence Is 1 In 2000 Pregnancies. The Diagnosis And The Management Is A Challenge.
The Predisposing Factors Are Previous Caesarian Delivery, Uterine Curettage, Myomectomy, Operative Hysteroscopy And
Manual Removal Of Placenta. Our Hospital Is A Rural Based Tertiary Teaching Hospital.

Case:
A 20 Year Old Gravida 3, Para 1, Live 1 And Abortion 1, Was Admitted In Our Hospital With A Complaint
Of 5 Months Amenorrhea With Mild Bleeding Per Vagina Since 5 Days. Previous History Of One Caesarian Section And
One Incomplete Abortion For Which Instrumental Evacuation Done. On Admission Her General Condition Was Stable
Except For Mild Anemia. On Gynaecological Examination And The Investigations The Diagnosis Of Right Cornual End
Ectopic Pregnancy Was Made. We Have Posted For Laparotomy. On Opening The Abdomen There Was A Huge Vascular
Mass Over The Isthmic Region Of The Uterus. On Giving The Incision Over The Mass There Was A Massive Bleeding With
Blood Clots And Products Of Conception. The Patient Went Into Shock On The Table. Haemostasis Could Not Be Secured
And Proceeded For Sub Total Hysterectomy And The Bladder Which Was Injured Was Also Repaired With The Help Of
The Surgeon. Inspite Of The Hysterectomy The Haemostasis Could Not Be Secured. Bleeding Could Be Controlled Only By
Abdominal Tight Gauze Pack Over The Bleeding Area And Left In Situ For 48 Hours. Patient Was Luckily Recovered After
The Operation And Discharged After 3 Weeks.

Conclusion:
The Rare Type Of Ectopic Pregnancy In The Caesarian Scar / Intramural Should Be Thought Of And There
Should High Degree Of Suspicion Now A Days Due To Increased Rate Of Caesarian Section. The Management Depends On
The Gestation And The Situation As There Are No Treatment Standards.

***************

Surgical Treatment Of Complete Perineal Tear With Fecal Incontenence

Author: Prof. Subhashchandra Mudanur R
Co Author: Lubna Lahori1, Neelamma Patil2, Aruna Nemagouda3, Neha Chandra4, Mounika Reddy C5

Background: Fecal Incontinence Due To Complete Perineal Tear Caused By Obstetric Injuries Is Still Prevalent In Rural
Indian Women. It Causes Lot Of Misery, Resulting In Poor Quality Of Life, Negative Self Image And Depression In Women.
It Is Estimated To Occur In 4-6% Of Cases Of Vaginal Deliveries. Complete Perineal Tear Occurs In 0.5-2% Of Vaginal
Deliveries. Due To Social Stigma And Embarrassment Most Of The Women Do Not Report And The Problem Remains
Unaddressed. As Such Once Diagnosed It Can Be Easily Treated By Conservative Or Surgical Methods.
Cases: Herewith We Report Results Of Surgical Repair Of 16 Cases With Perineal Tear Due To Injuries During Vaginal Birth,
Out Of Which 15 Were Old Perineal Tears Cases And 1 Fresh Tear. Cases Were Assessed Clinically And Some By
Ultrasonography. After Due Pre-Operative Preparations They Were Subjected To Sphincteroplasty Under Regional
Anesthesia By Layered Repair Method. Surgical Repair Involved Suturing Of Rectal Mucosa, Plication Of External And
Internal Sphincters And Perineal Muscles With Suturing Of The Skin. Post-Operatively All The Patients Had Anatomical
Restoration Of Anal Sphincter And Achieved Satisfactory Sphincter Control. Two Of Them Had Leakage Of Faces Through
Recto Vaginal Fistula In Postoperative Period Which Was Managed Conservatively.
Conclusion: Many Women Hesitate To Reveal Fecal Incontinence Due To Embarrassment And Social Stigma. if We
DonT Ask, They WonT Tell Hence It Is Important To Sensitize Physician And Obstetricians Providing Health
Care To Women To Specifically Elicit The History By Specific Questions And Manage Fecal Incontinence Effectively. Fecal
Incontinence Is A Treatable Condition In Most Of The Cases. Fecal Incontinence Due To Complete Perineal Tear Can Be
Managed By Surgical Repair, Which Will Help Women To Live A Good, Productive And A Happy Life.

Address For Correspondence:

Dr.S.R.Mudanur
Professor Of Obstetrics And Gynecology
BldeuS Shri. B.M.Patil Medical College And Hospital
Bijapur 586103. Karnataka, India
Email Id:Drmudanurs@Gmail.Com
Contact No: 09448820961

***************

A Case Report - Hydatid Cyst Of Ovary

Author: Dr. Sujatha Ryali
Co Author:

Background: Hydatid Cyst Is A Parasitic Infestation Caused By A Echinococcus Granulosus.Human Beings Are Accidental
Intermediate Hosts. Usually Involves Liver And Lungs. Ovary Is The Rarest Organ To Involve. Echinococcosis Is Caused
By Larval Cestodes Of The Phylum Platyhelminthes
Case Report : A 35 Year Old Woman With Low Ses From Chintalpadu Presented With Mass Per Abdomen Since Five
Months. Initially Small And Gradually Progressed To Present Size. H/O Pain Abdomen Since One Month. Not Associated
With Systemic Disturbances. Lmp 18/06/14. She Is Ill Nourished, Ill Built With Normal Vital Signs. Abdominal Examination
Showed Freely Mobile 15X10Cm Size Cystic Mass Felt In Right Iliac Fossa .Speculum Examination Shows Drawn Up Cervix
.B/E Retroverted Uterus With Freely Mobile Cystic Masses Felt Through Both Fornices. Origin Could Not Be Assessed.
Usg Shows Thick Walled Multiloculated Cyst Noted In Right Adnexa. Ca125 Levels Normal. Mri Showed Multiple Cystic
Lesions In Peritoneal Cavity Also In Right Adnexa, Moderate Splenomegaly .And Right Sided Plural Effusion With The
Impression Of Right Malignant Ovarian Cyst. Intra-Operatively Multiple Thick Walled Cysts In Different Sizes On Both
Adnexa And In Pod. Many Cysts Were Removed With Intact Wall, But One Cyst From Pod Ruptured Spontaneously. The
Ruptured Cyst Was Marsupialised And Many More Cysts Were Noted And Excised. Tah- Bso Done. And Peritoneal Cavity
Was Irrigated With Hypertonic Saline. The Uterus Along With Cervix And Both Ovaries With Cysts And Cysts With
Omentum Sent For Hpe. The Hpe Report Is Consistent With Hydatid Cyst Of Right Ovary. Intraoperative And
Postoperative Periods Were Uneventful. Advised Albendazole 600Mg/D For 6 Months And Discharged On 10Th Po Day.
Conclusion : Ovary Is The Rarest Organ To Involve And Has To Be Differentiated From Malignant Ovarian Cyst.

***************

Changes In The Levels Of Lactate Dehydrogenase And Aspartate Transaminases In Preeclampsia A

Clinicobiochemical Study
Author: Dr. Rupinder Kaur
Co Author: Dr. Ramesh Sonowal, Associate Prof. Assam Medical College And Hospital1,

Background: Preeclampsia Affects 5-10% Of All Pregnancies. Main Pathology Being Endothelial Dysfunction, There Occurs
Organ Damage Which May Lead To Elevation In Serum Levels Of Specific Enzymes Which Can Be Used As Markers For
Severity Of Disease.
Aims & Objective: To Evaluate The Changes In The Levels Of Lactate Dehydrogenase (Ldh) And Aspartate Transaminases
(Ast) In Patients Of Preeclampsia And Their Relation With The Severity Of Disease.
Materials/Methods: A Prospective Comparative Study Was Conducted In The Department Of Obstetrics And Gynaecology
Of Assam Medical College And Hospital, Dibrugarh. Total Of 100 Women Were Studied, 40 Were Normotensive Pregnant
Women, 30 Were Mild Preeclampsia And 30 Were Severe Preeclampsia. Chi-Square Test Was Used To Compare The
Results. Differences Were Considered Significant When P < 0.05.
Results: Ldh And Ast Levels Were Significantly Elevated In Women With Preeclampsia. Mean Ldh Levels In Mild
Preeclampsia Were 369.2 74.86 U/L, Severe Preeclampsia Were 828.5 115.6 U/L And Normotensive Patients Were
198 30.03U/L. Mean Ast Levels In Mild Preeclampsia Were 34.2 14.4 U/L, Severe Preeclampsia Were 150.6 92.1
U/L, And Normotensive Patients Were 26.42 5.82 U/L. Higher Levels Had Significant Correlation With High Blood
Pressure( P < 0.001).
Conclusion: Higher Levels Of Serum Ldh And Ast Are Seen In Patients Of Preeclampsia As Compared To Normotensive
Pregnant Women, Correlating With The Severity Of Disease.

***************

Analysis Of 50 Cases Of Adnexal Masses By Laparoscopy

Author: Dr. Haritha Pinnamaneni
Co Author: Haritha Pinnamaneni1, K. Gangadhar Rao2, K.Prabha Devi3,

Background: The Finding Of An Adnexal Mass Is A Common Gynaecological Problem. Adnexal Mass Has Presented A
Diagnostic As Well As Therapeutic Challenge. It May Occur In All Age Groups. 5-10% Of All Women Attending Gynaec Opd
Will Undergo Evaluation Of Adnexal Mass. 63% Of Ectopic Pregnancies Present As Adnexal Mass. Evaluation Of These
Masses Is Critical To Determine, Which Mass Can Be Followed And Which Require Surgical/Medical Intervention. The
Specific Signs And Symptoms May Facilitate Diagnosis Of Adnexal Mass.

Case : In This Study 50 Cases Of Adnexal Mass Are Analysed, Which Are All Managed By Laparoscopy Ranging From 5Cms
To 24Wks Gestation. Mode Of Treatment Is Ovarian Cystectomy, Excision Of Dermoid Cysts, Aspiration Of Chocolate
Cysts, Excision Of Cyst Walls, Ovariotomy. Demographic Data Noted On Age, Menstrual History, Marital Life, Parity And
Presenting Complaints. Common Adnexal Masses Are Simple Cysts, Serous Cyst Adenoma, Mucinous Cyst Adenoma,
Endometriotic Chocolate Cyst, Hydrosalpinx, Dermoid Cyst. Seventy Percent Of Them Have Size Less Than 10Cms. Benign
Ovarian Cysts Are More Common Between Age 15-45 Yrs. Common Symptoms Are Pain Abdomen.

Conclusion : Laparoscopic Management Of Adnexal Mass Is Cost Effective, Less Morbidity And Beneficial To The Patient
Than Laparotomy. Complications Are Very Less. Early Recovery Of The Patient Is Possible With Minimally Invasive Surgery.

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Cyclopia
Author: Dr. Lavina Chaubey
Co Author: Dr.Swati Verma1, Professor N.R.Agarwal2,

Background:
Cyclopia Is A Rare Form Of Holoprosencephaly And Is A Congenital Disorder Characterized By Failure Of The Embryonic
Prosencephalon To Properly Divide Orbits Of The Eye Into Two Cavities. Its Incidence Is 1 In 16,000 In Born Animals, And
1 In 250 In Embryos, 1 In 2,500 That End In Miscarriage. The Nose Is Either Missing Or Replaced With A Non-Functional
Form Of Proboscis. Such A Proboscis Is Characteristic Of A Form Of Cyclopia Called Rhinencephaly Or Rhinocephaly. Most
Such Embryos Are Either Naturally Aborted Or Are Stillborn Upon Delivery. Chromosomal Aberrations Or Toxins Can
Cause Problems In The Embryonic Forebrain-Dividing Process. It Can Also Occur When Certain Proteins Are
Inappropriately Expressed .
Case:
A 25 Year Old Partially Booked Primigravida (Hospital No. 12496) Reported To The Obstetrics Opd For Her Antenatal Visit.
There Was DateSize Disparity ( Dates: 23+1, First Trimester Usg: 21+5, Size: 16 Weeks) And Subsequent Usg Revealed
A Dead Fetus . Patient Gave History Of Low Grade Fever In The Past. She Was Induced And Expelled A Dead Fetus Of 300
Gms Which Showed Features Of Cyclopia With A Proboscis Above The Single Eye. Chromosomal Analyses, However Could
Not Be Done As The Fetus Was Partially Macerated.
Conclusion/ Clinical Relevance:
Holoprosencephaly Consists Of A Spectrum Of Defects Or Malformations Of The Brain And Face. At The Most Severe End
Of This Spectrum Are Cases Involving Serious Malformations Of The Brain, Malformations So Severe That They Often
Cause Miscarriage Or Stillbirth. Cyclopia Belongs To This Category. At The Other End Of The Spectrum Are Individuals
With Facial Defects Which May Affect The Eyes, Nose, And Upper Lip - And Normal Or Near-Normal Brain Development.
Seizures And Mental Retardation May Occur. Only One Case Of Cyclopia Has Been Reported From India In 2006.

***************

Delayed Diagnosis Of Aty[Ical Rupture Of Unscarred Uterus Due To Assisted Fundal Pressure
Author: Dr. Krithika Muthuswamy
Co Author:

Background:
Although Rare, Rupture Of An Unscarred Uterus Is A Serious Complication, Resulting In Maternal And Fetal Jeopardy.

Case:
A 36 Year Old Multigradiva Without Any Previous History Of Uterine Surgeries Delivered Vaginally At 39 Weeks Gestation
With Assisted Fundal Pressure In Second Stage Of Labour. Transabdominal Sonogram Done 72 Hours After Delivery For
Postural Hypotension And Abdominal Distension Revealed Free Fluid In The Abdomen. On Emergency Laprotomy, There
Was Serosal Rupture On The Posterolateral Side Of The Uterus. Patient Underwent Total Hysterectomy And Did Well
Postoperatively.

Conclusion:
Assisted Fundal Pressure In Second Stage Of Labour Can Cause Trauma To The Uterus Even If It Is Unscarred Previously.
Signs Of Hypotension Without Any Evidence Of Abnormal Vaginal Bleeding Should Be Thoroughly Examined For Uterine
Rupture And Early Diagnosis To Be Made To Prevent Morbidity And Mortality

***************

Scar Line Metastasis After Hysterectomy

Author: Dr. Renu Meena
Co Author:

Background: Although Cervical Cancer Is A Very Common Gynecologic Malignancy, Skin Metastasis Presenting As A
Persistent Disease Is Extremely Rare. Incidence Of Incisional Skin Metastasis From Carcinoma Cervix Is Extremely Rare
Ranges From 0.1-2% After Hysterectomy
Case: We Present A Case Report Of Carcinoma Cervix Whose Staging Was Not Done Prior To Hysterectomy & Was
Complicated By Secondary Vaginal Cuff & Abdominal Scar Line Metastasis After Six Month Of Surgery. After
Hysterectomy, Patient Was Not Followup Regularly. Six Month Later After Surgery Patient Presented With Nodular Lesion
On The Side Of Abdominal Scar & Vaginal Cuff. Her Scar Site Cytology & Cuff Biopsy Were Obtained. This Was A BiopsyProven Metastasis From The PatientS Primary Cervical Carcinoma. Patient Was Advised Chemoradiation.
Conclusion: As We All Know Metastasis To The Skin Occurs Rarely In Gynaecologic Cancer Especially In Cervical Carcinoma.
Pre Hysterectomy Screening, Proper Evaluation , Staging And Post Hysterectomy Followup Has An Important Role In
Controlling The Disease. In Conclusion Incisional Cutaneous Metastasis Is A Rarity With Carcinoma Cervix And Is
Considered As An Ominous Prognostic Sign With Short Survival After Diagnosis.

***************

Anemia As Predisposing Factor For Burst Abdomen

Author: Dr. Haleh Badar
Co Author:

Background: Burst Abdomen Is A Grave Post Operative Complication Especially In Patients Undergoing Emergency
Surgeries. Anemia (17%) Is One Of The Causes Predisposing To Burst Abdomen By Interfering With Wound Healing
Process.
Case: A 30 Years Old 8.5 Months G4 With No Antenatal Checkup Presented With Generalized Body Swelling & Pain
Abdomen .She Was Severely Pale With B.P.170/120Mmhg. Per Abdomen Examination Showed Polyhydramnios & Twin
Pregnancy With 1St Fetus In Transverse Lie With Contractions .On Vaginal Examination Os Admitted 1 Finger. She Was
Advised 2 Units Of Prbc & Twin Preterm Babies Was Delivered By Emergency C- Section. Blood Transfusion Could Not Be
Done Due To Unavailability Of AVe Blood Group. Post Operatively, She Was Managed With Iv Antibiotic, Anti
Hypertensive Drugs & Iv Iron Sucrose. She Was Discharged On Request With Stitches Removed On 10Th Post Operative
Day
After 24 Hours, She Again Presented With Pain Abdomen & Soaked Abdominal Dressing. On Examination It Was Burst
Abdomen. Immediately Wound Was Packed With Wet Sponge, Covered With Large Pressure Dressing And Later On
Secondary Suturing Along With Blood Transfusion Done. Post Operatively She Was Managed Conservatively And Switched
Over To Oral Diet On 3Rd Post Op Day. She Was Discharged With Hb 11G/Dl On 14Th Day Of Secondary Suturing. Now
She Is Doing Well Under Medical Follow Up.
Conclusion: In India, Majority Of Patients Are Anemic And Their Hb Deficit Remain Uncorrected Either Due To Lack Of
Health Awareness Or Facilities. Anemia Interferes With Wound Healing And Predisposes To Wound Dehiscence. Proper
Antenatal Check Up Is Must For Every Patient To Institute Early Preventive Measures And Safe Confinement Of High Risk
Cases. This Will Contribute To Safe Surgery & Save Life.

***************

Vacuum Retraction Of Uterus For The Management Of Atonic Postpartum Haemorrhage

Author: Dr. Hemmanur Samartharam
Co Author: Dr. H.S. Shankar Ram.1, Dr. S. Sandhya Ram.2,

Background: Creating Negative Pressure Inside The Uterine Cavity Results In Shrinking Of Uterus Which Can Assist The
Natural Physiological Process Of Contraction And Retraction To Stop Atonic Postpartum Hemorrhage. Methods: Sixteen
Women Who Had Normal Vaginal Delivers And Who Developed Atonic Postpartum Hemorrhage, And Who Did Not
Respond Well For Routine Use Of Inj. Methergine, Oxytocin Infusion, And Inj. Carboprost Were Included In This Study. A
Specially Designed Uterine Cannula Measuring 10Inch Long, With 18Mm Diameter, With Multiple Perforations On Uterine
Portion, And With Uterine Angle (Fig.1) Was Used. When The Bleeding Did Not Stop Due To Uterine Atony In Spite Of
Routine Measures, The Uterine Portion Of The Cannula Was Inserted In To The Uterine Cavity, And The Outer End Was
Connected To Suction Machine Through Rigid Tubing. A Negative Pressure Of 650Mmhg Was Created Inside The Uterine
Cavity And Maintained For 10Mns. This Procedure Was Repeated Every Hour For 3Hrs. After This The Cannula Was Kept
In Situ For Up To 6Hrs Observing The Women For Recurrence Of Bleeding. Negative Pressure Was Created Whenever
There Was Recurrence Of Bleeding. The Cannula Was Removed After 6Hrs In All Women. Results: Complete Cessation Of
Bleeding Which Was Associated With Contraction And Firm Retraction Of Uterus Was Observed In All Women Within
4Mns After Initiation Of Procedure. The Amount Of Blood Collected In The Suction Bottle Ranged From 150Ml To 250Ml.
Conclusion: Vacuum Shrinking Of Uterus Is A Very Effective Physical Method Which Can Assist The Natural Physiological
Process Of Contraction And Retraction To Stop Atonic Postpartum Hemorrhage. This Simple, Cost Effective, Life-Saving,
And Fertility Saving Technique, Which Can Avoid Laparotomy Can Be Made Available In Any Setting, And Can Become The
First Defense Against Atonic Pph.
***************

46 Xx Dsd ClinicianS Dilemma, Salvaging The Spirit

Author: Dr. Karthik Sds
Co Author: Kriplani A1, Kacchawa G2, Khadgawat R3, Manish S4, Badiger S5

Background: Disorders Of Sex Differentiation (Dsds) Are Rare Congenital Conditions With Atypical Development Of
Chromosomal, Gonadal, Or Anatomical Sex. Ovotesticular Dsds, Previously Called True Hermaphrodite, Are Rarest Variety
Of Dsds And Represents 5% Of All Cases. Around 400 Cases Have Been Reported.
Case Description: A 23 Year Old Subject Presented To Our Outpatient Department With History Of Cyclical Abdominal
Pain Since 5 Years. On Reviewing The History, Genital Ambiguity Noted At Birth Was Ignored By Parents. The Subject Was
Reared As Male, Oriented To Male Patterned Behavior And Male Friends. He Had Discomfort Regarding His Enlarged
Breasts, Absent Beard And Moustache. Breasts And Pubic Hair-Tanners Iii-Iv; Phallus Length Was 4 Cm With Perineal
Hypospadias And Midline Posterior Labioscrotal Fusion (Prader Scale-Ii-Iii); 4X4 Cm Testis Palpable In Right Scrotum.
Hormonal Analysis Had Shown S.Fsh-3.32Miu/Ml, S.Lh-1.25Miu/Ml, S.Testosterone-0.3Ng/Ml, S.Estradiol-36Pg/Ml,
S.Progesterone-0.4Ng/Ml, S.Cortisol-8.9g/Dl And S.Dheas-298.7g/Dl. Karyotype Was 46Xx. Mri Revealed
Rudimentary-Uterus With Ovary On Left Side And Testes With Hydrocele On Right Side. After Detailed Evaluation Of The
Physical And Mental Preference Of The Subject, Laparoscopic Excision Of Rudimentary Uterus With Left SalpingoOophorectomy And Right Orchidectomy After Consulting With Endocrinologist, Urologist, Plastic Surgeon And
Psychologist. Histopathology Revealed Ovarian Tissue In Left And Hyalinised Seminiferous Tubules In Right Gonad.
Discharged On Weekly Testosterone Injections. Undergone Subcutaneous Mastectomy After Three Months. Now The
Subject Is Psychologically Comfortable With His Physical Body, Developed Facial Hair, Feels Masculine And Able To Cope
Up Well With Society.
Clinical Relevance: Histological Documentation Of Both Types Of Gonadal Epithelium Required For Diagnosis. Gender
Assignment Done Based On Phallic Size And Patient Choice. Proper Counselling Of The Subject And Parents Is Essential
To Have Best Possible Results. We Are Reporting This Case Due To Rarity, Late Presentation And Complexity Requiring A
Multidisciplinary Team With Endocrinologist, Urologist, Psychiatrist, And Social Workers For Best Management.

***************

A Rare Case Of Chronic Ectopic Pregnancy With Failed Medical Management Of Tubal Abortion Presenting As Tubo
Ovarian Mass
Author: Dr. Prathyusha Javvadi
Co Author: Dr.Sajana Gogineni , Proffessor1, Dr.K.B.Gayathri , Associate Proffessor2,

Background: Ectopic Pregnancy Is Defined As Implantation And Subsequent Development Of Embryo Outside The Uterine
Lining. It Has Wide Range Of Presentation From Acute Hemoperitoneum To Chronic Ectopic Pregnancy. Chronic Ectopic
Is A Form Of Tubal Pregnancy In Which Salient Minor Ruptures/Abortions Of An Ectopic Pregnancy Instead Of A Single
Episode Of Bleeding Incites An Inflammatory Response Often Leading To The Formation Of Pelvic Mass . The Incidence
Of Chronic Ectopic Is 20.3%.
Casereport: A Case Of 22Yr Old Unmarried Female Came With C/O Pain Abdomen In The Right Iliac Fossa And Bleeding
P/V For 10Days. She Has Similar History 1 Month Back For Which She Received Analgesics For Pain. She Was
Hemodynamically Stable. Her Se Hcg Was 2000Iu/Ml. A Diagnosis Of ?Ectopic Pregnancy Was Made And Patient Was
Given Medical Management With Methotrexate.
Se Hcg After 48Hrs Showed A 15% Decline And Patient Was Advised To Follow Up In Opd Clinic With Upt. Her Se Hcg
Was Again Increased To 2900Iu/Ml 15Days After Last Methotrexate Dose,When She Was Reported With Pain
Abdomen.Usg Showed As Ectopic And She Was Then Diagnosed As Chronic Ectopic For Which Emergency Explorative
Laparotomy With Right Salpingoophrectomy Was Done. During Iop There Is A Right Tubo Ovarian Mass Identified
Incidentally.
Conclusion: Ectopic Pregnancy Is A Condition Where When Ruptured Patient DoesnT Remain Stable And Present With
Emergency Situations. In Present Days The Incidence Of Ectopic Pregnancy Is Increasing Due To Unprotected
Intercourse,StdS In Young Age.Many Factors Are Leading To Ectopic Pregnancy And This Condition Is Often
Misinterpreted With Other Conditions. So In Present Its Very Important To Identify And Rule Out Condition Of Ectopic In
Patients Presenting With Pain Abdomen And Bleeding P/V In Reproductive Age Group.

***************

Laparoscopy: Made Safer For Beginners (How I Introduced And Successfully Established Laparoscopic Techniques In A
Tier 3 Town In India)
Author: Dr. Anuradha Pichumani
Co Author:

Background: Endoscopic Access In Gynaecological Procedures Provides An Attractive Avenue For Surgical Advancement,
Reducing The Duration Of The Hospital Stay, The Recovery Period And The Discomfort To Patients While Increasing Their
Satisfaction Levels. However, Potential Injuries To Major Vessels, Bowel And Other Organs During The Blind Entry Process
Of The First Trocar, Coupled With The Limited Timely Availability Of Experienced Specialists In The Non-Metros For Backup
Support Intimidates Many Aspirants To Adopt This Safer Surgical Technique.

Case: Herewith, I Share My Successful Experience Of The Past Eight Years In Adopting A 10-Point Charter For Performing
Safe Laparoscopic Surgeries In A Suburban Setting With Limited Availability Of Medical Skills. Adopting Safer Techniques
Like HassonS Open Method, In Lieu Of The First Trocar, Avoids The Complications Resulting From Blind Entry, Even
As We Are Able To Enter The Cavity In Under 2 Minutes. Minimising The Number Of Trocars Avoids Inadvertent Injuries
To The Bowels. Over The Past 8 Years, More Than 400 Gynaecological Procedures (Diagnostic Laparoscopy, Hysteroscopic
Cannulation, Laparoscopic Cystectomy, Ectopics And Lavh) Have Been Performed With Only One Complication To Report,
In Line With The Complication Rates From Other Centres. (The One Complication Was Quickly Recognized And Resolved
With Timely Additional Help.)

Conclusion: With Adequate Training, Methodical Workflow, Judicious Selection Of Patients And Well-Trained Support
Staff, It Is Possible To Do First-Rate Laparoscopic Work In A Tier 3 Town With Limited Availability Of Experienced Super
Specialists.

***************

Successful Pregnancy Outcome After Laparoscopic Splenectomy And Cholecystectomy In A Primi With Hereditary
Spherocytosis
Author: Dr. Anupama Rohidekar
Co Author: Dr. Deepak S. Rohidekar1,

Background: Hereditary Spherocytosis (Hs), An Autosomal Genetic Disorder Of The Rbc Membrane Results In
Microspherocytic Rigid Rbcs Which Get Destroyed In Splenic Sinusoids Causing Hemolytic Anaemia, Jaundice, Gall Stones
& Splenomegaly Of Varying Severity In Affected Individuals. Pregnancy Can Precipitate A Crisis Endangering MotherS
And BabyS Lives, Making The Management Complicated.
Case: In October 2013, A 19 Yr Primi, Known Case Of Hs, Presented With 15+ Weeks Pregnancy, Hemolytic Anaemia (Hb7G%), Jaundice (S. Bilirubin-5.8Mg%), 18 Cm Splenomegaly & Non-Obstructive Gall Stones. She Had Been Advised
Termination Of Pregnancy Followed By Cholecystectomy & Splenectomy At 3 Other Major Hospitals.
After Multidisciplinary Assessment & Discussion With Patient & Family, A Collective Decision Taken To Conserve
Pregnancy, Proceed With Surgery & Accept Natural Consequences On Fetus.
2 Units Prbc Transfused & Polyvalent Pneumococcal Vaccine Given.
2 Weeks Later A Combined Laparoscopic Cholecystectomy With Splenectomy Performed. No Blood Transfusion Given.
She Recovered Uneventfully, Discharged After 3 Days.
Her Pregnancy Was Managed With Hydration, Stockings, Aspirin & Routine Care. Except For Thrombocytosis (Platelet
Counts Reached 15L), Her Antenatal Period Was Normal. At 34 Weeks, Aspirin Switched To Enoxaparin.
At 38+ Weeks, Labor Induced & She Had A Normal Delivery Of A Healthy 3.1Kg Male Baby.
Thromboprophylaxis Given. Discharged After 72 Hours.

No Further

The Baby Required Phototherapy For Hyperbilirubinemia At 1 Week Which Resolved In 48 Hours. Baby Was Solely BreastFed. In Neonatal Blood Work-Up, There Was No Anaemia & Hematologist Advised Further Investigation Only In Case Of
Anaemia. Both Mother & Baby Remain Under Regular Follow-Up & Are Healthy.
Clinical Relevance: This Is A Rare & Extremely Challenging Case Of Hs With Severe Hemolytic Crisis In 2Nd Trimester.
Termination Of Pregnancy Would Have Increased The Morbidity With Blood Loss, Risk Of Coagulopathy & Infection. With
No Definite Guidelines Or Protocol For Such A Condition, A Technically Demanding Laparoscopic Surgery For Removal Of
A Grossly Enlarged Spleen Was Undertaken Which Cured The Mother & Eventually, Saved Her Baby. This Is A True Example
Of safe Surgery Saves Lives.

***************

A 45Yr Old Woman With Endometrioid Type Of Endometrial Carcinoma Along With Giant Benign Serous Cyst
Adenoma
Author: Dr. Murari Ujjwala
Co Author:

Background: In India Endometrial Carcinoma Ranks 3Rd Among Genital Malignancies Next To Cervix And
Ovary.Endometrioid Type Of Adenocarcinoma Accounts For About 80% Of Endometrial Carcinoma.The Occurrence Of
Simultaneous Tumours Of Endometrium And Ovary Is Relatively Rare.
Case: A 45Yr Old Parous Lady Presented With Complaints Of Mass Per Abdomen For A Period Of 2Yrs, Mild Abdominal
Pain For The Last 5Months.On Examination Of Per Abdomen Mass Corresponding To 36Wks Size Of Pregnant Uterus .On
Bimanual Examination Uterus: CouldnT Be Felt Separately .Cervix Flushed With Vault.
Investigations : Ca125 Was 40U/Ml. Dilation And Curettage Of Endometrium Showed Villo Glandular Type Of Endometrial
Carcinoma. On Ct Scan Midline Cystic Lesion With Septations Extending From Pelvis To Epigastric Region About 27
21Cms Present.Uterus CouldnT Be Visualized.Impression: Benign Ovarian Cyst Adeno Carcinoma.
She Underwent Tah With B/L Salpingooopherectomy
Hpe Revealed Benign Serous Cyst Adenoma Of Ovary With Endometrioid Type Of Endometrial Carcinoma Of Uterus
Invading Inner Half Of Myometrium.
Conclusion
This Huge Tumor Evolved For A Long Time Unsuspected And Without Metastases In A Patient From A Developing Region.
The Diagnostic And Management Challenges Posed By This Unexpected And Unusual Presentation Of Mass Per Abdomen
That Is Benign Ovarian Tumour Along With Endometrial Malignancy Is Discussed

***************

Rupture Of Interstitial Pregnancy In Early Gestation Due To Prostaglandin Abuse

Author: Dr. Sandeep Kour
Co Author: Gurpreet Kour1,

Background: Indicriminate Use Of Oral Prostaglandins And Mifepristone As Over The Counter Drugs Has Become A Major
Problem.

Case:
Interstitial Pregnancy Occurs When The Fertilised Ovum Implants In The Interstitial Portion Of The Fallopian Tube .It
Occurs In Around 2% Of All The Ectopic Pregnancies . It Can Last Up To Mid Trimester Before It Ruptures Spontaneously
As It Can Grow Inside The Interstitium For Long Period Of Time. If Not Detected Early, Can Lead To A Fatal Outcome.
Mifepristone (Antiprogesterone) Followed By A Low Dose Of Misoprostol (Prostaglandin E1 Analog) Has Been Used For
Termination Of Early Pregnancy After Ruling Out Ectopic Pregnancy, But There Have Been Many Reports Of Misuse Of
This Combination Especially In The Developing Countries. Here We Report A Case Of Interstitial Pregnancy, Which
Ruptured At 6 Weeks Of Gestation Due To Misuse Of This Combination As An Over The Counter Drug Without Looking
For Ectopic Pregnancy.

Conclusion : There Is A Need For Strict Control On Dispencing Of Oral Prostaglandins And Mifepristone To Protect Patients
From Harm.
***************

A Case Of Ovarian Pregnancy

Author: Dr. Prathibha Vasudev
Co Author: Shankar J1, Ramaraju H E2,

Background: Ovarian Pregnancy Is A Rare Event. Reports Vary From One In 2100 Pregnancies To 1 In 60,000 Making
Ovarian Pregnancy 1 To 3% Of All Ectopic Pregnancies. Ovarian Pregnancy Is More Frequent In Ectopic Pregnancies
Associated With The Use Of Intrauterine Device.
Case Report: A 22 Year Old Primigravida, Married For The Last 5 Years Was Referred With 3 Months Of Amenorrhoea
With Vomiting And Pain Abdomen. On Examination, She Was Hemodynamically Unstable . Per Abdominal Examination
Showed Tenderness In Left Iliac Fossa And Right Hypochondrium, Along With Rigidity And Guarding. On Per Vaginal
Examination, Uterus Is Bulky And A Tender Cystic Mass Was Palpable In Left Fornix. Transvaginal Scan Showed Empty
Uterine Cavity And A Gestational Sac In Left Adnexa & Free Fluid In Abdomen. She Was Taken Up For Emergency
Laparatomy With A Diagnosis Of Left Ruptured Ectopic Pregnancy And At Surgery There Was Haemoperitoneum Of 2000
Ml , Uterus Was Found To Be Normal, Left Ovary Was Enlarged To 6X6Cm And Was Bleeding. It Was Connected To Utero
Ovarian Ligament And Also To Pelvic Wall By Suspensory Ligament Of Ovary. Left Salpingo Oophorectomy Done And
Specimen Sent For Histopathology Which Was Reported As Ectopic Gestation ,Left Ovary .
Conclusion: Ovarian Pregnancy Is Rare, At The Time Of Surgery , Ovarian Pregnancy Resemble Haemorrhagic Cysts.
Conservative Surgeries Such As Cystectomy Or Wedge Resection Can Be Performed .
1.Postgraduate Trainee
2.Professor And Unit Head,Dept Of Obg,Vims ,Bellary.
3.Assistant Professor,Dept Of Obg ,Vims ,Bellary.
Institution: Vijayanagara Institute Of Medical Sciences, Bellary.

***************

Serum Lead Levels During Pregnancy- A Cross Sectional Study(A Descriptive Observational Study)
Author: Dr. Gangula Kantha
Co Author: Dr.M.B.Bellad1,

Background: Serum Lead Levels Increase During Pregnancy And May Affect Health Of Pregnant Women And Fetus. This
Study Was Aimed To Know The Serum Lead Levels During Early, Mid And Late Pregnancies As Well As Its Association With
Maternal Outcomes Like Anemia And Hypertension In Pregnant Women.
Methodology: The Present Cross Sectional Study Of Two Year Duration Was Carried Out In The Department Of Obstetrics
And Gynaecology, Attached Teaching Hospital, Kle UniversityS Jawaharlal Nehru Medical College, Belgaum. A Total
Of 32 Pregnant Women Were Studied For Serum Lead Levels And Haemoglobin Levels.
Results: Total Sample Size35, 32 Women Were Analysed And 3 Were Loss Of Follow Up. With Increase In Duration Of
Gestation Serum Lead Levels Increases. The Correlation Of Anaemia And Mean Serum Lead Levels In Mid And Late
Pregnancy Showed Significant Rise In Mean Serum Lead Levels With Severity Of Anaemia (P<0.050).
Conclusion: The Serum Lead Levels In Pregnant Women Increase With Duration Of Gestation And Are Associated With
Anaemia And Hypertension.

***************

Swyer Syndrome - A Case Series

Author: Dr. Sumita Agarwal
Co Author: Dr. Neena Malhotra1, Dr. Aparna Sharma2, Dr. Vatsla Dadhwal3, Dr. Dipika Deka4, Dr. Kavita Khoiwal5

Background: Swyer Syndrome, Also Known As 46 Xy Pure Gonadal Dysgenesis Is A Rare Endocrine Disorder. Affected
Individuals Are Phenotypically Female With Female Genitalia, Normal Mullerian Structures, Absent Testicular Tissue And
A 46 Xy Chromosomal Constitution. The Condition Usually First Becomes Apparent In Adolescence With Primary
Amenorrhea And Delayed Puberty. This May Rarely Present In A Familial Form. The Occurrence Of Gonadoblastomas In
Such Individuals Has Been Well Documented.
Case: We Report A Series Of 6 Cases Of Swyer Syndrome. Two Of These Patients Were Siblings. The Mean Age At
Presentation Was 20 Years . The Chief Presenting Complaint Was Primary Amenorrhea. On Examination The Mean Height
Was 158.3 Cm. Breast Development Was Poor And All Had Sparse Axillary And Pubic Hair .Vagina Was Well Canalized In
All. Hormonal Evaluation Revealed Hypergonadotrophic Hypogonadism With Mean Fsh Level Of 95.81Miu/L And Mean
Lh Level Of 24.15 Miu/L. On Imaging A Small Uterus Was Seen In 5/6 Cases. Bilateral Ovaries Were Either Not Visualized
Or Streak Gonads Were Present. Adnexal Mass Was Detected In 2/6 Cases With Raised Ca 125 In One. Genetic Analysis
Revealed A Karyotype Of 46 Xy In All. Due To The Risk Of Malignancy Bilateral Gonadectomy Was Performed In All. Two
Of These Had To Undergo Exploratory Laparotomy And One Was Found To Have Metastatic Ovarian Carcinoma For Which
Debulking Surgery Was Done. On Histopathology Dysgerminoma Was Reported In 3/6 Cases. The Patients Were Started
On Hormone Replacement Therapy.
Conclusion: Early Diagnosis Of Swyer Syndrome Is Important Due To The Risk Of Development Of Dysgerminoma In The
Dysgenetic Gonads. Family Members Of The Affected Persons Should Be Screened For This Disorder.
***************

Awareness And Implementation Of W.H.O. Safe Surgery Check List .

Author: Dr. Shraddha Verma
Co Author: Dr. Manisha Jain1, Dr. Jyoti Nath Modi2,

Background: The W.H.O. Surgical Safety Checklist(2007), Aims At Improving Surgical Safety By Promoting Communication
Among Operating Team Members And Ensuring Safety Checks During Vital Phases Of Perioperative Care. Though The
Benefits Of The Safe Surgical Checklist Are Well Proven, Its Use And Implementation Are Still A Matter Of Concern.
Aim: To Study The Awareness And Implementation Of Who Safe Surgery Checklist At Our Centre.
Materials And Method: A Cross-Sectional Survey Was Carried Out Among The Operation Theatre(Ot) Staff (Surgical
Specialists Including Gynaecologists, Anaesthestists, Nursing And Paramedical Staff) At Our Medical College Hospital. The
Principal Investigator Individually Interviewed The Participants And Recorded The Information In A Predesigned
Proforma. Data Were Analyzed Using Descriptive Statistics.
Results: Of The 96 Participants Interviewed, 77(80%) Were Doctors [56 Surgeons; 21 Anaesthetists]; 12%Nurses And
8%Paramedical Staff. Overall, Almost 75% Of Participants Were Not Aware About The Who Safe Surgery Checklist. While
All Surgeons Reported Anticipating The Expected Blood Loss And Probable Duration Of Surgery, Only 2/3Rd Anticipated
The Critical Steps Of Proposed Surgery Prior To Starting Procedure. Also, 24% Of Surgeons Reported Personally Ensuring
The Timely Administration Of Antibiotic Prophylaxis. Most Anaesthetists(66%) Routinely Rechecked For History Of Allergy
In The Ot And 52% Personally Checked Boyles And Pulse-Oximeter Prior To Surgery. All (100%) Nurses Reported Routine
Pre-Checking Of Patient Identity, Consent, Doing Sponge And Instrument Count. All (100%) Ot Technicians Also Reported
Routine Pre-Checking Of Patient Identity And BoyleS Machine Prior To Surgery.
Conclusions: Though The Ot Staff Routinely Follows The Critical Elements Of The Who Safe Surgery Checklist, The
Awareness And Explicit Communication Of The Same Appears Suboptimal. Training And Education Of Ot Staff About The
Who Safe Surgery Checklist And Its Mandatory Use In Written Form For Each Patient Is Recommended.

***************

Isolated Thrombocytopenia In Pregnancy :A Case Series

Author: Dr. Laxmi Krishna.N
Co Author: Dr Laxmi Krishna.N1, Dr Amutha Giridhar2,

Background: Thrombocytopenia Occurs In 7-8% Of All Pregnancies. Besides Anaemia, It Is The Most Common
Haematological Disorder In Pregnancy.
Objective: Here We Analyse The Presentation ,Clinical And Laboratory Parameters And Feto-Maternal Outcome Of All
Cases Of Isolated Thrombocytopenia
Methodology: Retrospective Analysis Of Documented Cases Of Thrombocytopenia In Pregnancy Reporting To The
Obstetrics And Gynaecology Department From September 2011 To September 2014.

Observation: 13 Cases Of Thrombocytopenia In Pregnancy Were Noted Among 6339 Deliveries. Among The 13 Cases ,4
Were Diagnosed To Have Itp While The Remaining 9 Patients Had Gestational Thrombocytopenia. Among The Cases Of
Gestational Thrombocytopenia, 7 Presented In The Third Trimester And 3 Patients Were Treated With Steroids .All The
4 Patients Of Itp Were On Steroids With The Addition Of Azathioprine In 2 Patients.In A Severe Case Of Itp Patient Was
Started On Eltrombopag. Among The 13 Patients ,Bleeding Manifestations Were Present In 2 Patients And 4 Patients Had
A Platelet Count Less Than 25,000/Cu Mm At The Time Of Admission. Route Of Delivery Was Vaginal Among 9 Patients
While Caesarean Section Was Done In 4 Patients In View Of Previous Caesarean Section And Fetal Distress .Platelet
Transfusion Was Required In Four Patients. Neonatal Thrombocytopenia Was Noted In 2 Newborns.

Conclusion :All Pregnant Women Should Be Routinely Screened For Thrombocytopenia And Pregnant Women With Low
Counts Should Be Monitored Serially. Careful Management Of Such Patients Can Prevent Catatrophic Events. Newborns
Should Be Carefully Evaluated For Thrombocytopenia.
Keyword: Thrombocytopenia ,Itp ,Gestational Thrombocytopenia.

***************

Turner`S Syndrome 45Xo {Xy} Gonadal Dysgenesis

Author: Dr. Anitha Kavati
Co Author: Dr Anuradha Md Dgo1, Dr Chandrasekharrao Md Obg2, Dr Jhansivani Md Dgo3, Dr Swaruparani Md Dgo4, Dr
Karuna Md Obg5

Background: Turner`S 45Xo(Xy) Is A Disorder Of Sex Development Associated With A Numerical Sex Chromosome Results
From Y Chromosome Mosaicism Leading To Abnormal Gonadal Development
Case: A13Yrs Female Was Brought By Her Parents With History Of Clitoromegaly On History Patient Not Attained
Menarchy ,Physical Examination Revealed Short Stature With No Secondary Sexual Characters And Vaginal Examination
Revealed Narrow Introitus ,Clitoris Hypertrophied Enlarged And Looking Like Glans,Provisional Diagnosis Of Ambigious
Genitalia Was Made .Karyotyping Reported Turner Xo With Xy.Harmonal Profile Showed Increased Fsh ,Lh And Low
Estradiol Values .Usg Study Of Abdomen Uterus Less Than Normal Size,Gonads With Hypertrophied Stroma.
Conclusion: As Karyotyping Of The Patient Revealed Xy Gonadal Dysgenesi Lap Gonedectomy Followed By Gh Treatment
Can Be Done And In Future We Can Plan For Clitoral Resection And Neovaginoplasty
***************

Acquired Uterine Arterio- Venous Malformation(Avm): Case Report

Author: Dr. Sadaf Shaikh
Co Author: Dr Sadaf Shaikh1, Dr Archana Bhosale2, Dr Rahul Mayekar3, Dr Y S Nandanwar4,

Background: Uterine Avm Are Rare Lesion With Diverse Presentations With A High Index Of Suspicion Needed To
Diagnose Them. Despite Being Rare They Are Potentially Life Threatening And Embolization Can Safely And Effectively
Manage Them With Fertility Preservation.
Case: 22 Yr Old, Female Presented With Menorrhagia Secondary To Emergency Dilatation And Curettage Done After
Abortion. Radiographic Imaging Including Usg,Ct-Scan & Mri Were Suggestive Of Uterine Arteriovenous Malformation
With Right Internal Iliac As Feeding Vessel Which Was Confirmed By Uterine Artery Angiography. Patient Also Had
Persistently Raised Levels Of B-Hcg. Patient Was Successfully Treated With Uterine Artery Embolization With The
Potential For Future Pregnancies.
Conclusion: Uterine Artery Embolization Should Be Considered As The Optimum Treatment With High Success Rate And
Fertility Preserving Potential.

***************

Uterine Artery Pseudoaneurysm:A Rare Case Report

Author: Dr. Nithya B
Co Author: Dr.Padmini1, Dr.Meena2, Dr.Narmatha3,

Background:
Uterine Artery Pseudoaneurysm Is A Rare But Potentially Life Threatening Complication Of Pelvic Surgery.Radiology
Has Important Role In Diagnosis And Primary Management.The Lesion Is Rarely Discovered Unless It Presents With
Complications Of Delayed Rupture Of The Pseudoaneurysm Causing Haemorrhage.
Case Report:
A 65Yr Old Woman Para 6 Had Undergone Abdominal Hysterectomy 6 Months Earlier.Her Immediate Post Operative
Period Was Uncomplicated.She Then Presented To Our Hospital With Complaints Of Bleeding Per Vaginum For 2 Months
And Abdominal Pain For 1 Week.On Admission Routine Investigations Were Done.Ct Angiography Revealed The Diagnosis
Of Uterine Artery Pseudoaneurysm.It Was Successfully Treated By Embolization Of Both Uterine Arteries.
Conclusion:
In Rare Case Of Uterine Artery Pseudoaneurysm ,The Complications Of Aneurysmal Rupture Were Prevented By
Prompt Diagnosis And Embolization Therapy.

***************

Beware Of Patent Vitello-Intestinal Duct In Case Of Umbilical Adhesions

Author: Dr. Geetha V
Co Author: Dr.Kurian Joseph1, Dr.Rekha Kurian2,

Background:
Persistent Vitello-Intestinal Duct Is A Rare Embryonic Anomaly Of The Primitive Yolk Sac. The Vitello-Intestinal Duct
Provides Nutrition To The Early Developing Embryo. It Communicates Between The Primitive Yolk Sac And The Mid-Gut
Loop Through The Umbilical Coelome And Gradually Involutes From The Terminal Part Of The Ileum By The 5Th To 9Th
Week Of Gestation. The Commonest Form Of Presentation Of A Persistent Duct Is The MeckelS Diverticulum Found
In Approximately 2% Of The Population. About 10% Of The Diverticula May Be Attached To The Umbilicus With A Fibrous
Cord And May Sometimes Be Patent.

Case Report:

A 19 Year Old Girl With A Well-Developed Left Uterine Horn And A Functional Non-Communicating Right Uterine Horn
Underwent Laparoscopy For A Large Right Ovarian Endometrioma. Umbilical Adhesions Were Noticed And Carefully
Dissected And Right Endometriotic Cystectomy Done. A Diagnostic Hysteroscopy Was Also Performed To Assess The
Mullerian Anomaly. Intra-Operative Course Was Deemed To Be Uneventful/ Uncomplicated. However, On Third PostOperative Day The Patient Developed Signs Of Peritonitis. Laparotomy Revealed Fecal Contamination Which Was Traced
To Occult Injury Of A Patent Vitello-Intestinal Duct. Surgical Repair Was Done And Patient Made Good Recovery.

Conclusion:

A Meckels Diverticulum Is Frequently Suspected, Often Sought And Seldom Found But A Persistent Vitello-Intestinal
Duct Is Rarely Suspected. Recognising This Anomaly Can Be Simple And Could Prevent Potentially Serious Complications
During Umbilical Adhesiolysis, But Only If One Is Conscious And Cautious Of It.

***************

Study Of Sexual Assualt Victims Attending A Tertiary Care Hospital

Author: Dr. Sowmya Ramani
Co Author:

Background:
Reproductive-Aged Victims Of Sexual Assault Are At Risk Of Unintended Pregnancy, Sexually Transmitted Infections, And
Mental Health Conditions, Including Posttraumatic Stress Disorder.
Cases:
This Study Is A Retrospective Study Conducted On 50 Victims Of Alleged Sexual Assault Brought By Police For Medical
Examination To Government Lady Goschen Hospital, Mangalore Between 2012-2014. Objectives Were To Know

Age Distribution Of Victims

Association Of Physical Injuries With The Sexual Acts

Actual Procedure Comprising Of Meticulous History Regarding Circumstance Of Assault, Physical Examination And
Genital Examination Including Perineum, Vulva And Condition Of Hymen Was Performed. Data Were Tabulated &
Percentages Were Calculated.
Conclusion
Medical Consequences Of Sexual Assault Can Be Minor Or Some Sustain Grievous Injuries, Even Death. It May Lead To
Pregnancy. The Rape-Related Pregnancy Rate Is Approximately 5% Among Women Aged 1220Years. Total Number Of
Sexual Assault Among 12-20Years Of Age Group-32 Cases And 20-30Years-18 Cases.
Unintended Pregnancy Is Especially High Among Adolescent Victims Various Long-Term Health Effects Like Increased
In-Patient-Reported Symptoms, Diminished Levels Of Function, Alterations In Health Perceptions, And Decreased Quality
Of Life Are Sequel Of Childhood And Adult Sexual Abuse. Many Women Dont Spontaneously Discuss History Of Sexual
Assault But May Present With Chronic Pelvic Pain, Dysmenorrhea, And Sexual Dysfunction More Often Than Those
Without Such History. After Assault, A Rape-Trauma Syndrome Often Occurs And Cute Ptsd Is Long-Term Consequence
Roles And Responsibilities Of Health Care Providers Assimilated Based On The Study:

They Should Routinely Screen Women For History Of Sexual Assault, Paying Particular Attention To Those
Reporting Pelvic Pain, Dysmenorrhea, Sexual Dysfunction.

Counseling Can Help Victim To Understand Psychological And Physical Responses, Thereby Diminishing
Associated Symptoms

While Conducting An Evidentiary Evaluation Of Victim They Must Comply With State/Local/Statutory/Policy
Requirements Involving Use Of Evidence Gathering Kits

Clinical. Psychological Follow-Up- Visit Should Take Place Within 12 Weeks With Further Visits Scheduled As
Indicated By Results/Assessments.

Emergency Contraception Should Be Provided.

The Most Common Stds Reported In Victims Include Trichomoniasis, Gonorrhoea, And Chlamydia Trachomatis.
Prophylaxis For These Stis Is Recommended.


Of Particular Concern Is Hiv, Where The Status Of The Assailant Is Unknown Or Unavailable. Victims Hiv Status
Should Be Tested Within 72Hours Of Assault And Regardless Of Whether Nonoccupational Post Exposure Prophylaxis Is
Initiated, We Should Provide Hiv Risk Reduction And Primary Prevention Counselling.

***************

A Rare Case Of Monoamniotic Twins With One Fetal Anencephaly And Another Normal Fetus Managed Expectantly
Upto 32Wks Of Gestation.
Author: Dr. Sandhya Kongara
Co Author: Dr. N. Prabhavati1, Dr. Sivaranjani2, Dr.P. Chandrasekhar Rao3, Dr. P. Lavanya4, Dr. Aruna5

Background:

A Monoamniotic Twin Pregnancy,In Which Two Fetuses Coexist Within One Amnion. This Occurs If Cleavage Of Embryonic
Disc Occurs Between 8 And 13 Days After Fertilization. Prevalence Of Monoamniotic Twins Is Estimated To Be Between
1 In 5,000 And 1 In 25,000 Pregnancies. Occurence Of Monoamniotic Twin Pregnancy Discordant For Anencephaly Could
Be Estimated As 1 In 500 Million Live Births.

Two Types Of Problems Can Be Encountered In This Pregnancy. One Is Abrupt, Uncoordinated Movement Of Anencephaly
Fetus Can Cause Further Stretching And Compression Of Cord, Leading To Death Of Normal Twin. Second One Is
Polyhydramnios Due To Impairment Of The Swallowing Reflex Of Anencephalic Fetus.

Case Report:

A 23 Yr Old Antenatal Woman G2P1L1 With Previous Lscs 20 Weeks Of Ga Came To Hospital As Outpatient . Us Confirmed
Twin Gestation With One Normal Twin Second One Anencephalic Twin At 20 Wks.There Was Single Placenta And No
Inter Twin Membrane Suggestive Of Monochorionic And Mono Amniotic Twin Gestation.
Patient Refused Termination After Explaining Risk.
She Had Regular An Checkups. From 26Wks Monitoring Was Done By Serial Usg,Colour Doppler, Non-Stress Test Which
Were In Normal Range.
Patient Complained Of Labour Pains At 32 Wks, Was Hospatilized And Was Given 2 Doses Of Betamethasone For Lung
Maturity.
She Delivered Two Female Babies Through Vaginal Route. Twin A-Normal,1500Gms,Apgar 6-8 And Twin B-1100 Gms,
Apgar 2-0 Showed Anencephaly.

Conclusion:

In This Case,Expectant Management Up To 32 Wks With Regular Monitoring Resulted In Successful Delivery Of Normal
Twin.
***************

Case Report On Malignant Ovarian Tumour.

Author: Dr. Sanket Barik
Co Author: Dr.Ajit Kumar Nayak1,

Background:
32Yr Unmarried Lady Admitted To Hospital With Complain Of Sudden Onset, Rapidly Increasing Abdominal Distension
3 Months. On Examination- She Was Cachectic, Had A 24Wk Size Cystic Mass Per Abdominally. She Was Evaluated In
Suspicion Of Ovarian Malignancy. Her Tumor Markers Were Raised. Usg Doppler Showed Huge Multiloculated Cystic Mass
With Internal Septations, Papillary Projections & Solid Components With Low Resistance Blood Flow. Oncogynecology
Dept. Was Consulted, Total Abdominal Hysterectomy With Bilateral Salpingo Oopherectomy, Lymph Node Dissection &
Infracolic Omentectomy Done. After Imprint Cytology & Specimen Biopsy, It Came Out As A Case Of Mucinous
Cystadenocarcinoma Of Right Ovary. Cytoreductive Surgery Done Followed By Standard Postoperative Treatment With
Platinum Based Chemotherapy.
Case:
Mucinous Cystadenocarcinoma Of Right Ovary.
Conclusion:
Unfortunately, Recent Data Have Confirmed What Many Clinicians Have Long Suspected: That Mucinous Ovarian Cancers
Do Not Respond To The Standard Platinum Based Chemotherapy Routinely Employed In The Malignancy And Both
Progression- Free And Overall Survival Are Substantially Shorter For Mucinous Subtypes Compared To Other Epithelial
Ovarian Morphologies.

***************

Leiomyosarcoma Uterus.
Author: Dr. Shantipriya Murmu
Co Author: Prof. Dr. Maya Padhi1, Dr. Leesa Mishra2, Dr. Sandhyarani Behera3, Dr. Ajit Kumar Nayak4, Dr. Biranchi
Narayan Mohapatra5

Background:
A 46Yr Hf, P4L4 Was Admitted To Scbmch On 19.09.2014 With Complaints Of Dysmenorrhoea & Menorrhagia On
19.09.2014. She Was Non-Diabetic, Non-Hypertensive, Conscious, Oriented With Stable Vitals. Abdomen Was Soft &
Nontender With A Mass Of 18Wks Size. Per-Vaginally, The Uterus Was 18Wks Size, Anteverted, Firm, Mobile, Fornices
Free. On Evaluation, She Was Anaemic With Hb: 6Gm%. Other Routine Investigations Were Within Normal Limits. 2 Units
Of Blood Transfused. Pap Smear Showed Inflammatory Smear. Usg Revealed A Bulky Uterus With Large Sub-Serosal
Fibroid. Histopathological Study Of Endometrium Showed Non-Secretary Endometrium. Patient Was Discharged On
Request With An Advice To Take Oral Haematinics & Planned For Hysterectomy. Patient Returned On 13.10.2014 To Scb
Gopd And Readmitted With Complaints Of Increase Abdominal Pain. Abdominal Examination Revealed A Mass Of Size
26Wks With Irregular Margins. Per-Vaginally Uterus Was 26Wks With Restricted Mobility. Hb Was 10.8Gm% And Other
Routine Investigations Were Within Normal Limit. On Usg, There Was Bulky Uterus With A Large Sub-Serosal Fibroid With
Features Of Degeneration. No Free Fluid In Abdominal Cavity. Patient Was Planned For Total Abdominal Hysterectomy
With Bilateral Salpingo-Oophorectomy. Laparotomy Was Done On 26.10.2014. There Was Dense Adhesion Between Mass
& The Bowel, Adhesiolysis Done, Mass Made Free And A Large Subserous Fibroid Of With Degenerative Changes Detected
& Tah & Bso Done. Grossly Mass Was Of Size 12 X 5 Cm With Irregular Surface With Degenerative Changes Without Any
Capsule. Cut-Section Showed Normal Endocervical Canal, Entire Specimen Sent For Hp Study. Histopathology Study
Revealed well Differentiated Leiomyosarcoma. Chemotherapy Planned After 2Wks & Discharged On 30.10.2014
With Follow-Up Schedule.
Case:
Leiomyosarcoma Uterus.
Conclusion:
Leiomyosarcoma Uterus, A Rare Aggressive Tumour With Incidence 0.13-0.81% & Median Age Is 43-53Yr. Although
Advances Have Been Made In Treatment Protocol, Leiomyosarcoma Remain One Of Most Difficult Soft Tissue Sarcoma
To Treat.

***************

Complete Androgen Insensitivity Syndrome A Case Report

Author: Dr. Sapna Hp
Co Author: Dr Nandish Manoli1, Dr Jayashree. S2, Dr Sowmya. K3,

Background:
Androgen Insensitivity Syndrome (Ais) Is Also Known As Testicular Feminization Syndrome Which Was First Described By
John Morris In 1953. It Is A Rare X Linked Recessive Androgen Receptor Disorder Caused By Point Mutation Of Androgen
Receptor Gene. The Prevalence Is Estimated Between 1 In 20,000 To 1 In 60,000 Male Live Births. Ais Can Be Complete,
Partial Or Mild.
Case:
We Are Reporting An Unmarried 18 Years Aged Tall Statured Girl With Primary Amenorrhea With Presence Of Secondary
Sexual Characters And A Normal Female External Genitalia With Bilateral Soft Tender Palpable Masses In The Inguinal
Region. Ultrasound Showed Bilateral Testes In Inguinal Canal With Absent Mullerian Structures. High Testosterone Levels
Are Seen . Karyotyping Revealed 46Xy. After Thorough Genetic Counseling To Both Parents And Patient, Bilateral
Gonadectomy Was Done. She Has Been Put On Hrt And Also Counseled About The Necessity Of Vaginal Reconstruction
At The Time Of Marriage.
Conclusion:
Since Reveling The Actual Sex Of The Patient At The Time Of Puberty Is A Pschyco-Social Issue It Has To Be Tackled
Delicately. Knowledge And Understanding Of This Moiety Is A Key To Early Diagnosis And Treatment To Prevent Gonadal
Malignancy, So Such Disorders Has To Be Treated Correctly And A Precise Information Has To Be Specified To Parents Or
Guardians Concerning The Outcomes Of Fertility In Future.
***************

Pregnancy In Eisenmeger Syndrome

Author: Dr. Shwetha S
Co Author: Dr.Geetha Prasad Md Dgo1,

Background:
Eisenmeger Syndrome Consists Of Pulmonary Hypertension With Reversed Or Bidirectional Shunt At Atrial,Ventricular
Or Aorto Pulmonary Level . Pregnancy Should Ideally Be Avoided In A Patient With Eisenmeger Because It Carries A 50%
Risk Of Sudden Death,Especially A Few Days Post Partum.
Case:
22 Year Old Mrs.Egavalli, Primi, Lmp-26-10-13 Edd 3-8-14, Known Case Of Large Asd With Severe Pht ( Eisenmeger
Complex) Got Admitted In Icu On 2-7-14 At 35 Weeks Of Gestation With Complaints Of Severe Breathlessness For 5 Days.
Patients Is A Known Case Of Heart Disease Since 4 Years Of Age Not On Treatment Or Follow Up. In 2012 She Was
Evaluated In Private Hospital - Echo Feb 2012 Showed Large Os Type Asd.Bidirectional Shunt With Severe Pht. Patient
Was Started On T.Sildenafil And T.Bosetan And Then Discharged .
After Conception She Was Asked To Continue Sildenafil And Also Adviced To Continue Pregnancy.
On Admission She Was Unable To Maintain Saturation Without Oxygen (77% @ Room Air).. Cardiologist Opinion
Obtained.T..Bosetan And T. Sildenafil Continued.She Was Taken Up For Emergency Lscs On 7-7-14 In View Of Fetal
Distress .Preterm Boy Of 2Kg With No Signs Of Teratogenicity Delivered.Concurrent Sterilization Also Done
.Postoperatively She Was Started On Frusemide And Spironolactone Along With Other Drugs.Antithrombosis Prophylaxis
Also Given. Echo Taken On Pod10 Showed Large Asd With Bidirectional Shunt And Severe Pulmonary Hypertension(Trpg
99Mmhg). She Was Discharged On Pod 14. 6Th Week Follow Up She Was Well With A Healthy Baby.
Conclusion:
Although We Often Advice Termination Of Pregnancy In A Patient With Eisenmeger Syndrome Here We Have A Case Of
Successful Pregnancy With Newer Cardiac Drugs In Such A Patient .

***************

A Rare Case Report Of Malignant Mixed Germ Cell Tumour

Author: Dr. Nikila Prakasam
Co Author:

Background:
Germ Cell Tumour Accounts For About 5%- 10% Of Ovarian Malignancy..Mixed Germ Cell Tumour Contributes Less Than
5% Of All Ovarian Neoplasms. Malignant Mixed Germ Cell Tumour Are Still Rare. .Mixed Germ Cell Tumour Contains Two
/More Recognizable Germ Cell Entities.Most Common Component Being Dysgerminoma Occuring In Combination With
Others.
Case:
36 Yrs Old Woman,P3L3 Was Admitted With Complaints Of Lower Abdominal Pain And Abdominal Mass For 1 Month
Duration.There Was No H/O Menstrual Disturbance.On Abdominal Examination There Was Mass Of Size 15*10 Cm
Occupying Left Lumbar ,Iliac And Umblical Region. Routine Investigations-Normal. Ct Abdomen With Pelvis Showed
Heterogenous Enhancing Complex Solid Ovarian Mass Of Size 16*16Cm In Left Adnexa. Right Ovary And All Other OrgansNormal.X Ray Chest Normal Study.Staging Laprotomy Planned.Intraoperatively, There Was A Solid Left Ovarian Mass
Of About 18*16 Cm Noted.Capsule Breached. Right Ovary Normal.Uterus,Tubes Normal.50 Ml Of Haemorrhagic
Ascitic Fluid Aspirated.Other Organs Normal.No Lymphadenopathy/Omental/ Peritoneal Deposits.Hence Total
Abdominal Hysterectomy With Bilateral Salphingo-Oophorectomy With Infracolic Omentectomy Done. A Intra Op
Diagnosis Of Stage I C Malignant Ovarian Tumour Was Made. Post Op Period Uneventful.Hpe Report Showed Mixed Germ
Cell Tumour With Prominent Dysgerminoma Component With Foci Of Yolk Sac Component.Ascitic Fluid Positive For
Malignant Cells.Tumour Markers Afp,Hcg & Ldh Elevated ..She Underwent Two Cycles Of Chemotherapy With Bep
Regimen.Post Chemo Ct Showed No Residual Disease.Tumour Markers Returned To Normal Level.She Is On Regular
Follow Up.
Conclusion:
In Mixed Malignant Germ Cell Tumour The Prognosis Depends Upon 1.The Non Dysgerminomatous Component 2.Tumour
Size > 10 Cm 3.Staging At Initial Diagnosis.
Eventhough Chemotherapy Achieves High Remission The Patient Should Be Kept Under Close Surveillance

***************

Juvenile Granulosa Cell Tumour Of Ovary A Rare Presentation Of Sex Cord Stromal Tumour In Adolescent Girl
Author: Dr. Nasrin Hasan
Co Author: Dr.B.Tamilselvi1,

Background:
Granulosa Cell Tumours Are Sex Cord Tumours Secreting Estrogen Seen In Women Of All Ages. Juvenile Granulose Cell
Tumours Makeup Less Than 5 % Of Ovarian Tumours ,Presenting As Isosexual Pseudoprecocity . We Report A Case Of
Jgct In An Adolescent Girl Without Elevation Of Baseline Estradiol Nor With Hyperestrogenic Features
Case Report:
13 Year Girl , Menarche 6 Months Back,Known Hypothyroid , Irregular Cycles Since Menarche, Abdominal Pain And
Distention For 3 Months, General Examination Was Normal With No Signs Of Virilisation Nor Sexual Precocity. Per
Abdomen Revealed Irregular Pelvic Mass Of 36 Week Size Upto Right Upper Quadrant.Mass Was Dull On Percussion.Pr
No Abnormality
Usg : Huge Hyperechoic Mass With Multiple Cystic Areas Of Size 15*8*14 Cm Imp: Retroperitoneal Mass ? Right Ovarian
Mass
Mri Revealed Multilocated , Abdominopelvic Heterodense Soft Tissue Mass In Right Side Of Abdomen 20*15*10 Cm With
Areas Of Calcification Adherent To Bowel Loops And Displacing Aorta And Ivc To Left.
Imp; Complex Right Ovarian Cystic Mass
Tumour Marker Assay; Moderate Elevation Of Ca125 And Ldh
Staging Laparotomy Proceeded With Suspicion Of Dysgerminoma
Encapsulated Mass Arising From Left Ovary 20*15*10 Cm , Twisted Twice Around Pedicle ,With Congested Left Tube.
Uterus ,Right Tube And Ovary Normal. Rest Of Abdominal Viscera Normal
Hpe Revealed Juvenile Granulosa Cell Tumour , Macrofollicular Pattern With Focal Trabeculoid Pattern With Extensive
Lutenisation
Serum Estradiol And Inhibhin B Was Normal
Medical Oncologist Staged As Figo Stage 1A And Advised Regular Follow Up.
Discussion:
Juvenile Gct Is An Ovarian Tumour Of Variable Behaviour. Serum Estradiol And Inhibhin B Help In Diagnosis But Confirmed
Only By Histopathology. This Case Illustrates A Rare Form Of Ovarian Tumor In Young Girl Without Elevated Tumour
Markers .Surgery Is Curative.6Th Month Surveillance Normal Though Late Recurrence Is A Possiblity.

***************

Mifipristone Induced Fatal Septicemia Following Medical Abortion -A Rare Case Report
Author: Dr. Shanthadevi Sambath
Co Author: Dr.Rajakumari1, Dr.Noorul Hasan2, Dr.Aswin Ram3,

Background:
Medical Abortion With Mifipristone & Misopristol Is The Common Method Of Mtp For Pregnancy Of Less Than 7 Weeks,
Because It Is Safe, Easy To Take And Non Surgical.But Very Few Cases Of Fatal Complication Due To Fulminant Sepsis And
Toxic Shock Syndrome Have Been Reported All Over The World.Here Iam Presenting A Case Of Fulminant Septic Shock
Following Medical Abortion With Mifipristone And Misopristol.
Case Report:
29 Year P1L1 A Staff Nurse,With H/O Medical Abortion With Mifipristone And Misopristol Taken On Her Own, Got It Over
The Counter. 3 Days Later She Presented With H/O Diarroea And Vomiting And Pain Abdomen. About 10 Hours After
Admission She Developed Refractory Hypotension,Persistent Tachycardia,Oliguria But No Fever.Investigation Showed
High Urea,Creatinie, Raised Haematocrit, Leucocytosis And Low Platelet Count. Laparotomy Findings Are 1.5 Liters Of
Straw Coloured Fluid And Ovarian Enlargement,But The Uterus Was Normal.She Was Treated By Various Specialist In The
Icu. She Developed Multi-Organ Failure And Died On The 4Th Post Operative Day.
Discussion:
Mifipristone Has Antiprogesterone And Antiglucocorticoid Activity.Antiprogesterone Action Causes Separation Of
Products Of Conception And Opening Of Cervix Which Causes Nidation Of Clostridium Sordilli From Vagina Into Uterine
Cavity. Anti Glucocorticoid Activity Destroys Innate Immune Response Which Enhances The Growth Of Clostridium
Sordilli, A Gram Positive Anaerobic Bacteria Causing Severe Fatal Sepsis By Releasing Toxins Which Causes Multiorgan
Failure And Death.The Peculiarity Of This Infection Is Absence Of Fever,Refractory Hypotention,Persistent
Tachycardia,Effusion In Multiple Serous Cavities,Dramatic Leucocytosis And Hemoconcentration. All These Findings Were
Present In Our Case.
Conclusion:
Early Diagnosis Of This Fatal Infection Is Difficult Because Of Its Rarity And Its Atypical Presentation. Antibiotics Should Be
Given Along With Mtp Drugs. Self Medication Of These Drugs Without Monitoring Should Be Avoided. Temporary
Methods Of Contraception Should Be Motivated For These Unmet Need Women.

***************

Carcinosarcoma Of Ovary: A Rare Case Scenario

Author: Dr. Niroopama Pushpagiri
Co Author: Dr.Shanthi Dinakaran1, Dr. Alagamai2,

Background:
Ovarian Carcinosarcoma, Also Called As Malignant Mixed Mesodermal Tumors Are Rare NeoplasmS Comprising 1%
To 4% Of All Ovarian Cancers. It Is One Of The Most Lethal Female Malignancies, A Biologically Aggressive Tumor, Usually
Diagnosed At Older Age, With Poor Prognosis And Mean Survival Of 4 Months To 14 Months. Most Of The Cases Are In
Advanced Stage With Wide Metastasis At The Time Of Initial Presentation. We Report A Case Of Carcinosarcoma Of The
Ovary Of Stage Ic Which Was Successfully Treated With Surgery And Chemotherapy.
Case Report:
A 39 Years Nulliparous Lady Presented To Our Hospital With Distention Of The Abdomen For The Last 3 Months And No
Other Significant Medical History. Physical Examination Revealed Firm Nontender Mass Occupying The Whole Abdomen
With Resonant Flanks. Computed Tomography And Magnetic Resonance Imaging Of The Abdomen Revealed A Large
Abdomino-Pelvic Mass Of 22 Centimeters Width And 18 Centimeters On Its Long Axis, Arising From The Left Ovary.
Calculated Risk Malignancy Index Was Found To Be 66. The Findings Were Confirmed At Laparotomy And A Total
Abdominal Hysterectomy With Bilateral Salpingo-Oophorectomy Was Done Along With Biopsy Of The Omentum And
Adjacent Lymph Nodes. Peritoneal Washings Were Obtained For Histopathology [Hpe] Examination. The Patient Made A
Smooth Recovery. Hpe Report Showed Homogenous Carcinosarcoma With Positive Peritoneal Cytology Which Staged To
Ic. The Patient Underwent 6 Cycles Of Chemotherapy With Carboplatin And Ifosfamide And Was In Good Health At The
Time Of Recent Follow Up.

Conclusion:
Ovarian Cancers Are Difficult To Diagnose In Early Stage As Most Of Them Are Either Asymptomatic Or Present With
Vague Generalised Symptoms. Our Case Of Carcinosarcoma Was A Rarity To Be Staged To Ic And Was Aggressively Treated
With Surgery And Chemotherapy. This Allowed The Patient To Remain Free Of Recurrence For Nearly 15 Months Now.

***************

Leiomyoma Of Ovary- A Rare Case Report

Author: Dr. Sailabala Shaw
Co Author: Prof. Dr. Lucy Das1, Asso.Prof .Dr .Sasmita Swain2, Asst.Prof. Dr. Sujata Singh3, Asst.Prof. Dr.Sandhya Rani
Behera4, Sr.Dr.Anurekha J.P.5

Background:
Ovarian Leiomyoma Is A Rare Benign Tumor .It Accounts For 0.5% - 1% Of All Benign Ovarian Tumours. Mostly Unilateral
Presentation. It Probably Arises From Smooth Muscle Cells Present In The Ovarian Hilar Blood Vessels , Ovarian
Ligaments, Mature Cystic Teratoma , Walls Of Mucinous Cystic Tumour. It May Also Originates From Smooth Muscle
Metaplasia Of Endrometriotic Stroma , Undifferentiated Germ Cells On Cortical Smooth Muscle Metaplasia And Smooth
Muscle Cells Or Multipotential Cells In The Ovarian Stroma .Most Commonly Seen In Nulliparous Women. Oestrogen May
Play A Role In The Development Of Ovarian Leiomyoma. The Tumor May Be Asymptomatic Or May Manifest With Lower
Abdominal Pain.
Case:
A 19 Year Old Unmarried Girl Was Admitted To Our Hospital With Complain Of Mass Abdomen For 3 Months. On PerAbdominal Examination A Mass Of Size 24 Weeks, Mobile, Nontender With Firm To Hard Consistency Was Found .
Trans-Abdominal Ultrasonography And Computed Tomography Scan Revealed A Solid Ovarian Mass With Cystic
Degeneration And Minimal Ascites. Right Salpingo-Oophorectomy Was Performed. On Gross It Was A Solid, Multilobular,
Hard, Irregular Ovarian Mass Of Size 25 2015 Cm , Associated With Degeneration. Histopathological Examination
Revealed It An Ovarian Leiomyoma.
Conclusion:
Definitive Diagnosis Is Difficult Prior To Surgical Removal. Because There Is No Pathognomonic Symptoms Or
Characteristic Imaging Findings. Despite Its Rarity An Ovarian Leiomyoma Should Be Considered In The Differential
Diagnosis Of Solid Ovarian Tumours. Appropriate Diagnosis Requires Immune-Histochemical Analysis.

***************

A Rare Case Of Ectopic Hyperthyroidism- Struma Overii

Author: Dr. Indu Lata
Co Author: Dr Deepa Kapoor1,

Background:
Pancreatitis Is A Rare But Serious Condition In Pregnancy, Occurring In 1 In 1000 To 1 In 12,000 Pregnancies.1 Pancreatic
Pseudocysts Complicate 5% Of Cases Of Pancreatitis,2 Or Fewer Than 1 In 60,000 Deliveries. Pancreatic Pseudocyst In
Pregnancy Is A Rare Condition Whose Management Is Not Standardized. The Natural History Of Pancreatic Pseudocysts
In Pregnancy Appears Similar To That In Non-Gravid Patients. Hyperlipidemia Is Considered As A Common Cause Of
Pancreatic Pseudocysts In Pregnancy, Responsible For More Cases Than Other Causes Like Alcoholic And Biliary
Pancreatitis.
Case:
We Are Reporting Our One Case Report Of A 23-Year-Old Primigravida Woman At 25 Weeks' Gestation Presented With
History Of Nausea, Vomiting, And Intermittent Epigastric Pain For Last Six Months. She Had Past History Of Similar Pain,
Five Years Back And Diagnosed To Have Cystic Lesion In Pancreas Without Pancreatitis. She Was Managed Conservatively.
Due To Persistent Nausea And Vomiting Patient Nutritional Status Was Affected. So Patient Developed Intrauterine
Growth Restriction In Early Pregnancy.At 33 Weeks Gestation On Ultrasound, Previously Present Pseudopancreatic Cyst
Was Absent. At 38.3 Weeks Pregnancy Abdominal Ultrasound Shown Asymptomatic Incidental Cholilithiasis Along With
Fetal Intrauterine Growth Restriction Having Breech Presentation With Oligohydramnios. Emergency Caesarean Section
Was Done At 39 Weeks In View Of Fetal Distress On Contraction Stress Test Under Regional Anaesthesia.
Conclusion:
Symptomatic Pseuodopancreatic Cyst In Pregnancy Can Be Problematic In View Of Its DiagnosisS, Management And
Can Complicate Pregnancy And Its Outcome. If Not Subsided By Conservative Management, Surgery May Be Needed
Depend On Symptoms And Its Complications. Any Medical Or Surgical Illness During Pregnancy Can Increase The Mortality
And Morbidity In Both Mother And Fetus. Lifesaving Emergency Surgery Of Mother Can Be Done In Any Trimester.
Multidisciplinary Approach May Give Better Outcome In This Type Of Rare High Risk Pregnancies.

***************

Peripartum Cardiomyopathy -Case Series From A Tertiary Care Centre

Author: Dr. Lalitha Narayanan
Co Author: Dr Seetha Panicker1, Dr Shanmugasundaram2, Dr Gowrishankar3,

Background:
Peripartum Cardiomyopathy Is A Form Of Dilated Cardiomyopathy Occurring In The Last Month Of Pregnancy And 5
Months Post Partum. It Has A Variable Incidence, With An Incidence Of 1 In 2675 Among Asians. The Etiology Is Still
Uncertain Though Many Theories Exist. The Morbidity In Patients Ranges From Persistent Lv Dysfunction To Heart Failure
Requiring Transplantation And Death. The Recurrence Rate Is High (25-50%) Even In Patients Whose Lv Systolic Function
Has Improved.
Cases:
In A Retrospective Analysis,10 Cases Of Peripartum Cardiomyopathy Were Identified During The Period 2008-2014 In Our
Institution.5 Cases Were Diagnosed Antepartum And 5 Postpartum( 3 In The Immediate Postnatal Period And 2 Within 2
Months).Six Patients Were Multiparous. Mode Of Delivery Was Vaginal In Three Cases And Lscs In Seven. Four Patients
Delivered At Term And Six Were Preterm Deliveries Ranging From 29-35 Weeks. Five Of Them(50%)Had Associated
Hypertensive Disorders-One Had Chronic Hypertension,3 Pre-Eclampsia And One Had Eclampsia. Associated Medical
Disorders Were Hypothyroidism In Three Patients, Gestational Diabetes In Two And Dyslipidemia In Two Patients. One
Patient With Dyslipidemia Had A Thromboembolism With Hemiparesis And Another Had Sudden Cardiac Death. All Nine
Patients Were Followed Up At The Cardiology Op And Had Improved Lv Function.
Conclusion:
Prompt Diagnosis And Multidisciplinary Mode Of Management Helps In Reducing Morbidity In These Patients. Delay In
Diagnosis Is A Norm Since The Initial Symptoms Mimic Those In Normal Pregnancy. Increased Awareness Among Medical
Practitioners Could Help In Early Recognition And Referral To A Tertiary Centre. Education Of The Patients And The
Relatives Is Essential Regarding The Need For Treatment And Medical Follow Up With A Cardiologist. The High Recurrence
Rate In Subsequent Pregnancies Should Be Discussed With The Couple Along With The Need For Adequate Contraception
To Avoid Worsening Of Cardiac Status And Terminations.

***************

Abruptio Placentae- An Atypical Presentation

Author: Dr. Jogesh Barma
Co Author: Dr Nalini Arora1, Dr. Nita Singh2,

Background:
Placental Abruption Complicates 1% Of Births And Associated With High Perinatal Mortality .
Case Summary:
A 19-Year-Old Primigravida Presented At 22 Weeks Of Gestation With Generalized Weakness For The Last 7 Days. There
Was No History Of Pain Abdomen And Vaginal Bleeding. On Examination, There Was Severe Pallor, Pulse Rate Was
100/Min And Good Volume, Bp Was 118/70 Mmhg. Abdominal Examination Revealed Uterine Enlargement
Corresponding To 36 Weeks Of Gestation And It Was Neither Tense Nor Tender On Palpation. Ultrasonography Revealed
A 22 Weeks Live Fetus With Hugely Enlarged Placenta Occupying Whole Of The Uterine Cavity Suggestive Of
Hyperplacentosis Or Chorioangioma . Her Haemoglobin Was 5.7 Gm% , Other Haematological And Biochemical
Parameters Were Normal. Serum Beta Hcg Was 190242 Miu/Ml. After Receiving 4 Units Of Packed Cell Her Haemoglobin
Level Did Not Improve. Therefore Decision For Delivering The Foetus Was Taken And Artificial Rupture Of The Membrane
Was Done. Following This She Expelled A Dead Foetus Of 450 Gms With No Signs Of Maceration Through Partially Dilated
Cervix. Manual Removal Of Placenta Was Done Under General Anaesthesia Due To Cord Snapping. Massive Clots And
Altered Coloured Blood Were Expelled After Placenta. She Received 7 Seven Units Of Packed Cell And Three Units Of
Fresh Frozen Plasma During Her Hospital Stay. Placental Histopathology Showed Fresh Haemorrhage, Fibrin Rich Exudates
And Necrotic Stromal Fragments, No Chorionic Villi Or Malignant Change.
Conclusion:
Massive Abruption In Early Pregnancy Is Rare. On Ultrasonography Abruption In Acute Phase May Be Hyperechoic Or
Isoechoic When Compared With Placenta And Can Be Confused With Hyperplacentosis Or Chorioangioma. Meticulous
Approach And Timely Intervention Is Needed For Preventing Irreversible Damage.

***************

Successful Pregnancy Outcome Of Craniovertebral Junction Anomaly Complicating Pregnancy

Author: Dr. Vijaya M
Co Author: Dr.Premalatha.Mdog.Frcog1,

Background:
The Term Craniovertebral Junction Refers To The Occipital Bone That Surrounds The Foramen Magnum & The Atlas &
The Axis Vertebrae. It Is A Transition Site Between Mobile Cranium & Relatively Rigid Spinal Column. It Is Also The Site Of
The Medullary Spinal Junction. Cv Anomalies Are Defects Of Development & Not Necessarily Congenital & May Not
Manifest At Birth.
Case Description:
A 29 Year Old Lady Came To Mehta Hospitals At 21Weeks Of Gestation For Antenatal Visit As Advised By The Primary
Physician In Arani. She Was A Known Case Of Spastic Quadriparesis Super Added On Cerebral Palsy And Diagnosed To
Have Craniovertebral Junction Anomaly With Severe Foramen Magnum Stenosis By Ct Scan In 2007 And In January 2013
She Has Come With 21 Weeks Of Pregnancy And Mri Was Done ,Reviewed By Neurosurgeon Advised Sudden Movement
Of Neck Can Cause Quadriplegia And Has Advised Decompression Surgery. Complications Of Surgery And Chance Of
Abortion Was Explained And Patient Attender Refused Surgery And Continued Pregnancy. At 36Weeks Of Gestation She
Came With Complaints Of Pain Abdomen And Mild Iugr. In View Of Neurologic Complication That May Occur During
Vaginal Delivery, Elective Cesarean Was Performed Under General Anesthesia On June2013.She Had A Successful
Pregnancy Outcome And She Had Decompression Surgery On Sep2014.Both Mother And Baby Doing Well.
Conclusion:
Craniovertebral Junction Anomalies Are Rare And Especially With Pregnancy With Severe Foramen Magnum Stenosis.
This Case Is Presented Due To Its Rarity And Successful Management.

***************

Uretero-Uterine Fistula: A Very Rare Occurrence

Author: Dr. Alpa Khakhar
Co Author: Dr. Khakhar Alpa1, Dr. Raghavan Deepak2, Dr. Bhat Abhishek3,

Background:
Ureteric Injury Is Usually Iatrogenic In Origin. We Present A Case Of A Lady, Who Presented With Continuous Watery
Discharge Per Vaginum, Post Cesarean Section Done 6 Weeks Prior.

Case:
A 36 Year Old Lactating Multiparous Lady Underwent Repeat Elective Lower Segment Caesarean Section 1 Months
Earlier. She Presented With Complaints Of Continuous Leakage Per Vaginum Which Was Watery In Nature. Ct Ivu Was
Performed Which Was Suggestive Of A Communication Between Distal Right Ureter & Uterus. She Was Taken Up For
Abdominal Hysterectomy With Right Ureteric Reimplantation With Boari Flap & Psoas Hitch Of The Bladder With Dj
Stenting. A Follow Up Cystogram Was Done 10 Days After Discharge Which Showed No Leakage From Bladder. Foleys
Catheter Was Removed On 20Th Post Operative Day & Dj Stent After 3 Months Of Surgery. At Three Months, An Ivu, And
Possibly A Mag3 Renogram Was Obtained To Confirm Patency Of The Anastomosis

Conclusion:
The Goals For Management Of Uretero-Uterine Fistulae Are The Conservation Of Renal Function And Restoration Of
Ureteral Integrity Through Ureteroneo-Cystostomy Or End To End Anastomosis. There Are No Clear Guidelines As To How
To Manage Uretero-Uterine Fistulae As They Are Rare Compared To Other Fistulae. The Resolution Of This Case And
General Management Of Uretero-Uterine Fistulae Are Discussed.

***************

Arterio-Venus Malformation In Uterus A Hidden Cause Of Life Threating Vaginal Bleeding- A Case Series.
Author: Dr. Dipnarayan Sarkar
Co Author: Dr Mriganka Mouli Saha1, Dr Sarbeswar Madal2, Dr Jhuma Biswas3, Dr Smriti Prasad4, Dr Soumen Mandal5

Background:
Uterine Arteriole-Venus Malformation Is Rare But Life Threatening Condition In Obstetrics Patient. Prompt Diagnosis And
Treatment Is Essential To Save PatientS Life

Case:
Uterine Arteriole Venus Malformation (Avm) Is A Life Threatening Condition. It Occurs After Traumatic Gynecological
Surgery Such As Cesarean Section, Medical Termination Of Pregnancy And After Evacuation Of H Mole. Here The Five
Cases, All Patient Came With Severe Menorrhagia After Traumatic Gynecological Surgery And Diagnosed As Avm By Color
Doppler And Ct Angiography. Some Patients Were Treated Successfully By Embolizetion And Some Needed Hysterectomy.

Conclusion;
Uterine Artery Malformations Should Be Suspected When Heavy Vaginal Bleeding Occurs Which Will Not Be Controlled
By Medical Or Surgical Treatment.

***************

Study On Impact On Gdm Screening With 75G Ogct In Antenatal Mothers

Author: Dr. Anusuya Natarajan
Co Author: Professor Dr.Vijaya,M.D,D.G.O1,

Background:Women Diagnosed To Have Gestational Diabetes Mellitus Are At Increased Risk Of Future Type 2 Diabetes
As Are Their Children.Timely Action Taken In Screening All Pregnant Women For Glucose Intolerance,Achieving
Euglycemia In Them And Ensuring Adequate Nutrition May Prevent The Vicious Cycle Of Transmitting Glucose Tolerance
From One Generation To Another.
Materials And Methods:According To Dipsi Guidelines,All Pregnant Women Were Screened For Gdm By Giving 75G Oral
Glucose Load,Irrespective Of Whether She Is In The Fasting Or Nonfasting State Disregarding The Time Of Her Last
Meal.Gdm Was Diagnosed If 2-Hour Blood Sugar Level Is >140Mg/Dl(7.8Mmol/L).But For Our Study >130Mg/Dl Is Taken
As The Cut-Off Value So That More Patients Can Be Screened.High Risk Pregnant Women With Normal Glucose Tolerance
In The First Trimester Were Again Tested Around 24Th-28Th Wk And 32Nd-34Th Wk.All The Mothers Were Screened At
The Booking(First Visit)Itself.Exclusion Criteria:Type 2 Diabetes Mellitus Patients.
Results:Among The 7200 Patients Screened Over The One Year Period,18% Were Detected To Have Gdm,5% Had Igt And
The Remainng Had Normal Glucose Challenge Test.All Pregnant Women With Normal Glucose Challenge Test Were
Tested Again In The Second Trimester And 2% Were Detected To Have Gdm And In Third Trimester 3% Were Detected
To Have Gdm.Those Who Were Diagnosed As Gdm Were Advised Diet And Exercises.2% Of Them Were Treated With
Insulin.Among The Igt Group 5%Developed Gdm In The Later Stage.
Conclusions:Universal Screening With 75G Ogct Should Be Done For All Antenatal Women And Repeated Screening
Should Be Done In The High Risk Women Even If The Initial Ogct Is Normal.All Gdm Patients And Their Off Springs Should
Be Followed Up With Lifestyle Modifications For Prevention,Postponement And Early Detection Of Diabetes.

***************

Uterine Necrosis Following B-Lynch And Gunasheela'S Global Stitch Sutures For Primary Postpartum Haemorrhage
Author: Dr. Punya Shivappa
Co Author: Dr Sailakshmi M P A1, Dr Nagaratnamma R2,

Background-Primary Post Partum Haemorrhage(Pph) Is One Of The Top 5 Causes Of Maternal Mortality In Both
Developed And Developing Countries. Successful Techniques Using Compression Sutures To Control Pph Have Been
Described , In Some Cases Using A Combination Of Techniques. We Describe A Case In Which Compression Sutures To
Control Pph Were Complicated By Subsequent Myometrial Necrosis.
Case- A Healthy, 22 Yr Old Pregnant Woman, Primi, Had A Full Term Normal Vaginal Delivery At 39 Weeks 5 Days
Gestation , Then Underwent A Laparotomy Procedure To Control Pph After Failed Medical Management. B-Lynch Suture
Plus 3 Tiers Of Gunasheela'S Global Stitches Were Used To Control Pph As The Uterine Atony Did Not Subside Even After
Step Wise Devascularisation Was Done. On Post Operative Day 8, A Large Myometrial Defect Was Identified In The
Uterine Wall Using Mri Scan.Patient Underwent Hysterectomy, Post Operative Period Was Uneventful And Later Was
Discharged.
Conclusion- While Various Uterine Compression Sutures Have Become Useful In The Containment Of Pph Due To Uterine
Atony And Have Prevented Many Immediate Hysterectomies, Complications Are Being Reported As Thier Use Has
Increased. It Is Important For The Clinicians To Be Prepared, To Tackle The Potential Complications Following These
Sutures, As In This Case, Prompt Imaging With Pelvic Mri Was Invaluable In Diagnosing The Necrosis Of The Uterine Wall.
***************

Snake Bite During Pregnancy

Author: Dr. Arvinder Kaur
Co Author: Dr Surinder Kumari Prof Gyne 1, Dr Beant Singh
Associate Prof2, Dr Bhupal Jps3, Dr Surbhi Saini4,

Background--Snake Bite Envenomation Is Rare In Pregnancy And Obstetrical Consequences Are Severe. Severity Depends
On The Envenomation And The Time Elapsed Before Starting Treatment. Snake Bite In Pregnancy Is Rarely Reported.It
Introduces Immense Fear And Panic Not Only In Patient But Also In Caregivers.
Case --We Present A Rare Case Of A 26 Years 2Nd Gravida In Last Trimester ,Who Was Bitten By A Snake. Unable To Seek
Medical Help Presented In Early Labor Nine Hours After The Event..She Had Neuroparalytic And Hematological
Complications.She Was Managed In Icu With Anti Snake Venom And Delivered An Alive Male Baby With Good Apgar
Score
Conclusion- Snake Bites Are Encountered Rarely During Pregnancy.It Is Important To Deal Such Case Vigilantly.Judicious
Use Of Anti Snake Venom Increase The Survival And Reduce The Complications
The Detail Of Clinical Features And Management Will Be Discussed
***************

Benchmarking In Obstetric Practice

Author: Dr. Sunil Takiar
Co Author:

Benchmarking In Obstetric Practice

Background: Benchmarking Is That Process Through Which Best Practice Is Identified And Continuous Quality
Improvement Pursued Through Comparison And Sharing.
Obstetric Practice Differs In That There Are Problems In Quality Control Due To Individualistic Variations
Like Past Obstetric History, Fetal Presentation, Duration Of Pregnancy, Presence Of Associated Clinical Conditions, Etc.
Aim Of Benchmarking Is To Compare Self With The Equable But best In Class Hospital Care Providers Using
best Practice Parameters & Implement Them Using Quality Measures Based On
A)

Process E.G. Ctg Monitoring

B)

Outcome E.G. Live Birth Rates

C)

Structure Of Care Provider

Methods Of Measuring Hospital Performance Would Include

A)

Regulatory Inspections

B)

Public Satisfaction Surveys

C)

Third Party Assessment

D)

Comparison Of Statistical Indicators

(Last Two Comprising Accreditation)

Specific Issues Related To Obstetric Practices Include
A)
Anc Reach And Attendance In Hospital Setting Including Fully Equipped Facility For Institutional Delivery With
Availability Of High Risk Management Facilities Like Icu, Btd, Etc.
B)

Structural Infrastructure And Appropriate Staff Vs. Patient Ratio.

C)

Ot / Nicu Availability And Safe Practices.

D)

Caesarean Section Vs. Vbac Rates.

E)

Maternal/ Perinatal Mortality Rates.

Challenges Which Are Faced For Ensuring Conformity In Standards And Evaluation Among Various Hospitals Are
A)

Non-Conformity Between Quality Of Service Providers/ Cost And Client Satisfaction.

B)

Nationally Available Data Are Limited And Flawed.

C)

Adverse Outcomes Are Rarely Reported And Difficult To Compare Between Groups.

D)
Specialty Training To Nursing Staff, The Backbone Of Obstetric Services, Is Inadequate/ Improper And Poorly
Monitored.

Suggestions To Improve Obstetric Services Would Include

A)

Standardized Educational And Document Management Protocols.

B)

Clinical Updates To Eliminate errors In Clinical Judgment.

C)

quality Measurement Tools To Be Applied To The Whole Team Rather Than Individual Reprimand.

D)

Accurate Data Collection From Frontline Practitioners And Its Evaluation.

***************

Sexually Transmitted Infections In Hiv Seropositive And Seronegative Females In A Tertiary Care Centre
Author: Ruby
Co Author:

Bhatia Ruby, Kaur Parmjit, Bawejak.Ish, Bahl Rk, Sandhu Ivy, Aman Dev
Deptt Of Obstetrics And Gynaecology And Skin & Vd, Gmc Patiala, Pb, India

Introduction :The Relationship Between Stis And Hiv Infection Is Complex And Manifold. Both Are Acquired Through
Sexual Transmission. Women Are More Vulnerable To Stis For Socioeconomic And Biological Reasons. Stis Are Markers
For High Risk Behaviour For Hiv Infection.
Aims And Objectives :To Study High Risk Factors And Prevalence Of Stis In Females With/Without Hiv Infection. Cellular
Changes In Pap Smear Due To Stis If Any. Diagnosis And Treatment Of Sexual Partners And Counselling Services For Both.
Material Methods :An Observational Study On 100 Females With Stis (50 With Coexistent Hiv Infection And 50 Without
Hiv Infection) In The Age Group 15-49 Years Attending Skin And Vd/ Gynaecology Opd Of Rajindra Hospital, Patiala. A
Detailed History, General And Local Examination With Laboratory Investigations Including Pap Smear Done In All Cases.
Results :Prevalence Of Stis/Rtis Was Observed To Be Highest In The Sexually Active Group (25-34 Years), 52% In Hiv
Positive Women And 46% In Hiv Negative Women. Majority Of Patients (94% /92%) In Both The Groups Were From Local
Population, Illiterate Or Upto Class V (72% /52%), Unemployed (68% /52%), From Low Socioeconomic Status (88% /68%).
Only 18% In Hiv Positive Women And 8% In Hiv Negative Women Had More Than One Sexual Partner. Sexual Partners
Also Suffered From Stis In 67% In Hiv Positive And 43% In Hiv Negative Women. Majority Of Women In Both The Groups
Were Ignorant About Stis (82% / 62% Respectively). Vaginal Discharge Was Most Common Presenting Complaint
(66%/80%) Followed By Genital Ulcer (16% / 8%) In Both The Groups. Inflammatory Pap Smear Were Significantly Higher
(56%) In Hiv Positive Women.
Conclusion :Illiteracy, Ignorance, Low Socioeconomic Status In Sexually Active Group Were Significant Factors Facilitating
Spread Of Stis. Hiv Positive Women Must Have A Pap Smear Alongwith Screening For Stis.

***************

Spontaneous Closure Of The Hymen During Term Pregnancy

Author: Dr. Dr. Gomathy E Jayakanthan
Co Author:

Case Report

Spontaneous Closure Of The Hymen During Term Pregnancy

Background:
The Hymen Is A Membrane, Partially Closing The External Vaginal Opening. The Human Female Is The Only Primate To
Posses A Hymen.It Is Composed Mainly Of Elastic And Collageneous Connective Tissue Covered By Stratified Squamous
Epithelium. Imperforate Hymen Is A Rare Genital Disorder, Which Is Diagnosed During Adolescence Due To
Hematocolpos, At Pregnancy The Epithelium Of Hymen Becomes Very Thick And Rich In Glycogen.
Case:
A 23Year Old Primigravidae Of 38Weeks+5Days Gestation With Vaginal Atresia Was Seen At Our Hospital With Labou R
Pains .On Initial Per Abdomen Examination Regular Uterine Contractions With A Duration Of 30Secs Were Observed, Fhr
140Bpm,Cephalic Presentation,Vaginal Examination Was Not Possible Due To A Fully Intact And Bulging Hymen.
Ultrasonography Revealed A Single Live Intrauterine Fetus Of Gestation Of 38Weeks That Was Corresponding To
Gestational Age With Adequate Liquor. Her Ctg Was Reactive. She Was Immediately Taken For Emergency Lscs And A
Live Male Baby Extracted On 26/9/13 At 11:40Am Weighing 2.28Kgs With An Apgar Score Of 7/9 At 1 And 5 Minutes.
Stellate Incision Was Made On The Hymen Separated By Artery Forceps For Vaginal Drainage. There Was A Cervix Seen
Inside With External Os Closed.
In Her Detailed History, She Attained Menarche At 16Years.Andno Complains Related With Menstrual Activity. She Had
Regular Coital Activity Until The Pregnancy Was Confirmed. She Had A Patent Hymenal Orifice At 6 Th Postpartum Week
The Couple Began Coital Activity And Have Not Reported Any Coital Or Menstrual Problem Until Now.
Discussion:
This Case Of Spontaneous Closure Of Hymen In The Absence Of Previous Surgical Procedures Might Be Attributed To
Glycogenated Epithelium Occurring In Response To Estrogen Exposure At Pregnancy.If This Was Detected During Her
Regular Antenatal Check Up And Treated ,We Could Have Given Her A Vaginal Delivery.

Key Words: Hymen, Pregnancy.

Corresponding Author: Dr Gomathy .E
Assoc Prof In Obg,Sdumc,Kolar,Karnataka
Email-Id:- Egomathy72@Yahoo.Com
Ph No :-+91 9980131436

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Giant Placental Choriangoma With Successful Perinatal Outcome: Rare Entity

Author: Dr. Shobha More
Co Author: Dr Geeta .J.Doppa1, Dr Ravikanth.G.O.2,

Case ReportGiant Placental Choriangoma With Successful Perinatal Outcome: Rare Entity

Drshobhamore1 ,Drgeeta Doppa2 , Dr Praveen Ns3 ,Junior Resident1,Prof & Hod2,Asst Prof3
Kvg Medical College, Sullia, D.K, Karnataka.

Background:Chorioangiomas Are The Most Common Benign Tumors Of The Placenta Originatingfrom Primitive
Angioblastictissues.Giant Placental Chorioangiomas Are Associated With High Prevalence Of Pregnancy Complications
And A Poor Perinatal Outcome. Giant Chorioangiomas> 5Cm In Diameter Are Rare Tumours, Prevalence Ranging From
1:9,000 To 1:50,000 Pregnancies. These Large Chorioangiomas Are Associated With Pregnancy Complications: Premature
Labour,Placentalabruption,Polyhydramnios And Fetal Hydrops, Growth Restriction, Hepatosplenomegaly, Cardiomegaly,
Congestive Heart Failure And Death.Neonatal Consequences Include Severe Microangiopathichaemolyticanaemia,
Thrombocytopaenia And Hydrops
.
Case Presentation:We Report A Case Of A Large Placental Chorioangioma, Complicated By Severe Polyhydramnios,
Severe Anemia ,The Antenatal Management And Maternal And Fetal Outcomes. 34 Year Old Elderly Primigravida With
32 Week Gestation With Severe Polyhydramnios, Chorioangioma Of Placenta , (8X 7 Cm) With Pprom.The Baby Required
Exchange Transfusion,And Phototherapy.

Conclusion: Large Placental Chorioangioma Are Rare And May Lead To Adverse Perinatal Outcomes. Prenatal Diagnosis
Of These Tumours With Close Follow-Up During The Antenatal Period And Early Intervention Is Crucial, And May Result
In A Healthy Mother And Fetus

***************

Midtrimester Life Threatening Vaginal Bleeding - An Abnormal Outcome

Author: Dr. Pradip Saha
Co Author: Anuradha Phadikar1, Malay Kr Nandi2, Priyaranjan Chatterjee3,

Case Report: Mrs. S.S, 21 Yrs Primigravida Referred From Ghatal Subdivision Hospital To Our Medical College On
11.12.2013 At 10 Pm With Sudden Onset Of Severe Bleeding Per Vagina Following Cessation Of Menstruation For 6
Months. She Was Unable To Recollect Her Last Menstrual Period. Pregnancy Test Was Positive, 5 Months Ago. She Was
Known Hypothyroid But Drug Defaulter. On Admisson, She Had Severe Palllor, Pulse Rate- 110/Minute, B.P - 90/60 Mm
Of Hg. On Abdominal Examination, Height Of Fundus - 26 Weeks & No Foetal Parts Palpable & Fhs - Absent. On Vaginal
Examination, Profuse Bleeding Noted & External Os - Closed. No Ultrasound Was Done & No Emergency Scan Fascility
Was Available At Night In Our Hospital. She Was Resuscitated And 2 Units Of Blood Transfused And A Decision Of
Hysterotomy Was Undertaken At Midnight To Save The Life Of The Patient. On Hysterotomy, No Foetus Was Found But
Placenta Like Material With Huge Amount Of Blood Clots Was Found Inside The Uterus. Bilateral Theca Leutin Cyst Was
Noted. Postoperative Hb - 5.2 Gm/Dl, Tsh Level 116.2 Micro Iu/Ml, Beta Hcg Titre - 2224.7 Micro Iu/Ml. She
Transfused 3 Units Of Blood & Levothyroxine Was Initiated After Consultation With Endocrinologist. Postoperative Period
- Uneventful & She Was Discharged At Home With A Hb% - 9.2 Gm/Dl.
On Histopathology Partial Mole Was Diagnosed Presence Of Few Chorionic Villi Showing Hydropic Degeneration And
Some Villi Are Showing Normal Architecture. She Is Now Doing Well & Followed Up In Our Gynaecology And
Endocrinology Clinic.
Conclusion: Partial Hydatidiform Mole Is An Extremely Rare Clinical Entity Which Represent A Part Of The Gestational
Trophoblatic Neoplasia Spectrum. Fetal Tissue Usually Present In Partial Molar Pregnancy But In Our Index Case No Fetal
Tissue Detected Though Amnion Is Seen.
***************

Chronic Inversion Of Uterus With Fundal Fibroid

Author: Dr. Soubhagya Subudhi
Co Author: Dr Subhra Ghosh,Associate Prof,Scb Medical College1,

Case Report-A 28Yrs Female,P1 L1 Was Admitted To Labour Room On 10.11.13 With Chief Complaints Of Something
Descending Per Vagina For 1 1/2 Yrs Which Increased Suddenly 8Hrs Before Admission, Menorrhagia For 1Yr & Foul
Smelling Vaginal Discharge For 3 Months.She Had One Vaginal Delivery 21/2 Years Back. On Inspection Of Vulva There
Was A Large Globular Foul Smelling Congested Mass Of 25X 10 X 6 Cm. Cervical Os Could Not Be Identified. On P/V
Cervical Rim Was Felt & Uterus Was Not Felt. On Sound Test- Uterine Sound Was Not Passed. On Eua- There Was Inversion
Of Uterus, Cervix & Vagina With Fundal Fibroid. A Diagnosis Of Chronic Inversion Of Uterus With Fundal Fibroid Was
Made. Her Hb Was 6.4Gm%.She Was Given 3Units Crossmatched Blood And Dressing With Betadine, Glycerine &
Metrogyl Ointment Done For 9 Days. On 20.11.13 Laparotomy With Krustner Approach With Myomectomy Was Done
Under Spinal Anesthesia. On Laparotomy, There Was Large Intramural Fibroid Of 10 X 10 X 10 Cm Near Cervical
Region,Myomectomy Was Done. Uterus Was Reposed Vaginally & Was Repaired Through Abdominal Approach. Post
Operative Period Was Uneventful And She Was Discharged On 7Th Pod.
Discussion-.Uterine Inversion Refers To Descent Of The Uterine Fundus To Or Through The Cervix, So That The Uterus Is
Turned Inside Out. Uterine Inversion Is A Rare Condition That Occurs Usually As A Complication Of Deliveries.Acute
Inversion Occurs In 1 In 50,000 Deliveries Chronic Nversion Is Extremely Rare Representing About One Sixth Of All
Inversions. Chronic Non Puerperal Uterine Inversion Is Often Associated With Uterine Pathology. Prolapsed Fibroids Tend
To Be The Most Common Inciting With Occasional Report Of Inversion Associated With Uterine Neoplasm And
Endometrial Polyp.

***************

Fibroid Or Ovarian Tumour?

Author: Dr. Abdul Fazal
Co Author: Dr. Pushpalatha1, Dr. Vasantha2,

Case Review.

Title : Fibroid Or Ovarian Tumour ?

Background: Fibroid Is The Most Common Benign Female Genital Neoplasm. Although The Incidence Of Uterine Fibroids
Is 30% Of All Women In The Reproductive Age Group, Broad Ligament Fibroids Are Rare Making Up Only 1%
Approximately. True Broad Ligament Fibroids Achieve Enormous Size And Generally Present With Pressure Symptoms.
The Most Important Aspect Of Very Large Broad Ligament Fibroids Are The Diagnostic Difficulties Associated With It And
Rarity Of Its Occurrence And Hence This Particular Case Is Being Reported.

Case: 31 Year Old Female Of Socioeconomic Class I, Unmarried Nulligravida Presented To Our Opd With Lower Abdominal
Distension And Pain For The Past Two Months. Data Collected By A Detailed History, Clinical Examination, Laboratory
Investigations, Ultrasound And Ct. Laparotomy And Proceed Was Decided Upon With The Help Of An Onco-Surgeon. The
Intra Operative Findings Were A Large Left True Broad Ligament Fibroid Of Size 30*25*7 Cm. The Mass Was Sent For
Frozen Section Which Revealed A Leiomyoma With Extensive Myxoid Degeneration. The Patient Recovered Well Post
Surgery And Went Home On The Seventh Day.

Clinical Relavence: The Mass Pre Operatively Was Indistinguishable From An Ovarian Tumour/ Primary Peritoneal
Malignancy And All Imaging Modalities Gave Conflicting Reports About The Same. There Was No Displacement Of The
Ureters Nor Any Dilatation Of The Renal Pelvicalyceal System.Therefore An Exploratory Laparotomy Was Decided Upon
And A Very Large Vertical Midline Incision Was Used.
***************

Cyclical Menuria Due To Congenital Vesico Vaginal Fistula With Partial Vaginalatresia[Lower 2/3Rd]
Author: Dr. Sai Darla
Co Author: Dr P.Chandra Sekhar Rao1, Dr V A A Lakshmi2,

Case: A Female Patient 23 Years Old Came To Opd With A Complaint Of Anxious To Conceive .Her Marital Life Was 2
Years .She Had Regular Menstrual Cycles Once In 35 Days Since Menarche .
On Clinical Examination She Is Feminine With Good Secondary Sexual Characters .
On Local Examination External Genitalia Was Developed .Vaginal Introitus Not Seen .Anus Looks Patulous Loose On
P/R.Uterus And Cervix Felt .
On Enquiry Couple Are Practicing Anal Intercourse And Regarding Menstruation She Revealed That She Was Having
Cyclical Bleeding Through Urethra Once In 35 To 40 Days,Which Was Confirmed After Visual Examination Of Collected
Urine At The Time Of Menstruation .Hence A Provisional Diagnosis Of Congenital Vvf With Vaginal Atresia Was Made
She Was Admitted And Investigated .All Blood Investigations Are Within Normal Limits
Ultrasound: Uterus, Cervix And Both Ovaries Normal .Both Kidneys And Collecting System Normal
Retrograde Ct Cystogram : Reverse Filling Of Bladder And Dye With 300 Ml Of Normal Saline Done.Fistulous Tract Opened
And 15-20 Ml Of Dye Collected In The Upper Part Of Vagina.
Mri: Mri Also Confirmed The Communication Between Bladder And Upper Vagina .Upper 7 Mm Of Vagina Appears Patent
Cystoscopy :Done During Menstruation .A Fistula Identified 2Cm From Right Ureteric Orifice And Menstrual Blood Is
Coming Out Of It In To Bladder.Hence A Final Diagnosis Of Congenital Vvf With Lower 2/3Rd Vaginal Atresia Was Made
A Team Of Plastic Surgeon ,Urologist And Gynaecologst Was Made And 2 Stage Repair Was Planned
First Stage :Neo Vaginal Creation By Mc Indoes Method
Second Stage : Repair Of Vvf By Abdomino Vaginal Method .
She Was On Regular Follow Up.

***************

Clinical Study Of Oligohydramnios And Role Of Colour Doppler In Prediction Of Adverse Perinatal Outcome
Author: Dr. Renuka Jindal
Co Author: Dr Ashok Salwan1, Dr Sujata Sharma2,

Clinical Study Of Oligohydramnios And Role Of Colour Doppler In Prediction Of Adverse Perinatal Outcome
Jindal Renuka , Salwan Ashok , Sharma Sujata
Aims And Objectives:1. To Study The Effects Of Oligohydramnios On Fetal Outcome.
2. To Study The Role Of Color Doppler In Assessment Of Fetal Wellbeing And Relation With Perinatal Outcome.
Materials And Methods:This Was A Prospective Longitudinal Observational Study, Conducted From 2013 To Sept 2014, In The Deptt Of Obs And
Gynae, At Bebe Nanki Mother And Child Care Centre, Amritsar. 40 Patients Of Gestation More Than 34 Weeks With
Oligohydramnios Were Studied. Patients Were Evaluated By History Taking, Clinical Examination, Lab Tests And
Ultrasonography Reports. All These Patients Were Monitored Regularly With Nst Twice Weekly And Colour Doppler
Weekly. Those Patients With Abnormal Doppler Findings Were Timely Intervened.
Results:-Patients With Reduced Liquor Carries Increased Risk Of Antepartum And Intrapartum Complications. Majority
Of Patients Were Primigravidae, Complicated By Pih In 37.5% Cases, Nonreactive Nst Was Seen In 42.5% Cases, Meconium
Stained Liquor Was Seen In 47.5% Cases And Those Patients Who Were Assoc With Abnormal Colour Doppler Report
Were Associated With More Fetal Distress And Higher Caesarean Rate. Out Of Forty Delivered Babies, 13 Babies Were
Admitted In Nicu, Three Babies Died Mainly Due To Due To Respiratory Distress Syndrome. Majority Of These Patients
With Adverse Perinatal Outcome Were Associated With Abnormal Colour Doppler Findings. Colour Doppler Was Found
To Be A Sensitive Predictor Of Adverse Perinatal Outcome.
Conclusion:- . Abnormalities Of The Amniotic Fluid Volume Can Interfere Directly With The Fetal Development And Is An
Indirect Sign Of Chronic Fetal Hypoxia. In Patients With Oligohydramnios, The Presence Of Abnormal Doppler Velocimetry
Measurement Is Related To Increased Risk Of Adverse Perinatal Outcome. Thus Afi Of 5 Cm, Especially When
Associated With Abnormal Doppler Velocimetry, Mandates Closer Antenatal Surveillance. When Appropriately Used, It
Helps To Identify The Fetus At Compromise And Helps To Plan Timely Intervention, To Reduce Perinatal Mortality In Cases
With Oligohydramios.

***************

Clinicopathological Profile And Pten Immunohistochemical Expression In Women With Endometrial Hyperplasia And
Endometrial Carcinoma In Developing Countries
Author: Dr. Shivani Mishra
1,
Co Author: Prof. Uma Singh Prof. Madhu Mati Goel2, Prof. Nisha3, Dr. Sabuhi Qureshi4,

Clinicopathological Profile And Pten Immunohistochemical Expression In Women With Endometrial Hyperplasia And
Endometrial Carcinoma In Developing Countries
-Dr. Shivani Mishra, Prof. Uma Singh, Prof. Madhu Mati Goel, Prof. Nisha, Dr. Sabuhi Qureshi
Department Of Obstetrics And Gynaecology, Kgmu, Lucknow

Abstract
Aims And Objectives-To Study Clinicopathological Profile And Pten Immunohistochemical Expression In Women With
Endometrial Hyperplasia And Endometrial Carcinoma In Developing Countries.
Materials And Method-The Study Was Conducted In The Department Of Obstetrics And Gynecology In Collaboration With
Department Of Pathology, Kgmu, Lucknow Over A Period Of One Year On 168 Women Of More Than 40 Years Of Age
With Abnormal Uterine Bleeding.
Results-Out Of 168 Cases, 50(29.8%) Had Eh And 11(6.5%) Had Ec. Mean Age Of Eh And Ec Was 46.406.17 Years And
55.918.14 Years, Respectively, 84% Of Eh Were <50 Years And 63.6% Of Ec Were More Than 50 Years Age, 78% Of Eh
Were Premenopausal And 81.8% Of Ec Were Postmenopausal,72% Of Eh Had Menorrhagia And 83.8% Of Ec Had
Postmenopausal Bleeding.84% Of Eh Were Obese,10% Had Diabetes And 18% Had Hypertension Whereas 90.9% Of Ec
Were Obese,27.3% Had Diabetes And 45.5% Had Hypertension, With Higher Odds Ratio. 78% Of Eh And 72.2% Of Ec Had
Enlarged Uterus With Odds Ratio 5.17 And 2.63 Respectively. Mean Size Of Uterus In Eh And Ec Was 177.8172.1Mm
And 122.975.3% And Mean Endometrial Thickness In Eh 13.53.2 Mm And Ec 11.33.6Mm Respectively. 4 Ein Cases
Diagnosed- 1 (2.73%) Had Simple Endometrial Hyperplasia Without Atypia, 1 (20%) Had Complex Endometrial Hyperplasia
Without Atypia And 2 (50%) Had Complex Endometrial Hyperplasia With Atypia. Out Of 27 Cases Of Endometrial
Hyperplasia, Loss Of Pten Expression Was Found In 11 Cases. The Loss Of Pten Expression In Sh Without Atypia Was
29.4%, In Sh With Atypia Was 66.66%, In Ch Without Atypia Was 50% And Ch With Atypia Was 66.66%.

Conclusions-Ec Haspositive Correlation With Age,Menopause,Bmi,Diabetes,Hypertension,Size Of Uterus And

Endometrial Thickness. Ein Diagnosed More In Cases Of Ch As Compared To Sh. Loss Of Pten Expression Is More In Ch
With Atypia As Compared To Sh Without Atypia.

Eh-Endometrial Hyperplasia,Ec-Endometrial Carcinoma,Sh-Simple Hyperplasia,Ch-Complex Hyperplasia,Ein-Endometrial

Intraepithelial Neoplasia,Pten-Phosphatase And Tensin Homolog.

***************

Comparision Of Obstetric Outcome Between First And Second Stage Caesarean Sections In Tertiary Hospital, Mmc &
Ri, Mysore
Author: Dr. Ashraf M
Co Author: Dr Prameela1, Dr Babitha2, Dr Madhuri3, Dr Shilpa4,

Comparision Of Obstetric Outcome Between First And Second Stage Caesarean Sections In Tertiary Hospital, Mmc & Ri,
Mysore
Dr Prameela

Dr Ashraf Ali M

Aim & Objectives : To Determine Maternal And Neonatal Outcome Associated With Cesarean Section Done In Women At
Term In Second Stage Of Labour, And To Compare Them With Outcomes Of First Stage Cesarean Section.
Materials And Methods: A Retrospective Cohort Study, Comparing Two Groups; Group I: 60 Women, Who Underwent
Cesarean Section In Second Stage Of Labour And Group Ii: 60 Women, Who Had Cesarean Section In First Stage Of Labour.
The Study Was Done At Cheluvamba Hospital, Mysore Medical College And Research Institute Between June 2013 To
June 2014. Data Was Collected From Parturition Register And From Medical Records Of The Patient.

Results: Out Of 14999 Deliveries, 14 % Of Cesareans Were Performed . 60 Caesearean Sections Were Performed In 2Nd
Stage . Group I Patients Had Higher Maternal And Perinatal Morbidity Like Increased Blood Loss (43.3 %), Uterine Incision
Extension (23.3 %), Atonic Pph (25 %), Prolonged Bladder Catheterization (51.6 %), Wound Infection (16%) And
Postpartum Fever (21.6 %) While Only Complication In First Stage Sections Was Atonic Pph(2%). There Were More Nicu
Admissions In Group I (60 % Vs 6%) Than In Group Ii. There Were 10 Perinatal Deaths In Group I And None In Group Ii.
Mean Birth Weight Of Babies Was More In Group I Compared To Group Ii .

Conclusion: Second Stage Cesareans Are Associated With Significant Intra-Operative And Neonatal Morbidity. Higher
Birth Weight Is A Risk Factor For Cesarean Section In
Second Stage Of Labour.

***************

Comparison Of Ca-125 Levels In Threatened Abortion And Normal Pregnancies

Author: Dr. Vijaya Revankar
Co Author: Dr Vijaya Manohar Revankar1,

Comparison Of Ca-125 Levels In Threatened Abortion And Normal Pregnancies

Abstract
Aims
1)

To Evaluate The Predictive Value Of Serum Ca-125 In Women With Threatened Abortions

2)
To Assess The Value Of Maternal Serum Ca-125 Levels In Predicting The Pregnancy Outcome In Women With
Threatened Abortion.
Materials And Methods
A Prospective Study Conducted At Government Lady Goschen Hospital, Obg Department Mangalore From November
2010 To July 2012. The Study Group Included 23 Women With Pregnancies Between 6 To 12 Week Of Gestation With
Demonstrable Fetal Cardiac Activity Complicated By Vaginal Bleeding Or Blood Stained Discharge. The Control Group
Included 27 Women With Normal Singleton Pregnancies Between 6 To 12 Weeks Of Period Of Gestation.
Results
The Patients With Threatened Abortion Group Have The Maximal Rise In Ca-125 Levels Compared To The Controls. There
Was Statistical Difference Between The Groups: Control Vs. Threatened Abortion Group (P<0.0001), Threatened Aborted
Vs. Threatened Ongoing P=0.01 While None Amongst Control Vs. Threatened Ongoing P=1.0. Thus The Difference In The
Maternal Serum Levels Of Ca-125 Between The Threatened Aborted And The Control Pregnancies Were Found To Be
Highly Significant Statistically. Based On The Observations Of Our Study, The Sensitivity, The Specificity, Positive Predictive
Value, And Negative Predictive Value Of Serum Ca-125 With A Cut Off Of >125 U/Ml In Predicting Miscarriage Were
21.73%, 100%, 62.5% And 60% Respectively.
Conclusion
Serum Ca-125 Evaluation Can Prove To Be Interesting Tool In Assessing First Trimester Threatened Pregnancies. Ca-125
Level At A Cut Off Of 125 U/Ml To Be An Extremely Specific Test Which Lacks Sensitivity. Future Large Scale Studies With
Different Cut Off Levels May Be Required To Validate The Findings And Widen The Scope Of Ca-125 As A Diagnostic And
Prognostic Tool In Threatened Pregnancies.

***************

Comparison Of Cardiac Changes In Normotensive And Hypertensive Pregnant Women

Author: Dr. Chaitra S
Co Author: Dr Chaitra S1, Dr Sundari N2, Dr Ashwini Nayak3, Dr Asha Swarup4,

Comparison Of Cardiac Changes In Normotensive And Hypertensive Pregnant Women

Dr Chaitra S , Dr Sundari N, Dr Ashwini Nayak ,Dr Asha Swarup
Department Of Obstratics And Gynaecology
M S Ramaiah Medical College, Bangalore.

Introduction: Hypertension Complicates 5% To 7% Of All Pregnancies. A Subgroup Of Preeclampsia, Characterized By

New-Onset Hypertension, Proteinuria, And Multisystem Involvement, Is Responsible For Substantial Maternal And Fetal
Morbidity And Is A Marker For Future Cardiac And Metabolic Disease.
Objective: To Compare And Analyse The Ecg And Echo Changes In Women Beyond 28 Weeks Period Of Gestation, Of
Those With Normal Pregnancy To Those Affected By Pre Eclampsia And Gestational Hypertension.
Method: This Study Was Performed On Them At M S Ramaiah Teaching And Memorial Hospital, Karnataka, India. As A
Pregnant Woman In Her Third Trimester Checks Into The Antenatal Clinic, They Were Divided Into Either Of Two Groups,
Group A (Those With Normal Blood Pressure) And Group B (Those With Elevated Blood Pressure) After Her Consent Ecg
And Echo Was Performed. Group A And Selected Group B Underwent The Test On Outpatient Bases And Women Who
Were On 2 Or More Anti-Hypertensive, Who Were Admitted Underwent The Test As Inpatient. This Test Was Performed
On A Total Of 300 Pregnant Women, 150 In Each Group.
Result: A Predictable Change In Ecg And Echo Was Noted In Normotensive Women, Due To Physiological Changes In
Pregnancy. Whereas The Massive Difference In The Results Obtained In Group B Was What Lead To The In Depth Analysis
Of The Subgroups (Divided Based On The Number Of Drugs Women With Hypertension Were On).
Every Woman Who Was On 2 Antihypertensive Had A Left Axis Deviation Of Beyond 30 Degrees. Women Who Were On
3 Antihypertensive Had A Peculiar Result, As Follows:
O

A Mild Right Axis Deviation

Grade Ii Diastolic Dysfunction

Moderate Pr

Reduction In The Ef When Compared To The Other Subgroups

Increase In The Pasp

Conclusion: Our Study Has Documented The Significant Difference In The Ecg And Echo Changes Amongst The Two
Groups. The Study Also Was Able To Identify How The Severity Of The Condition And The Number Of The Drugs The
Women Were On Had A Peculiar Ecg And Echo Changes.

***************

A Right Unruptured Cornual Ectopic

Author: Dr. Preethi Bhonagiri
Co Author: Dr Ananthreddy1, Dr Unmesh2,

Cornual Pregnancy Is A Rare Form Of Ectopic Pregnancy, Accounts For 2-4% Of All The Ectopic Pregnancies. But It Has
Catastrophic Presentation When The Diagnosis Is Missed,Mortality Rate Associated With It Is 2-2.5%. Cornual Pregnanciy
Often Ruptures Later Than Other Type Of Tubal Pregnancies, Because Myometrium Is More Distensible Than The
Fallopian Tube. Here We Report A
Case Of Primigravida With 7 Weeks Of Gestational Age,Presented To Us With Complaints Of Pain Abdomen And Bleeding
Pervaginum. It Was Diagnosed To Be An Unruptured Right Cornual Ectopic By Transvaginal Ultrasonography, Which Was
Managed By Emergency Exploratory Laparotomy And Evacuation Of The Ectopic Gestation. However If A Patient Present
With Rupture There Will Be Massive Haemorrhage, Such Cases Are Usually Managed By Cornual Resection Or May Even
Require Hysterectomy. The Management Of An Cornual Ectopic Pregnancy Should Be Ascertained By Ultrasonography
And To Be Planned Depending Upon The Size And Viability Of The Sac. Some Of The Facts Associated With Cornual Ectopic
Pregnancy To Be Discussed.
***************

Cornuotomy- A Novel Conservative Approach To Cornual Pregnancy

Author: Dr. Geovin Ranji
Co Author: Dr.Rajeswari K S1, Dr. Preet Agarwal2,

Cornuotomy A Novel Conservative Approach To Cornual Pregnancy

Dr. Geovin Ranji G., Senior Resident
Dr.Rajeshwari K.S., Professor
Dr.Preet Agarwal, Associate Professor
Background:
Cornual Pregnancy Is The Least Common Type Of Ectopic Pregnancy. Medical Management Of Cornual
Pregnancy With Methotrexate Has High Failure Rates And Risk Of Rupture Uterus And Need For Surgical Intervention.
Surgical Treatment Has Been Traditionally Been Cornual Resection Which Jeopardizes Future Pregnancy Outcome.
Cornuotomy Is A Novel Conservative Approach For Unruptured Cornual Ectopic Pregnancy.
Case:
36 Year Old G4P1L1A2 With Previous Vaginal Delivery 13 Years Ago And Two Mtps Was Diagnosed To Have Right
Cornual Pregnancy At 8 Weeks Of Gestation. She Was Given Multiple Dose Regime Of Methotrexate And Folinic Acid.
Hcg Levels Continued To Increase And Repeat Scan Confirmed A Live Cornual Ectopic Pregnancy. Hence Decided For
Surgical Intervention. Laparoscopy Was Done And Confirmed The Diagnosis Of Unruptured Right Cornual Ectopic
Pregnancy. Through A Suprapubic Transverse Incision, Abdomen Opened In Layers. After Injecting Vasopressin Through
A Posterior Transverse Incision Gestational Sac Extruded In Toto. Products Of Conception Removed Completely By Suction
Evacuation And Curettage. Incision Closed In Layers. Patient Had An Uneventful Recovery.
Clinical Relevance:
Timely Cornuotomy Can Be Considered As A Primary Modality For Unruptured Cornual Pregnancy As It
Avoids Multiple Injections And High Failure Of Methotrexate; Does Not Adversely Affect Further Fertility And Pregnancy;
And Prevents Life Threatening Rupture And Hemorrhage.

***************

Correlation Of Amniotic Fluid Index In Labour With Perinatal Outcome

Author: Dr. Karuna Kumari Cherukuri
Co Author: Dr Anuragamayi.Y1, Dr Rajyalaxmi.D2, Dr Supriya3,

Correlation Of Amniotic Fluid Index In Labour With Perinatal Outcome

Dr.Ch.Karuna Kumari,Asst.Professor.Dr.D.Rajyalakshmi Professor,Dr.Y.Anuragamayi Asst Professor,Dr.Supriya, Post
Graduate.

Aim: To Detect The Afi In Labor And To Assess The Course Of Labour,Mode Of Delivery And Perinatal Outcome In Relation
To Afi.Objective Of The Study Is The Early Detection Of Fetal Distress And Prevention Of Neonatal Morbidity And
Mortality.
Material And Methodology:
This Study Was Conducted In Department Of Obstetrics And Gynaecology,Rangaraya Medical College ,Kakinada From
October 2011 To October 2013 With Gestational Age Between 37 To 42 Weeks.150 Cases Admitted For Labor And
Delivery Were Selected As The Basis Of Simple Random Sampling System.The Women'S History, Clinical Examination
Record And Afi Were Measured And Perinatal Outcome Was Compared Between 3 Groups I.E., Afi<5,Afi 5-8,Afi>8. The
Present Study Was A Prospective Study Conducted In The Department Of Obstetrics And Gynaecology,Rangaraya Medical
College,Kakinada From Oct 2011 To Oct2013 To Enumerate Perinatal Outcome Correlation To Afi Statistical Analysis.
Results: The Caesarian Section Rate For Fetal Distress, Low Birth Weight, Was In Patient With Oligohydramnios.There Is
Also Increased Incidence Of Meconium Stain,Apgar At 5 Min <5.There Was Significant Difference In Meconium
Staining,Apgar Score At 5 Minutes <7,(Between The 3 Group)(X2=30.8 P<0.05)(X2=29.8 P<0.005)Respectively.
Conclusion:
A Significant Correlation Was Found Between Afi In Labour With Perinatal Outcome In Terms Of Meconium Staining And
5 Min Apgar Score. Afi Is Useful Screening Test In Predicting Foetal Distress In Labour, Requiring Intensive Intrapartum
Foetal Surveillance.

***************

Correlation Of Pre Operative Ca 125 And Imaging In The Diagnosis Of Ovarian Masses
Author: Dr. Haritha Soleti
Co Author: Haritha G1, Dr. Latha Balasubramani2, Dr. B. Sivanesan3, Dr. V. Nagarajan4,

Correlation Of Preoperative Ca125 & Imaging In The Diagnosis Of Ovarian Masses.

Dr. Haritha G1, Dr. B. Sivanesan2, Dr. V. Nagarajan2, Dr. Latha Balasubramani2.
1. Dept Of Obgyn, Gknm Hospital. 2. Division Of Gynaecologic Oncology, Vn Cancer Centre, Gknm Hospital.

Objective- To Evaluate The Correlation Of Preoperative Ca125 And Ct Findings In The Diagnosis Of Ovarian Malignancy.

Materials And Methods- 29 Pre And Post Menopausal Women Were Evaluated And Operated For An Ovarian Mass
Between June 2011 To June 2014 At A Single Tertiary Care Centre.

Inclusion Criteria- Women Who Underwent Upfront Staging Laparotomy For An Ovarian Mass Based On Ca 125 And
Imaging Were Included.
- Ca 125, Imaging And Histopathological Evaluation Were All Done At The Same Hospital.

Exclusion Criteria- Patients Who Underwent Neoadjuvant Chemotherapy, Had Their Imaging Or Ca 125 At Outside
Hospital Were Excluded.

Results- We Analysed Data From 29 Women Who Fulfilled Our Criteria. Women In Our Dataset Were Between 39Yrs To
74 Yrs. 42% Were Premenopausal And 58% Were Postmenopausal.The Range Of Ca 125 In Malignant Tumours Were 11
To 1103 Units/Ml And For Benign Tumours 11 To 188 Units/Ml. Ca 125 Was Elevated In 21 Women ( 74%) And Normal In
8 Women (26%). Among The 21 Women With Elevated Ca 125, Ct Showed Malignant Features In 19 Cases, Complex
Mass In 2 Cases. Among These Two Cases, Final Histopathology Showed Benign Tumour In One And Malignant Tumour
In The Other. Of The 21 Woman With Elevated Ca 125, Final Histopathology Showed Malignant In 76%, Benign In 19%
And Could Not Determined In 5% Cases. Of The 8 Woman With Normal Ca 125, On Final Hpe 75% Showed Benign And
25% Showed Malignant Features.
Concordance Between Ca 125 And Hpe Was Seen In 75% And Discordance In 24% Cases.
Concordance Between Ct And Hpe Was Seen In 66% And Discordance In 31% Cases.
Concordance Between Serology, Ct And Pathology Was Seen In 52% And Discordance In 48%. Hpe Was
Discordant With Ca 125 In 30% And With Ct In 70% Women.

***************

Counceling Of Patients Before A Major Gynae /Obst Operation

Author: Dr. Sabuj Sengupta
Co Author:

Counceling Of Patients Before A Major Operation Is Almost Mandatory All Over The World. In Our Country This Part Is
Most Neglected. Many Doctors Still Feels That The Decision Made By Him Is Final And No Explanation Is Necessary To The
Patient Or Party.100 Gynaecologists Were Interviewed And Their Opinions In This Regard Were Noted.Both Senior And
Junior Doctors Werein The Group.Even To Day 60% Of Senior Doctors Feel That This Is Not That Important.70% Of Junior
Doctors Agree That This Is Definitely An Important Factor To Avoid Many Post Operative Complications And Debate.
***************

Couvelaire Uterus Without Placental Abruption: A Rare Case Report

Author: Dr. Shreedevi Kori
Co Author: Dr S R Mudnur1, Dr Neelamma Patil2, Dr Aruna S N3, Dr Aishwarya R4, Dr Keval Patil5

Couvelaire Uterus, Named After The French Obstetrician In View Of His Research Work On The Anatomy Of Pregnant
Uterus With Uterine Hemorrhages. This Results Due To Extravasation Of Blood Into The Uterine Musculature And Beneath
The Peritoneum And Imparting The Classical Appearance Of A Dark Purple Coloured Ecchymotic Uterus. It Usually Occurs
In Association With Placental Abruption, Placenta Praevia, Coagulopathy, Preeclampsia And Eclampsia. Here We Report
A Rare Case Of Couvelaire Uterus Without Any Features Of Placental Abruption And Other Risk Factors. ItS Usually
Diagnosed Incidentally During Caesarean Section And Not On Ultrasonography.
A Case Of 29 Year Old Primigravida With 39 Weeks Of Gestation With Vertex Presentation With Gestational
Hypertension And Mild Anemia In Latent Labour Presented To Us With Fetal Distress(Persistent Variable
Decelerations).She Underwent Emergency Caesarean Section. Intraoperatively There Was Couvelaire Uterus Without
Evidence Of Abruptio Placentae ,Thick Meconium Stained Liquor And Baby In Lot. Couvelaire Uterus Involving Both
Anterior And Posterior Surface Of Uterus, Placenta Fundal And Anterior, No Evidence Of Placental Abruption Or
Retroplacental Clots. No Postpartum Hemorrhage. Intra And Postoperative Periods Were Uneventful And Patient Was
Discharged On 8Th Post-Operative Day After Suture Removal. Baby Was Kept For Observation In Nicu For A Day In View
Of Thick Meconium And Then Shifted Mother Side.
Couvelaire Uterus Is Commonly Seen In Association With Abruptio Placenta Or Complicated With
Coagulopathy. Here By Reporting A Rare Presentation Of Couvelaire Uterus Without Any Risk Factors And Diagnosed
Incidentally During Caesarean Section.

***************

Crash Caesarean Section -Cheers ,Tears And Jitters!

Author: Dr. Sally Abraham
Co Author: Dr Shameena1, Nil2, Nil3, Nil4, Nil5

Crash Caesarean Section (Described By Mackenzie And Cookie) Is Emergency Caesarean Section Performed When There
Is Immediate Threat To The Life Of The Mother And Or Fetus .
Aims And Objective Of The Study:To Review The Risks And Benefits Associated With Crash Caesarean Section ,Ways To
Achieve A Swift And Safe Delivery.
Materials And Methods:A 5 Year Retrospective Study Conducted At Yenepoya Medical College Hospital Mangalore.
Results
Total Number Of Deliveries 5843 , Number Of Caesarean Section 1741 ( 29.4%)
Number Of Crash Caesarean :189(10.8%)
Indications. Abnormal Fetal Heart Pattern, Placenta Previa, Abruptio Placenta ,Failed Instrumental Deliveries,Cord
Prolapse ,Scar Dehisence ,Maternal Hypovolaemic Shock.
Decision To Delivery Interval (Ddi)
69 Cases (36.5%) 20 To 30 Minutes
71 Cases (37.5%) 31 To 40 Minutes
36 Cases (19.04%) 41 To 60 Minutes
Maternal Complications
1 Maternal Death (Rupture Of Splenic Artery Aneurysm) (0.5%)
1 Bladder Injury (0.5%)
1 Bowel Injury 0.5%)
7 Had Negative Birth Experience
8 Extension Of Uterine Incision ,Traumatic Pph (4.2%)
9 Wound Infection (4.7%)

Total Number Of Live Births :185 (97.88%)

Fetal Complications
Neonatal Deaths : 6
Perinatal Mortality :5.29%
Birth Injury: Fracture Femur 1
Minor Laceration 3
Conclusion

Rcog And Acog Recommends Ddi Of < 30 Minutes. The Reason For Long Ddi Was In Obtaining Consent ,Preparation For
Operation, Difficulty In Surgery Due To Previous Scar, Delivery Of Deeply Impacted Fetal Head. To Shorten Ddi ,Anticipate
The Possibility Of Emergency Caesarean Section In High Risk Cases, Keep Patient Fasting ,Start Iv Line And Reserve Blood.
Consider Epidural Labor Analgesia So That A Top Up Can Be Offered If Emergency Caesarean Is Needed. Operation
Theatre Should Be Adjacent To The Labor Room. An Experienced 'In House' Operating Team Will Reduce Ddi For A Swift
And Safe Caesarean.

***************

Critical Analysis Of Intrauterine Death

Author: Dr. Vidhya Lakshmi
Co Author: Dr Mahendra G1, Prof Dr Vijayalakshmi2,

Critical Analysis Of Intrauterine Death

Dr. Vidhyalakshmi R1, Dr. Mahendra G2, Prof.Dr.Vijayalakshmi3

1 Post Graduate, 2 Assistant Professor, 3 Professor And Head
Name Of The Institution Adichunchanagiri Institute Of Medical Sciences, B.G Nagara
Ph No - 09655747729
Email Id Vidhyar178@Yahoo.In

Objective:
To Identify The Prevalence, Socio-Epidemiological And Etiological Factors In Order To Streamline Preventive And
Management Protocols For Iud

Method:
The Present Study Is A Retrospective Study Conducted Over A Period Of 2 Years(August 2012 August 2014) In A Rural
Tertiary Care Hospital. Antepartum And Intrapartum Events Leading To Intrauterine Demise Were Recorded Along With
The Sociodemographic And Clinical Parameters.

Results:
Out Of A Total 2126 Deliveries Conducted Over A Period Of Two Years, 101 Fetal Deaths Were Observed. Prevalence Was
47.5/1000 Live Births. Majority Of The Iuds Were Found To Occur In The Maternal Age Group 21-25Years(56.4%), In
Multiparas(58.4%), And Gestational Age < 34 Weeks.
Fetal Characteristics Assessed Showed The Majority Of The Foetuses Weighed Between 0.5 To 0.99 Grams(37.6%),
Male(54.45%), Non Macerated(82.1%).
Causal Factors Included Severe Anemia(4.95%), Hypertensive Disorders(25.74%), Diabetic(0.99%), Congenital
Anomaly(10.89%), Rh Incompatibility(2.97%), Abruptio Placenta(9.90%), Placenta Previa(1.98%), Iugr(1.98%), Post
Term(1.98%).
1.98% Were Found To Have Cord Prolapse. 16.83% Had Cord Around The Neck. 10.89% Of The Iuds Were Unexplained.
Majority Of The Dead Foetuses Were Expelled Through Vaginal Route(86.13%). 1.98% Had Assisted Delivery With Vacuum
And Forceps. 11.98% Underwent Lscs.

Conclusion:

Despite Advances In Diagnostic And Therapuetic Modalities, The Rate Of Stillbirth Is Unexplainably High. This Emphasizes
The Importance Of Antenatal Care, Identification Of Risk Factors And Its Treatment. Majority Of Fetal Wastage Can Be
Improved With Maternal Health.
***************

Association Of Raised Serum Uric Acid In Early Pregnancy With The Development Of Gestational Diabetes Mellitus
Author: Prof. Shailaja Gurujala
Co Author: Shailaja G1, Jyothi Sachan2,

Department Of Obs And Gynae , St.Theresa Hospital, Hyderabad

Aim: To Find Out Of Association Of Raised Serum Uric Acid In Early Pregnancy With The Development Of Gestational
Diabetes Mellitus (Gdm)
Material And Methods: This Was A Prospective Cohort Study Done On 215 Pregnant Women In Our Hospital .Maternal
Serum Uric Acid In Early Pregnancy (<20 Week) Was Measured. At 24-28 Weeks Gestation Oral Glucose Tolerance Test
Was Also Done And Gdm Was Diagnosed. All Women Were Followed Up Till Delivery For Maternal And Foetal Outcome.
Results: In Our Study Out Of 215 Subjects ,42 Subjects Had Serum Uric Acid Range Between 1.0-2.0Mg/Dl , None Of
Them Developed Gdm And 140 Subjects Had Serum Uric Acid Range Between 2.1-3.0Mg/Dl, Only 1 Subject Developed
Gdm (0.7%). 26 Subjects Whose Serum Uric Acid Range Was 3.1-3.9Mg/Dl , 4 Subjects Developed Gdm (15%). But 7
Subjects Out Of 215 In Whom Serum Uric Acid 4.0Mg/Dl, 6 Were Developed Gdm (85%). Above Finding Shows
Striking Association Between Early Trimester Raised Uric Acid And Risk Of Developing Gdm. Out Of 215 Subjects, 22 Had
Serum Uric Acid 3.4 Mg/Dl, Out Of Which 10(45.4%) Developed Gdm And 192Subjects Had Serum Uric Acid <3.4
Mg/Dl, Out Of Which Only 1(0.52%) Developed Gdm. Using A Cut Off Value Of Serum Uric Acid 3.4 Mg/Dl Yielded A
Positive Predictive Value 50%, Negative Predictive Value 99%, Sensitivity 90% And Specificity 95%. During Follow Up
Complications Like Preeclampsia, Gestational Hypertension, Polyhydroamnios, Preterm Delivery And Nicu Admission For
Newborn Were More In Raised Serum Uric Acid Subjects.
Conclusion: Early Trimester Uric Acid Concentration 3.4Mg/Dl Was Associated With A Trend Towards Increased Risk
Of Developing Gdm. Thus Early Trimester Serum Uric Acid Concentration May Be Used As Predictor Of Development Of
Gdm.

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Eclampsia-Prevalent Yet Preventable Complication -Experience At Tertiary Care Centre

Author: Dr. Arunakumari Konkati
Co Author: Dr.Usha Suresh1, Dr.P Vijaya2, Dr.G Prathiba3,

Dr K Aruna Kumari(Asst Prof),Dr Usha Suresh(Prof),Dr.P.Vijaya Dr G Pratibha(Prof)

Aim-To Analyse 152 Cases Of Eclampsia At Mgmh Petlaburj Hyderabad Omctelangana From Jan-Sep 2014
Materials And Methods-152 Cases Of Eclampsia Are Analysed As To The Antenatal Care,Severity Of Htn,Type Of
Eclampsia,Gestational Age,Mode Of Induction,Mode Of Delivery ,Complications,Maternal And Perinatal Outcome With
An Aim To Revise And Improvise Existing Protocols
Results-Total Deliveries - 12406

Incidence-1.2%
Unbooked -76.9%
Referrals-55%
Age <20-36.8%
Primi-59.2%
Gestational Age Is >28 Weeks In 89% Mild Pih In 45.3%
Type Antepartum -81.5%
Intrapartum-10.5%
Postpartum-7.8%
Admission Delivery Interval Within 24Hrs In 94.2%
Inductions Done In 76/140 Out Of 62 Delivered Misoprostol With Oxytocin Is Main Drug Of Induction
Vaginal Delivery60.5%
Lscs -27.6%
Abortions-11.8%
18 /152 Came With Iud
Pnmr In Lscs-9.2%,Vaginal Delivery-23.6%
Pnmr In Less Than 1.5Kg Is 13.4%,Above 1.5Kg Is 10.4%
4 Maternal Deaths,2 Cases Severe Htn & Cva,1 Aspiration Pneumonitis,1 Pulmonary Embolism
Conclusion Eclampsia A Life Endangering Obstetric Emergency.
This Disease Of Primies
Vaginal Delivery Rate-60.5%,Lscs Rate-27.6%,
94%Delivered With In 24Hrs

Pnmr In Lscs-9.2%Vs Vd-23.6%

Total Pnmr-32.8%
Neonatal Salvage Rate Is Better In Lscs Group Than Vd
Early Resort To Lscs Is Whenever Indicated Improves Neonatal And Maternal Survival
Maternal Mortality 2.6%
Wide Awareness Of Protocols At Referal Centres ,Early Treatment And Timely Referal Of Pre-Eclampsia,Availibility Of
Micu And Nicu Facilities Will Further Improve Maternal And Foetal Outcome.

***************

A 3 Year Study Of Cardiac Disease In Pregnant Women In A Tertiary Care Set Up

Author: Dr. Mansi Dhingra
Co Author: Dr Nirmala S.1,

Dr Mansi Dhingra (1), Dr Nirmala S(2)

1 Post Graduate , Department Of Obstetrics And Gynecology , Kempegowda Institute Of Medical Sciences .
2 ,Dr Nirmala S .Hod And Professor , Department Of Obstetrics And Gynecology , Kempegowda Institute Of Medical
Sciences
Aim And Objective- To Analyze Pregnant Women With Heart Disease And To Assess Its Influence On Feto-Maternal
Outcome .
Materials And Methods The Study Was Carried Out During The Period Of November 2011 To October 2014 .45
Pregnant Women With Cardiac Diseases Who Were Admitted In Department Of Obstetrics And Gynecology At Kims
Hospital Were Included In The Study .
Results Rheumatic Heart Disease (N 24 ,53.33 %) With Isolated Mitral Stenosis (24.4 %)Was The Predominant
Cardiac Problem Among The Study Subjects While Atrial Septal Defect (11.1 %) Was The Most Common Form Of
Congenital Heart Disease .Based On The Nyha Functional Classification 74 % Were In Class I , 22.3 % Patients Were In
Class Ii And 2.22 % Were In Class Iv On Presentation .28.9 Percent Deliveries Were Preterm .The Pregnancy Duration Was
Shortened In More Advanced Classes Of Heart Disease .60 % Of The Cases Were Delivered By Cesarean Section .Average
Birth Weight Of Babies In Class I Was 2.63 +/- 0.2 Kg , 2.5 +/-0.3 Kg In Class Ii , 2.1 Kg In Class Iv .Out Of 45, 2 Patients Had
Heart Failure During The Hospital Stay .There Were 2 Perinatal Mortalities And One Maternal Mortality .
Conclusion Rhd Was The Predominant Type Of Heart Disease In Pregnancy And Most Women Were Class I At The
Time Of Admission .The Preterm Delivery And Cesarean Rates Were Significantly High . A Multidisciplinary Approach Is
Needed To Reduce Morbidity , Mortality And To Optimize The Outcome .

.
***************

Pelvic Floor Muscle Training During Pregnancy To Reduce Urinary Incontinence

Author: Dr. Nithya Naaram
Co Author:

Dr Nithya.M.Naaram
Dr. Lalitha Devadason

Sri Ramachandra Medical University, Porur, Chennai

Objective :Urinary Incontinence Is A Chronic Health Complaint That Severely Reduces Quality Of Life And Has Many
Sufferers Reporting Effects On Their Social , Domestic , Physical, Occupational And Leisure Activities. Pregnancy And
Vaginal Delivery Are The Main Risk Factors In The Development Of Urinary Incontinence Because Pregnancy And
Childbirth May Cause Damage To The Fascias, Ligaments , Pelvic Floor Muscles And Nerves Supporting And Controlling
The Bladder Neck And Urethra.
Methods:We Conducted A Prospective Case Control Study In Sri Ramachandra University. Three Hundred Women Were
Allocated To A Study Group Or To A Control Group. The Study Group Attended A 12 Week Intensive Pelvic Floor Muscle
Training Program During Pregnancy Supervised By Physiotherapist. The Control Group Received The Customary
Information. Outcome Measure Was Self Reported Symptoms Of Urinary Incontinence.
Results : At Follow Up , Significantly Fewer Women In The Study Group Reported Urinary Incontinence. 64 Of 150 (42.7%)
Versus 76 Of 150 (50.7%) At 34 38 Weeks And 46 Of 150 (30.7%) Versus 59 Of 150 (39.3%) At 6 Weeks Postpartum.
Conclusion :Intensive Pelvic Floor Muscle Training During Pregnancy Prevents Urinary Incontinence During Pregnancy
And After Delivery

***************

Prevalence Of Stis In Asymptomatic Married Pregnant Adolescent And Its Association With Adverse Obstetrical
Outcome
Author: Dr. Priti Ghope
Co Author: Jyotsna Suri1, Pratima Mittal2, Daman Saluja3,

Dr Priti Ghope , Dr Jyotsna Suri , Dr Pratima Mittal , Dr Daman Saluja

Aim And Objective :
To Determine The Prevalence Of Stis (C. Trachomatis, N. Gonorrhoeae And T. Vaginalis,) In Asymptomatic Married
Pregnant Adolescent
To Study The Association Of Stis With Adverse Obstetrical Outcome
Method :
Dry Vaginal Swabs From 320 Asymptomatic Pregnant Adolescent Women In The Age Group Of 17 To 19 Years, Attending
The Obstetrics Outpatient Clinic Of Vmmc & Safdarjung Hospital, New Delhi Were Collected. Genomic Dna Was Extracted
And Used As Template For Pcr Amplification Using Primers Targeting Pfob, Gyr A And Orf1 Gene For Diagnosis Of T.
Vaginalis, C. Trachomatis And N. Gonorrhoeae Respectively. Patients Followed Up Throughout Pregnancy Till Postpartum
Upto 6 Week.
Result:
Total Prevalence Of Stis Among Asymptomatic Pregnant Adolescents Was 12.81% Prevalence Of N. Gonorrhoeae Was
8.44 % , T. Vaginalis Was 2.5% , C. Trachomatis Was 1.86% And Coinfection Among Stis Was 2.5% . Association Of Ptlp
And Pprom With Sti Infection Was Found Statistically Significant (P Value =0.0006, 0.03) Respectively. Association Of
Preterm Birth , Low Birth Weight, Nicu Admission Rate Was Statistically Significant. ( P Value- 0.0006 ,0.000001,0.004)
Respectively.
Conclusion:
Asymptomatic Married Adolescents Pregnant Women Are Prone To Sti And These Infections Had Adverse Obstetrical
Outcome

***************

Torsion Of Term Gravid Uterus

Author: Dr. Parimalam Ayyar
Co Author:

Dr.A.Parimalam , Prof Dr.E.Kalarani M.D.,D.G.O.

Case Report:
Mrs.X, 25 Yrs Old G2P1L1, Post Caesarean Pregnancy Of 9Months Amenorrhoea, Presented To Opd With Acute
Lower Abdomen Pain Followed By Fainting, She Had Feeble Pulse, Tachycardia, Hypotension, Hypothermia And Pallor. In
View Of Deteriorating General Condition Of Patient, Decision Of Emergency Lscs Was Taken. On Opening The Peritoneal
Cavity There Was A Levorotation Of Term Uterus To 180 Degree On Its Longitudinal Axis, At The Level Of Junction Of
Cervix And The Corpus. Untwisting Of Uterus Was Done In The Direction Opposite To That Of Torsion, Proceeded With
Emergency Lscs. Post-Operative Period Was Uneventful. In Our Review Of Literature, We Found Only 317 Patients
Documented Till Date. Prompt Diagnosis Of This Condition In Women Presenting With Acute Abdomen And Early
Intervention Results In Saving The Life Of The Mother, Decreasing Maternal Mortality And Morbidity.

***************

Vaginal Route Pleasure Not A Pressure !!!

Author: Dr. Sithara D
Co Author: Dr. V. Radha1,

Dr.D.Sithara (Iiird Year M.S.Obg Postgraduate)

Dr.V.Radha (Associate Professor)
Sri Ramachandra University,
Porur, Chennai.
Introduction:Hysterectomy, Which Is One Of The Most Common Surgeries Performed On Women, Dates Back To Ancient
Times.Aim:To Determine The Outcome Of Non-Descent Vaginal Hysterectomy (Ndvh) In Comparison With Total
Abdominal Hysterectomy (Tah).Objectives:To Assess The Following Parameters Mentioned And Their Outcome Among
The Non-Descent Vaginal Hysterectomy And The Total Abdominal Hysterectomy Groups. Material And Methods:A
Prospective Observational Study Done In The Department Of Obstetrics And Gynaecology At Sri Ramachandra University
Between July 2012 And June 2014, Where A Total Of 640 Cases Of Hysterectomy Were Observed, Of Them 256 Cases
Underwent Non Descent Vaginal Hysterectomy And 384 Cases Underwent Total Abdominal Hysterectomy. Thus Uteri
Upto 16Weeks Size With Benign Gynaecological Conditions Undergoing Hysterectomy Were Included In This Study. The
Parameters Observed Were Type Of Surgery, Age Distribution, Parity Index, Previous History Of Any Surgeries, Uterine
Size, Uterine Volume, Indication For Surgery, Type Of Anaesthesia, Duration Of Surgery, Technique Of Removal,
Salpingectomy, Oophorectomy, Intra-Operative Complications, Blood Loss And Blood Transfusions, Needing For
Conversion To Laparotomy, Post-Operative Morbidity, Hospital Stay, Pain Scale And Histo-Pathology.Results:On A Total
Of 640 Cases, 256 Cases (40%) Were Ndvh And 384 Cases (60%) Were Tah. Thus A Statistically Significant Difference In
The Parity Index, Uterine Size, Uterine Volume, Duration Of Surgery, Intra-Operative Blood Loss, Post-Operative Blood
Transfusion And Morbidity, Post-Operative Pain Scale And Duration Of Hospital Stay With A P Value Of <0.05 Was
Observed In Ndvh Group When Compared With The Tah Group.Conclusion:Non Descent Vaginal Hysterectomy (Ndvh) Is
A Safe And A Feasible Procedure And Is Considered Superior To Total Abdominal Hysterectomy (Tah) For Benign
Gynaecological Disorders Requiring Hysterectomy.

***************

Maternal And Fetal Outcome Of Placenta Previa

Author: Dr. Shruthi Krishnamoorthy
Co Author: Dr K. S. Rajewari1,

Dr.Shruthi Krishnamoorthy (Iiird Year M.S.Obg)

Dr.K.S.Rajeswari (Professor)

Aim Of The Study

The Aim Is To Study The Maternal And Fetal Outcome Of Placenta Previa.

Material And Methods

This Is A Prospective Observational Study Done In The Department Of Obstetrics And Gynaecology At Sri Ramachandra
University Between July 2012 And June 2014,

Placental Localization Done, And Low Lying Placenta Is Identified On Trans Abdominal Scan And The Findings Are
Confirmed With A Transvaginal Scan At 28 Weeks According To BrownS Classification.

The Clinical Characteristics Of The Mother On Admission, Obstetric History And Clinical Examination Were Recorded In
Detail. Cases Were Managed According To The Degree Of Placenta Previa And Gestational Age, Taking Into Account The
Fetal And Maternal Condition. Minor Degree Of Placenta Previa Cases Were Allowed For Vaginal Delivery And Caesarean
Section Resorted To In Case Of Complications. Major Degree Of Placenta Previa Cases Underwent Emergency Caesarean
Section. Anticipating Pph, Oxytocics, Methergin Or Prostaglandins Were Used.

Results

Incidence Of Placenta Previa Was The Highest In The Maternal Age Group 20-29 Years I.E. 72.9% Mean Maternal
Age +- Sd Was 27.43 +- 4.5 Years.

Incidence Of Placenta Previa Was Highest In 73.55 % The Multiparous Group. 26.43 % In The Primi Group And
6.32 % In Grand Multi Group.

59.65 % Of Cases Required Blood Transfusion And Shock Was Noticed In 9.85 % Of Cases, Pph Was Noticed In
37.4 % Of Cases, Adherent Placenta Noticed In 13.44 % Cases.


The Perinatal Mortality Was The Same In Both The Clinical Types Of Placenta Previa. Chi Square Value Was 1.28
Which Is Not Significant.

Conclusion
Placenta Previa Leads To Increased Maternal Morbidity Due To Antepartum Haemorrhage, Operative Procedures,
Multiple Blood Transfusions.

Perinatal Morbidity Depends On Gestational Age At The Time Of Delivery.

***************

Evaluation Of Molecular Methods Against Conventional Methods And Laparoscopy In Detection Of Genital
Tuberculosis In Infertile Women
Author: Dr. Katam Reddy Sravanthi
Co Author:

Evaluation Of Molecular Methods Against Conventional Methods And Laparoscopy In Detection Of Genital Tuberculosis
In Infertile Women
K.Sravanthi, H.Anupama. Gandhi Medical College, Secundrabad, Ap.
Aim: Evaluation Of Molecular Methods Against Conventional Methods And Laparoscopy In Detection Of Genital
Tuberculosis In Infertile Women.
Objective: To Compare Evaluation Of Molecular Methods Against Conventional Methods And Laparoscopy On Detection
Of Genital Tuberculosis In Infertile Women.
Meterial&Methods: Prospective And Comparative Study Of 200 Cases Of Infertile Women In Deportment Of Obg,Gandhi
Medical College/Hospital For Duration Of 2Yrs.All Patients Are Examined Including Written Consent, History, Physical
Examination, Bimanual Examination. Routine Investigations & Specific Investigations Were Done Are Cervical Swab,
Endometrial Aspiration, Hsg &Laproscopy Done,Pod Washings Taken.
Inclusion Criteria :
1)

Age Of 20 35 Yrs

2)

Primary Or Secondary Infertility Of More Than One Year

3)

Willing To Follow Up

Exclusion Criteria :
1)

Male Factor Infertility

2)

Subjects With Pcos , Std Infections , Endometriosis & Fibroids

Study Design : Prospective & Comparative Study.

Study Period : 2Yrs.
Sample Size : 200.
Setting : Obg Deportment,Gandhi Hospital, Secundrabad Ap.
Results : Among 200 Cases Of Infertility-Primary Infertility Cases -140 Among This From Rural Area-60 Urban Area80.Secondary Infertility Cases-60Among This From Rural Area-20 Urban Area-40.25%Tbpcr Positive In Ea Sample.Only
1.1%Culure Positive In Ea Sample.Sensitivity &Specifity Of Tbpcr In Detection Of Female Genital Tb Is 90%&92&

Conclusion :
1)Microscopic Examination Of Afb Requires 10000 Organisms In The Sample & For Culture Requires 100 Organisms But
For Tbpcr Requires < 10 Pg Of Dna Of Afb 2)Where Tbpcr Positive Early Laparoscopic Was Done &Findings Correlated
With It & So We Can Start Treatment Earliarly.
3)It Is Diagnostic Tool For Latent Fgtb With Negative Conventional Tests.

***************

Evaluation The Learning Curve In Total Laparoscopic Hysterectomy

Author: Dr. Ruma Dutta
Co Author: Dr.Ruma Dutta1, Dr.Geeta J.Doppa2, Dr.Ravikanth.G.O.3,

Evaluation The Learning Curve In Total Laparoscopic Hysterectomy

Dr.Ruma Dutta1,Dr.Geeta J.Doppa2,Dr.Ravikanth3.G.O.
Junior Resident1,Prof&Hod2,Asst Prof3.
Kvg Medical College,Sullia, D.K. Karnataka.
Introduction
Laparoscopic Hysterectomy Is A Minimally Invasive Surgery. Retrospective Studies Have Demonstrated A Number Of
Advantages Of Laparoscopic Hysterectomy. There Is A Lot Of Concern Over The Training Period Of It, As It Is Associated
With Higher Complications During Training Period. Many Studies Suggest That Complication Rates Are Inversely
Proportional To The Volume Of Surgical Work Load.
Objective: To Assess The Learning Curve In Total Laparoscopic Hysterectomy.
Material And Method: This Study Had Included Consecutive 140 Cases Of Total Laparoscopic Hysterectomy For Benign
Gynecological Conditions Were Considered Performed During The Period May 2010 To April 2013. We Had Made First 70
Cases As Early Group And Later 70 Cases As Late Group.
Results: The Mean Operating Time In Early Group Was 101Min And In Late Group Was 81Min (P= 0.000). There Were
Total Of Five Complications, Three In Early Group And Two In Late Group. Mean Hb Deficit In Early Was 1.83% As
Compared To 1.14% In Late Case Which Was Statistically Significant (P=0.00). Mean Hospital Stay Was 3.31 Day As
Compared To 2.14 Day In Late Group.
Discussion: Reduction In Operating Time And Perioperative Complications Are The Two Factors Most Often Quoted In
The Medical Literature. Our Analysis Showed Statistically Significant Reduction In Operating Time, Hemoglobin Drop And
Hospital Stay In Late Group As Compared To Early Group. There Was Positive Association Between The Size Of Uterus
And Operating In Both The Group And Overall As Shown By Correlation Coefficient.
Conclusion: There Need To Be Minimum Number Of 70 Surgeries To Be Performed To Improve The Outcome Significantly.
Total Laparoscopic Surgeries Can Be Performed Safely During The Learning Curve.
Key Words: Laparoscopic Hysterectomy, Learning Curve, Bladder Injuries, Ureteric Injury.

***************

Role Of Laparoscopy In Infertility

Author: Dr. Nafis Fatima
Co Author: Prof. Noor Afshan Sabzposh1, Prof. Imam Bano2,

Fatima Nafis, Sabzposh Noor Afshan, Bano Imam

Introduction: Infertility Is Defined As The Inability Of A Couple To Conceive After Unprotected And Adequate Sexual
Intercourse. It Is A Problem Of Global Proportions Affecting 10-15% Of The Couples. In Case Of Female Infertility, Uterine
Factors Account For 10-15% Of The Cases. Tubal Factors Like Pelviperitoneal Adhesions, Hydrosalpinx, Proximal Tube
Obstruction, Endometriosis Etc. Account For About 40% Of The Cases Of Female Infertility. Laparoscopy Is Considered As
Invaluable For The Evaluation Of Tubes And Pelvis Because It Provides Easy Visualization Of The External Appearance Of
The Fallopian Tubes, Ovaries, Panoramic And Magnified View Of Other Pelvic Organs
Aim: To Assess The Role Of Laparoscopy In Infertility.
Material And Method: The Study Was Carried Out In 75 Infertile Women Attending The Gynaecology Opd In The
Department Of Obstetrics And Gynecology ,Jnmch, Aligarh Muslim University,Aligarh Over 2 Years. Women With Primary
Or Secondary Infertility Between 20-45 Years And Those With Suspected Pelvic Causes Of Infertility Were Included While
Any Medical Disorder Contraindicating General Anesthesia And Laparoscopy Was Excluded. Laparoscopy Was Done In
The Follicular Phase Of Menstrual Cycle.
Study Design: Observational/Prospective
Observation & Result Will Be Discussed At The Time Of Presentation.

***************

Retrospective Observational Study Of Relaparotomies At Nri Medical College / General Hospital.

Author: Dr. Lakshmi Velpula
Co Author:

Following Primary Surgery, Relaparotomy May Be Needed For Complications Developed Post-Operatively.
Aim Of This Study Was To Determine The Incidence, The Indications, Procedures And Outcomes Of Relaparotomy
Admitting In Nri Medical College / General Hospital. It Was A Retrospective Study Done During The Period Of
January 2011June 2014. The Cases Of Relaparotomies That Were Done After Primary Surgery Were Recorded
Using A Protocol Prepared For The Study. Data Was Analysed. Total 27 Relaparotomies Done During The Above
Period. The Incidence Of Relaparotomy From Total Surgeries Was 0.34%. Indications Of Relaparotomy Included
Burst Abdomen 9/27(33%), Intraperitoneal Haemorrhage 8/27(29.6%), Rectus Sheath Haematoma 3/27(11.1%) ,
To Remove Big Ovarian Cyst 1/27(3.7%), For Removal Of Abdominal Pack After 48 Hrs 1/27(3.7%) ,Bladder Injury
1/27 (3.7%) ,Sepsis 2/27 (7.4%), Recurrent Ovarian Cyst 1/27(3.7%) & Few For Combined Indications 1/27(3.7%).
Mortality 4/27(14.81%). Relaparotomy Causes Much More Morbidity & Mortality With Increase In Hospital Stay
Including Icu , Increased Blood Transfusion And Cost. Careful Selection Of Cases For Primary Operation, Expertise
Of The Surgeon, Good Surgical Technique And Careful Postoperative Follow Up Can Reduce The Need For ReLaparotomy.
***************

Role Of Chromohysteroscopy In Detection Of Endometrial Pathology In Perimenopausal & Postmenopausal Women

Author: Dr. Gargi Agarwal
Co Author: Prof. Nisha1, Prof. Uma Singh2, Prof. S.P. Jaiswar3, Dr. Sabuhi Qureshi4,

Gargi Agarwal, Prof. Nisha Singh, Prof. Uma Singh, Prof. S.P Jaiswar, Dr. Sabuhi Qureshi
Abstract
ObjectiveTo Evaluate Diagnostic Accuracy Of Chromohysteroscopy In Cases Of Aub After 40 Years Of Age.
Material And MethodsThis Was A Cross-Sectional Interventional Study Conducted In 50 Women (37 Perimenopausal
And 13 Postmenopausal) Who Presented With Menorrhagia, Metrorrhagia, Polymenorrhagia Or Postmenopausal
Bleeding. Cases With Thyroid Disorders, Coagulation Disorders, Cervical & Vaginal Causes Were Excluded. All Cases
Underwent Diagnostic Hysteroscopy And Findings Were Recorded. Chromohysteroscopy Was Done By Instillation Of 0.5%
Toluidine Blue Dye And Staining Pattern Was Recorded. Hysteroscopic Guided Biopsy Was Taken From Stained Area &
Unstained Area Separately. Endometrial Aspiration Biopsy Was Taken Thereafter. The Histopathological Results Of These
Three Samples Were Compared For Each Participant. Statistical Analysis Was Done Using Spss Version 15.0.
Results37/50 Women Had Endometrial Lesions On Diagnostic Hysteroscopy I.E., Hyperplasia (58%), Polyp (20%),
Fibroid (16%) And Ulcerative Lesion (2%). On Hpe, 20% Cases Showed Endometrial Hyperplasia While 4% Cases Had
Endometrial Carcinoma. 75% Cases Of Histology Proven Hyperplasia Or Carcinoma Showed >50% Staining By Toluidine
Blue Dye. Out Of 12 Cases Of Endometrial Hyperplasia And Carcinoma, Stained Tissue Biopsy Detected 10 Cases (83.33%)
And Unstained Tissue Biopsy Also Detected 83.33% Cases While Only 75% Cases Were Diagnosed By Endometrial
Aspiration. Diagnostic Accuracy Of Both Endometrial Aspiration (94%) And Hysteroscopic Guided Biopsy (96%) Was
Significantly Higher (P Value-<0.001) Than That Of Diagnostic Hysteroscopy (60%). The Diagnostic Accuracy Of Stained,
Unstained And Endometrial Aspiration Biopsy Did Not Show Any Statistically Significant Difference.
ConclusionsChromohysteroscopy With Toluidine Blue Did Not Significantly Increase The Diagnostic Accuracy Of
Endometrial Biopsy. This Shows That Toluidine Blue Does Not Specifically Stain Areas Of Endometrial Hyperplasia Or
Carcinoma.

***************

Geller'S Score, To Identify The Obstetric Near Miss

Author: Dr. Sowparnika S N
Co Author: Dr.Sowparnika.S.N1, Dr . Suresh.S.Kanakannavar2,

GellerS Score, A System To Identify The Obstetric Near Miss

Dr. Sowparnika1, Dr Suresh.S,Kanakannavar2

Postgraduate1, Assistant Professor2 Bmcri, Bangalore.

Introduction:

Obstetric Near Miss (Onm) Describes A Situation Of Lethal Complication During Pregnancy, Labour Or Puerperium In
Which The Women Survives Either Because Of Medical Care Or Just By Chance. Gellers Score Is The Scoring System Used
To Identify The Near Miss Cases.

Aims And Objective:

To Validate The GellerS Scoring System Http://Www.Ncbi.Nlm.Nih.Gov/M/Pubmed/15358399/ And To Analyze

The Factors Affecting Maternal Morbidity And Mortality In High Risk Antenatal Cases.

Methodology:

It Is A Retrospective Cross Sectional Study Done In Vanivilas Hospital Attached To Bmcri Between 1-7-2014 To 30-9-2014.
32 High Risk Antenatal Cases Admitted To Obg Icu Are Studied With Respect To The Factors Affecting Maternal Morbidity
And Mortality And To Calculate The Ratio Of Maternal Mortality To Near Miss Cases. Gellers Score Is Applied And
Sensitivity And Specificity Of The Same Are Calculated.

Results: The Sensitivity And Specificity Of The Gellers Scoring System Is Proved To Be 100% And 61% Respectively. Among
The Cases Admitted To Icu, Age Of The Patient, Gestational Age And Obstetric Index Are Comparable.71.8% Of Cases
Among Them Were Unbooked. 43.75% Of Patients Were Admitted Because Of The Complication Of Hypertensive
Disorders Of Pregnancy, 31.25% For Severe Anemia, 6.25% For Sepsis,18.75% For Other Causes. The Maternal Death:Onm
Is 1:8

Conclusion: Gellers Scoring System Is Validated To Near Miss Cases From The Study. Hypertensive Disorder Of Pregnancy
Is The Leading Cause Of Maternal Mortality Antenatally. For Every Maternal Death There Are 8 Onm.

***************

Genito-Urinary Fistula - An Update

Author: Dr. Pramila Modi
Co Author:

Genito-Urinary Fistula (Guf) Is An Abnormal Communication Between Genital Tract And Urinary System. Guf Includes
Mainly Vesico-Vaginal And Uretero-Vaginal Fistulae, While Other Less Common Types Are Vesico-Uterine, UrethroVaginal, Vesico-Cervical. The First Recorded Reference Of Vvf Being In 1550 Bc In The Remains Of The Egyptian
QueenS Mummy.
Developing Countries Have High Incidence Of Vvf Than In The Developed. It Is As A Result Of Prolonged, Obstructed
Labour, Destructive Operations & Unsafe Abortion. In Developed Countries Guf Is Due To Difficult Gynaecological Surgery,
Hysterectomy, Radiotherapy And Trauma. Direct Injury, Ischaemia Leads To Necrosis And Fistula. Diagnosis Is Done By
Speculum Examination. Moir Test By Double Dye, Cystoscopy, Fluro-Urodynamic Study And 3D Urography.
Preventive Strategies Like Safe Delivery & Surgery Must Be Adopted To Bring Down The Incidence. Conservative Therapy
By Continuous Bladder Drainage And Antibiotics Are Beneficial. Immediate Repair Of Injury Gives Best Results. Surgical
Treatment Is The Gold Standard. Repair Is Best Done Either At The Earliest Or After 3 Months. There Should Be No
Infection & Surrounding Tissue Must Be Healthy.
Principle Of Fistula Repair Remains Same Whatever Technique Is Adopted I.E. Mobilizing Bladder From Vagina, Identifying
Ureters, Closing Bladder Testing For Integrity And Closing The Vagina. Route Of Operation Is Either Transvaginal Or
Transabdominal. The Choice Is By The SurgeonS Experience. When The Vvf Is Very Large, Multiple Or There Is Vaginal
Scarring, Abdominal Route Is Chosen.
Currently Minimal Invasive Surgery By Laparoscopic Repair Is Becoming Popular. The Advantage Is Less Morbidity And
Minimum Hospital Stay. Robotic Assisted Surgery Is Upcoming. It Involves More Cost And Time And Needs Expert Surgical
Skill. In Case Of Irreparable Large Vvf Urinary Diversion Is The Only Option. Repair Of These Fistulae Are Tailored According
To The Type Of Injury And Tissue Loss. Ureterovaginal Fistula Are Dealt By Stenting, Reimplantation Or Anastamosis.
Safe Delivery & Surgery Prevents Guf.

***************

Gestatation Age Assessment Study

Author: Dr. Sangeeta Batra
Co Author:

Gestatation Age Assessment Study

Dr. Sangeeta Batra
Aims & Objectives: Providing Abortion Services By Medical Methods Presumably Is Dependent Mostly On The Correct
Estimation Of The Uterine Size Before, During And After The Abortion Process And Ruling Out Ectopic Pregnancy. A Study
Was Thus Conducted To Estimate The Number Of Pelvic Bimanual Examinations Required To Get Proficient In Uterine
Size Estimation For Provision Of Medical Abortion.
Materials & Methods: 44 Doctors Undergoing Comprehensive Abortion Care Training At 19 Training Centers Participated
In The Study Over A Period Of Six Months. Local Ethical Clearance Was Got From A Participating Medical College, For The
Study. The Data Included The Period Of Amenorrhea Or Date Of Last Menstrual Period (Lmp) As Given By The Woman,
The Uterine Size Estimated By The Trainee Doctor And The Confirmation Of The Uterine Size, As Done By The Master
Trainer From The Training Center. The Data Was Analyzed To Determine The Experience Level At Which The Uterine Size
Assessed By The Trainee Doctor And The Master Trainer Was The Same.
Results: There Is A Wide Variation In The Number Of Pelvic Examinations That Trainees (Mbbs Doctors) Require To
Achieve Accuracy In Assessing Gestation Age. A Number Of Factors Can Be Attributed To This Variation Namely; The
Personal Skill Of The Trainee, Previous Exposure Of The Trainee In Assessing Gestation Age And Influence Of The Trainer
As A Mentor.
Conclusions: The Average Number Of AssessmentS At Which The Mbbs DoctorS Assessment Matches That Of
The TrainerS Is 13 Pelvic Examinations. At The Average 13Th Examination There Is Consistency Of Correct Assessment
Of Gestational Age.

***************

Aub -M:Gynandroblastoma
Author: Dr. Jasmine Abraham
Co Author:

Gynandroblastomas Are The Rarest Type Of Ovarian Sex Cord Stromal Tumours With Very Few Cases Reported In
Literature.Gynandroblastoma Have Low Malignant Potential And Women Present At A Mean Age Of 30 Years With
Menstrual Irregularities And Virilisation.
A 30 Year Old Lady P2L2 Presented With Complaints Of Menometrorrhagia Of 2 Years Duration And Abdominal
Discomfort Of 1 Week.
On Evaluation Pallor Was Present .No Evidence Of Virilisation. No Palpable Supraclavicular Lymph Nodes.
Bmi:19.7 Kg/M2
P/A:A Firm ,Non Tender Pelvic Mass Of 14 Weeks Size .No Ascites .No Hepatosplenomegaly.
P/S:Cervix Was Healthy With Bleeding Through The Os
P/V:Uterus Not Palpable Separately. Pelvic Mass Of 14 Weeks Size Palpable Through Posterior Fornix
Pr :Rectal Mucosa Free. Mass Felt Anteriorly
Imaging Showed Left Ovarian Tumour 12 *8 Cms Solid Mass With Cystic Areas, Abutting The Rectum, But Not Invading
The Same.
Complete Blood Count,Lft And Rft Were Within Normal Limits
Ca 125-43.88U/L. Serum Beta Hcg,Afp And Alp Was Within Normal Limits.
Cxr Was Normal
On Exploratory Laparotomy- Left Ovarian Tumour 11*9*4 Cms With Intact Capsule With Solid And Cystic Areas .No
Adhesions. No Metastasis .Uterus And Opposite Adenexa Normal. No Pelvic Lymphadenopathy. Frozen Section :Sex Cord
Stromal Tumour. Surgically Staged As 1A .Hence Proceeded With Tah +Bso +Appendisectomy +Infracolic Omentectomy .
Final Histopathology Report -Left Ovary Gynandroblastoma Composed Of Adult Type Granulosa Cell And Sertoli Leydig
Cell Component . Endometrium Was Proliferative With No Evidence Of Hyperplasia.
Patient Is On Regular Follow Up And Is Doing Well To Date( 3 Years And 6 Months Since Surgery) With Lifestyle
Modification And Phytoestrogens

This Case Is Reported For Its Rarity.

***************

Health Education Educating The Educators Need Of The Hour

Author: Dr. Tanuja Paipuru
Co Author: Dr.P.A.Chandrasekharan1,

Health Education Educating The Educators Need Of The Hour

Aim -To Assess The Training Of Post Graduate Doctors In Health Education.
Method- Questionnaire Adopted From hecat ,For Assessing Knowledge In Doctors Regarding Health Education
Is Used In The Study. Fifty Postgraduate Students From Various Departments Of Sri Venkateswara Medical College
Tirupati, Andhra Pradesh Participated In The Study.
Results92% Are Aware Of Nature, Philosophy And Scope Of Health Education.100% Have Opinion That Health Education Is Very
Important In Securing Public Health.80% Participate In Health Education Activities (32% Daily,48% Occasionally) But Only
38% Carried Out Specific Health Education Activities Till Now.
76% Opined Formal Training Is Required But None Of The 50 Participants Had Formal Training.36% Were Totally Unaware
Of Planning For Health Education Activities Whereas Others Knew It Partially .Only 12 % Were Aware Of The Media For
Health Education Activities Where As 68% Were Aware Of Only Audio Visual Aids.88% Were Able To List A Few
Characteristics Of Good Health Education Material But None Of Them Listed All The Characteristics . Only 32% Involved
In Preparation Of Health Education Materials. Regarding Health Education Communication 62% Were Totally Silent And
Regarding Factors Improving Effectiveness Of Health Education Activities 56% Were Silent. 88% Were Aware Of At Least
3 Methods Of Health Education Communication And Methods.42% Felt That Responsibility Of Health Education Activities
Rests On Professionals Whereas 22 % Assigned It To Government.
ConclusionThough 100 Percent Of The Participants Agreed That Health Education Activities Are Very Important ,There Seems
Substantial Lack Of Knowledge And Skill To Implement It. It Seems All The Health Care Givers Should Be Formally Trained
To Ensure Change Through Health Education.

***************

Management Of Eclampsia At Tertiary Care Centre -Maternal & Perinatal Outcome

Author: Dr. Anitha Medabalmi
Co Author:

Hypertensive Disorders In Pregnancy Are Common Significant Contributing Factors To The Maternal And Perinatal
Morbidity And Mortality. It Accounts For 13% Of Maternal Deaths Globally, Including India. Hypertensive Disorders As
Such Accounts For 5 To 10%. Eclampsia Is A Commonest Complication Of Severe Pih And Is Largely An Inevitable
Complication Due To Lack Of Early Booking, Good Antenatal Care, And Early Obstetrical Decision. As Per The William
Standard Text Book An Incidence Of Eclampsia Was Approximately 1 In 2,300 Deliveries.
This Prospective Study Was Conducted At Department Of Obgy, Narayana Medical College And Hospital, Nellore, Andhra
Pradesh. 100 Cases Of Eclampsia Were Recruited For The Study Over A Period Of The 3 Years. They Were Observed And
Analysed For The Pattern Of Presentation, Response To Treatment, Booking Status, Condition At Admission, Gestational
Age At The Time Of Admission And Type Of Eclampsia, Mode Of Delivery, Hospital Stay, Perinatal And Maternal Outcome.
Our Study Included Mostly Younger Age Group, Primis, Unbooked, And Mild To Moderate Anemia, With Severe Pih.
Majority Of Them Are Presented With Antipartum Convulsions. Our Study Indicates That There Is Mostly Lack Of Early
Booking. Most Of The Cases Were Booked Late In The Third Trimester. In The Present Study Prevalence Of Major
Complications Of Pih Include, Abruptio Placentae 10%, Neurological Deficits 6%, Aspiration Pneumonia 5%, Pulmonary
Edema 4%, Cardio Pulmonary Arrest 2%, Acute Renal Failure 4%, Maternal Death 1%. In The Present Study Around 65 To
70% Delivered Uneventfully With Good Maternal And Perinatal Outcome. Maximum Hospital Stay Is Not More Than 7 To
10 Days.
Eclampsia Is Basically A Preventable Complication. Good Antenatal Care Is A Prerequisite For Prevention. Hence Insisting
On Institutional Deliveries Of All The Primis, Booking Them At Very Early Pregnancy Can Prevent Or Minimize The Major
Morbidity Or Mortality.

***************

Hysteroscopic Evaluation In Gynaecological Cases

Author: Dr. Navneet Kaur
Co Author: Dr.Parmjit Kaur1, Dr. Surinder K. Bhupal2, Dr. Ruby Bhatia3, Dr. K.D. Singh4, Dr. Aman Dev5

Hysteroscopic Evaluation In
Gynaecological Cases

Dr. Navneet Kaur, Dr. Parmjit Kaur, Dr. Surinder K Bhupal, Dr. Ruby Bhatia, Dr. K.D Singh, Dr . Aman Dev .Dept. Of
Obstetrics And Gynaecology, Govt. Medical College, Patiala.

Introduction : Hysteroscopy Is An Endoscopic Method For Visualisation Of Uterine Cavity. Hysteroscopy Is Current Gold
Standard In Detecting Intrauterine Pathology.
Aims And Objectives : To Visualize And Identify Pathology In Uterine Cavity In Gynaecological Patients.To Perform Any
Operative Procedures If Possible . To Note Complications During The Procedure.
Material And Methods : Hysteroscopic Evaluation In Gynecological Cases Was Carried Out As One And Half Year
Prospective Study From Jan 2013 To June 2014 In Obstetrics And Gynaecology, Rajindra Hospital, Patiala. Hysteroscopy
Was Done In Total Of 60 Patients In Gynae Operation Theatre After Informed Consent Under General Anaesthesia.
Result : Out Of 60 Patients, Infertility Was The Most Common Presenting Complaint I.E. 39 (65%) Followed By Menstrual
Irregularities 21 (35%). Normal Uterine Cavity Was Found In Majority 66.67% Of Patients With Infertility. Among The
Remaining The Commonest Abnormality Detected Was Intrauterine Adhesions 8 (20.51%) Followed By Submucous
Fibroid 2 (5.13%). Out Of 21 (35%) Patients With Menstrual Irregularities, Menorrhagia 13 (61.90%) Was The Leading
Complaint Followed By Metorrhagia 5 (23.81%). The Commonest Abnormality Detected On Hysteroscopic In Patients Of
Menstrual Irregularities Was Endometrial Hyperplasia 7 (33.3%) While Endometrial Polyp 5 (23.81%) Were The Second
Common Abnormality Detected. Significantly More Abnormal Findings Were Diagnosed In Patients With Menstrual
Irregularity Than Infertility. Minor Complications Like Post Procedure Pain (6.67%) And Spotting (5%) Occurs Due To
Procedure Or Anaesthesia. Operative Hysteroscopic Procedures Were Performed Where Needed.
Conclusion : Half (50%) Of Patients Had Positive Findings Making The Investigation A Necessary Tool In The
Armamentarium Of A Modern Gynaecologist In Abnormal Uterine Bleeding And Infertilty.
***************

Immotile Cilia Syndrome - A Tale Of Two Pregnancies

Author: Prof. Vasantha N.Subbiah
Co Author: Dr.L.Kavitha1, Dr.Anoop Sreevalsan2, Dr.Surya.P3, Dr.Ramesh Raja4, Dr.Kavitha.D5

Immotile Cilia Syndrome Also Called As Kartagener'S Syndrome Is A Rare Autosomal Recessive Genetic Ciliary Disorder
Comprising Traid Of Situs Inversus, Chronic Sinusitis And Bronchiectasis. The Basic Problem Lies In The Defective
Movement Of Cilia Leading To Recurrent Chest Infection, Ent/Nose/Throat Symptoms And Infertility. We Hereby Report
Two Cases Of This Rare Entity And Pregnancy Outcome.One Was A Spontaneous Conception Complicated By Eclampsia
And Twin Pregnancy. The Other Was An Icsi Pregnancy
***************

Mixed Germ Cell Tumour - A Rare Case Report.

Author: Dr. Hema Priya.L Kukreja
Co Author: Dr.Ambarish Bhandiwad1,

In The First Two Decades Of Life, Almost 70% Of Ovarian Tumors Are Of Germ Cell Origin, And One Third Of These Are
Malignant. Germ Cell Malignancies Grow Rapidly And Are Characterized By Subacute Pelvic Pain Related To Capsular
Distention, Hemorrhage, Or Necrosis. The Rapidly Enlarging Pelvic Mass May Produce Pressure Symptoms On The Bladder
Or Rectum, And Menstrual Irregularities Also May Occur In Menarcheal Patients.Mixed Germ Cell Malignancies Of The
Ovary Contain Two Or More Germ Cell Elements. They Are A Rare Group Of Malignancy,And The Most Important
Prognostic Features Are The Size Of The Primary Tumor And The Relative Size Of Its Most Malignant Component. The
Most Common Component Of A Mixed Malignancy Is Dysgerminoma, Followed By Est. The Mixed Lesions May Secrete
Either Afp, Hcg, Or Both Or Neither Of These Markers, Depending On The Components.
We Report A Case Of A Fourteen Year Old Girl Who Presented With A Rapidly Growing Abdominal Mass. A Staging
Laparotomy And Unilateral Salpingo Oopherectomy Was Done, And With Histopathology, A Diagnosis Of Mixed Germ
Cell Tumour Stage Ia Was Made. Post Operative Chemotherapy Was Started With Bep Regime. The Patient Developed A
Massive Pulmonary Embolus And Could Not Be Revived.
***************

Immune Thrombocytopenia-Single Institutional Experience With Maternal And Perinatal Outcome In 28 Pregnancies
In 24 Women
Author: Dr. Chithra Ramachandran
Co Author:

In Women With Preexcisting Itp The Effects Of Pregnancy On Course Of The Disease Poorly Known.We Conducted A
Retrospective Cohot Study Serching For Clinical Course , Treatment And Neonatal Outcome Reveiwing Medical Records
From 2006 To 2014 In Pregnant Patients Already Diagnosed With Itp.Out Of 28 Pregnancies15 Had Platelet Count <50,000
In The 1 St Trimester. 6 Of The 15 Had Platelet Count >50000 In The 3 Rd Trimester With Oral Corticosteroids. 5 Patient
Received Iv Corticosteroids And 3 Were Given Imunoglobulin Whose Platelets Were <35,000 In The Preparation For
Delivery.2 Patient Were Refractory To Both .11 Patients Underwent Cesarean Section For Obstetric Indications . There
Were No Serious Bleeding Issues .Prophylactic Platelet Transfusion Was Given To10 Patients Whose Platelets Were
<40000. Neonatal Thrombocytopenia Was Detected In 3 Babies Which Was Managed With Platelet Transfusion No Babis
Showed Features Of Intracranial Henmorrhage .Itp Is Not A Contraindication For Pregnancy And The Overall Risk Is
Accepatable.Patients Should Be Moniterd And Managed In Close Collaberation With Hematologist Anaestheciogist And
A Neonataologist.
***************

Successful Pregnancy Outcome In A Patient With Ventriculo-Peritoneal Shunt

Author: Dr. Prashanthi Damodharan
Co Author: Dr.Prashanthi Damodharan1, Dr.Lalitha Devadasan2,

Incidence Of Pregnant Women With Ventriculoperitoneal Shunts Is Rising Rapidly In Developed Countries. To The Best
Of My Knowledge Only A Few Scattered Cases Have Been Reported In India. Advances And Expert Care In The
Management Of Congenital Hydrocephalus With Ventriculo-Peritoneal Shunts In Young Women Have Led To An Increase
In Life Expectancy And A Substantial Increase In The Number Of Them Becoming Pregnant. Though These Shunts Are
Good In Relieving Symptoms,They Are Prone To Infection, Obstruction Causing Shunt Malformation Often Requiring
Revision Surgeries. In Pregnancy, The Risk Of Shunt Malfunction Is High And Has Been Reported To Occur In About
5075% Of Cases, More So Following Cesarean Deliveries In Comparison To Vaginal Delivery. The Growing Number Of
Cases Emphasizes The Need For Obstetricians, Neurologists, Anesthetists To Be Well Aware Of The Possible Complications
And Its Management. The Following Section Describes One Such Patient, A 22 Year Old Primi Gravida At 39 Weeks Of
Gestation Who Underwent Vp Shunt At The Age Of 11 Years For Aqueductal Stenosis. Antenatal Period Was Uneventful.
She Delivered A Healthy Male Child By Cesarean Section Weighing 3.36 Kg. Postoperatively Patient Developed
Cardiomyopathy. Patient Recovered Well And Was Discharged On 10 Th Postop Day.
The Presence Of A Cerebral Shunt In Pregnancy Does Not Necessarily Alter The Course Of Pregnancy Nor Its Outcome. In
India, Rarely Do We Come Across A Gravid Young Woman In The Reproductive Age With A Preexisting Vp Shunt.I Am
Reporting One Such Case Of Vp Shunt With A Successful Pregnancy Outcome.

***************

Incidence Of Toxaemia Of Pregnancy In Hypothyroid Patients

Author: Dr. Amrita Jaipuriar
Co Author:

Incidence Of Toxaemia Of Pregnancy In Hypothyroid Patients

Aim And Objective

To Study The Incidence Of Toxaemia In Hypothyroid Pregnant Patients And Comparing
It With The General Pregnant Patients (Who Were Not Hypothyroid).

Material And Method

The Patients Admitted In The Garg Hospital, Gorakhpur, From April
2011 To August 2014 For Delivery. All The Patients Were Clinically And Serologically
Assessed For Hypothyroidism.
Observation And Results
As Gorakhpur Lies In The Subhimalayan Belt Incidence Of Hypothyroidism Was Found
To Be High In Our Patients. Out Of A Total Of 1291 Patients, 167 Were Found To Be
Hypothyroid (12.93%). Amongst The General Patients Which Were 1124, 63 Patients Had
Toxaemia Of Pregnancy (5.6%), But Out Of 167 Hypothyroid Patients 29 (17.36%) Had
Toxaemia. Although Many Of These Patients Were Maintaining Euthyroid State After
Medications, Higher Rate Of Caesarean Section, Poor Foetal And Neonatal Out Come
And Maternal Complication Were Observed In These Patients.

Conclusion
Hypothyroidism Needs Definite Treatment And Proper Control. Prenatal And Early
Antenatal Thyroid Screening Should Be Done For All The Patients. Measures Should Be
Taken To Prevent Toxaemia Of Pregnancy.

Dr.Amrita Sarkari Jaipuriar M.S.,D.N.B,

***************

A Comparative Study Of Liquid Based Cytology And Colposcopic Impression In Discharge Per Vaginum
Author: Dr. Nisha Bhagat
Co Author: Dr Nisha Bhagat1, Dr Manjit Kaur Mohi2, Dr Manjeet Kaur3, Dr Balwinder Kaur4, Dr Vijay Bodal5

Introduction
Cervical Cancer Develops From Well Defined Precursor Lesions In A Varied Period Of Time. Detected In Early Or
Preinvasive Stages,Cervical Cancer Is Preventable And Curable, So Detection Of Precancerous Lesions Is Very Important.
Colposcopy With Directed Biopsy Is Used In The Evaluation Of Patients With Cervical Lesions And Described As Gold
Standard For The Diagnosis Of Cervical Precancerous Lesions.
Aims And Objectives

To Study The Socio-Demographic Parameters Of Women With Symptomatic And Suspicious Looking Cervix.

To Compare The Findings Of Liquid Based Cytology And Colposcopy, Taking Histopathology As Gold Standard In
Detecting Premalignant Lesion Of Cervix.
Material And Methods
This Was A Prospective Study Conducted On 300 Sexually Active Women.Liquid Based Cytology Was Performed And
Colposcopy Was Done In All Women Who Came With Complaints Of Discharge Per Vaginum, Intermenstrual Or Post
Coital Bleeding. Final Comparison Between Liquid Based Cytology And Colposcopy Was Based On Histopathology.
Results
71.33% Were Between 21-59 Years, 63% Belonged To Rural Area , Majority Of Patients (46.34%) Were Multiparous,
37.33% Of Patients Were Permanently Sterilized And Among Them 51.06% Had Cin. 58.34% Had First Coitus Between
Age Group Of 11-20 Years And Maximum Incidence Of Cin (68.08%) Was Seen In Same Group. 79 Out Of 300 Smears
(23%) Were Abnormal And Included 12.33 % Of Ascus And Asc-H, 6.67% Of Lsil, 3.67% Of Hsil And 0.33% Of Squamous
Cell Carcinoma. Out Of Them 25 Cases Were Cin Positive On Histopathology. The Relationship Between Results Of Lbc
And Colposcopy, And Lbc With Histopathology With P Value 0.000 And 0.04 Was Significant, While Between Colposcopy
And Histopathology With P Value 0.103 Was Not Significant.
Conclusions
This Study Demonstrated High Accuracy And Correlation Between Colposcopy And Histopathology Than With Lbc. So,
Colposcopy Has Better Efficacy In Detecting Cervical Lesion Compared To Lbc.

***************

Bowel Hematoma Following Vaginal Delivery- A Case Report Author. Dr. V. Krishnaveni
Author: Dr. Krishnaveni Veeranan
Co Author: Prof.Dr.Ramalakshmi1,

Introduction :
Bowel Hematoma Following Vaginal Delivery Is A Rare Phenomenon.
Case Presentation :
A 29 Years Old P2L2 Following Vaginal Delivery Of A Term Baby At A Primary Health Center Referred As Traumatic Pph.
On Exploratory Laparotomy Found To Have Huge Anterior Wall Uterine Hematoma And Bilateral Broad Ligament
Hematoma And Bowel Hematoma And Retroperitoneal Hematoma For Which Total Abdominal Hystrectomy Was
Proceeded.
Conclusion :
Fundal Pressure During Ii Stage Of Labour Is A Blunt Injury Abdomen Endangering The Mother'S Life. Inspite Of All
Measures To Reduce The Maternal Mortality In Modern Obstetrics Still We Loose The Precious Life Due To Iatrogenic
Which Is Preventable. So Effective Health Education To Paramedical Staffs Ensure Changes.

***************

Warfarin Induced Massive Haemoperitoneum Due To Corpus Leuteal Cyst Rupture

Author: Dr. Sathiya S
Co Author: Dr.Vijayalakshmi1, Prof.Famida2, Dr.Renuka3, Dr.Sailatha4,

Introduction :
Ovulation Is A Physiological Process. But In Reproductive Age Group It Could Be Life Threatening Due To Hemorrhage
From Corpus Leuteal Cyst. Incidence Of Corpus Leuteal Cyst Rupture Is Not Known. But Women On Anticoagulant Therapy
Tend To Suffer More Severe Hemorrhage And In This Population The Incidence Due To Corpus Leuteal Cyst Rupture Is
3%-11%
Abstract :
Mrs.K, 33Yrs, P1L1, Lmp-2Months Back, A K/C/O Valvular Heart Disease With Mvr Done 15Yrs Back On Warfarin Came
With Severe Abdominal Pain,Distention And Vomiting For 2 Days. On Examination: Patient Conscious, Disoriented,
Afebrile, Pallor+++, Pr-114/Min, Bp-50/?, Cvs-Loud S1, Ejection Metallic Click+,Rs-Basal Crepts+, P/A- Distension+,
Guarding+, Diffuse Tenderness+, Free Fluid+, P/V-Bleeding Through Os+. Investigations: Hb-2.2G%, Bt-5Min, Ct->1Hr, Inr2.9, Upt-Negative, Usg-Massive Ff In Peritoneum. Emergency Laprotomy Intra-Operative Findings Haemoperitonuem
4Lts, Uterus, B/L Tubes And Right Ovary Were Normal. Left Corpus Leuteal Cyst Rupture.Proceeded With Left
Salpingo-Opherectomy And Intra Abdominal Drain Kept. Blood And Blood Products Like Cryoprecipitate, Ffp And Plasma
Were Given To Correct Blood Loss And Inr. Higher Antibiotics Were Started. Coagulation Profile Returned To Normal After
36 Hrs. Pod-2 Patient Went Into Atrial Fibrillation. Diagnosed To Have Gone Into Sudden Cardiac Arrest, Severe Metabolic
Acidosis And Transient Stuck Prosthesis. After Initial Resuscitation Patient Reverted. Warfarin Started On Low Dose On
Pod-5. Patient Was Discharged On Pod-14.
Conclusion :
Although Significant Ovulation Related Hemorrhage Is Rare In Healthy Women, It Could Carry Considerable Risk In
Women On Anticoagulants.

***************

Feto-Maternal Outcomes Among Women With Previous Cesarean Section At A Tertiary Care Hospital In Puducherry,
India
Author: Dr. Neelima Chauhan
Co Author: Mary Daniel1, Tahmina S2, Ramesh Chand Chauhan3,

Introduction And Objectives: Women With Previous Cesarean Section (Cs) Constitute A High Risk Group In Obstetrics.
The Present Study Was Done To Determine The Mode Of Delivery, Maternal Morbidity And Perinatal Outcomes Among
Women With Previous Cs.
Material And Methods: A Hospital Based Observational Study Was Done In Pondicherry Institute Of Medical Sciences,
Puducherry. All Pregnant Women Of 34 Weeks Of Gestation With History Of Previous One Lower Segment
Caesarean Section (Lscs) And Singleton Pregnancy In Cephalic Presentation Were Enrolled. Study Protocol Was Approved
By Institute Ethics Committee. Proportions Were Calculated For Categorical Variables And Chi-Square Test Was Applied
For Significance.
Results: Among 100 Women Included In The Study, Majority (60.0%) Was 2Nd Gravida And Most (40.0%) Belong To 2529 Years Of Age-Group. On Assessment 75% Of Women Were Found Eligible For Trial Of Vaginal Delivery. Of Them 41.3%
(N=31) Women Refused For Trial. Other 44 Women Who Were Given Trial Of Labour, 18 (40.9%) Delivered Vaginally And
26 (59.1%) Women Were Taken For Emergency Cesarean Section. Overall, 82% Women Delivered By Cs. Among Them
Elective And Emergency Cesarean Section Was Done In 56.1% And 43.9% Of Cases Respectively. Most Common Indication
For Emergency Cesarean Section In Trial Of Labour Group Was Scar Tenderness (46.2%) Followed By Non-Progress Of
Labour (34.6%). There Were 10% Women Who Had One Or More Complications During Labour. The Most Common
Complication Was Hemorrhage (70%). Among Women Who Underwent Elective Cs, Emergency Cs And Vbac, The
Proportion Of Complications Was 11.1%, 8.7% And 11.1% Respectively. Total 25% Of Neonates Had Complications. Of
Them 56% Belonged To The Emergency Cesarean Section Group Followed By Vbac Group (28%).
Conclusion: Trial Of Labour Is A Reasonable Option For Many Pregnant Women With One Prior Low Transverse Uterine
Incision.
***************

__ Does Pre-Surgical Uterine Artery Embolization Improves Operability And Outcome? Report Of Three Cases
Author: Dr. Priyata Lal
Co Author: Dr.Urvashi.Prasad.Jha1, Dr.Neema Sharma2, Dr.Ramandeep Kaur3, Dr. Ritambhara Agarwal4,

Introduction- Combined Approach Of Pre Surgical Uae In Myomectomy Has Demonstrated Good Results In Some Short
Term Studies. The Aim Of Our Report Is To Assess The Effect Of Pre Operative Uae Performed The Day Before The
Myomectomy.
Materials And Methods - We Undertook Three Cases Of Laparoscopic Myomectomy A Day After Uae. Two Patients Were
Nulliparous. The Fibroid Was Single And 32 Weeks In Size In The First Patient. The Second Had Recurrent Multiple Large
Fibroids 24 Weeks In Size And Previous History Of Two Myomectomies. Two Cases Had Associated Adenomyomas.
Results- No Technical Failure Or Complication Was Encountered At Uae. Significant Shrinkage In Size Was Seen After 24
Hours Of The Uae.
At Surgery Minimal Blood Loss And Good Delineation Of Tissue Planes Was Noted. Difficulties Were Faced With
Morcellation Due To Degeneration And Softening. Friability Of The Overlying Myometrium Was Observed In One Patient.
Conclusions- Pre Surgical Uae Minimizes Operative Difficulties, Blood Loss And Apparently Reduces Duration Of Surgery.
Before Making Recommendations Experience With More Cases Is Required In Terms Of Delineation Of Planes,
Enucleation, And Suturing, Morcellation, And Blood Loss, Reconstructibilty Of Uterus And Post Operative Outcomes

***************

Therapeutic Efficacy Of Lng-Ius As An Alternative To Hysterectomy For Management Of Dub In Peri-Menopausal

Women
Author: Dr. Jagannath Mishra
Co Author: Dr. P.C. Mohapatra1, Dr. Tushar Kar2, Dr. R.K Panigrahi3,

Introduction- Dub Is A Significant Clinical Problem Among Women Of Peri-Menopausal Group. Current Medical Treatment
For Dub Is Not Optimal And Many Patients Proceed To Surgery.
Objectives-Therapeutic Efficacy Of Lng-Ius As An Alternative To Hysterectomy For Management Of Dub In PeriMenopausal Women.
Materials And Methods-The Study Comprises Of 235 Cases Attending Gopd At Scb Medical College, Cuttack, Odisha Over
A Period Of 3 Years And The Following Factors Were Observed During Follow Up
A)

Number Of Pads Used Per Day

B)

Duration Of Bleeding

C)

Hemoglobin Level

D)

Objective Sense Of Well Being

Result & Conclusion- Lng-Ius Is A Highly Effective Intrauterine Device In Treating Dub And Stands As An Alternative To
Surgery In Patients Who Can Afford And Those Who Are Scared Of The Risks Involved In Surgery.

***************

Case Report Of Bilateral Gartners Duct Cyst

Author: Dr. Haritha Mannem
Co Author: Dr.Mohan Lalmeena1, Dr.B.S.Meena2, Dr.Kusum Lata Meena3,

Introduction
Gartner Duct Cysts Are Cystically Dilated Mesonephric (Wolffian) Duct Remnants Found In The
Anterolateral Part Of The Proximal Third Of Vagina.They Represent 11% Of The Vaginal Cysts.Gartners Duct Are Identified
In Approximately 25% Of All Adult Women And Nearly 1% Evolve Into Gartners Duct Cysts.During Around 8Th Week Of
Embryological Development The Mesonephric Ducts Develop From Their Predetermined Structure And Later Regress.
Remnants Often Remain As Gartner Ducts , Epoophoron,Paraophoron. Gartner Ducts If They Develop Secretory
Mechanism,Cause Dilatation Of The Surrounding Cells And Thus Yield Gartner Duct Cyst. Classically These Cysts Are
Solitary ,Asymptomatic ,Unilateral With Average Diameter Of 2Cm Located In Anterolateral Wall Of Proximal Third Of
Vagina.

Case Report
A 40 Year Old Premenopausal Woman Presented To Gynaecology Opd Stating That She Has Noticed A Growth
Protruding From Her Vagina Since 7 Years.It Has Been Painless And Gradually Increasing In Size.She Denies Any Vaginal
Bleeding,Urinary Retention,Incontinence,Fever,Injury Or Pain Abdomen.She Has No Significant Past Surgical Or Medical
History.Her Vital Signs And General Physical Examination Are Normal.On Inspection A 6X7Cm And 4X5 Cm Cystic Masses
Arising From Right And Left Lateral Vaginal Walls Respectively Are Noted.They Are Nontender And Irreducible.She Was
Posted For Cystectomy Along With Marsupialization And The Tissue Obtained Was Sent For Hpr.The Report Identified
Them As Gartner Duct Cysts.

Discussion
The Differential Diagnosis Of A Cyst In The Lateral Vaginal Wall Of Female Genital Tract Includes Bartholins Gland
Cyst,Broad Ligament Cysts,Gatrner Duct Cyst,Prolapsed Urethra,Prolapsed Uterus,Vaginal Wall Inclusion
Cyst,Endometriosis,Malignant Mass Etc.Magnetic Resonance Imaging Is The Best Imaging Modality For Localizing Gartner
Duct Cysts.Histological Examination May Be Employed To Correctly Identify The Cellular Remnants Composed Of Non
Mucin Secreting Low Columnar Or Cuboidal Epithelium.Excision Of The Cyst Along With Marsupialization Has Beem
Satisfactory Treatment In These Cases.Only In Exceptionally Rare Cases There Has Been A Malignant Transformation
Identified.

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Is Diagnosis Of Gdm By Hapo Criterion More Prudent Than Who Criteria?

Author: Dr. Apoorva Reddy
Co Author: Apoorva Pallam Reddy1, Yasodhara Pallam Reddy2, Rajiv Kumar Saxena3,

Introduction

Gestational Diabetes Mellitus (Gdm), Complicates About 5-10% Pregnancy. It Shows Wide Range Of Prevalence When
Different Diagnostic Criteria Are Used.

The Criteria For Gdm Diagnosis Recommended By Who, Established More Than 40 Years, Were Based On Observation
Of Non Gravid Patients. These Criterion Remain In Effect Till Date.
The Hyperglycemia And Adverse Pregnancy Outcome (Hapo) Study Designed To Clarify This, Showed Unambiguous Linear
Positive Relation Between Maternal Glycaemia And The Adverse Pregnancy Outcomes. Based On The Hapo Study, Iadp
Has Laid New Recommendations For Diagnosis Of Gdm As: Fasting: 92Mg%, 1Hr : 180Mg%, 2Hr : 153Mg%.

Aim
To Evaluate If The New Criteria Laid Down By Iadp Will Help To Reduce The Morbidity Associated With Gdm, When
Compared With The Existing Who Criteria.
Methods
A Prospective Study Was Performed On Pregnant Women Reporting To Labour Room For Delivery, With Ogtt Done During
Antenatal Period.
Overt Diabetes Mellitus Excluded.
Based On Their Ogtt Values, Data Divided Into 3 Groups
Group A: Gdm Diagnosed By Who Criteria.
Group B Gdm Diagnosed By Iadp Criteria.
Group C Normal Ogtt Values Control Group.

Results
350 Gravid Women Were Observed.
Incidence Of Gdm In Group A: 22.6% Group B: 45.1% .
Maternal Complications Like Prom, Pph And Lscs Rates Were Significantly Increased In Gdm Mothers As Compared
To Controls. (P >0.01)
Neonatal Complications: No Significant Difference Between The Gdm Groups And Controls With Respect To
Macrosomia, Neonatal Hypoglycaemia And Hyperbilirubinaemia. However Nicu Admission Rate Was Significantly Higher
In Both Group A & B When Compared To Controls.

Conclusion:
If The Who Criterion Were Taken Into Consideration For Diagnosis, Significant Number Of Cases Would Have Been Missed
Out Which Are At Increased Risk For Morbidity. Hence Lowering The Cut Off Values For Diagnosis Of Gdm As Proposed
By Iadpsg Will Be Prudent.

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Advanced Abdominal Pregnancy With Features Of Dic And Septicaemia

Author: Dr. Indu Shekhar
Co Author: Dr Karmela Kujur1, Dr Sweta Agarwal2,

Introduction
Extrauterine Abdominal Pregnancy Is Extremely Rare And Is Frequently Missed During Antenatal Care.This Is A Report Of
A 32 Weeks Extrauterine Pregnancy In An Elderly 2Nd Gravid ,Who Likely Had A Ruptured Ectopic Pregnancy With
Secondary Implantation With Poor Anc Visits ,Late Diagnosisand Delayed Consultation Leading To Dead Macerated Baby
With Endangering MotherS Life Who Came To Us With Impending Disseminated Intravascular Coagulation .She Was
Saved By By Our Meticulous Effort And Timely Intervention.
Case Presentation
A 35 Years ,Elderly 2Nd Gravid From Extremely Rural Area Of Jharkhand Presented To Our Opd With Dyspnoea
,Amenorrhoea From 1 Year And Bleeding Per Vagina From 20 Days.Her Abdominal Ultrasound Showed Intraabdominal
Still Foetus Outside Uterus Lying Transversely In Abdomen With No Cardiac Activity Of 22 Weeks Size.A Mild Collection
Seen In Pod Of Size 99*45*59.An Cect Showed An Extrauterine Single Dead Foetus With Positive Spalding Sign With
Placenta Contiguous With The Uterus And Merging With The Sac Containing The Foetus.Her Laboratory Finding Showed
Reduced Platelets Count Of 85000/Cumm And Serum Fibrinogen Of 160Mg% And Increased Serum Creatinine Of
1Mg%.Her Haemoglobulin Was 11Gm%.She Moving Towards Dic.She Was Posted For Laparotomy After Transfusion Of 2
Units Of Ffp And 2 Units Of Packed Cells.A Dead Macerated Baby Was Delivered From Peritoneal Cavity With Uterus In
Its Normal Size And Position.The Placenta Was Completely Removed After Separation From Its Attachment Over The
Right Cornual Portion Of Uterus And Its Attachment Over Large Bowel And Omentum.There Was Small(1Cm*1Cm)
Perforation Over The Right Cornua Of Uterus Which Was Freshened And Repaired. The Patient Was Discharged After 7
Days After Suture Removal.
Conclusion
Early Diagnosis Of An Abdominal Pregnancy Can Be Managed Till Term With Good Maternal And Foetal Outcome.

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Old Screening Techniques Revisited

Author: Prof. Anjalakshi Chandrasekar
Co Author: Christe. D. M1,

Introduction
Large Population Numbers And High Rates Of Incidence Of Cancer Cervix In Low Socio Economic Population Groups In
Chennai City And Neighbouring Districts Poses A Major Problem For The Health Department. The Govt. Has Recently
Introduced Colposcopes To Detect Early Cervical Precancerous Lesions And Early Cancer Of Cervix.
Aim:
To Find Out The Efficacy Of Low Cost Available Methods Of Screening For Cancer Cervix .Settings Colposcopy Clinic In A
Tertiary Care Public Referral Hospital, In Chennai
Methods
The Study Was Conducted For A Period Of Three Years With Power Above 80%. As The Average Age Of Cin In This Area
Was 35 Years. Women With At Least Five Years Of Coital Activity And Aged Below Fifty Years Were Included In The Study..
A Total Of 100 Women Were Diagnosed With Cin And 244 Women With Chronic Cervicitis By Hpe Reports . Ten Women
Were Hiv Positive.
Results
Low Cost Screening Tests Of Via And Vili Were Positive In 75% Of Women With Cin And In Combination With Colposcopy
Positive In 93% . The Diagnostic Accuracy Of Colposcopy Was Highest At 86%.The Results Of Older Women Aged Above
Thirty Five With Those Aged Below Thirty Five Years Were Compared , With The Results Of The Total Group Of Women .
Conclusion
The Combination Of Low Cost Tests Of Via And Vili Were Effective In Detecting Cin In 75% Of Women And Along With
Colposcopy In 93%Of Women.

***************

Role Of Antenatal Class In Improving The Positive Outcome For Mother And Baby
Author: Dr. Deepthy M
Co Author: Dr.Saroj Rahulan1,

Introduction
Pregnancy Is Always Associated With Many Doubts And Confusions .This Is Even More So In Primis ,Most Of Them
Harbour False Beliefs And Hearsays Making Antenatal Period And Childbirth A Night Mare.In Busy Opd We May Not Be
Able To Answer All Doubts ,So In Our Hospital We Started A Monthly Once Antetal Class For Primis Along With
Spouse/Mother Where Pregnancy ,Childbirth And Early Postpartunam Period Was Explained With The Help Of Visual
Media.Classes Were Taken By Consultant Itself.
Aim:To Assess The Effectiveness Of Antenatally Taken Class On Pregnancy,Delivery And Early Postpartum Period For
Primis In Terms Of Their Experience After They Have Gone Through Actual Process
Materials And Methods
50 Primis Who Attended The Antenatal Class During A Period Of 2013 Sep To 2014 Aug And Who Delivered At Westfort
Hospital Were Selected(Group A).The Same Number Of Primis Who DidnT Attend And Delivered During The Same
Period Wasalso Selected(Group B).Both Were Given A Questionnaire After 6 Weeks Poastpartum.The Parameters
Assessed Were Their Perception Regarding The Actual Delivery,Need For Analgesia,Decision Making,Achievement Of
Normal Delivery And Over All Satisfaction In Undergoing Delivery And Early Postpartum Child Care.
Observations
There Was A Visible Difference In The Anxiety Level Which Appeared Much Lower In Groupa.The Duration Of Labour Was
Less,And Vaginal Birth Rate More.The Satisfaction Of Being Prepared And Part Of Decision Making Was Also More .
Conclusion
Conducting Antenatal Class For Pregnant Ladies Away From Formal Op Goes A Long Way In Improving The Outcome Of
Labour.This Simple Methods Is Feasible In All Set Ups And Helps To Improve Doctor Patient Communication As Well.

***************

Evaluation Of Pre Evacuation And Post Evacuation Serum Beta Hcg Ratios In Molar Pregnancy For Early Prediction Of
Persistent Gestational Trophoblastic Neoplasia
Author: Dr. Seema Singhal
Co Author: Dr. Nivedita Sarda1, Dr. Seema Singhal2, Dr. Shipra Gupta3, Dr. Renu Arora4,

Introduction
Present Study Was Conducted To Determine Predictive Value Of Pre Evacuation And Post Evacuation Serum Beta Hcg
Ratio At Each Week Till 5 Weeks For Prediction Of Persistent Gestational Trophoblastic Neoplasia.
Material And Methods
A Longitudinal Cohort Study With A Total Of 40 Patients Of Molar Pregnancy Was Conducted. After Evacuation These
Patients Were Followed Weekly With Serum Beta Hcg Levels Till 3 Consecutive Negative Levels Were Obtained Or The
Patients Developed Persistent Gtd. Patients Were Then Divided Into Spontaneous Remission Group And Persistent Gtn
Group. Serum Beta Hcg Levels Pre Evacuation And Ratios Of Pre And Post Evacuation At Each Week Were Compared In
Both The Groups And Predictive Values Were Obtained. Spss Version 22 Was Used For Data Analysis
Results
25% (10 Out Of 40 Cases ) Of H. Mole Developed Persistent Gtd. Using The Roc Curve, The Optimal Cut Off Ratio Of Pre
Evacuation And Post Evacuation Beta Hcg At Each Week Upto Week 5 Was Determined Keeping The Sensitivity For
Prediction Of Persistent Gtn At 100%.
The Cut Off Ratios At Week 1,2,3,4 And 5 Were Found To Be 72.6, 245, 700, 1450 And 2650 Respectively. The Above
Ratios Had A Specificity Of 86.6%, 80%, 90%, 86.7% And 83.3% Respectively At Week 1,2,3,4 And 5. The Cut Off Ratio Of
700 At Week 3 Was Found To Be Best With A Sensitivity Of 100%, Specificity Of 90%, Ppv Of 77% And Npv Of 100%. There
Was A Gain Of 5.1 Weeks As Compared To The Diagnosis By Figo Criteria.
Conclusion
Ratio Of Pre Evacuation And Post Evacuation Beta Hcg At Any Time From Week 1 Through Week 5 Can Be Used As A
Predictor For The Development Of Persistent Gestational Trophoblastic Neoplasia.

***************

Correlation Between Fetal Biometry And Fetal Transverse Cerebellar Diameter In Determination Of Gestational Age
From The 15Th Week Of Gestation To Term In Healthy Women With Uncomplicated Pregnancy
Author: Dr. Madhumitha M
Co Author: Dr.Suma K B1, Dr.Chandrashekhar2,

Introduction
The Estimation Of Gestational Age From Individual Parameters Like The Biparietal Diameter, Head Circumference (Hc),
Abdominal Circumference (Ac) And Femur Length (Fl) Show A Lot Of Variability. There Are Conditions That Can Alter The
Shape Of The Foetal Skull Which In Turn Can Affect The Bpd, Affect The Abdominal And Femoral Measurement. The
Present Study Is Being Undertaken To Measure The Transverse Cerebellar Diameter (Tcd) To Validate It As A Additional
Morphological Measurement Of Foetal Growth With Less Variability And A More Accurate Parameter For The
Determination Of Gestational Age.

Objective
To Perform Obstetric Ultrasonography In Healthy Women With Uncomplicated Pregnancy Between The 15Th Week Of
Gestation And Term To Determine A Correlation Between The Transverse Cerebellar Diameter And The Gestational Age
As Determined By The Last Menstrual Period And Other Sonographic Parameters Like Biparietal Diameter, Head
Circumference, Abdominal Circumference And Femur Length.

Materials And Methods

300 Healthy Women With Uncomplicated Pregnancy Between The 15Th Week Of Gestation And Term From The
Obstetrics And Gynaecology Department Of J.S.S Hospitals, Mysore Will Be Included In This Study. The Study Period Is
For Eighteen Months; From October 2012 To June 2014. Gestational Age For The Measured Tcd Is Obtained From The
Reference Chart predicted Menstrual Age For Transverse Cerebellar Diameter Of 14 Mm To 56 Mm.

Results
Tcd Positively Correlated With Bpd, Hc, Ac And Fl. Nomogram Of The Tcd Shows That There Is A Linear Relationship
Between The Cerebellar Growth And Gestational Age.

Conclusion
Tcd Can Be Used As A Reliable Parameter For Determination Of Gestational Age.

***************

Laparoscopic Management Of Large Ovarian Cyst During Pregnancy

Author: Dr. Chaya S.M
Co Author: Dr.Chaya S.M.1, Dr.Saraswathi Ramesh2,

Introduction
The Incidence Of Adnexal Masses During Pregnancy Varies From 6% To 25%. Most Of These Masses Are Functional
Ovarian Cysts And Generally Resolve During Pregnancy, Leaving Between 0.7% - 1.7% Of Women With Persistent Masses.
Although Ovarian Cyst Torsion, Hemorrhage Or Rupture Leading To Abdominal Pain Is Uncommon In Pregnancy, Some
Women May Require Emergency Surgery For These Complications. To Avoid These Complications, Elective Surgery Is
Recommended For Huge Ovarian Cysts In Second Trimester Of Pregnancy.
Case Report
27 Year Old Spontaneously Conceived G2P1L1 Presented To Our Hospital At 11 Weeks Period Of Gestation With Usg
Report Showing A Large Abdominopelvic Cyst Measuring 24X18X10 Cms Seen In Midline Extending From Epigastrium To
Pelvis With Internal Septations Along With Single Live Intrauterine Gestation Of 11 Weeks. In View Of The Large Cyst And
Its Associated Complications, Planned For Operative Laparoscopy In 2Nd Trimester.
Surgery Was Performed At 15 Weeks Period Of Gestation. Under Ga, Laparoscopic Left Salpingo-Ovariotomy Was Done.
Intra Operative & Post Operative Periods Were Uneventful. Histopathological Report Was Borderline Mucinous
Cystadenoma.
She Had An Uneventful Antenatal Course And Delivered A Male Baby Weighing 3.2Kg At Term Through A Vaginal Delivery.
Conclusion
Laparoscopic Surgeries During Pregnancy Is Challenging Due To Various Issues Ranging From Anaesthesia To Operative
Techniques. Appropriate Case Selection, Experienced Surgeon, Well Trained Laparoscopic Team Are Essential
Prerequisites For A Successful Laparoscopic Surgery During Pregnancy.

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Role Of Health Education And Decision Aid On CoupleS Choice Of Mode Of Delivery
Author: Dr. Sukumar Barik
Co Author: Dr Farheen Faruque1, Dr Biswajyoti Guha2,

Introduction: A Decision-Aid For Women Facing Choices About Birth Is Effective In Improving Knowledge And Reducing
Decisional Conflict. Caesarean Delivery On Request Is An Area Of Increasing Debate Over Last Few Years. The Clinical,
Ethical, Economic And Social Aspects Of This Issue Are Highly Controversial.
Objective: The Purpose Of This Study Was To Find Out The Influence Of Health Education And Decision Aids In Decision
Making Of Mode Of Delivery; To Uncover The Magnitude Of Problem In First-Time Mothers Undergoing Cesarean Section
In The Absence Of Medical Indication And To Find Out Their Reasons For The Request.
Methods: Prospectively Collected Data Of All The Caesarean Delivery Of A Unit From September 2005 To September
2007(Group - 1) Were Compared With Data From September 2011 To September 2014(Group - 2). Cases With Other
Obstetric / Medical Problem Along With Request Were Excluded From This Study.
Results: Eighty Two (45%) Of 182 Caesarean Deliveries Are Exclusively Done For Request In Group 1; 164 (40 %) Of 414
Caesarean Delivery Are Done For Same Indication In Group 2. Main Reasons For Request Are Decision Of The Senior
Members Of The Family, Experience Of Peer, Fear For Vaginal Delivery, Fear About Pain, Uncertainty About Time Of
Delivery, Desire For Small Family.
Conclusions: This Small Study Demonstrates Health Education Including Decision Aids Did Not Significantly Contributed
To The CoupleS Choice Of Mode Of Delivery. Opinion Of Senior Members Of The Family And Information Obtained
From Peers Still Has Strong Influence In Decision Making.

***************

Is Term Viable Pregnancy Possible In Women With Undetectable Amh Levels (<0.16Ng/Ml)?
Author: Dr. Prema Vaidyanathan
Co Author: Prema Vaidyanathan1,

Introduction: Anti-Mullerian Hormone (Amh) Is Used As A Measure To Predict Ovarian Reserves. The Objective Of This
Study Is To Examine The Possibility Of Spontaneous Pregnancy In Female Patients With Undetectable Levels Of AntiMullerian Hormone (Amh), Below 0.16 Ng/Ml; Comparing Different Age Groups. We Have Not Come Across Any Study
So Far That Has Studied More Than Two Patients With Amh Levels Lower Than 0.16Ng/Ml.
Methods: This Study Included 151 Women Who Visited The Clinic From Period Of January 2013 To January 2014, Ranging
In Age From 23-46 Years. All Patients Had Blood Work Done To Assess The Amh Levels And The Levels Ranged From
28Ng/Ml-0.01Ng/Ml. Patients With Amh Levels Less Than 0.16 Were The Focus Of This Study (N=22). This Group Was
Further Divided Into Three Subgroups Based On Age.
Results: First Subgroup Of Patients Were 30 Years Or Under (N=5). Second Group Ranged From 31-40 Years (N=12) And
Third Group Of Patients Were Over 40 Years Of Age (N=5). Pregnancy Results Are Shown In The Table Below.
Table 1: Results Showing The Total Number Of Pregnancies In Each Subgroup.

Patients With Undetectable Amh Levels (N-22)

Group 1 21-30

Group 2 31-40

12

Group 3 > 40

Age Range

Total Number Of Patients Pregnancy

Conclusions: In This Study, We Found That Extremely Low Levels Of Amh In Younger Women (Less Than 30 Years Of Age)
Can Still Result In Spontaneous Pregnancy That Have A Better Chance To Go Up To Full Term As Compared To Older
Women .All Patients With Undetectable Amh Levels May Not Need Donor Eggs To Achieve Pregnancy. Hence Age Is A
Better Predictor Of Pregnancy Than Amh Levels Alone.

***************

Extra Peritoneal Cesarean Section Vs Conventional Method A Comparitive Study

Author: Dr. Jeena Pavithran
Co Author: Dr Jeena Pavithran1, Dr Ganesh Shinde2, Dr Balaji Jadav3,

Introduction: Caesarean Section Is One Of The Most Commonly Performed Surgeries In The World. Because Of The Huge
Numbers Even Small Improvement In Technique Can Cause Significant Impact In Morbidity Rates And Cost Burden.
Aims & Objectives:
1.

To Study Feasibility Of Extra Peritoneal Cesarean Section In Current Practice

2.

To Compare This Technique With Trans Peritoneal Section.

3.

To Study The Merits & Demerits Of This Technique.

Materials And Methods: A Prospective Comparative Study Was Performed In A Single Unit Of Obstetrics And Gynecology
Department At A Tertiary Hospital For 2 Years. Patients Were Recruited With Well Defined Inclusion And Exclusion Criteria
& They Were Divided Into Two Groups With 50 Patients In Each Group Of One Who Were Operated By Extra Peritoneal
Cesarean Section & Other Operated By Trans Peritoneal Cesarean Section.
Conclusion: From This Study We Conclude That This Technique Is Feasible. The Advantages Observed Are Less Chances
Of Paralytic Ileus, Early Mobilization Of Patient, Less Post Operative Pain, Less No Of Days Of Hospital Stay Etc. The
Demerits Observed Are The Time Required For Skin Incision To Baby Delivery Time Is Little More In Inexperienced Hands.

***************

Clinical Study Of Post Operative Wound Infections In Obstetrics And Gynaecological Surgeries In A Tertiary Care Set
Up
Author: Dr. Monika Kotpalliwar
Co Author: Dr. Inamdar1, Dr. Hariharan2,

Introduction: Despite Advances In Operative Techniques And A Better Understanding Of The Pathogenesis Of Wound
Infection And Wound Healing, Post Operative Wound Infection(Surgical Site Infections) Continue To Be A Major Source
Of Morbidity And Mortality For Patients Undergoing Operative Procedures. The Overall Surgical Site Infection Rate
Worldwide Has Been Varied From As Low As 2.5% To As High As 41.9%. The Overall Wound Sepsis Rate In India Is From
10%-33%. However, The Incidence Of Wound Complications In The Obstetric Population Varies With Rates Ranging From
2.8%-26.6%.
Aim And Objectives: To Find Out The Incidence And Risk Factors Responsible For Post Operative Wound Infection (Ssis)
And In Elective And Emergency; Obstetrics And Gynecological; Abdominal Surgeries.
Material And Methods: Prospective Study Was Carried Out From August 2011 To August 2013 For The Patients Who
Underwent Surgery In The Department Of Obgy At Avbrh Wardha. All These Patients Were Prepared For Operative
Procedures Through Abdominal Approach, Either Elective Or Emergency Operations.Operated Patients Were Followed
Up Regularly.The Wound Was Checked On 4Th Post Operative Day Routinely And Earlier And Later According To The
Complaint Of The Respondents.
Results: Ssis Was Found In 213 Patients Out Of 3475 Patients With An Overall Post Operative Wound Infection Rate Of
6.12%. The Rate Of Ssis Was More In Emergency Surgery Patients(16.01%) As Compared To Elective Surgery
Patients(51.17%), And That Too Among Obstetric Emergency Cases(51.17%). The Wound Infection Was More Frequently
In Caesarean Section(55.40%) Than Gynecological Surgeries(44.60%).Significant Association Was Observed Between The
Nature Of Surgery And Southampton Wound Grading System(P Value=0.027).
Conclusion:Ssi In Rural Setup Was Found To 6.12%,So All Preventive Measures Have To Be Taken To Still Reduce The
Infection Rate.

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Maternal Outcome With 12 Hours Magnesium Sulphate Therapy In Eclampsia

Author: Dr. Nidhi Garg
Co Author: Dr. Shaheen1, Dr. Namrata2, Prof. Rajyashri3, Dr. Zehra4,

Introduction: Eclampsia Refers To The Occurrence Of One Or More Generalized Convulsions And/Or Coma In The Setting
Of Preeclampsia And In The Absence Of Other Neurologic Conditions. The Incidence Is Higher In Developing Countries As
Compared To Developed Countries. Administring Magnesium Sulphate For 24 Hours After The Last Fit Or Delivery
(Whichever Is Later) Is Best Empirical. It Has Not Been Properly Subjected To Scientific Scrutiny.
Objective: The Objective Of This Study Is To Assess And Compare The Efficacy Of Continuing 12 Hours Magnesium
Sulphate Therapy With 24 Hours Magnesium Sulphate Therapy After The Last Fit Or Delivery (Whichever Is Later) In
Ecclampsia.
Methods: Cases And Controls Were Given Loading Dose Of 4Gm Iv Magnesium Sulphate Followed By Maintenance Dose
Of 1Gm/Hr For 12 Hours And 1Gm/Hr For 24 Hours After The Last Fit Or Delivery(Whichever Was Later) Respectively.
Primary Outcome Was Observation Of Presence Or Absence Of Recurrent Convulsions. PatientS Recovery Was Also
Analyzed In Terms Of Mobilization, Total Dose Of Magnesium Sulphate Given, Duration Of Hospital Stay And Duration Of
Foley'S Catheterization.
Results: Incidence Of Eclampsia In Our Study Was 3.9%.No Recurrence Of Convulsions Was Noted In The 12 Hour Therapy
Group.The Mean Amount Magnesium Sulphate Used In The 12 Hour Therapy Group Was 23.22.8 Grams As Against
34.93.2 Grams Used In The 24 Hour Therapy Group. Foley Catheter Was Removed Significantly Earlier In 12 Hour
Therapy Group.
Conclusion:The Results We Found Were Extremely Significant Although Larger Randomized Trials In Multiple Centers Are
Needed Before A Definitive Recommendation Can Be Made, The Findings Of This Study Support The Use Of Shorter
Duration Magnesium Sulphate Protocols As A Viable Alternative To The Standard 24 Hours Therapy.

***************

Study Of Effect Of Pritchard Regimen On Maternal And Fetal Outcome In Cases Of Eclampsia:
Author: Dr. Sahana Rao
Co Author: Dr Srinivas K1, Dr Malini K V2,

Introduction: Eclampsia, Defined As One Or More Seizures Associated With Pre-Eclampsia, Remains A Leading Cause Of
Maternal Mortality And Morbidity. Magnesium Sulphate Is Drug Of Choice For Preventing Both The Initial Episode Of
Eclampsia And Recurrence Of Seizures.
Aims And Objectives: To Study Effect Of Pritchard Regimen Of Mgso4 On Maternal And Fetal Outcome In Patients With
Eclampsia.
Methodology: It Is Retrospective Study For Period Of Three Years From August 2011-May 2014 Conducted At Vanivilas
Hospital Attached To Bmc&Ri. 640 Cases Of Eclampsia Were Studied In Whom Mgso4 Is Used As Per Pritchard Regimen
For Control Of Seizures. Cases Were Studied With Respect To Total Amount Of Mgso4 Given, Presence Of Toxicity,
Presence Of Recurrent Seizures, Need For Additional Drugs, Maternal Complications, Death Attributable To Mgso4. Fetal
Outcomes Like Apgar At Birth, Nicu Admissions, Causes For Admission, Mortality Were Noted.
Results: 50.75% Patients Were In Age Group Of 21-25 Years. 65.4% Patients Were Primigravidae. Average Dose Of Mgso4
Required Other Than Loading Dose Was 6.4 And Mean Amount Required Is 32.35G. Mild Toxicity Was Noted In About 7%
Cases Which Warranted Skipping Of 1Or 2 Doses. No Serious Toxicity Noted. Convulsion Delivery Interval Was Between
8-12Hours In 49%Patients. 2.5% Patients Had Recurrent Seizures For Which Other Medications Were Used. Maternal
Complications Were Seen In About 30% Of Cases Which Includes 7% Maternal Mortality Not Attributable To Magnesium
Toxicity. Fetal Outcome Includes 37% Stillborn, Out Of Remaining, 62.4% Of Babies Required Nicu Admission.
Conclusion: The Maternal And Perinatal Morbidity, Mortality Is Very High In Patients With Eclampsia And Mgso4 Proves
To Be The Most Effective Drug For The Same With Minimal Adverse Effects. The Use Of Mgso4 As Per Pritcard Regimen
Could Be Safely Used In These Patients.

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Knowledge And Attitude About Emergency Contraceptives Among Nursing Staff In A Tertiary Care Hospital
Author: Dr. Neha Pruthi
Co Author: Dr Rekha Bharti1, Dr Pratima Mittal2, Dr Jyotsna Suri3,

Introduction: Emergency Contraceptives Are Accessible And Acceptable Contraceptive Methods For Most Women. With
Their Proper Use, About Three-Quarters Of Unwanted Pregnancies Can Be Prevented. Although The Pills Are Sold Over
The Counter, Health Care Providers Play A Critical Role In Informing Their Clients About Emergency Contraception, And,
Therefore, It Is Imperative That Providers Themselves Be Well Informed About The Methods.
Aim: To Determine The Knowledge And Attitudes Of Nursing Staff Towards Levonorgestrel (Lng) Only Emergency
Contraception Pill (Ecp)
Materials & Methods: In This Cross-Sectional Study, Subjects Were 100 Nurses Working In The Department Of Obstetrics
And Gynaecology In A Tertiary Hospital. Self-Administered Questionnaire Was Used To Collect Data.
Results: Majority (81%) Of The Respondents Were Familiar With The Lng Only Emergency Contraception Pill, Only 35%
Considered It An Abortifacient While 42% Were Unsure. Barriers To Promote Its Use Were Identified As It Will
Promote Promiscuity (39%), Teratogenicity (44%), Inexperience (40%). Menstrual Irregularity Was The Most
Commonly Believed Side-Effect (38%) Of This Pill. Overall Attitudes Regarding Emergency Contraception Were Positive;
However, Most (82%) Nurses Were Not Satisfied With Their Current Knowledge Of Emergency Contraception Pill.
Conclusion: Although A Large Majority Of Respondents Reported Considerable Familiarity With Lng Only Ecp, There Were
Lacunae In Their Knowledge. Therefore, Interventions Providing Education To Nursing Staff Regarding Lng Only Ecp Is
Strongly Recommended.

***************

Changing Trends In The Route Of Hysterectomy In A Tertiary Care Hospital

Author: Dr. Bindu Menon
Co Author: Dr.Sareena Gilvaz1,

Introduction: Hysterectomy Is One Of The Commonest Gynaecological Operation Done For Various Conditions. It Can Be
Performed By Various Routes Depending On The Indications, Associated Factors And Above All Surgeons Experience.
Vaginal Hysterectomy Has A Clear Advantage Over Other Routes In Terms Of Intra Operative And Postoperative
Complications.
Aim: Is To Analyse Various Routes Of Hysterectomy Done For Benign Conditions In Our Hospital During The Last Five
Years And To Compare The Advantages And Disadvantages Of The Same.
Materials And Methods:- A Retrospective Study Was Conducted At Jmmch .All Cases Of Hysterectomy Done For Benign
Conditions By Various Routes Such As Abdominal, Vaginal And Laparoscopy During The Above Time Period Were
Included In The Study And Critically Analysed.
Observations And Results : Although The Total Number Of Hysterectomies Remains Almost The Same Over The Last 5
Years, We Noticed An Increasing Trend Towards Less Invasive Procedures Like Non Descent Vaginal Hysterectomy (Ndvh)
And Total Laparoscopic Hysterectomy (Tlh) In The Last Couple Of Years. While Abdominal Hysterectomy Is Considered
Easier And Commonly Performed, We Find Ndvh Is A Safer Option In A Low Resource Setting Than Tlh.
Conclusion: The Indications For Hysterectomy Have Remained Almost Same For Benign Conditions. The Major Change
Towards Non Invasive Methods Have Shifted The Focus To Ndvh And Laparoscopic Hysterectomies . We Have Found That
With Some Amount Of Training And Specially Designed Instruments Vaginal Hysterectomy Is A Safe And Cheaper
Alternative To Abdominal Or Laparoscopic Hysterectomy In Majority Of Situations, With Clear Advantages In PostOperative Pain And Other Complications.

***************

Hysterotomy Still Done- Are They Justified? An Analysis On Its Morbidity & Mortality
Author: Dr. Anurekha Periyasamy
Co Author: Anurekha Jp1, Jagannath Mishra2, Ajit Kumar Nayak3, Purna Chandra Mahapatra4, Lucy Das5

Introduction: Hysterotomy Is Essentially An Early Caesarean Section I.E., Before 28 Weeks Of Gestation.
Aims &Objectives: Analysis Over Four Years To Evaluate The Morbidity And Mortality Associated With Hysterotomy In
Late Second Trimester Abortion.
Materials & Methods: Prospective Observational Study Conducted From Jan 2010 To Sep 2014 At Scbmch, Cuttack. All
The Patients Who Underwent Hysterotomy In The Study Period Were Included.
Results: Totally 12 Patients Underwent Hysterotomy. 3/12 Patients Presented With Severe Bleeding P/V And 1/12 Patient
Presented With Impending Scar Rupture At 26 Weeks And Hence Were Taken Up For Operative Procedure Without
Preceding Medical Attempts. In The Rest 8 Patients The Mean Interval Time From Induction To The Decision For
Hysterotomy Was 45.5 Hrs (29-60 Hrs). Among Them 3/8 Were For Failed Abortion. One Patient Had AntepartumEclampsia With Uncontrolled Seizures, Another Had Clinical Features Of Chorio-Amnionitis And So An Earlier Decision
Was Made At 36 Hrs & 29 Hrs Respectively. 3/12 Patients Had Coagulopathy Pre-Operatively With Hellp & Dic And 2/12
Patients Had Arf Postoperatively. One Patient Died Of Septicaemia.
Conclusion: Lot Of Advances In Pharmaceutical Options And Accessibilities For Termination Of Pregnancies And Labour
Induction, So Much As The Guidelines Have Been Proposed; Hysterotomy A Bad Choice, A Last Choice But Still It Has To
Be Done In Few Cases.
Key Words: Hysterotomy, Late Second Trimester Abortion, Failed Abortion.
***************

Outcome Of Instrumental Vaginal Deliveries In Referred Cases

Author: Dr. Asha M B M B
Co Author: Dr R C Prameela1,

Introduction: Instrumental Vaginal Deliveries Is An Important Procedure Which Can Be Used As An Alternative To
Caesarean Section When Indicated And This Reduces The Caesarean Section Rate.
Aims And Objectives: To Determine The Incidence And Indications Of Instrumental Vaginal Deliveries. To Know The
Maternal And Fetal Outcome In Ventouse And Forceps Deliveries.
Material And Method: This Was A Retrospective Study Carried Between 01/06/2014 To 31/08/2014 At Cheluvamba
Hospital, Mysore Medical College And Research Institute. The Hospital Records Of All The Referred Patients Who Had
Ventouse And Forceps Deliveries Were Obtained And Data On Age, Parity, Referral And Type Of Procedure Performed,
Apgar Score And Complications Were Entered Into A Proforma And Analyzed.
Result: During The Period Under Review There Were Total Of 3385 Deliveries, Lscs 843 Cases(24.9%), Total Instrumental
Vaginal Deliveries 110 Cases(3.2%). 33 Ventouse Deliveries(0.9%), 57 Low Forceps Deliveries(1.68%) And 20 Outlet
Forceps Deliveries(0.59%).Most Common Indication For Instrumental Deliveries Being Fetal Distress(62 Cases) ,
Prolonged Or Maternal Exhaustion Second Stage Of Labour (36 Cases).Cut Short 2Nd Stage Of Labour- Previous
Lscs(8Cases) And Eclampsia(2Cases), Rhd(1Case), Sickle Cell Anemia With Avascular Necrosis Femur Neck(1Case).Number
Of Alive Babies(103 Babies), Perinatal Mortality 7Cases(0.20%), 8 Babies Required Nicu Admission For 3-4 Days, 1 Baby
Had Sub Dural Hematoma, 2 Babies Had Forceps Mark. Complications Like Vaginal Tear (4 Cases), Episiotomy
Extension(18 Cases).
Conclusion: Ventouse And Forceps Remains Appropriate Tool In The Armamentarium Of The Modern Obstetrician .The
Major Factor Which Determines The Safety Of The Instrument Is The Operator Rather Than The Instrument. Extreme
Caution, Proper Expertise And Judicial Use Of This Instruments Are Required To Prevent Undue Risk Of Mother And Fetus
.Encouraging Operative Vaginal Deliveries May Help To Reduce Unwanted And Raised Caesarean Section Rates.

***************

Interprofessional Education(Ipe) - Teach Together & Learning Together.

Author: Prof. Hephizibah Kirubamani N
Co Author: Dr.Anupama1,

Introduction: Interprofessional Education Is For Collaborative Patient-Centered Practice. Improvement In Collaborative

Preparation Of Health Professionals Will Achieve Substantial Improvement In The Quality Of Health Care. Teamwork
And Interprofessional Practice And Learning Are Becoming Integral To Health Care.

Aim &Object: To Promote And Assess Cohesive Atmosphere Between The Different Health Professional Students By
Ipe Training
Materials& Method: Prospective Study Was Conducted At Saveetha Medical College Obstetrics& Gynaecology
Department. From June 2013 -14. Two Undergraduate Students Each From Medicine, Nursing And Physiotherapy
Formed A Team And They Were Given A Case And They Followed The Case From Admission To Discharge. Six Such
Teams Were Trained. Concerned Faculty Briefed The Objective And Learning Outcome Expected And Provided Structured
Activities. Monitoring Was Done Daily. Team Members Discussed Among Themselves. Team Members Shared The
Necessary Knowledge Of Their Concerned Profession. Team Members Were Present Inside O.T, Physiotherapy
Department, Nursing College And Were Able To Know About The Instruments And Various Procedures . Team Members
Were Evaluated By Pre And Post Test On The Knowledge And Skill Learnt In The Relevant Area Of Understanding In The
Disciplines. Their Knowledge Gained About Other Profession, Co-Ordination Between Team Members, And Total Care
Of The Patient Were Assessed.
Results: Skill Level Of The Team Member On Working And Sharing Of The Knowledge As Team Were Assessed Pre And
Post Training 22%% Vs 92%.Students Gained More From Each Others And Their Profession Skill Level Was Increased
To 90%.Confidence Level Was Evaluated Based On Interview Which Showed Steep Rise In Confidence After Training94%
But Pre Training Confidence Was Nil. Participants Appreciated The Cohesive Atmosphere Between Team Member.
Conclusion: For Teaching And Learning Of Ipe Faculty Members Play A Critical Role And They Must Be Prepared To Meet
This Challenge . Complex Medical Issues Can Be Best Addressed By Interprofessional Teams.

***************

To Study The Safety And Efficacy Of Intravenous Iron Sucrose Comlex Therapy In Iron Deficiency Anaemiain The
Pregnant Women
Author: Dr. Isha Gupta
Co Author: Dr. Khushpreet Kaur1, Dr. Parneet Kaur2, Dr. Rama Garg3,

Introduction: Iron Deficiency Is A Most Common Nutritional Deficiency In A Pregnancy. Prophylactic Oral Iron Is
Recommended During Pregnancy To Meet The Increased Requirement. In India, Women Become Pregnant With Low
Baseline Haemoglobin Level Resulting In Moderate To Severe Anaemia.Oral Iron Supplementation Is Certainly Very
Appropriate And First Line Of Treatment For Most Iron Deficiency Anaemia. But A Good Number Of Patients Do Not Show
The Desired Response Because Of Various Reasons Like Intolerance To Iron, Abnormalities In Absorption And NonCompliance. Therefore Oral Iron Therapy In Some Women Becomes Inadequate And They Can Be Benefited From
Parenteral Iron Therapy.
Aims & Objectives: This Study Was Undertaken To Study The Safety And Efficacy Of Intravenous Iron Sucrose In Anaemic
Antenatal Women.
Material And Methods: A Prospective Study Was Conducted In Obstetrics And Gynaecology Department Of Gmc Patiala
.50 Pregnant Women With Diagnosed Anaemia Were Given Intravenous Iron Sucrose Complex In A Dose Of 200 Mg Thrice
Weekly Schedule After Calculating The Dose Requirement
Results:The Mean Haemoglobin Was Raised From 7.550.55 To 10.350.63 Gm% (P Value Is 0.0001 And Significant)
Over A Period Of 4Weeks.There Was Significant Raise In Mean Serum Ferritin Level From 5.182.63 To87.6055.59 (P
Value Was 0.0001) .Other Parameters Like Mcv And Pcv Also Improved Significantly. No Major Side Effects And
Anaphylactic Reactions Were Noted
Conclusion: Parentral Iron Therapy Was Effective In Increasing Haemoglobin, Serumferritin Levels And Other Haemogram
Parameters In Pregnant Women. Intravenous Iron Sucrose Can Be Safely Used In Hospital Settings.

***************

Comparative Study Of Effect Of Mifepristone (Antiprogesterone)

And Ormeloxifene (Serm) On
Size Of Uterine Leiomyoma And
Uterine Artery Blood Flow
Author: Dr. Abhijit Rakshit
Co Author: Dr. Prabhanjan Chattopadhyay1, Prof. Subhash Chandra Biswas2,

Introduction: Leiomyoma, Commonest Neoplasm Of Uterus, Is A Steroid Dependent Tumour Which Has Receptors For
Estrogen And Progesterone. Therefore, Antiprogesterone Like Mifepristone And Ormeloxifene, The Selective Estrogen
Receptor Modulator (Serm) May Induce Regression Of Fibroid Uterus.
Aims & Objectives : To Compare Changes In Size Of Fibroid After Treatment With The Study Drugs By Ultrasonography
And Doppler Study. Also To Assess Improvement Or Deterioration Of Subjective Symptoms Of Patients.
Method: 39 Women Of 30-50 Years Attending Gopd And Inpatients Diagnosed With Fibroid Uterus By Ultrasonography
Were Recruited For Study.20 Patients Received Mifepristone 50 Mg Once Daily For 3 Months And 19 Patients Got
Ormeloxifene 60 Mg Twice Weekly For Same Duration. Follow Up Was Done Once In A Month For Assessment Of
Subjective Symptoms And At The End Of 3 Months Pelvic Sonography Was Repeated To Assess Change In Size Of
Leiomyomas.
Results: Following Treatment , There Was Decrease In Size Of Fibroid In 75% In Mifepristone Group Against 21.05% In
Ormeloxifene Group. None Of The Patients In Mifepristone Group Showed Increase In Volume Of Fibroid Against 52% Of
Patients In Ormeloxifene Group. Difference In Volume Of Fibroid Between Groups Following Treatment Was Found To
Be Significant , P<0.001.
Conclusion: Mifepristone Can Successfully Reduce Volume Of Uterine Fibroid Whereas The Effect Of Ormeloxifene On
Uterine Fibroids Are Variable.

***************

Maternal Mortality: A Five Year Study In A Tertiary Care Center

Author: Dr. Manila Nainawat
Co Author: Dr. (Prof.) Manju Sharma1, Dr. (Prof.) Seema Mehta2,

Introduction: Mmr Acts As A Marker Of General Health Of A Country And Is A Measure Of Risk Of Death Once A Woman
Becomes Pregnant.
This Study Was Done To Evaluate The Maternal Mortality Rate In Our Hospital, To Assess The Epidemiological Aspects
And Causes Of Maternal Mortality And To See Difference With Respect To Implementation Of Jssk In Rajasthan.
Methods: This Retrospective Study Includes Maternal Mortality In Obstetrics And Gynecology Department In Sms
Medical College , Jaipur From 1St Jan 2009 To 31Stdec 2013.
Result: Mmr Of Present Study From 2009-2013 Is 242 /100000 Live Births. Mmr Before Jssk (Jan 2009 To Aug 2011) Is 265
And Mmr After Jssk (Sep 2011 To Dec 2013) Is 222. Most Of Dying Mothers Were Illiterate With Mean Age Of 223 Years
(45.4%). Mortality Is More In Rural Area (68.7%) With Lower Socioeconomic Class (80.3%). Hemorrhage (28.8) Being The
Commonest Direct Cause Of Mortality While Anemia (19.6%) Being Indirect Cause.
Conclusion: Mmr In Our State Is Still Very High. So There Is Need To Improve Maternal And Child Health Care. Though
Jssk Helped Us To Improve Maternal And Child Health Care System And Bring Down Maternal Mortality A Bit.
Keywords: Mmr, Maternal Mortality.

***************

Current Trends In Cases Of Rupture Uterus

Author: Dr. Chaitra Kulkarni
Co Author: Dr Joshi Suyajna D.1,

Introduction: Rupture Uterus Is An Obstetric Emergency Leading To Fetomaternal Morbidity And Mortality. Requires
Specialised Medical Facilities And Trained Personals. Increase In The Rate Of Primary Caesarean Sections Has Increased
The Risk Of Rupture Uterus.
Objective: A Study Of Current Trends In The Incidence, Etiological Factors, Management Of Uterine Rupture And Foetal
And Maternal Outcome.
Method: A Study Of Current Trends Of Uterine Rupture Cases Which Occurred Over A Period Of 30 Months From January
2011 To June 2013, In The Department Of Obstetrics & Gynaecology Vims, Bellary Was Undertaken
Results: The Study Revealed That The Incidence Of Spontaneous Rupture Is 10% While The Incidence Of Scar Rupture Is
76% .The Incidence Of Traumatic Rupture Is 14 %. More Number Of Uterine Rupture Was Managed Conservatively By
Repair (90%) Than Hysterectomy. Maternal And Perinatal Mortality Were 2.4 % And 85 % Respectively

Conclusion: Prevention Of The Overall Incidence Of Rupture Uterus Needs To Be Aimed At By Good Antenatal, Intra Natal
And Postnatal Care With Special Focus On Reducing The Incidences Of Previous Scar Rupture Which Is Slowly Emerging
As The Commonest Cause Of Uterine Rupture. There Has Been More Of Conservative Approach Followed In Recent Period
In Cases Of Rupture Uterus With Better Fetomaternal Outcome.

***************

An Audit Into Diagnosis And Management Of Ectopic Pregnency At District General Hospital, Davangere,
Karnataka. A 1Yr Retrospective Study.
Author: Dr. Padmavathi Ravipati
Co Author: Dr. Bandamma . N.S1,

Introduction: This Study Aims To Evaluate The Diagnosis, Conservative, Medical And Surgical Management Of Ectopic
Pregnancy And Associated Outcomes.

Methods: A Retrospective Audit Of 81 Cases Of Ectopic Pregnancy Between August 2013 To August 2014. Outcomes
Included Intended And Actual Management, Indications And Outcomes Of Conservative, Medical Management And
Surgical Procedures Undertaken And Associated Complications.

Results: 81 Cases Of Ectopic Pregnancy Were Analysed. Ectopic Pregnancy Accounted For 8% Of Gynecology Admissions
And 20% Of Gynecology Surgeries, Represented 3.8Cases/1000 Deliveries. Of These 36 Were Right , 42 Were Left Tubal
Ectopic And 2 Pregnancy Of Unknown Location. 90% Of The Patients Were Diagnosed Clinically And Substantiated By One
Scan And A Positive Urine Pregnancy Test. Ruptured Ectopic Pregnancy Was The Common Presentation In Our Setting.
Others Needed More Than 2 Scans Due To Early Gestation At Presentation. Surgical Management Was The Commonest
Treatment Modality With 78 Patients Managed By Laparotomy And 3 Managed By Laparoscopy Salpingectomy Was Done
In 73 Cases And milking Out Done For 3 Cases And Linear Salpingectomy Was Done For 2 Cases. 1 Case, Which
Was Diagnosed As Ectopic Turned Out To Be Splenic Rupture On Table. 2 Cases Had Negative Laparoscopy And Products
Were Evacuated From The Uterus Subsequently. Blood Transfusion Was Required For 76 Cases. Icu Admission With
Mechanical Ventilation Was Required For 2 Cases And 1 Mortality Due To Irreversible Shock. Mean Hospital Stay Was 4
Days.

Conclusion:
Ectopic Pregnancy Is One Of The Commonest Causes Of 1St Trimester Maternal Death. Surgical Management Remains
The Most Popular Treatment Modality. Lack Of Monitoring Facilities, Cost And High Patient Load Were Found To Be
Restricting Factors For Medical Management. Early Diagnosis And Effective Management Of Ectopic Pregnancy Is A Must
By Dedicated Early Pregnancy Unit To Prevent Mortality.

***************

Thrombocytopenia In Pregnancy: Predictors Of Adverse Maternal Outcome

Author: Dr. Venigalla Sunita
Co Author:

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.
Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.

Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.
Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.

Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.
Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.

Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.
Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.

Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.
Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.

Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.
Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

Introduction: Thrombocytopenia In Pregnancy Is Both Physiological And Pathological. 9-10% Of Pregnant Women
Experience Thrombocytopenia Associated With Pathological Conditions Such As Dengue Fever, Hellp Syndrome Etc
Objectives: In This Study We Have Analyzed1) Common Causes Of Thrombocytopenia In Pregnancy And 2) Factors
Associated With Adverse Outcome.
Materials And Methods: This Is A Prospective And Retrospective Study Carried Out At Rl Jallappa Hospital And Research
Centre, Kolar From January 2010 To September 2014 ( On Going Study). All Pregnant Women Admitted To The Hospital
With Platelet-Count <1,50,000/Cumm Were Included In The Study. Age, Parity, Gestational Age, Etiological Factors Such
As Dengue Fever And Other Infections And Other Pathological Conditions, Associated Complications Such As Renal
Failure, Pph, Requirement For Platelet And Other Blood Component Transfusions, Maternal And Fetal Outcomes Were
Noted.
Results: There Were 68 Women With Thrombocytopenia In Pregnancy. A Majority Of Women Had Associated
Pathological Conditions Such As Preeclampsia (23), Febrile Thrombocytopenia(8), Unknown Causes (19) And Were
Already In Labour Or Required Induction Of Labour. 10 Women Remained Undelivered After Treatment Of The Underlying
Problem. There Were 3 Maternal Deaths, One Due To Severe Anemia With Pancytopenia With Failure, One Due To
Consumptive Coagulopathy Following Lscs Done Outside (Unknown Cause), Last Due To Severe Anemia With Hellp With
Exacerbation Of Bronchial Asthma Requiring Ventilatory Care. 50% Of Women Did Not Require Any Platelet Transfusion
But 75% Of Women Needed Other Component Transfusions Like Packed Cells And Fresh Frozen Plasma.There Were No
Deaths Due To Bleeding From Coagulation Failure.

Conclusion: The Most Important Causes Of Maternal Deaths Were Associated Co-Morbid Conditions Such As Severe
Anemia With Failure, Hellp Syndrome And Consumptive Coagulopathy With Multiorgan Failure. Associated Anemia Was
A Common Co-Morbid Condition.

***************

Retrospective Analysis Of Clinical Pregnancy Rate In Fresh And Frozen Embryo Transfer Cycles.
Author: Dr. Anubha Bansal
Co Author: Dr.Swati Garg1, Dr.Sangita Sharma2, Dr.Alka Gahlot3,

Introduction: Transfer Of Frozen Thawed Embryos In Artificially Prepared Cycles Gives A Successful Chance At Achieving
A Pregnancy By Modifying The Cycle With Medication, So That The Endometrium Is In The Correct Phase Of Implantation
Window As Far As Possible. Hormonal Environment In The Fresh Cycle May Alter The Endometrium And Therefore,
Impair Implantation. With The Natural Cycles, Assessing The Exact Timing For Thaw And Transfer Is Much More Complex
And The Success Rates Are Also Lower.
Aim & Objectives :The Objective Of This Retrospective Analysis Was To Assess The Outcome Of Frozen And Fresh Embryo
Transfer Cycles In Terms Of Clinical Pregnancy Rate (Cpr).
Materials & Methods: 50 Cycles Of Frozen And Fresh Embryo Transfers Were Analysed Respectively. Group I - Frozen
Embryo Transfer Cycles (Fet) (N-50)
Group Ii Fresh Embryo Transfer
Cycles (Et), Immediately Following Oocyte Retrieval (N- 50).
Cpr Was Computed
And Statistically Analysed. Subgroup Analysis Was Done With Respect To Age Of The Patient And The Cause Of Infertility.
Results: Cpr Of Fet And Et Is 61.2% And 53.1% Respectively In Women <35Yrs Age; 47.3% And 38.8% In Women >35Yrs
Age Respectively. Cpr Of Fet And Et In Various Causes Of Infertility Are: Tubal Factor(63.6%,56.25%); Male
Factor(50%,85.7%); Pcos(50%,37.5%); Respectively.
Conclusion: Cpr In Frozen Embryo Transfer Cycles Is Better Than Fresh Embryo Transfer Cycles, Probably An Altered
Hormonal Environment May Be The Reason. Supraphysiological Levels Of Serum Estradiol During Controlled Ovarian
Stimulation (Cos) May Lead To Endometrial Advancement During The Fresh Cycle When Compared To The Fet Cycles.
Every Ivf Lab Should Have A Robust Cryopreservation Programme To Promote Fet Cycles And Improve The Success Rates.

***************

Agenesis Of Corpus Callosum

Author: Dr. Chitra Andrew
Co Author: Dr.Shivani1, Dr.Jaya V2,

Introduction:
Agenesis Of Corpus Callosum(Acc) Is A Congenital Malformation Accounting For 0.3 To 0.7% In General
Population And 2 To 3% In The Developmentally Disabled Population. We Describe A Case Which Had Antenatal Diagnosis
Of Acc Associated With Ventricular Septal Defect,Single Umblical Artery And Club Hand.The Interventional
Study(Amniocentesis) Was Done For The Fetus To Know Any Syndromal Association
Case Report- 30 Yr Old G2A1, Concieved Spontaneously.At 24 Weeks Of Gestational Age She Was Diagnosed As Agenesis
Of Corpus Callosum With Associated Malformations(Ventricular Septal Defect, Single Umbilical Artery, Club
Hand).Karyotyping Was Opted To The Patient. After Getting Consent From The Patient Amniocentesis Was Done Under
Aseptic Precautions. Karyotype Report-Trisomy 18(Edward Syndrome
Conclusion -The Diagnosis Of Agenesis Of Corpus Callosum Should Be Suspected From A Midtrimester Anomaly Scan
1.Hypoplastic Or Absent Cavum Septum Pellucidi On Axial Transthalamic Vie2.Colpocephaly(Dilatation Of The Atria And
The Occipital Horns).Definitive Diagnosis Of Agenesis Of Corpus Callosum Is Demonstration Of Corpus Callosum On
Misagittal And Coronal Views Of The Fetal Brain And The Associated Chromosomal Anomalies Can Be Diagnosed By Doing
Karyotyping

***************

Hysteroscopic Tubal Cannulation Under Laparoscopic Guidance-A Safe And Valuable Therapeutic Modality In The
Management Of Proximal Tubal Occlusion
Author: Dr. Sutha Vassan G
Co Author: Dr.Sheela Ramesh1,

Introduction:
The Incidence Of Infertility Is On The Rise. Proximal Tubal Occlusion Accounts For 15-25% Of Tubal Pathologies.
With The Advent Of Operative Hysteroscopy, Tubal Cannulation Is Less Morbid And Cost Effective With Good Pregnancy
Rate. It Avoids Need For Ivf In Selected Patients.
Aims:
To Evaluate The Results And Complications Of Hysteroscopic Tubal Cannulation In Women With Proximal Tubal
Occlusion.
Study Design:
This Is A Retrospective Study Evaluating 25 Cases Of Primary Infertility With Bilateral Proximal Tubal Block. The Study
Period Was From March 2012 To February 2014. All The Cases Were Diagnosed By Preliminary Hsg Evaluation.
Materials & Methods:
By Using 2.9Mm Bettochi Operative Hysteroscope With Novy'S Co Axial Catheter, Tubal Cannulation Was Performed
In All Cases Under General Anaesthesia, Under Laparoscopic Guidance. They Were Followed For A Period Of 6 Months To
2 Years. Phone Enquiries Were Made For The Patients Without Follow Up.
Results:
Out Of 25 Patients, 18 Women Had Successful Cannulation On Both Tubes With Overall Success Rate 72%. Overall
Pregnancy Rate Was 27%. The Mean Time To Become Pregnant Was 5.2 Months By Natural Cycles. Minor Complications
Encountered Were False Passage In One Case, Cervix Dilation Problems In Five Cases. We Did Not Have Any Major
Complications Like Uterine Perforation, Infection, Air Embolism Or Massive Bleeding.
Conclusion:
The Results Obtained With Hysteroscopic Tubal Cannulation Are Encouraging. As This Procedure Carries Minimal
Risk, It Should Be Offered As The Initial Method In The Management Of Proximal Tubal Occlusions. The Minimal
Complications Encountered In The Study, Even In The Early Learning Curve Of The Surgeon, Emphasises The Safety Of The
Procedure.

***************

Clinical And Ultrasound Study Of Liquor Volume And Its Correlation With Perinatal Outcome
Author: Dr. Manasa Nakkina
Co Author: Dr Nandish S Manoli1,

Introduction:
Hydramnios And Oligohydramnios Was Known To Cause Increase In The Risk Of Adverse Pregnancy Outcomes, Perinatal
Mortality And Morbidity(By 2 To 5 Fold) ( 1)
Objectives Of The Study:
The Present Study Was Conducted To Determine The Perinatal Outcome In Singleton Term Pregnancy With Abnormal
Liquor Volume
Methodology:
An Afi Of 5-24Cm Is Taken Normal. Afi Of 5Cm Is Considered Oligohydramnios And 25Cm As Polyhydramnios.
Source Of Data:
50 Patients In Jss Hospital With Term Pregnancy , Afi 5 Cm And 25 Cm Were Matched With Equal Number Of
Controls Of Having Normal Afi (5-24 Cm) From November 2012 To June 2014.
Results:
The Caesarean Section Rate Was High In Both Oligohydramnios (88.57%) And Polyhydramnios(80%).17.14% Cases Had
Meconium Stained Liquor In Oligohydramnios And 20% In Polyhydramnios.In Oligohydramnios 37.3% Cases Had Low
Birth Weight Babies.One Case In Polyhydramnios Was >4Kg.28.57% Cases Requires Nicu Admission In Oligohydramnios
Due To Lbw Babies, Rds And Meconium Aspiration. 34.44% Requires Nicu Admission In Polyhydramnios Group Due To
Hypoglycemia, Rds, Sepsis.
Conclusion

To Conclude, Antepartum Oligohydramnios Or Polyhydramnios Was Not Significantly Associated With Increased
Perinatal Morbidity In Our Institution . However There Was Increased Risk Of Caesarean Section In Our Study

***************

Diagnostic And Prognostic Significance Of Serum Soluble Endoglin Levels In Preeclampsia, Eclampsia And Normal
Pregnant Women In North Indian Population
Author: Prof. Rekha Sachan
Co Author: Patel Ml Assistant Professor Department Of Medicine King George Medical University Lucknow1, Dhiman
Soniya Junior Resident 3 Department Of Obstetrics & Gynaecology, King George Medical University Lucknow 2, Natu Sm
Professor Department Of Pathology King George Medical University Lucknow 3,

Introduction:
A Hypertensive Disorder Of Pregnancy Is The Most Common Complication. The Incidence Of Eclampsia Is 0.3%-0.9% And
It Has A Maternal Mortality Rate Of 0.5%-10.0%.
Aim & Objectives:
To Evaluate The Diagnostic And Prognostic Value Of Serum Soluble Endoglin Levels (Seng) And Preeclampsia And
Eclampsia.
Methods:
Total 90 Womens Of 20-40 Weeks Of Gestation Were Enrolled Out Of Which 30 Preeclampsia, 30 Eclampsia As Per
Nhbpep 2000 Working Group And 30 Normotensive Pregnant Women As Controls. Serum Soluble Endoglin Levels Were
Measured By Elisa Technique Using Elisa Kit Uscn Life Sciences.
Results:
After Roc Analysis At A Cut Off Value Of Seng 6.2Ng/Ml, Area Under Curve Was 1 And It Was 100% Sensitive And
100% Specific In Diagnosing Preeclampsia. Mean Serum Seng Levels Were Minimum In Controls (2.080.56Ng/Ml) And
Maximum In Eclampsia (14.961.96Ng/Ml) And Difference Was Statistically Significant. Strong Correlation Of Seng Was
Observed With S. Uric Acid (R=0.722), S. Ldh (R=0.791), Systolic (R=0.928) And Diastolic (R=0.916) Blood Pressure. With
Decreasing Birth Weight A Significant Increase In Seng Levels Was Observed (P<0.001). Cases With Low Apgar Score And
Need Of Resuscitation And Neonatal Admission Had Significantly Higher Seng Level (P<0.05). Highest Mean Level Of
Maternal Seng Was Observed With Maternal Death (17.840.22Ng/Ml) And Neonatal Death (16.111.13Ng/Ml). After
Comparison Statistically Significant Difference In Mean Seng Level Was Observed With Healthy Neonates And Neonatal
Death (P=0.001), Healthy Mothers And Maternal Death (P=0.005).
Conclusion:
Thus Seng Has A Good Diagnostic And Prognostic Value Because It Has Positive Correlation With Prognostic Markers Like
Serum Uric Acid And Ldh And It Has Negative Association With Birth Weight And Positive Association With Adverse
Maternal And Neonatal Outcome.
***************

An Unusual Case Of Post Hysterectomy Ectopic Pregnanacy

Author: Dr. Lalitha Eerati
Co Author: Dr G.C Prabhakar1, Dr.Vijayashree2, Dr.Kavitha3, Dr.Usha Rani4, Dr.Geetha5

Introduction:
An Ectopic Pregnancy May Occur After Hysterectomy, But It Is Incredibly Uncommon. Since First Described By Wendeler
In 1895, At Least 67 Ectopic Pregnancies (Tubal, Ovarian And Abdominal) Have Been Described In Patients Subjected To
Prior Hysterectomy. Here We Present A Rare Case Of Tubal Ectopic Pregnancy In A Woman Who Underwent Subtotal
Hysterectomy 4 Years Back.
Case Report: A 46 Year Old P4L3D1 Lady , Presented To The Emergency Department With Complaints Of Pain Abdomen
And Vomitings. She Underwent Supracervical Hysterectomy 4 Years Back .On Ultrasound Examination, A Left Adnexal
Mass Of 10X9 Cms Suggestive Of Gestational Sac With Fetal Cardiac Activity Was Present Along With Haemoperitoneum.
Urine Pregnancy Test Was Positive. On Laparotomy, There Was Haemoperitoneum With Left Tubal Ectopic Gestational
Sac Which Ruptured Accidentally Revealing Small Fetus With Placental Tissue. Left Salpingo Oophorectomy Was
Done.Histopathological Examination Showed Throphoblastic Tissue In The Left Tube With Hematosalpinx.
Conclusion:
Due To Its Rare Occurrence, Diagnosis Of Ectopic Pregnancy May Not Be Initially Considered When A Post Hysterectomy
Patient Presents With Abdomino Pelvic Pain Causing Delay In Diagnosis Leading To Potentially Life-Threatening Risks For
The Patient. Therefore, It Is Imperative To Maintain A High Index Of Suspicion For Ectopic Pregnancy In A Post
Hysterectomy Patient Presenting With Acute Abdominal Pain If The Ovaries Are In Situ.

***************

An Unusual Case Report:Pregnancy With Celiac Disease

Author: Dr. Sonal Agarwal
Co Author: Dr.B.S.Meena1, Dr.K.L.Meena2, Dr.M.L.Meena3,

Introduction:
Celiac Disease Is A Multisystem Multisymptom Autoimmune Disease Which Not Only Triggers Gut Tissue But Also
Skin,Blood,Musculoskeletal And Neurological System.Placental Abruption,Gestational Hypertension,Uterine
Hyperkinesia,Threatened Miscarriage,Severe Anaemia And Intrauterine Growth Restriction Is More Common In Pregnant
Women With Celiac Disease Than Pregnant Women Without Celiac Disease.Other Autoimmune Disorders Like Tropical
Sprue,Graves Disease,Type 1 Diabetes Mellitus,Syphilis,Dermatitis Herpatiformis May Be Associated.
Case:
A 35 Year Old Pregnant Lady Reported To Our Hospital In Third Trimester With Complaints Of Pain
Abdomen,Diarrhoea,Cough,Weakness Since 9 Days.During Hospitalization,Patient Was Investigated So As To Lead To A
Proper Diagnosis For Further Management.Her Investigations Revealed That She Was Vdrl Positive,Her Haemoglobin Was
6.8Gm%,Wbc 2940/Cumm,Mcv 110.2Fl,Serum Cpk-Mb 115.56 U/L,Serum Total Bilirubin 2.13 Mg/Dl,Plt
57000/Ul.Obstetric Sonography Revealed Iugr Baby.Whole Abdomen Sonography Showed Hepatosplenomegaly.A
Bedside Gastroenterologist Reference Was Done.Her Upper Gastrointestinal Tract Endoscopy Was Conducted Which
Showed Signs Of Celiac Disease Such As Scalloping Of Duodenum And Decrease In Villi Fold Height.Peripheral Blood Smear
Had Picture Of Hypochromic Microcytic Anaemia And Anisocytosis.11 Units Of Blood And Its Derivatives Were
Transfused.Antibiotics Were Given For Symptomatic Treatment And As Prophylaxis For Opportunistic Infections.Steroids
Were Given For Lung Maturity Of The Baby.Gluten Free Diet Was Given.After 2 Weeks Of Conservative Treatment,She
Had Lower Segment Caesarean Section For Bad Obstetric History And A Male Child Of 1.9 Kg Was Delivered With Apgar
Score 6/10.
Clinical Relevance:
Most Of The Celiac Disease-Related Pregnancy Problems Seem To Occur In Women Who Have Not Yet Been Diagnosed
With Celiac, Or In Women Who Have Been Diagnosed But Who Are Not Following The Gluten-Free Diet.With Proper
Antenatal Care And Treatment, Abortions And Intrauterine Deaths Of Fetus In Such Patients Can Be Avoided Leading To
Decrease In Maternal And Fetal Morbidity And Mortality.

***************

A Rare Case Of Cyclops And Proboscis And Nodular Pinna, Developmental Anomaly Of Face.
Author: Dr. Sravani Karra
Co Author: Dr.P.Chandrasekhar Rao1, Dr.V.A.A.Lakshmi2, Dr.P.Jayanthi3,

Introduction:
Cyclops: Midline Fusion Of Two Eyes
Proboscis: Cylindrical Projection Nose Jetting Out From Below The Forehead
Embryology:
28Th Day: Frontonasal, Maxillary; Mandibular

Processes Lens And Nasal Placodes

31-35 Days: Nasal Pits

6Th Week: Tubercle For Pinna On Each Side
7Th Week: Eyelids Are Established

8Th Week: Eyes Shift From Lateral To Frontal Position Bucco Nasal Membrane Ruptures
Presentation:
Typically Nose Is Missing
Replaced By Non Functioning Nose- Proboscis
Proboscis: Generally Appear Above Central Eye And Is Characeteristic Form Of A Cyclopia Called Rhinocephaly And
Rhinencephaly
Causes:
Genetic Problems
Toxins Cyclopamine
Inappropriate Expression Of Proteins Which Hinder The Division Into Hemispheres
Shh( Sonic Headgehog Gene Regulator)
Shh Is Involved In Theseperation Of Single Eye Into Two Bilateral Fields. Shh Emitted From The Prechordal Plate
Suppresses Pax6 Which Causes Eye Fields To Divide Into Two.If Shh Gene Is Mutated The Result Is Cyclopia A Single Eye
In The Centre Of Face
Case Discussion
Primi Gravida Aged 19 Years
Age Of Menarche 13Yr ,Marital Life 8Months
2Nd Degree Consanguinity Antenatal Woman
1St Visit At16 Weeks .She Was Adviced
Blood Tests & Ultrasound Scan

Investigations Hb 10 Grams%Blood Group O+Ve, Vdrl Negative,Hiv,Hcv,Hbsag Ve

She Was Admitted In Month Of Feb 2014
As Ultrasound Report Showed Intrauterine Gestation Of 16Weeks With Inencephaly
Patient Was Adviced Termition Of Pregnancy
By Extra Amniotic Ethacrydine Lactate
Induction Abortion Interval Was 18Hours
Abortus Was A Female Foetus
Developmental Anomaly Of Face Cyclops,
Proboscis,Nodular Pinna Noted
***************

Combined Protein C And Protein S Deficiency In Pregnancy

Author: Dr. Natasha Dsouza
Co Author: Dr. Natasha D'Souza1, Dr. P. K. Shah2, Dr. H. K. Chaudhari3, Dr. Keshav Pai4,

Introduction:
Hereditary Or Acquired Thrombophilia Occurs In Two-Thirds Of Women Presenting With Recurrent Miscarriages, PreEclampsia, Intrauterine Growth Restriction, Abruption Placenta Or Still Births, Which Are Associated With Micro Vascular
Thrombosis In Placental Blood Vessels. Protein C And Protein S Deficiencies Are Associated With A Variably Increased Risk
Of Thrombosis And Are Inherited Independently In An Autosomal Dominant Trait. Combined Deficiency Of Protein C And
Protein S Is Rare.
Case Report:
A 35 Year Old Female Patient, Married Since 8 Years, G6P2L2Sa4, A Known Case Of Protein C And Protein S Deficiency.
Her Younger Unmarried Sister Had Protein S Deficiency. She Had 4 Consecutive First Trimester Spontaneous Abortions.
In Her 5Th Pregnancy, She Was Diagnosed With Protein C And Protein S Deficiency At 20 Weeks. Anticardiolipin Antibody
Was Also Positive. She Received Anticoagulation With Subcutaneous Heparin. Elective Lower Segment Cesarean Section
Was Done In View Of Precious Pregnancy At 37 Weeks. A Female Child Weighing 2.3 Kilograms Was Born 5 Years Ago And
Doing Well. On Post-Operative Day 12, She Developed Myoclonic Seizures Of Left Upper Limb And Was Given
Anticoagulation For Superior Saggital Sinus Thrombosis.
Her 6Th Pregnancy Was A Spontaneous Conception. Subcutaneous Heparin Was Given. She Developed Pregnancy
Induced Hypertension At 34 Weeks Which Was Controlled With Antihypertensives. FoleyS Induction Of Labour Was
Done At 39 Weeks. Emergency Lower Segment Cesarean Section Was Done In View Of Non Progress Of Labour. A 2.4
Kilograms Male Child Was Born With Apgar 9/10. Heparin Was Restarted After 48 Hours. There Was No Thrombotic
Episode After This Pregnancy.
Conclusion:
Patients With Protein C Or Protein S Deficiency May Remain Asymptomatic Or Present With Thromboembolic Events, But
With Combined Deficiency Of Protein C And Protein S The Risk Of Thrombosis Is High And Occurs Early In Life. Longterm
Anticoagulation Proves To Be Useful.

***************

Treatment Of Iron Deficiency Anaemia, Iv Ironsucrose Vs Standard Therapy, Impact On Feto-Maternal Outcome:
Study In A Tertiary Care Hospital.
Author: Dr. Biranchi Mohapatra
Co Author: Prof.Dr. Purna Chandra Mahapatra1, Dr. Kirtirekha Mohapatra2, Dr. Ajit Kumar Nayak3, Dr. Sandya Rani
Behera4,

Introduction:
In India, During Ante Natal Check-Up Oral Iron Is Prescribed To All But Limiting Factors Are Noncompliance, Gi Upset,
Malabsorption, Unfavourable Drug Kinetics. Iv Iron Sucrose Efficiently Raise The Hb Level As Evidenced By Some Studies.
Aim: To Study The Safety, Efficacy And Composite Impact Of Iv Iron Sucrose In Improving The Feto-Maternal Outcome As
Compared To Standard Therapy Of Ida In Pregnancy.
Place/Period Of Study:
Dept.Of O&G Scbmc&H, Cuttack From Feb To Aug 2014(6 Month).
Inclusion Criteria:
20-45Yrs Old Women With Consent To Participate, Between 20-28Wks Singleton Gestation, Hb: 5-8Gm% Or Between 2832Wks Singleton Gestation, Hb: 5-9Gm%, Residing Within 20Km & Willing For Delivery In Scbmch.
Exclusion Criteria:
3Rd Order Pregnancies, Hb< 5Gm% Or >9Gm%, Haemoglobinopathies, Mch/Trbc Ratio 14, Pih, History Of
Bleeding Diathesis.
Method Of Study:
Hb Level, Cbc & Comment On Ps Done For All Antenatal Women Attending Opd. Serum Ferritin Estimated In Selected
Cases. Study Enrolled 75 Eligible Iron Deficiency Anemia Cases. After Randomization(Ivrs-Interactive Voice Response
System), 38 Women Received Iv Ironsucrose & 37 Received Standard Oral Iron. Followed Up Every Fortnight Till Delivery.
Hb Level Estimated At Admission & Amtsl Done. Calibrated Pph Bag Used To Estimate Amount Of Blood Loss. The Birth
Weight Measured. Mother & Baby Followed Upto 6Wks Postpartum.
Results & Conclusion:
Of 75 Women, 65 Came For Delivery In Scbmc, 33 Were In Iv Arm & 32 In Standard Arm. On Analysis Between Two Group,
Mean Hb Level Increased From 7.85 0.81 To 10.35 2.1 And 8.02 0.88 To 10.04 1.49 (P Value>0.05)
Respectively But Within The Group There Was High Statistical Significance (P Value<0.05).
Only 2 Patients Had Mild Anaphylactoid Reactions. No Significant Difference In Amount Of Blood Loss In Iv Vs Standard
Arm. No Significant Difference In Birthweight Between Both Arms.

***************

Post Lscs Uterine Wound Dehiscence And Utero Peritoneal Fistula

Author: Dr. Gidigi Chandrakala
Co Author: Dr. Gidigi Chandrakala, Md, Dgo1, Dr. Yasmin Iqbal, Md2, Dr. Challa Suryakantham, Dgo3, Dr. Garikapati
Swarnalatha, Dgo4, Dr. Patro Nalinikanth, Ms(Gen Surgery)5

Introduction:
We Report A Rare Case Of Lscs With Partial Dehiscence Of Lower Uterine Segment Caesarean Wound Leading To Rare
Occurrence Of Utero Peritoneal Fistula Presenting With Profuse Watery Discharge Per Vaginum.
Case:
An Obese 100 Kgs Multipara P3C2D1A1 Woman With Multiple Small Fibroids Came To The Hospital On 10Th Pod Of Lscs
With A Complaint Of Leaking Of Urine For Two Days And Abdominal Wound Dehiscence. S+9-He Was Admitted For Work
Up And Management. She Was Started On Higher Antibiotics, Resuturing Of Abdominal Wound Done. We Ruled Out
Urinary Tract Injury Of Thorough Clinical Examination, Usg, Contrast Ct And Diagnosed Partial Uterine Dehiscence And
Utero Peritoneal Fistula Which Was The Cause For Leaking Of Watery Discharge Per Vaginum.
Conclusion:
She Has Been Treated Conservatively With Antibiotics And Higher Protein Diet. Till Now There Is No Documented Report
Of Such Cases Managed Conservatively.

***************

Granulosa Cell Tumor Of Ovary

Author: Dr. Anoop Sreevalsan
Co Author: Dr.Janani.K.S1, Dr.Kavitha.L2, Dr.Rajakeerthana3, Dr.Swarnapriya.K4, Dr.Vasantha N.Subbiah5

Introduction:Granulosa Cell Tomours Are A Part Of Sex Cord Stromal Tumors.They Arise From The Granulosa Cells.Al
Though Commonly A Tumor Of The Ovary ,It Can Also Arise From The Testis.It Accounts For 2-3% Of Ovarian
Malignancy.Peak Age Of Occurence Is Between 50 And 55 Years.
Cae Report: Hereby Presenting A Case ,Mrs.X, 50 Year Old Came With Complaints Of Menorrhagia For Past One Year.Her
Ultrasound Abdomen And Pelvis Showed A Complex Solid Cystic Mass Lesion In Pelvis Likely To Be A Malignant Ovarian
Tumor.A Frozen Showed On Table Showed Round Oval Cells With Nuclear Grooving Inconspicous Nucleoli And Scanty
Cytoplasm,Call Exner Bodies Present.,Asitic Fluid Showed Negative Cytology.Proceeded With A Total Abdominal
Hysterectomy With Bilateral Salphingoopherectomy With Para Aortic Lymph Node Dissection.
***************

Dynamics Of Contraceptives Use In Women Attending A Tertiary Care Hospital

Author: Dr. Subhashree Rout
Co Author: Dr. P.C. Mohapatra1, Dr. Tushar Kar2, Dr. R.K Panigrahi3,

Introduction-With A Population Of 1213 Million By 2011, India Is The 2Nd Most Populous Country In The World, Next To
China Whereas It Is 7Th In Land Area. From Puberty Till Menopause, Women Are Faced With Concerns About Childbearing
Or Its Avoidance; The Only Options Left Are Temporary Or Permanent Methods Of Family Planning. The Government Of
India Has Shown A Lot Of Commitment In Reducing The Growth Rate Of India And In Increasing Use Of Contraception.
Aims And Objectives- One Of The Main Objectives Of This Study Is To Spread The Knowledge Of Family Planning Methods
And Develop Among People And Attitude Favorable For Adoption Of Contraceptive Method.
Materials And Methods-In This Cross Sectional Study A Total Of 500 Females In Their Reproductive Age Group Attending
Opd Of Dept. Of O&G And Post Partum Centre, Were Questioned Regarding Their Contraception Knowledge, Attitude &
Practices Of Contraception By Using Preformed Questionnaire.
Result-It Is Found That Most Popular Method Of Contraception Is Stated To Be Female Sterilization. The Reason Given
For Adoption Of Sterilization Includes Its Permanent Nature, Physical Safety And Comfort And No Fear Of Failure. Fertility
Intention Was Expressed As The Reason For Not Using Contraceptives By 43.8%.
Conclusion-In Recent Years The Need For Such Kind Of Studies Is Very Important As More Specific Knowledge Can Be
Acquired About Factors That Determine The Fertility Control Measures And Family Acceptance. This In Turn Can Be Used
To Develop Suitable Family Planning Programmes For Them.

***************

Is Early Prediction Of Preeclampsia Possible In A Low Resource Setting?

Author: Prof. Manisha Kumar
Co Author: U Gupta1, J Bhattacharya2, R Singh3, K Sharma4, S Singh5

Is Early Prediction Of Preeclampsia Possible In A Low Resource Setting?

Manisha Kumar, U Gupta, J Bhattacharya, R Singh, S Singh, K Sharma, M Goel
Lady Hardinge Medical College & Ssk Hospital
New Delhi

Introduction: Preeclampsia (Pe) Is The Major Cause Of Maternal And Perinatal Mortality In A Developing Country Like
India, Early Intervention Can Improve Perinatal And Maternal Outcome Aim: To Evaluate Role Of Maternal Factors Along
With Biomarkers As Predictor Of Preeclampsia. Methodology: It Was A Prospective Cohort Study. The Base Cohort
Population Constituted Of 2210 Singleton Pregnancies. Maternal Variables Such As Bmi And Map Were Recorded, Uterine
Artery Doppler Pulsatality Index, Biomarker Papp-A, Free - Hcg, Between 11 Weeks To 14 Weeks Gestation Were Noted.
Women Who Developed Hypertension Were Treated As Cases And Were Compared With Women Who Remained
Normotensive And Had Normal Outcome, Appropriate Statistical Analysis Was Applied. Results: Pe/Gestational
Hypertension Was Seen In 198/2053 (9.6%) Women. Among The Maternal Characteristics The Mean Bmi Of Cases Was
23.65.6 And Map Was 87.113.2, It Was Significantly More Than Controls. In Uterine Artery Doppler Studies Pi Was
Significantly High In Cases (2.0) Than Controls (1.7). Among Biomarkers Papp-A Was Significantly Lower In Cases (0.5
Mom) Than Controls. The Logistic Regression Analysis Showed Best Set Of Variables Associated With Pe Were Bmi, Map,
Papp-A, Uterine Artery Pi And Notch On Left Side. With Cut Off Of Papp-A At 0.5 Mom, The Positive Predictive Value Was
21% And Negative Predictive Value Of 89%. Conclusion: Maternal Characteristics Such As Bmi And Map Along Biomarker
PappA And Uterine Artery Pi Were The Best Predictors Of Preeclampsia. The High Sensitivity, Specificity And Npv Make
This Test A Useful Screening Test. It Is The First Study On First Trimester Prediction Of Preeclampsia In Indian Population
Showing That Screening For Preeclampsia Was Feasible In A Low Resource Country Like India.

Funding Agency: Indian Council Of Medical Research, New Delhi

***************

Medieval Treatment Methods In Modern Times

Author: Dr. Santosh Kumari Singhal
Co Author: Dr Manoj Kumar Singhal1,

It Is Well Said That neem Haqim Khatra-E-Jaan.We Came Across Such An Event When A Multiparous Pt. Named
Raghubiri 28 Yrs Female Presented To Us With The C/O Faecopurulent Discharge P/V And Pus Through Perianal Area,After
Swab Insertion By dai(Unqualified Midwife) Few Days Ago.The dai Was Consulted For Treatment Of
Prolapse Uteri.She Had A Long Drawn Morbidity In The Form Of B/L Ischiorectal Abscess, Rectovaginal Fistula Requiring
Colostomy, Repair Of R/V Fistula Followed By Colostomy Closure. Pt Became Alright To The Extent That Later She Became
Pregnant And Opted For Mtp. Ironically She Did Not Agree For Tubal Ligation.
On The Basis Of Detailed Questioning And Reviewing The Sequence Of Events Of Morbidity Of Patient We Infer That
"Dai Did Put In Some Highly Corrosive Chemical Substance Causing Enormous Misery To The Patient.

***************

Benign Tumor Mimicking Ovarian Malignancy

Author: Dr. Jeyalakshmi Karthikeyan
Co Author: Dr.M.Banumathy1,

Jeyalakshmi K 1 , Banumathy M 2
1 Dnb Resident, 2 Head Of The Department, Department Of Obstetrics And Gynecology,
Sri Ramakrishna Hospital, Coimbatore, Tamilnadu.
Background :

Perimenopausal Women With Vague Symptoms Often End In A Diagnosis Of Ovarian Malignancy With Poor Prognosis.
We Encountered A Similar Scenario And Specific Risk Factors To Undergo Surgery In Addition. To Our Surprise And
Patient`S Fortune Surgery Was Successful And The Ultimate Diagnosis Is Struma Ovarii- A Relatively Rare Tumor Which
Comprises 1% Of All Ovarian Tumors And 2.7% Of All Dermoid Tumors. Thyroid Tissue Components(More Than 50%).
Case :
A 52Years Perimenopausal Multiparous Lady Admitted With Pain Abdomen, Loss Of Weight And Appetite. Had Subtotal
Thyroidectomy For Toxic Nodular Goiter 7Years Back. Patient Had Stormy Postop Period With Bilateral Recurrent
Laryngeal Nerve Palsy For Which She Underwent Surgery 3 Times For Complete Recovery But Occasional Stridor Still
Persist. Her Thyroid Function Tests Were Normal On Admission. Abdominal Examination Revealed A Lobulated Mass Of
10X6Cm In Right Iliac Fossa With Variable Consistency. Transvaginal Ultrasonography Revealed Complex Adherent Cystic
Mass In Right Adnexa With Internal Haemorrhage ,Same Confirmed By Ct Suggestive Of Malignancy,With Borderline
Elevation Of Ca 125 69.87U/Ml.With Necessary Precautions By Multidisciplinary Team, Staging Laparotomy, Infracolic
Omentectomy And Pelvic Lymphadenecto Done. Postoperative Period Uneventful. Histopathology Turned Out To Be
Benign Struma Ovarii.On Follow Up , Evidence Of Hypothyroidism Noted And Supplementation Initiated.
Conclusion:

Struma Ovarii, A Monophyletic Teratoma Composed Of Thyroid Tissue, Generally Benign Although Malignant
Transformation Has Been Reported . The Preoperative Diagnosis Is Difficult. This Report Emphasizes That There Are
Benign Gynecological Conditions Might Show Clinical, Ultrasonographic And Biochemical Signs Suggestive Of Malignancy.
The Treatment Of Benign Struma Ovarii Consists Of The Unilateral Oophorectomy Without The Need For Complementary
Treatment, Except For The Alteration Of Thyroid Function.

***************

Malignant Mixed Mullerian Tumour

Author: Dr. Rajakeerthana.R R
Co Author: Dr.R,Rajakeerthana1, Dr.Swarnapriya2, Dr.Kavitha.D3, Dr.Anoop Sreevalsan4, Dr.Vasantha .N. Subbiah5

Malignant Mixed Mullerian Tumor Is A Aggressive Form Of Uterine Cancer Constitutes Of 3-4% Of Uterine Malignancy
And Its Biphasic, Mrs Sundari 62 Yrs Old Postmenopausal Lady Came With Complaints Of Postmenopausal
Bleeding,Attained Menopause At 45Yrs, O/E Patient Was Obese Vitals Were Stable On Speculum Examination Cx Was In
Mid Position Bleeding Through Os Was Present,On Per Vaginal Examination Uterus Was Bulky ,An Irregular Growth Felt
Through Os, Trans Vaginal Ultrasound Reveled Thickened Endometrium,With Subserousal Fibroid Followed By Fractional
Curettage ,And Found To Be Malignant Mixed Mullerian Tumor, Staging Laparotomy Tah With Bso With Pelvic Lymph
Adenectomy With Infra Colic Omentectomy Done , Hpe Reports Were As Malignant Mixed Mullerian Tumor With
Heterologus Type,Post Operative Period Uneventful, Post Operative Adjuvant Radiotherapy Was Given Under Supervision
Of Medical Oncologist , Early Diagnosis And Treatment Can Increase Prognosis Of These Rare Tumors.
***************

Presentation Of A Case Report

Author: Dr. Ratan Mandal
Co Author: Debashis Bhar1, Sunanda Maji2, Aditi Das3, Titol Biswas4,

Management Of A Case Of Caesarean Section Complicated With Uncorrected Tetralogy Of Fallot And Preeclampsia

Abstract: Tetralogy Of Fallot Is The Most Common Congenital Cyanotic Heart Disease In Pregnancy. The Objective Of
Anaesthetic Management Mainly Depends On Maintaining Of Systemic Vascular Resistance And Decreasing Pulmonary
Vascular Resistance. In Preeclampsia Systemic Vascular Resistance Is Already Elevated. Thus Treatment Of Preeclampsia
May Worsen Cyanosis. Here We Present A Unique Case Of Caesarean Section Complicated With Both Preeclampsia And
Tetralogy Of Fallot. The Case Was Managed With General Anaesthesia Using Etomidate. Maintenance Of Systemic And
Pulmonary Vascular Resistance Enabled Us To Manage The Case.
Key Words: Tetralogy Of Fallot, Preeclampsia, Pregnancy, Caesarean Section.

Introduction: Tetralogy Of Fallot (Tof) Is The Most Common Congenital Cyanotic Heart Disease And Accounts For 5% Of
All Congenital Heart Diseases Presenting With Pregnancy (1). Several Case Reports Have Been Published Describing
Anaesthetic Management Of Caesarean Section In Parturient With Uncorrected Tof Using Both General And Regional
Anaesthesia (2,3).To The Best Of Our Knowledge No Case Report Has Been Documented About The Anaesthetic
Management Of Caesarean Section Of A Parturient Having Both Preeclampsia And Tof. Here We Present A Rare Case Of
Anaesthetic Management Of Caesarean Section Complicated With Uncorrected Tof And Preeclampsia.

Case Report: A 21 Year Old Unbooked Primigravida With Breathlessness On Normal Day To Day Activity Was Admitted
In The Labour Room Of Our Institute With 36 Weeks Of Gestation. From The Previous Prescriptions And Reports It Was
Found That The Patient Was Suffering From Uncorrected Tof. Her Echocardiography Which Was Done In The First
Trimester Revealed Tof With Moderate To Severe Right Ventricular Outlet Obstruction With Hypoplastic Pulmonary
Artery And Pulmonary Valve With No Evidence Of Pulmonary Artery Hypertension. A Large Malaligened Ventricular Septal
Defect With 30% Overriding Of Relatively Large Aortic Root Was Reported. Biventricular Systolic Function Was Good
With 62% Left Ventricular Ejection Fraction.
On Examination, The Patient Weighing 52 Kg Had Clubbing, Pedal Edema And Central Cyanosis. Her Pulse Was 96/Min,
Blood Pressure (Bp) 160/100 Mmhg And Respiratory Rate 42/Min. Chest Auscultation Revealed Ejection Systolic Murmur
Of Grade 3 Intensity Along The Left Sternal Border Without Any Palpable Thrill. Fine Basal Crepitations Were Also
Audiable. Proteinurea Was Detected On Bedside Urine Examination. Her Hemoglobin Was 13.5Gm% According To One
Month Old Report.
After Taking High Risk Consent The Patient Was Posted For Emergency Caesarean Section Due To Preeclampsia Associated
With Nonreassuring Fetal Heart Rate. Magnesium Sulphate (Mgso4) 10 Gm (5 Gm In Each Buttock) Intramuscularly (Im)
Was Administered For Seizure Prophylaxis. No Antihypertensive Was Used To Reduce Bp. Intravenous (Iv) Pantoprazole
40 Mg And Metoclopramide 10 Mg Were Given 1 Hour Before Surgery. Ampicillin 2 Gm Iv Was Administered Half An Hour
Before Surgery For Infective Endocarditis Prophylaxis.
On Arrival To Operation Theatre Her Pulse Was 92/Min, Bp 154/96 Mmhg And Oxygen Saturation (Spo2) 85-86% In Room
Air Which Improved To 89% With Moist O2 Inhalation (6 Litre/Min Via Polymask). Central Venous Cannulation Was Done
In Right Internal Jugular Vein And Central Venous Pressure (Cvp) Was Measured 10 Cm Of Water. Phenylephrine 100
Mcg/Ml And Esmolol 10Mg/Ml Was Kept Ready Before Induction.

General Anaesthesia (Ga) Was Planned. Glycopyrolate 0.2 Mg Im, Paracetamol 1Gm Iv And 500 Ml Of Ringer Lactate Was
Administered 15 Min Prior To Induction. After Preoxygenetion With 100% O2 For 3 Min Trachea Was Intubated With
Cuffed Endotracheal Tube Of 7 Mm Inner Diameter Following Rapid Sequence Induction (Rsi) With Etomidate 15Mg And
Succinylcholine (Sch) 50Mg. Anaesthesia Was Maintained With O2 And N2O 50:50 Till The Delivery Of The Baby. After
The Delivery Of The Baby 10 Units Of Im Oxytocin, 50 Mcg Of Iv Fentanyl And 50 Mg Of Iv Tramadol Was Administered.
Baby Cried Immediately After Birth And Uterus Was Well Contracted. After The Effect Of Sch Was Over 1 Mg Of
Vecuronium Was Administered. Low Volume Ventilation With Tidal Volume Of 350 To 400Ml Was Done. Rate Was
Adjusted To Keep End Tidal Carbon Dioxide (Etco2) Between 35-40 Mmhg. Spo2 Was Closely Monitored To Prevent
Hypoxia.
Bp Was Maintained Between 146/86 And 154/96 Mmhg. Heart Rate Varied From 90 To106/Min. Spo2 Was Maintained
Between 85% And 90%. Ecg Tracing Was Uneventful And Cvp Was Maintained Between 9-11Cm Of Water. On Completion
Of The Surgery And After The Vaginal Cleaning Was Done N2O Was Discontinued And The Effect Of Muscle Relaxants
Was Reversed With 2Mg Of Neostigmine And 0.4 Mg Of Glycopyrolate. Duration Of Surgery Was 25 Min. Intraoperative
Blood Loss Was About 300 Ml And 400 Ml Of Ringer Lactate Was Transfused. In The Postoperative Period Spo2 Was
Maintained Between 86 To 88%. Hr And Bp Was 96/Min And 155/90 Mmhg Respectively. Postoperative Period Was
Uneventful.
Discussion: The Four Components Of Tof Are Malaligned Ventricular Septal Defect (Vsd), Obstruction To Right Ventricular
(Rv) Outflow, Aortic Overriding Of Vsd, And Right Ventricular Hypertrophy (Rvh).
Increased Resistance To Right Ventricular (Rv) Out Flow Promotes Right To Left Shunting Of Deoxygenated Blood Via Vsd
Leading To Cyanosis. As The Size Of Vsd And Rv Out Flow Obstruction Is Relatively Fixed Shunt Fraction Mainly Depends
On The Pressure Gradient Between Right And Left Ventricle Which Is Dependent On Pulmonary Vascular Resistance (Pvr)
And Systemic Vascular Resistance (Svr) Respectively. Right Ventricular Outflow Obstruction May Be Due To Fixed
Pulmonary Stenosis Or Dynamic Infundibular Hypertrophy. In The Later Case Decrease In Rv Volume Or Increase In
Contractility May Increase Out Flow Obstruction. (4)
Thus The Objective Of Anaesthetic Management Mainly Depends On Maintaining Of Svr And Decreasing Pvr. Regional
Anaesthesia By Neuraxial Blockade Usually Decreases Svr So It Is Generally Not Recommended Though There Are Some
Case Reports Of Using Graded Epidural Technique For Anaesthetic Management Of Caesarean Section In Patients Of Tof
(3). But As Our Patient Had Preeclampsia Where Decreased Blood Volume Can Cause Drastic Fall In Bp And The Platelet
Count Of The Patient Was Unknown, We Have Planned For General Anaesthesia.
Etomidate Has Maximum Hemodynamic Stability Along With Rapid Induction And Recovery Among The Intravenous
Anaesthetic Agents (5). It Causes No Change In Heart Rate And 15% Fall In Svr Which Was Counteracted By Infusion Of
500 Ml Of Rl And Sympathetic Stimulation Caused By Laryngoscopy. Ketamine Which Is Commonly Recommended For
Induction Of Anaesthesia In Tof Was Not Used Because It May Cause Uncontrolled Increase In Bp In Case Of Preeclamsia
(4,5).
In Preeclampsia Svr Was Already Elevated And The Shunt Fraction Was Reduced, So Labetalol Was Not Used To Reduce
Bp. Mgso4 Used For Seizure Prophylaxis Was Helpful For Hemodynamic Stability During Laryngoscopy And Intubation (6).
It Was Also Responsible For Potentiating The Action Of Muscle Relaxants Thus The Dose Of Muscle Relaxants Were
Decreased ( 6).
Inhalational Anaesthetics Were Avoided Because They May Reduce Svr. Though N2O Have The Potential To Increase Pvr
This Effect Is Not Significant (4). Low Volume Ventilation And Prevention Of Hypoxia Also Contributed To Maintenance
Of Pvr.
Esmolol Which Is Selective And Short Acting 1 Antagonist, Was Kept Ready To Overcome Any Cyanotic Spell Due To
Infundibular Contraction Resulting From Increased Heart Rate And Contraction Due To Sympathetic Activity.
Phenylephrine, A Selective 1 Antagonist, Was Prepared Beforehand To Overcome Any Fall In Svr.

With Uncorrected Tof 10% Maternal Mortality And 14% Foetal Mortality Has Been Reported (7). Foetal Mortality Is
Reported To Be 100% If Hematocrit Is More Than 65% (8). In This Case Low Haemoglobin Concentration (13.5 Gm%) Was
Helpful For Favourable Foetal Outcome.
It Can Be Concluded That Anaesthetic Management Of Caesarean Section In Patients Of Tof And Preeclampsia Can Be
Done Successfully Using General Anaesthesia Because Svr Is Better Maintained With Ga.
References:
1)

Hofman Ji. Incidence Of Congenital Neart Disease: I Postnatal Incidence. Pediatr Cardiol 1995;16:10313.

2)
Juwarkar C, Bharne Ss. Anesthetic Management Of A Parturient With Uncorrected Tetralogy Of Fallot For
Cesarean Section. Anesth Essays Res 2012;6:244-6.
3)
Baidya Dk, Dhir R, Dehran M, Mahapatra Bp. Centralneuraxial Anesthesia For Caesarean Section In Parturients
With Uncorrected Tetralogy Of Fallot: Two Cases. J Obstet Anaesth Crit Care 2012;2:47-9.
4)
Franco Sa, Hines Rl. Congenital Heart Disease. In: Hines Rl, Marschall Ke ,Editors. StoeltingS Anesthesia And
Co-Existing Disease. 6Th Ed.Philadelphia: Elsevier Saunders; 2012. P. 53-72.
5)
Stoelting Rk,Hillier Sc. Nonbarbiturate Intravenous Anesthetic Drugs. In; Stoelting Rk,Hillier Sc, Editors.
Pharmacology & Physiology In Anesthetic Practice 4Th Ed. Lippincott Williams & Wilkins: 2006.P. 155-78.
6)

Sirvinskas E, Laurinitis R. Use Of Magnesium Sulfate In Anaesthesiology. Medicina 2012 ; 38 (7): 695-98.

7)
Cunningham Fg, Gant Nf, Leveno Kj, Gilstrap Lc Iii, Hauth Jc, Wenstrom Kd. Williams Obstetrics. 21St Ed. New
York: Mcgraw-Hill; 2001. P. 1193.
8)
Drenthen W, Pieper Gp, Roose-Hesselink Jw, Van Lottum Wa,Voors Aa, Mulder Bj, Et Al. Outcome Of Pregnancy
In Women With Congenital Heart Disease: A Literature Review. J Am Coll Cardiol 2007;49:2303-11.

***************

Effect Of Term Membrane Stripping In Cervical Ripening

Author: Prof. Sudha S
Co Author: Dr Divya K1, Dr Sarala Sreedhar2, Dr Janu M K3, Dr Radhamany K4,

Manual Stripping Of The Bag Of Membranes Is Thought To Induce Cervical Ripening And Onset Of Labour. It Is An Old
Method And In Practice For Last 200 Years.

Aim: Of This Study Is To Assess Whether Membrane Stripping Will Reduce The Incidence Of Post Term Pregnancies And
The Need For Induction Of Labour. And The Incidence Of Maternal And Fetal Morbidities

Materials And Methods: 300 Patients Were Equally Randomised Into Two Groups Study And Control Comprising 150
Each. All Patients In The Study Group Were Subjected To Stripping Of The Membranes Between 38 40 Weeks. The
Gestational Age On Admission, Bishops Score And The Need For Induction, Duration Of Labour, Incidence Of Premature
Rupture Of Membranes, And Neonatal Complications Were Analysed In Both Groups.

Results: Incidence Of Postdatism Was 6.7% In The Study Group Compared To 32.7% In The Control Group. 75% In The
Study Group Had A Bishop'S Score >4 Compared To Only 38.7% In The Control Group. 71% In The Study Group Had
Spontaneous Onset Of Labour Compared To 34% In Control Group 11% In Study Group Had Premature Rupture Of
Membranes Compared To Control Group. There Were No Increased Incidence Of Neonatal Complications.

Conclusion: Term Membrane Stripping Is An Effective Tool To Ripen The Cervix And Significantly Reduced The Need For
Induction. A Mild Increased Risk Of Prom Was Seen In The Study Group. There Were No Significant Fetal Complications

***************

Mature Cystic Teratoma Of The Fallopian Tube Associated With Uterine Leiomyoma: A Rare Case Report
Author: Dr. Sunil Samal
Co Author: Setu Rathod1, P. Reddi Rani2,

Mature Cystic Teratoma Of The Fallopian Tube Associated With Uterine Leiomyoma: A Rare Case Report
Sunil Kumar Samal *, Setu Rathod *, P. Reddi Rani **
* Assistant Professor, ** Professor
Mahatma Gandhi Medical College & Research Institute, Pondicherry
Background
Benign Mature Solid And Cystic Teratomas (Dermoid Cysts) Are Known To Occur Most Commonly In The Gonads.
Teratoma Of The Fallopian Tube (Solid Or Cystic) Is Extremely Uncommon. In Addition, The Incidence Of A Mature Cystic
Teratoma Of Fallopian Tube Containing Haemorrhagic Fluid In Association With Uterine Leiomyoma Is Extremely Low.
Case
We Report A Case Of 46-Year Lady P1L1 Who Attended Menopause One Year Back Presented With Heavy Bleeding Per
Vaginum For Last 7 Days. After Evaluation She Was Diagnosed As A Case Of Fibroid Uterus With Left Ovarian Simple Cyst
Of Size 4X4 Cm. The Patient Had Undergone Abdominal Hysterectomy With Bilateral Salpingooophorectomy.
Intraoperatively, The Uterus Was Found To Be Enlarged Due An Intramural Leiomyoma. There Was A Haemorrahagic Cyst
Of Size 4X4 Cm Was Found At The Infundibular Part Of The Fallopian Tube. Bilateral Ovaries Were Normal. The
Contralateral Adnexa And Left Ovary Were Normal. On Cut Section, A Intramural Leiomyoma Of Size 10X10 Cm Was
Found. Cross Section Of Cyst Revealed, 20 Ml Of Haemorrhagic Fluid With A Tooth Like Structure In The Wall. The Distal
And Proximal Portions Of The Tubal Lumen Appeared Normal. Histopathology Confirmed The Diagnosis Of Mature
Teratoma Of The Fallopian Tube. The Patient Had No Symptoms Or Signs At The 6-Month Follow-Up.
Conclusion
In Literature, Most Of The Reported Cases Of Fallopian Tube Dermoid Were All Incidental Findings During An Operation
Or Examination Of A Surgical Specimen. Prognosis Is Favourable Following Complete Surgical Excision. Gynaecologist
Should Consider The Possibility Of This Disease Entity While Making Differential Diagnosis.

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Pyometra : A Rare Complication Of B-Lynch Suturing

Author: Dr. Shamalee Mistry
Co Author: Dr. Arun H. Nayak1, Dr. Meenal S. Sarmalkar2,

Mrs. Xyz, 28 Year Old , P1L1 With Day 26 Of Ceasarean Section Was Admitted With The Complaints Of Foul Smelling
Purulent Discharge Per Vagina And Intermittent Fever Spikes Since L Week. Patient Underwent Emergency Lscs In View
Of Persistent Occipito-Posterior Position With B Lynch Suturing Done. Usg Was Suggestive Of Postpartum Status With
Thickened Endometrium With Multiple Air Specks And Air In The Uterine Wall?With Gas Forming Organisms. Ct Scan
Suggestive Of Well Circumscribed Collection Of 10 *6*5Cm Intrauterine Collection Having Air Locules Suggestive Of
Emphysematous Infective Process. Patient Started On Injectable Higher Antibiotics .On Day32 Drainage Of Pyometra
Done , Sent For Culture And Sensitivity.Patient Was Discharged On Day 40. On Follow Up Visit In Opd, On Day 46
Organized Pus Was Removed And Sent For Histopathology . Now Following Up The Patient With Successive Usg Scans.

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Rare Case Of Recurrent Morquios Syndrome A- Role Of Cvs

Author: Dr. Inampudi Chowdary
Co Author:

Name: D.Karuna
Age :22Yrs
Sex : Female
Address: Nandigama,Satenapalli,Guntur.
History:A 22Yr Female G3P2L2 With 5 Months Amenorhea With Previous 2 Lscs With History Of Morquios Syndrome In 2
Babies Came To Know Whether Fetus Is Affected With Morquios Or Not.
Examination: Height:158 Cm
Weight:52Kgs
Pr

:82/Mt

Bp

120/80 Mm Of Hg

Obstretic Examination: P/A:Pfanensteil Scar+

Uterus 18-20 Wks
Fp+
Uterus Relaxed.
Investigations: Antenatal Scan,Chorionic Villous
Sampling,Karyotyping For Both Children
Babies

Galactose 6Sulfatase Enzyme

Present Pregnancy

9.2

Refernce Value
(95-360)

1St Baby

4.2

(40-170)

2Nd Baby

2.3

(40-170)

There Are Decreased Levels Of Galactose 6 Sulfatase Enzyme Levels In Both Babies And Fetus.
Treatment:We Counselled The Patient To Continue The Pregnancy.As The Patient Wanted Termination Hysterotomy Was
Done And The Pregnancy Was Terminated.
Discussion:
Morquios Syndrome A (Mucopolysacharoidosis Iv)
Autosomal Recessive Disorder
Galns Gene Mutation Located On Chromasome 16
Prevalence - 1 In 200000-300000

Recurrence - 25% Chance Of Getting To Other Child.

Clinical Features:Appears Healthy At Birth,
Short Stature,Short Neck(Flat Vertebra)
Pectus Carinatum,Odontoid Hypoplasia,
Atlanto Axial Insability,Joint,Knock Knees
Dyostosis Multiplex,Duck Waddling Gait,
Thin Tooth Enamel,Corneal Clouding,Mild
Hepatosplenomegaly.
Life Span:May Die As Early As 2-3 Days Or Some May Live Up To 60-70 Yrs.
Enzyme Replacement Thrapy:(Vimzim)
Elosulfase Alfa Replaces Deficient Enzyme N Acetyl Galactosamine 6 Sulfatase (Glans)
It Is Taken Up In To Lysosomes And Increases Catabolism Of Keratan And Chondroitin Sulfate.
Dose: 2Mg /Kg. Once A Week
***************

Non - Descent Vaginal Hysterectomy

Author: Dr. Sadhana Mehta
Co Author: Dr. Smt. Bhagawato Devi Yamuna Singh Prize On Geriatic Gynecology 1,

Non Descent Vaginal Hysterectomy

By - Dr. Sadhana Mehta
M.B.B.S., M.S. (Obstetrics & Gynecology)

Abstract

Objective: - To Study The Advantages Of Performing Vaginal Hysterectomy In Patients Having No Descent Of Uterus, Using
Ligasure.

Methods: - All Patients Requiring Hysterectomy For Benign Gynecological Disorders Who Did Not Have Any Uterine
Decent Were Recruited For This Study. Ndvh Was Performed In Cases Where The Uterus Was Mobile With Size Not
Exceeding 16 Weeks Gestation And With Adequate Vaginal Access. Morcellation Techniques Like Bisection,
Myomectomy, Wedge Debulking Or A Combination Of These Were Employed In Bigger Sized Uterus. Ligasure Was Used
In All Cases Of Vaginal Hysterectomy. When These Prerequisites Are Not Fulfilled Such Patient Were Taken Up For
Abdominal Hysterectomy.

Observation: - A Total Of 112 Hysterectomies Were Performed During The Study Period From April-2013 To May-2014 At
Arpit Nursing Home. Vaginal Route Was Employed In 70 Patients And Abdominal In 42 Patients. Out Of 70 Vaginal
Hysterectomies, 58 Patients Had No Descent Of Uterus And 12 Patients Had Decent Of Uterus. Out Of All 70 Cases Of
Vaginal Hysterectomy 39 Patients Were In The Age Group 41 To 45 Years And Fibroid Was The Commonest Indication (In
25 Patients) And Second Commonest Indication Of Hysterectomy Was Dub.
Morcellation Techniques Were Employed In 40% Of All Cases. Mean Operating Time Was 45 Minutes And Average Blood
Loss Was Between 100Ml To 400Ml And Hospital Stay Was Two Days, Complications Were Minimal. When We Compared
Abdominal Hysterectomy With Non Descent Vaginal Hysterectomy, All These Complications Like Morbidity, Mean Blood
Loss, Post Operative Recovery, Hospital Stay Were Minimal In Ndvh Using Ligasure.

Conclusion: - Vaginal Hysterectomy For Non-Decent Large Uterus Is Safe And Feasible Method Provided One Is Familiar
With The Morcellation Techniques And To The Use Of Vessel Sealer Clamp.

***************

Comparison Of Maternal And Perinatal Outcome Between Women With Impaired Glucose Tolerance And Normal
Pregnant Women In A Tertiary Hospital
Author: Dr. Karthiga Prabhu J
Co Author: Anjalakshi Chandrasekar1,

Objective :
To Compare The Maternal And Perinatal Outcome In Women With Impaired Glucose Tolerance And Normal Pregnant
Women
Materials And Methods :
This Case - Control Study Was Conducted In Srm Medical College From April To September 2014. Impaired Glucose
Tolerance (Igt) Was Diagnosed When 2Hour Non- Fasting 75Gm Gtt Was 120-139 Mg/Dl And Women With
Ogct<120Mg/Dl Were Taken As Controls. For Each Igt Patient , 2 Consecutive Women With Normal Ogct Were Taken As
Controls. Maternal And Neonatal Parameters Were Noted And The Results Were Compared.
Results :
Impaired Glucose Tolerance Was Detected Antenatally In 64 Delivered Women During The Study Period. Igt Was
Detected In Second Trimester In 7 Cases And The Remaining In Third Trimester. There Was No Significant Difference In
Age, Parity, Height, Weight, Pre -Pregnancy Bmi Between Cases And Controls.
Family History Of Diabetes Was Significantly More In Cases Than Controls (31.74% Vs 17.46%, P=0.04). There Was No
Significant Difference In Hypertensive Disorders, Preterm Labour, Prelabour Rupture Of Membranes , Mode Of Delivery
And Nicu Admission . Lga Babies (>=3500G) And Maternal Serum Triglycerides Were Significantly More In Igt When
Compared To Controls (15.87% Vs 6.34%, P=0.03And 210.8 68.48 Mg/Dl Vs 179.6556.52Mg/Dl, P=0.009
Respectively). Hypertriglyceredemia (>235 Mg/Dl) Was Seen In 60% Of Lga Babies When Compared To 20% Of Aga Babies
(P=0.01).
Conclusion :
Igt Did Not Result In Significant Maternal Morbidity. But Close Monitoring Of These Mothers Is Essential In View Of
Occurrence Of Lga Babies And Hypertriglyceredemia.

***************

Retroscpective Comparitive Study Of Obstetric Complication And Maternal Mortality In Registered And Unregistered
Women At Tertiry Care Centre,Jharkhand
Author: Dr. Alka Kumari
Co Author: Dr Sangita Singhal1,

Objective - To Analyze Pregnancy Outcome, Obstetric Complication And Maternal Mortality In Registered And
Unregistered Women Undergoing Caesarean Section At Our Hospital.

Material And Methods-- This Retrospective Comparative Study Included Women(1450) Undergoing Caesarean Section
From April 2013 To March 2014. Data Was Collected From From Pre Structured Performa Of Operation Room.

Result -- Out Of Total 1450 Women Included In Study 70 % (1015) Were Unregistered And 30% (435) Were Registered
.Surgical Complications Were Less Than 1 % In Registered And More Than 4 % In Unregistered. Because Of
Multidisciplinary Team Approach At Our Institute Many Women With Complication In Unregistered Group Could Be
Saved. No Maternal Mortality Was Reported In Registered Group Whereas Maternal Mortality In Unregistered Group
Was Due To Delay In Reaching Appropriate Care.

Conclusion -- Maternal Morbidity And Mortality Is Still High In Our Region Because Of Poor Primary And Secondary Level
Facilities..By Improving Health Education At Community Level Regarding Importance Of Antenatal Care ,Improvement In
Primary And Secondary Health Care,Timely Referral To Tertiary Level Can Play A Crucial Role In Decreasing Maternal
Morbidity And Mortality.

***************

Predictive Value Of Vili In Comparison To Cytocervical Smear In Diagnosis Of Cin And Earlycervical Carcinoma Ce
Author: Dr. Rajshri Purbey
Co Author: Dr Rajshri Purbey1,

Objective - To Find Out The Predictive Value Of Vili In Comparison To Cytocervical Smear When Colposcopy Biopsy Is
Considered As Gold Standard For Diagnosis Of Cin And Early Cervical Carcinoma In Remote Areas, As Well As
Complementary With Pap Smear In Tertiary Centre.
Methods - This Was A Hospital Based Observation, Based On 500 Symptomatic Patients Attending Gynae Opd From Oct
2011 To Sept 2013. These Patients First Subjected To Pap Smear Followed By Vili And Colposcopy. Patients In Whom,
Either Of Test Positive Were Subjected To Biopsy And Histopathological Reports. We Exclude Late Stage Of Cervical
Carcinoma.
Results - In 500 Symptomatic Patients, 76 Patients Were Vili Positive, 46 Patients Were Pap Smear Positive, 60 Patients
Were Colposcopy Positive And 53 Patients Were Biopsy Positive. Vili And Colposcopy (Combined Index) Missed 1 Case Of
Cin And 1 Case Of Adenocarcinoma Whereas Pap Smear Missed 20 Case Of Cin. Sensitivity, Specificity, Positive And
Negative Predictive Values Of Vili Were 96.2%, 94.40%, 69.10% And 99.52% Respectively. In Other Hand Same Value Of
Pap Smears Were 62.26% 97.09%, 71.73% And95.5% Respectively.
Conclusion - Pap Smear Has Various Limitations Besides Low Sensitivity .These Include The Need For Repeated Visits For
Screening, Collection Of Reports, Evaluation Of Abnormal Results. Advantages Of Vili Are, That It Is Easily Available, Can
Be Easily Performed By Paramedical Workers And Doctors, Test Results Are Immediately Available And "See And Treat
Policy Can Be Used. In Low Resource Settings, Screening Of Cervical Carcinoma By Pap Smear Can Be Replaced By
Cheaper And Easily Available Method Like Vili, Which Has High Sensitivity To Detect Any Grade Of Dysplasia. Vili May Be
Complementary To Pap Smear In Tertiary Centre.
Keywords: Vili - Visual Inspection Of Cervix With Lugol' S Iodine

***************

Etd - Expected Time Of Delivery - A New Simple Clinical Tool For Management Of Labour
Author: Dr. Prakash Mishra
Co Author: Dr Lalmohan Nayak1,

Objective : Etd Is A Simple Mental Tool, Which In A Patient In Active Phase Of Labour, Can Predict The Expected
delivery Time And Programmes Its Management. This Tool Was Developed By Dr A K Debdas 2006 (India). The
Objective Of This Study Was To Check Its Usefulness.
Materials: A Total 100 Cases Of Normal Singleton Pregnancy(Except Cases
Of Malpresentation , Prev.Cs & Gross Cpd) In natural Labour(Neither Induced Nor Augmented) And Who
Delivered Normally Vaginally Were Collected In Prospective Manner From The Labour Unit Of V S S Medical College &
Hospital ,Burla ,Sambalpur , Odisha. During November 2013 To August 2014.The Proportion Of Primi & Multi Is 61:39.The
Gestation Ranged From 37 To 42 Weeks . The Heaviest Baby Weighed 3900 Gm.
Method: At The Very First Pv Examination In active PhaseOf Labour When The Cervix Was Atleast 4Cm Dilated,
Etd Was Calculated By Using The FriedmanS Formula For Cervimetric Progress Of Labour As 1Cm Per Hour
E;G If In A Case The Cervix Is 4Cm Dilated At 2Pm , Her Etd Would Work Out As 2Pm+ 6 Hours = 8 Pm .Assuming That
She Would Take 6Hrs To Dilate The Remaining 6Cm To Become 10Cm.
Result : On Matching The Actual Time Of Delivery With The Calculated Etd, It Was Found That 75.5% Of Primi &
90.7% Of Multi Delivered Before The Predicted Etd. Those Who (Both Primi & Multi) Failed To Deliver By Their Predicted
Delivery Time They All However Delivered By The 4 Hours Action Time Point.
Conclusion : Etd Is A Highly Reliable Clinical Tool, Which Manages Labour , Prevents Prolonged & Obstructed Labour .So
Etd May Serve As An Alternative To The Partogram.

***************

Polycystic Ovarian Syndrome : A Clinical , Hormonal , And Metabolic Assessment In Relation To Body Mass Index.
Author: Dr. Prajna S
Co Author: Dr. Bindu M1, Dr. Sareena Gilvaz2,

Objective : To Compare The Clinical , Hormonal And Metabolic Profile Between Lean And
Polycystic Ovarian Syndrome.

Overweight Patients Of

Materials And Methods : Sixty Women With Polycystic Ovarian Syndrome(Pcos) Were Studied And Divided In To Lean
(Body Mass Index(Bmi) Between 18.5 And 23) And Overweight( Bmi >/= 23). Metabolic And Hormonal Profile (Serum Fsh
, Lh , Testosterone , Prolactin , Tsh On Days 2-3 Of Menstrual Cycle , Serum Insulin Fasting And 2 Hour Post Glucose ,
Glucose Tolerance Test , And Fasting Serum Lipid Profile ) Was Performed Along With Pelvic Sonography ; And Clinical
Features , Viz. Waist Hip Ratio , Hirsuitism , Acne , Acanthosis Nigricans Were Recorded.

Results : Average Age , Hirsuitism ( 80.9% Vs. 89.7% ) , Irregular Cycles (92.8% Vs. 96.6% ) , Acne ( 9.5% Vs. 15.5 %) ,
Endometrial Thickness > 4Mm (9.5% Vs 15.5%) , And Hormonal Profile Were Similar In The Lean And Overweight Pcos
Groups. Family History Of Diabetes (9.5% Vs. 24.1 % ), Abnormal Glucose Tolerance Test (Gtt) (4.7 % Vs. 10.3% ), Deranged
Lipid Profile (14.2% Vs. 31%) And 2 Hour Postprandial Insulin Levels Were Higher In The Overweight Pcos ( P< 0.05). Insulin
Resistance Was Observed In 83.3% Of Lean Pcos But Was Still Lower Than 93.1% Seen In Overweight Pcos ( P< 0.05 ).

Conclusion : Clinical And Hormonal Profile Was Similar Between Normal And Elevated Bmi Pcos Patients . However Insulin
Resistance Was Observed In 83.3% Of Lean Pcos.Family History Of Diabetes , Impaired Gtt , Deranged Lipid Profile And
Insulin Resistance Were More Prevalent In Overweight Pcos .

***************

An Evaluation Of Causes Of Peri Natal Mortality & Measures To Reduce It At Tertiary Centre Of Bundelkhand
Region
Author: Dr. Vidya Chaudhary
Co Author: Dr. Sanjaya Sharma1, Dr. Shilpi Srivastava2, Dr. Suhila Kharakwal3,

Objective- 1.To Evaluate The Causes Of Perinatal Death

2. How To Reduce It
At Tertiary Centre Of Bundelkhand Region In M.L.B. Medical College Jhansi, Uttar Pradesh (India).
Method-A Retrospective Study Was Done Over A Period Of Last One Year From June 2013 To May 2014. There
Was Total 2691 Deliveries Occurred , Out Of Which 184 Was Perinatal Death . Perinatal Mortality Rate Was 68.37
Per 1000 Total Birth And Causes Of Perinatal Deaths Was Identified And Analyzed.
Result-Out Of 68.37% Perinatal Mortality Majority Of Perinatal Deaths(54.3%) Occurred Due To Preterm Low Birth
Weight With Or Without Associated Other Factors, 8.6% Due To Congenital Anomalies, More Than 38% Perinatal
Death Due To Maternal Factor Like Ante Partum Haemorrhage, Eclampsia ,Obstructed Labour, Malpresentation ,
Medical Problems In Pregnancy.
Conclusion- The Distribution Of Causes Of Death In This Population Suggests A Great Potential For Prevention. Early
Identification Of Mothers At Risk Of Pregnancy Complications Through Antenatal Care By Screening, Teaching
Pregnant Women To Recognize Signs Of Pregnancy Complications, Timely Access To Obstetric Care, Monitoring
Of Labour For Fetal Distress, And Proper Newborn Resuscitation May Reduce To Some Extent The Perinatal Deaths.
There Should Also Be Increased Awareness Among Paediatricians And Obstetricians For Co-Ordinated Approach
To Bring Down Perinatal Mortality.

***************

Impact Of Onsite Health Education On Perception And Behaviour Of Housewives Towards Cervical Cancer Screening:
A 2 Year Study.
Author: Dr. Phebe Wallace
Co Author:

Objective- Cervical Cancer Screening Has Been An Effective Tool For Early Detection Of Cervical Cancer Since 1940S,
But Still India Represents 26.4% Of All Women Dying Of Cervical Cancer Globally. Hence, The Study Aims To Evaluate The
Change In Knowledge, Perception And Behaviour Through Health Education Given At The Time Of Screening, In Industrial
Township Housewives Of 40 Years And Above Age Group, Undergoing Pap Screening For First Time, In The Year 2012-13
And 2013-14.
Material And Method- Prior To Screening, A Pretested Questionnaire Was Completed By Housewives Group Undergoing
Screening For First Time. It Included Demographic Details, Cervical Cancer And Pap Smear Knowledge, Their Perception
Towards Pap Smear And Cervical Cancer And Reasons For Not Undergoing The Test.
Health Education Was Given In Simple Language And Doubts Were Clarified At The Time Of Screening And Educative
Material Were Distributed.
The Questionnaire Was Same For Both Years And The Changes In Their Perception, Behaviour And Knowledge Was
Compared. The Significance Was Calculated.
Result- 67.5% Reported For Screening In 2012-13 Whereas 89% Reported In 2013-14.
In Year 2012-13, Only 38.51% Had Some Perception About Cervical Cancer And 26.6% About Pap Smear, But In 2013-14,
95.45% & 94.25% Had Knowledge About Cervical Cancer And Pap Smear Respectively.
Change In Perception, Knowledge And Behaviour Was Significant, When Calculated.
The Main Reasons For Not Undergoing Screening, In The First Year, Was Lack Of Perception, Fear Of Vaginal Check-Up
And Hesitation, Which Changed Significantly In The Following Year.
Conclusion- Health Education And Information On Pap Smear Is Still Inadequate.The Fear And Embarrassing Issues Are
Still Not Addressed Properly. The Barriers Can Be Dealt With Proper, Immediate, Onsite Health Education And
Information, As Per The Needs Of The Woman, And The Utilization Of This Effective Screening Tool Can Be Improved.

***************

Umbilical Coiling Index-A Predictive Marker For Adverse Obstetric Outcome

Author: Dr. Ruchi Hooda
Co Author: Dr. Monika Rajput1, Dr. Sunita Malik2, Dr. Sheeba Marwah3, Dr. Rameshwar Bishnoi4, Dr. Nilu Kumari5

Objective- To Measure Umbilical Coiling Index (Uci) Postnatally, And To Evaluate Its Association With Maternal And
Perinatal Outcome
Methods: The Prospective Study Was Conducted At Vmmc & Sjh, New Delhi Over Six Months Over All Women Who
Delivered Singleton Live/Stillbirths.(N=2000). Multiple Pregnancies, Malpresentations, Previously Diagnosed Iud, And
Elective Caesarean Section Were Excluded. Post-Delivery, Umbilical Cord Was Clamped At Fetal End And Cut Flush With
Fetal Surface Without Milking. The Placenta Was Allowed To Separate Spontaneously, And Total Number Of Coils, And
Length Of Cord Was Measured Against A Measuring Tape In Cm By Attending Doctor/Nurse. Any Significant Postpartum
Events Were Noted. A Coil Was Defined As Complete 360 Degree Spiral Course Of Umbilical Vessels. Uci Was Determined
By Counting Number Of Coils And Dividing By Length Of Cord . Subjects With Uci<10Th Percentile, > 90Th Percentile,
And10-90Thpercentiles Were Defined As Hypocoiled, Hypercoiled, And Normocoiled, Respectively. Maternal
Demographic Factors And Medical/Obstetrical Data, Alongwith Neonatal Clinical Events, Were Noted. The Following
Maternal-Fetal Outcomes Were Measured: Maternal Age, Parity, Obstetric History ,Pog, Maternal Diabetes/
Hypertension ,Anaemia, Heart Disease, Infertility, Prom,Aph, Chorio-Amnionitis, Oligohydramnios/Polyhydramnios, Fgr,
Fetal Congenital Anomalies, Fetal Heart Rate Disturbances, Meconium Stained Amniotic Fluid , Interventional Delivery,
Pph, Sex, Birth Weight Apgar Score In Minute 5 And Admission To Neonatal Intensive Care Unit. Then Relationship Of
Uci And Hypo- And Hyper-Coiled Cord With Them Was Evaluated And Data Analyzed Using Appropriate Tests. Statistical
Significance Was Defined As P < .05.
Results: Frequency Distribution Of Uci Was Normal. Maternal Risk Factors For Hypercoiling Were Extremes Of Age;
Obesity, Gdm, And Preeclampsia For Hypo-Coiling, Fetal Death, Chorio-Amnionitis, Fetal Structural/Chromosomal
Abnormalities,And Fd, Operative Delivery, And Lower Apgar Score At 5 Min For Hypocoiling.
Conclusion: Abnormal Uci Relates To Adverse Perinatal Outcome.

***************

Third Trimester Vitamin D Supplementation And Vitamin D Levels At Term

Author: Dr. Praveena Shenoi
Co Author: Namrata Nagendra1, Triveni2,

Objective
To Study The Prevalence Of Vitamin D Deficiency In Pregnant Women At 28 Weeks Gestation, Initiate Supplementation,
And Evaluate The Therapy In Women Delivering At Term
Materials And Methods
Serum Vitamin D (Svd) Levels Were Checked Using Chemiluminescence In Women Presenting At 28 Weeks Of Gestation
To Cloudnine Hospital, Bangalore. Women With Svd 30Ng/Ml Received Vitamin D 500Iu/Day; Svd 20-29.9Ng/Ml
Received 4000Iu/Day; Svd 19.9Ng/Ml Received 60,000Iu/Week Till Delivery. Svd Levels Were Rechecked When They
Presented In Labour At Term.
Women With Multiple Gestation, Preterm Delivery, History Of Thyroid Surgery And Non-Compliers Were Excluded From
The Study.
Results
A Cohort Of 200 Women Was Enrolled. Thirty-Four Women Had Svd >30Ng/Ml, Of Whom 17 (50%) Became Deficient At
Term. Seventy-Five Women Had Svd 20-29.9Ng/Ml, Of Which 38 (50%) Normalized At Term, 33 Remained At 2029.9Ng/Ml, And 4 Reduced To 10-19.9Ng/Ml. Seventy-Four Women Had Svd 10-19.9Ng/Ml At 28 Weeks, And Levels
Normalized In 40 (54%), Rose To 20-29.9Ng/Ml In 24, Remained At10-19.9Ng/Ml In 7, And Fell Below 10Ng/Ml In 3.
Seventeen Women Had Svd <10Ng/Ml At 28 Weeks, And, At Term, 6 (35%) Normalized, 9 Rose To 20-29.9Ng/Ml, And 2
Remained Less Than 10Ng/Ml (P 0.056). None Developed Hypervitaminosis Nor Had Levels In The Toxic Range
(>100Ng/Ml).
Conclusion
Our Study Showed That 83% Women Are Vitamin D Deficient At 28 Weeks. Women With Sufficient Vitamin D At 28 Weeks
May Become Deficient At Term Despite Supplementation Of 500 Iu/Day. In Women With Levels 20-29.9Ng/Ml, Only 50%
Normalized At Term. And, With Higher Supplementation Of 60,000Iu/Week Given To Mothers With Levels
19.9Ng/Ml, Levels Normalized In 54% Women In The 1019.9Ng/Ml Group And 35% In The <10Ng/Ml Group. This
Suggests That The Recommended Regimens Of Prevention And Supplementation Of Vitamin D In Pregnant Women Need
To Be Revised Upwards In Our Population.

***************

Comparative Study To Reduce Interval Of Mifepristone And Misoprostol Intake For Medical Abortion
Author: Dr. Deepti Rastogi
Co Author:

Objective: To Reduce The Interval Between Mifepristone And Misoprostol For Induction Of Abortion To 24 Hours And
Compare It To The Standard Interval Of 48 Hours
Design: Random Controlled Trial
Materials & Methods: 100Women With Less Than 63 Days Of Pregnancy Opting For Medical Means Of Abortion Were
Included In This Study
Results: There Was No Significant Difference In The Misoprostol To Abortion Interval, Rate Of Incomplete Abortion Or
Complication Rate In Study Group When Compared To The Control Group
Conclusion: Our Study Suggests That A Shorter Interval Between Mifepristone And Misoprostol Also Yields Comparable
Results

***************

A Randomized Trial Comparing Oral Nifedpine & Intravenous Labetalol In Severe Pre Eclampsia & Eclampsia
Author: Dr. Kirtan Krishna
Co Author: Kirtankrishna1, Dr Bshyamasundara Bhat2, Dr.N.Shailaja3, Dr.L.Krishna4,

Objective: To Compare The Efficacy Of Oral Nifedipine And Intravenous Labetalol In The Control Of Hypertension In
Patients With Severe Preeclampsia And Eclampsia.
Methods: Enrolled Patients Will Be Randomized To Receive Either Oral Nifedipine Or Intravenous Labetalol. All Patients
With Imminent Eclampsia, Eclampsia Will Receive Magnesium Sulphate As Per The PhysicianS Discretion (Pritchard
Or Single Dose Regimen) For Seizure Prophylaxis At The Time Of Enrollment. Frequent Clinical And Biochemical
Monitoring Of Maternal Status With Careful Blood Pressure Monitoring Every 20 Min. Periodic Fhr Monitoring Was Done.
All Examinations Were Carried Out In The Labour Ward.
Main Outcome Measures: Primary Outcome Will Be Time To Achievement Of The Therapeutic Goal. Secondary Outcome
Variables Will Be Agent Failure, Urinary Output, And Adverse Effects.
Results : The Primary Outcome Which Was The Time Required To Achieve The Target Blood Pressure, The Median Time
Was 32.0 18.64 Minutes (Mean Sd) In Nifedepine Group As Compared With 37.04 16.36 Minutes In Those
Receiving Labetalol (P = .002). In The Nifedepine Group 63.3% Required Only 1 Dose Compared To 36.6% In The Labetalol
Group. Only Two Women In The Nifedepine Group Required Maximum Number Of Doses That Is 5 Doses. In The Labetolol
Group Three Women Required Cross Over To Nifedepine Group As The Blood Pressure Was Not Controlled Even With
Maximum Dose Of Labetalol & Were Considered As Agent Failure. There Were No Cross Overs In Nifedepine Group.
Conclusion: In This Study Nifedipine Achieved The Therapeutic Blood Pressure Goal More Rapidly And With Fewer Doses
Than Labetalol. The Pharmacokinetics Of Nifedipine Include Rapid Onset, Long Action, Oral Bio Availabilty, And Infrequent
Side Effects. Hence Nifedipine May Be Preferable As It Is A Simple, At Dose, Is An Oral Regimen And Is More Cost
Effective

***************

Acceptability For The Use Of PostPartum Intra Uterine Contraceptive Device (Ppiucd) With Evaluation Of Safety,
Efficacy And Expulsion
Author: Dr. Vinita Gupta
Co Author: Dr.(Mrs) Bharati Saxena1,

Objective: Acceptability For The Use Of PostPartum Intra Uterine Contraceptive Device (Ppiucd) With Evaluation Of
Safety, Efficacy And Expulsion
Methodology: The Study Was Conducted On Patients Delivered In Jay Kay Lon Hospital, Govt Medical College Kota From
1 March 2013 To 28 February 2014. Cases Were Counselled For Post Partum Intra Uterine Device Insertion. Acceptance
Rate Of Ppiucd Was Assessed With Evaluation Of Safety, Efficacy And Expulsion Rate At Six Week Follow Up.
Result:
1.

Overall Acceptance Rate Was 1% For Ppiucd. (Total Deliveries Were 11209)

2.
Total 112 Post Partum Intra Uterine Device Were Inserted During Post Placental (26), Intra Caesarean (65) And
Within 48 Hours (21) Period.
3.

The Insertion Of Ppiucd Was Easy In 110 (98.21%) Cases And No Difficulties Were Reported.

4.
Of 112 Inserted 11 (10.89%) Cases DidnT Report For Follow Up. While From Rest Of Cases 70% Came On
Scheduled Time For Follow Up.
5.
Major Complain On Follow Up Was Excess Of Bleeding Per Vagina (14.85%) Followed By Pain Abdomen (27.7%).
57.42% Cases Had No Complains.
6.
On Follow Up The Position On Iucd Was In Situ In 89% Cases; Usg Was Needed In 11.8% Cases For Location.
5.94% Cases Had Expelled Iucd
7.

83.1% Cases Were Willing For Continuation While 12.87% Cases Demand Removal.

8.

2.97% Cases Were Willing For Re-Insertion Of Iucd

Conclusion: Although Acceptance Rate For Ppiucd Was Found Low In Study But It Is Concluded That Ppiucd Is Safe
Effective Feasible And Reversible Method Of Contraception. If It Would Be Included In Routine Obstetric Management Of
Patients It Can Address The Unmet Need For Contraception.
***************

Retrospective Study Of Maternal And Fetal Outcome In Cardiac Disease Complicating Pregnancy
Author: Dr. Triparna Sravanthi
Co Author: Dr.K .Prabhadevi1, Dr.C.Vasanth Kumar2,

Objective: Retrospective Study Of Maternal And Fetal Outcome In Cardiac Disease Complicating Pregnancy.Methods:
It Is A Retrospective Study Carried Out In The Tertiary Care Center,Nri College/Gh Chinakakani,Guntur District,Ap
Between August
2011 July 2014. 150 Pregnant Women With Cardiac Disease, Confirmed By Clinical And
Echocardiographic Evaluation Were Included In The Study. Demograghic Data Like Booked/Unbooked,Age, Parity Socio
Economic Status Recorded. Functional Classification(Nyha),Type Of Structural Lesion,
Gestational Age At
Admission,Mode Of Delivery,Maternal Cardiac Events, Maternal And Perinatal Outcome Recorded. Results:Incidence Of
Cardiac Diseases In Our Institute Is 1.72%(N-150/8674Deliveries) ). 56% Booked And 44% Unbooked. Majority Of Patients
Belong To Socioeconomic Status Iii& Iv -81%.Most Common Valvular Lesion-Rheumatic 66%, Post Mitral Valve
Replacement 23%.Among Total Admitted 23% Grade Iii & Iv Nyha. 18.2% Belongs To High Risk Stratification. The Mode
Of Delivery By Caesarean Section Is 66 Cases(60%). Most Of The Cases Being Repeat Caesarean Section 35 Cases (31.8%).
Maternal Mortality 3.33% Among Cardiac Disease And Perinatal Moratlaity Is 5.3%Cases. Maternal Mortlity In Our
Institute Is 2.7/1000.Among Total Maternal Deaths Of 24 For 3 Years 5 (20%) Deaths Are Due To Heart Disease. All 5 Are
Unbooked,Low Socioeconomic Admitted With Grade Iii &Iv Nyha.Outcome In Post Cardiac Surgery Patients Is Uneventful.
Conclusion: All Heart Patients Should Have Pre Pregnancy Counselling,Any Lesions That Are To Be Corrected By Surgical
Intervention Should Be Dealt Before Pregnancy For Better Maternal And Perinatal Outcome.All Heart Disease
Complicating Pregnancies Should Be Taken Care At The Tertiary Institute Early Diagnosis And Timely Intervention Can
Decrease Complications.
***************

Renal Transplantation And Pregnancy

Author: Dr. Sumesh Choudhary
Co Author: Choudhary Sumesh D1, ,Mishra Vineet V2, , Aggarwal Rohina S3, , Dharaiya Nisarg D4,

Objective: The Aim Of This Study Is To Evaluate Maternal & Fetal Outcome In Cases Of Renal Transplant Patients.
Material And Method: This Is A Prospective Longitudnal Study From 2010 To 2014 At A Tertiary Care Centre. We Analyzed
Eight Pregnancies In Five Renal Transplant Recipients For Maternal And Fetal Outcome In Terms Of Clinical And Biological
Data.
Result: The Mean Age Was 28.6 3 Years. The Mean Time Interval Between Renal Transplantation And Pregnancy Was
2 Year & 7Months. Regarding The Immunosuppressive Therapy All Patients Received Steroids, Three Patients Received
Tacrolimus, One Patient Received Sirolimus And Mycophenolate Mofetil That Was Changed 1 Month Before Conception.
There Was No Significant Difference Between The Serum Creatinine Levels Before And During Pregnancy. Amongst The
Seven Patients, Two Of Them Had Pre -Existing Hypertension. Of These Two Patients, One Developed Super Imposed PreEclampsia. The Other Complications Which Were Noted Were Urinary Tract Infection In One Case, Premature Labour Pain
In One Case, Anaemia In Two Cases. No Neonatal Complication Except Low Birth Weight Was Noted. Two Cases Had
Spontaneous Abortion. Caesarean Section Was Performed In Two Cases Due To Severe Oligohydroaminos.
Conclusion: Pregnancy In Renal Transplant Patient Can Be Continued Under Optimal Circumstances, Including Stable
Allograft Function For At Least 1 Year Post Transplant Without Rejection With Good Control Of Blood Pressure, And After
Appropriate Adjustment Of Immunosuppressant And Other Known Teratogenic Medications Prior To Conception.
Keywords: Pregnancy, Renal Transplant, Immunosuppressive Therapy

***************

Serum Vitamin-D Levels In Pregnant Women And Its Association With Hypertensive Disorders Of Pregnancy
Author: Dr. Latha Chaturvedula
Co Author: Rajeeb Jena1, Mg Sridhar2, R Sasirekha3,

Objective: This Prospective Observational Study Was Undertaken To Assess The Serum Levels Of 25(Oh) D In Pregnant
Women From 16 To 20 Weeks And To Identify The Association With The Development Of Hypertensive Disorders In
Pregnancy And Other Secondary Outcomes Of Pregnancy. Methods: Study Was Conducted In The Departments Of
Obstetrics And Gynecology, And Biochemistry Jipmer, Puducherry Where 352 Pregnant Women Participated From
September 2012 To July 2014. Serum Vitamin D Level And Was Estimated By Elisa Method And The Cut Off Value Was
Identified. Patients Were Followed Till Delivery And Maternal Outcome Like Hypertension And Perinatal Outcome Like
Preterm Birth, Fetal Growth Restriction, Intrauterine Death Or Respiratory Distress Was Documented. Serum Vitamin D
Levels Were Compared Between The Afore-Mentioned Outcomes And The Normal Population.. Results: Demographic
Variables Among The Normal And Hypertensive Groups Of The Study Population Were Comparable. The Median Serum
25(Oh)D Level Was Estimated To Be 18.3Ng/Ml [With Range 5.2-43.12].The Median Value Of Vitamin D In Normotensive
Population Was 18.69(Ranging From 6.2-43.12)Ng/Ml And Was Significantly Higher Than That Of Hypertensive Population
.I.E. 11.78 (Ranging From 5.20-25.90)Ng/Ml. The Cut Off Value For Predicting Hypertension In Pregnancy Was 14.96 Ng/Ml
With Sensitivity Of 74% And Specificity Of 76%.Weight And Serum Vitamin D Were Independent Predictors For
Hypertensive Disorders Of Pregnancy With P Value Of 0.024 And 0.00 Respectively. There Was Inverse Correlation
Between Serum Vitamin D Levels And The Severity Of Hypertension (P=0.00). The Serum Vitamin D Levels Were Low
Among Those Mothers Who Delivered Preterm Than Those At Term Gestation (P=0.00),Also Were Significantly Low
Among The Mothers Who Had Babies With Respiratory Distress, Iugr And Iud When Compared To Those With Live Births
(P=0.00) .Conclusion: Serum Vitamin D Levels In Early Gestation Were Inversely Associated With Severity Of Hypertension
In Pregnancy And Adverse Perinatal Outcomes.
***************

Hysterosalpingo-Contrast-Sonography (Hycosy) And Colour Doppler In The Evaluation Of Tubal Patency As A Safe
Outpatient Procedure In An Infertile Women.
Author: Dr. Jeena Baburaj
Co Author:

Objective: To Analyze The Applicability Of Hysterosalpingo-Contrast-Sonography (Hycosy) And Colour Doppler In The
Evaluation Of Tubal Patency In Infertile Women, As An Outpatient Procedure.
Method: 100 Women With Primary Or Secondary Infertility Were Evaluated For Tubal Patency In Two Year Period From
January 2012, With Hycosy And Colour Doppler. A Combination Of 100Ml (200Mg) Injection Ciprofloxacin, 100Mg
Hydrocortisone And 4Cc Air Is Used As The Contrast Medium. Using A No. 8 Foleys Catheter This Contrast Medium Was
Injected In To The Uterine Cavity By 8Th 9Th Or 10Th Days Of Menstrual Period. In Hycosy, Tubal Patency Was Confirmed
By Visualizing The Spill Of Contrast Media From The Fimbrial End Of Fallopian Tubes (Water Fall Sign) And Mosaic Pattern
In Colour Doppler. Post Procedure Collection Of Fluid In Cul- De- Sac And Free Floating Fimbria Of The Tube Were Other
Supportive Signs.
Results: Out Of 100 Women Studied Bilateral Tubal Patency Was Confirmed In 84 Subjects (84%). Bilateral Tubal Block
Was Seen In 2 (2%) And 14(14%) Had Unilateral Tubal Block. There Were No Major Side Effects. 30 Women (30%)
Complained Of Lower Abdominal Pain And 6 (6%) Had Vaginal Spotting. Procedure Was Not Completed In Six Women
Because Three Had Syncope After Inflating The Foleys Bulb And The Other Three Had Catheterization Failure. The Failure
Rate Was 5.6 %( 6/106). Successful Completion Of Hycosy Was Possible In 94.3% Of Subjects Without Any Major
Complications.
Conclusion:
Hycosy Can Be Done As A Screening Test To Assess Tubal Patency By A Gynecologist With Sufficient Experience In Pelvic
Sonography, As A Safe, Non Invasive Outpatient Procedure With No Radiation Hazard Or Infection. Easy Tubal Passage
Can Allow Medical Treatment, While A Doubtful Or Frankly Occluded Fallopian Tube Should Be Investigated By
Laparoscopy

***************

Transversus Abdominis Plane (Tap) Block For Postoperative Analgesia

Author: Dr. Jasmine Salkar
Co Author: Dr Sarada S,1, Dr Vasundhara K2, Dr Uma Maheshwar3,

Objective: To Assess The Effectiveness Of Surgical Tap Block In Providing Post-Operative Analgesia In Women Undergoing
Gynaecological Surgeries And Caesarean Section.
Methodology: 40 Women Between The Ages Of 18 And 60 Years, Who Underwent Either Total Abdominal Hysterectomy
Or Exploratory Laparotomy Or Caesarean Section Under Spinal Or General Anesthesia Were Given Ultrasound Guided
Transverses Abdominis Block Perioperatively With Bupivacaine 0.25% 20 Ml Bilaterally For Analgesia After Surgery. The
Post-Operative Pain Was Assessed By Visual Analogue Pain Score (Vas Scale) At Specific Time Intervals Up To 24 Hrs.
Results: Successful Outcome Was Reported In 82.5% (33/40) Of The Patients. Tap Block Was Shown To Reduce The Need
For Postoperative Opioid Use, Increase The Time To First Request For Further Analgesia, And Provide More Effective Pain
Relief, While Decreasing Opioid Related Side Effects Such As Sedation And Postoperative Nausea And Vomiting. It Also
Improved PatientS Satisfaction Regarding Analgesia After Abdominal Surgery.
Conclusion: Adequate Postoperative Pain Relief Modifies The Surgical Stress Response, Aids Recovery And Leads To A
Better Outcome Following Surgery. It Should Be Considered As Part Of A Multimodal Approach To Anaesthesia And
Enhanced Recovery In Patients Undergoing Abdominal Surgery.

***************

Pregnancy Outcomes In Hiv Seropositive Women At Government Maternity Hospital, Tirupati, A Tertiary Healthcare
Center.
Author: Dr. Sindhoora Ambati
Co Author:

Objective: To Assess The Influence Of Hiv Infection On The Pregnancy Outcomes Of Hiv Seropositive Women At
Government Maternity Hospital, Tirupati, A Tertiary Healthcare Center.
Methods: This Is A Retrospective Study Of Hiv Seropositive Pregnant Women From Our Center Who Delivered Between
April 2013 To March 2014.

Results: Out Of A Total Of 12,931 Pts Who Were Delivered Between April 2013 And March 2014, 100 Patients Were Hiv
Seropositive (0.77%).
Most Patients Are Young (85% In 20-29Yrs Age Group) And Majority Were Of Low Parity (Primi-41%, G2-45%). 59% Of
Them Were From Rural Areas And 49% Were Unbooked Cases. 21% Were Newly Detected Patients And 23% Were Not
On Art At The Time Of Labour.
28% Had Previous Bad Obstetric Outcomes: Abortions (13%) And Infantile Death (15%). This Time, 3 Had Mtp, 6 Had Iud
And 1 Had Still-Birth And 9 Had Pre-Term Delivery.
Obstetric Complications Were Prom (11%), Antepartum Eclampsia (3%), Pih (5%), Oligohydramnios (3%), Severe Anemia
(2%) And Past Dates (17%).
28 Patients Underwent Lscs For Obstetric Indications.
Of The 90 Live Births, 6 Were Pre-Term And Many Were Under Weight. All Of The Infants And Mothers Received Arv
Prophylaxis. Only 44 Of The 90 Live Births Had Follow Up Data. 75% Received Exclusive Breast Feeding And All Recieved
Co-Trimoxazole Prophylaxis. 3 Of The Infants Died Within Days Of Birth And None Of The Others Tested By Dbs At 6 Weeks
Or 6 Months Were Seropositive.

Conclusions: Most Of The Hiv Seropositive Women Were Relatively Young And Of Low Parity With 1/5Th Of Them Newly
Detected. They Have Relatively Higher Incidence Of Antenatal Complications And Bad Obstetric Outcomes.
Art Prophylaxis Appears To Effectively Prevent Mother To Child Transmission. There Was No Difference In Hiv
Transmission Between Lscs And Vaginal Delivery And Breast Feeding Appears To Be Safe.

***************

Screening Of Pih By Uterine Artery Doppler,Isometric Grip Test & Roll Over Test
Author: Dr. Chaitra Thunga
Co Author: Dr Shailesh J Kore1,

Objective: To Compare The Efficacy Of The Three Screening Tests I.E. The Isometric Grip Test, Uterine Artery Doppler &
Roll Over Test In Terms Of Their Predictive Values For The Development / Non Development Of Gestational Hypertension.
To Determine The Sensitivity, Specificity, Positive & Negative Predictive Values Of The three Screening Tests &
To Evaluate Their Clinical Utility.

Study Design: Prospective Study Was Carried Out On 120 Low Risk Women Attending The Opd At Lokmanya Tilak
Municipal Medical College,Sion, Among Those Only 106 Patients Were Included In The Final Analysis. The Isometric Grip
Test Performed At 18-20 Weeks With Hand Dynamometer.Uterine Artery Doppler Performed At 18-20Weeks And Ri
Calculated. Roll Over Test Performed At 28-29 Weeks,Increase In 20Mmhg Dbp From Turning Left Lateral To Supine
Position Was The Criteria.

Results: 19% Women Developed Pih, Maximum Patients Were Primigravida And Between 21-25Years Age Group. Out Of
15 Positive Isometric Grip Test 11 Developed Pih , Sensitivity Of 55%. Out Of 6 Positive Roll Over Test 5 Developed Pih,
Positive Predictive Value Of 83%.Uterine Artery Doppler - The Most Sensitive Of All The Tests.The Roll Over Test Is Very
Specific.

Conclusion: Patients With All The Three Positive Tests Have High Probability Of Developing Complications Of Pih. Roll
Over Test Has Highest Specificity. Uterine Artery Doppler - Highest Sensitivity & Can Be Used In Clinical Practice Routinely.

***************

Role Of Uterine Artery Doppler, Serum Papp-A And -Hcg At 11-14 Weeks Of Gestation In Prediction Of
Preeclampsia
Author: Dr. Zeba Khanam
Co Author: Dr Zeba Khanam1, Dr Saumya Prasad2, Dr Pratima Mittal3, Dr Jyotsna Suri4, Dr Anita Kumar, Dr Rekha
Bharti, Dr Shabnam Bhandari Grover. 5

Objective: To Determine Role Of Uterine Artery Doppler(Uta), Serum Pregnancy Associated Plasma Protein A(Papp-A)
And Beta-Human Chorionic Gonadotrophin(-Hcg) Estimation, At 11-14 Weeks Of Gestation, In Predicting Preeclampsia.
Material And Methods: Uta And Papp-A Were Estimated In 80 Gravid Women At 11-14 Weeks Of Gestation. Mean UtaPi And Uta-Ri Were Recorded. Serum Papp-A <0.4 Mom And -Hcg <0.5Mom Were Taken As Abnormal. All 80 Patients
Were Followed Clinically During Entire Pregnancy Till Delivery. Preeclamptic Features If Any, Were Documented.
Results: Normal Uta-Pi Was Found In 39 Patients And Only 1 Out Of Them Developed Preeclampsia. Out Of 41 Patients
With Pi Above Mean 1.5(Sd0.5), 3 Developed Preeclampsia (Sensitivity75%,Specificity 50%,Ppv7.3%,Npv 97.4%). Normal
Uta-Ri Was Found In 38 Out Of 80 Patients And 2 Of Them Developed Preeclampsia. In The Remaining 42 Patients With
Ri Above Mean 0.7(Sd 0.1), 2 Developed Preeclampsia(Sensitivity50% ,Specificity48%,Ppv4.7%,Npv94.7%). Uta-Ri And
Uta-Pi Both Were Elevated In 37 Patients. Out Of Them, Only 3 Developed Preeclampsia(Sensitivity75%,Specificity
55.2%,Ppv8.1%, Npv97%). Normal Serum Papp-A Was Found In 24 Patients And Only 1 Out Of Them Developed
Preeclampsia. Out Of 56 Patients With Low Papp-A,
Only 3 Developed Preeclampsia
(Sensitivity75%,Specificity30%,Ppv5.3%,Npv95.8%). Normal -Hcg Was Found In 21 Patients And 2 Of Them Developed
Preeclampsia. In Remaining 59 With Low -Hcg Values, Only 2 Developed Preeclampsia (Sensitivity50.76%,Specificity
25%,Ppv3.3%,Npv90%). Combined Screening With Uta, Papp-A And -Hcg Improved Specificity, Ppv And Npv To 90%,
27% And 98.5% Respectively, However Sensitivity Remained The Same.
Conclusion: Uterine Artery Doppler Is A Useful Screening Modality In Prediction Of Preeclampsia, However Combined
Estimation Of Serum Papp-A And -Hcg Values Increases Sensitivity And Specificity Of Uterine Artery Doppler Test.

***************

Severe Acute Maternal Morbidity (Samm) In A Tertiary Care Hospital

Author: Prof. Shirley George
Co Author: Dr Shilpa Venkatesh1, Dr Vani Ram Kumar2, Dr Sheela Cn3, Dr Annamma Thomas4,

Objective: To Evaluate Severe Maternal Outcomes (Including Maternal Deaths And Maternal Near Miss Cases Or Samm).
Materials & Methods: A Prospective Study Of Severe Maternal Outcomes (Including Maternal Deaths And Maternal Near
Miss Cases) In Department Of Obstetrics & Gynecology, Sjmch Bangalore From May 2012 To April 2013 Was Done. The
Total Number Of Deliveries And Total Number Of Live Births Were Recorded. For Each Woman, Data Was Collected On
The Occurrence Of Selected Severe Pregnancy-Related Complications, Use Of Critical Interventions And Admission To
Intensive Care Unit.
Results: The Total Number Of Deliveries Was 2340. The Numbers Of Maternal Deaths Were 3. The Total Number Of Live
Births Was 2194. The Nature Of The Near Miss Cases During The Study Period Was Recorded. Prevalence Of Samm Was
2.025%.
Conclusion: In Areas Where The Maternal Mortality Is Low, There Is A Need To Shift Focus To Maternal Near Miss Cases
Or Samm (Severe Acute Maternal Morbidity), Which Is A Useful Adjunct To Maternal Death Enquiries. Data Collected On
Near Miss Cases Or Samm Helps To Identify Health System Failures Or Priorities In Maternal Health Care More Rapidly
Than Maternal Deaths.

***************

Awareness And Acceptability Of Screening For Downs Syndrome In Women

Author: Dr. Snigdha Kumar
Co Author: Dr. Kamal Patil1, Dr. M.K.Swamy2,

Objective: To Evaluate The Awareness In The Women Regarding Prenatal Screening For DownS Syndrome And To
Promote Its Acceptance In Them.

Method: All Women Less Than 23 Weeks Period Of Gestation Attending Anc At KleS Prabhakar Kore Charitable
Hospital & Mrc Were Asked To Fill Out A Questionnaire To Assess Their Knowledge About DownS Syndrome. The
Women Along With Their Spouse Then Underwent Detailed Prenatal Counselling And Were Offered Screening Tests
According To Their Period Of Gestation. The Women Were Allowed To Make A Voluntary Choice.

Results: Out Of All The Women Included In The Study, Very Few Were Aware About The Screening Tests For DownS
Syndrome. Acceptability Rate For The Offered Tests Was High, Specially Among Those Who Were Either Aware Of The
Screening Tests Or Who Had A Past History Or Family History Of Congenital Or Chromosomal Disorder.

Conclusion: There Is A Lack Of Awareness Regarding DownS Syndrome Screening Among Women Specially Regarding
Various Tests And Their Availability. There Is A Need For A Systematic Informing, Counselling And Guiding Pregnant
Women About The Availability, Implications And Limitations Of The Screening Tests.
***************

Do Size And Number Of Myomas A Deciding Factor For An Approach To Myomectomy?

Author: Dr. Garima Kachhawa
Co Author: Kriplani A1, Malik N2, Mahey R3, Badiger S4, Gupta M5

Objective: To Evaluate The Operative And Clinical Outcomes After Laparoscopic Myomectomy Irrespective Of The Size
And Number Of Myomas.
Material And Methods: A Total Of 173 Women Who Underwent Laparoscopic Myomectomy Between 2009 To 2013 Were
Reviewed And The Patients` Data Was Stratified Into 2 Groups According To The Gross Uterine Size: Group 1 Included
Women With Uterine Size <12 Weeks Gravid Size While Group 2 Included Women With Uterine Size >=12 Weeks.
Perioperative And Long Term Outcomes Were Compared.

Results: The Mean Age And Bmi Of Patients Were 31.35.5 Years And 24.91.9 Kg/M2. Group 1 Comprised 37 Women
(21.3%) While Group 2 Comprised 136(78.6%) Women. Infertility Was Present In 79.7%(138/173), Menorrhagia In
41.6%(72/173), Dysmenorrhoea In 38.2% (62/173) And Lump Abdomen In 38.7% (63/173) Women. Primary Infertility
Was Present In 63% (138/173) Of Women And Secondary Infertility In 37%, 4.6% Had Recurrent Abortions While 13.8%
Were Unmarried. In All, 53.2% Had Single Myoma While 46.8% Had Multiple Myomas Ranging From 2 To 12. The Uterine
Cavity Was Entered During Myomectomy In 15.6% Women [Group1:13.5% (5/37), Group2: 16.2% (22/136); P=0.69]. The
Mean Blood Loss And Operative Time Was Was Significantly More In Group 2 (P=0.001; P=0.00). Long Term Follow Up
Was Studied In 149 Women, 95.3% (142) Had Resolution Of Symptoms While 4.7% Women With Dysmenorrhoea Had
No Change In These Symptoms. Out Of 124 Infertile Women, 61.2% (76/124) Conceived [59.3% (19/32) In Group 1 While
61.9% (57/92) In Group 2]. Out Of These, 47.3% (36) Had Vaginal Delivery, 43.4% (33) Underwent Caesarean Section,
6.5% (5) Had Abortions While 2.6% (2) Are Still Pregnant.

Conclusions: Laparoscopy May Be Considered As An Appropriate, Safe And Effective Approach For Myomectomy With
Good Surgical And Reproductive Outcome. Size And Number Of Myomas No Longer Should Be Considered A Limitation
In Selecting Laparoscopic Route.
***************

Role Of Vulvar Cytology Vs Colposcopy In Women With Chronic Vulvovaginal Complaints And Future Role Of Hpv Pcr
As A Primary Screening Modality
Author: Dr. Sunaina Wadhwa
1,
Co Author: Dr. Pratima Mittal Dr.Harsha Gaikwad2, Dr.Jyotsna Suri3, Dr. Mausmi Bharadwaj4, Dr. Suresh Bhambhani5

Objective: To Evaluate The Role Of Cytology, Colposcopy And Hpv Pcr Test In Patients With Chronic Vulvovaginal
Symptoms.
Materials And Method: It Was A Cross Sectional Study Conducted On 100 Sexually Active Female With Chronic
Vulvovaginal Complaints > 6 Months. Pregnant Females, Known Case Of Malignancy Of Lower Genital Tract, Patients With
Active Bleeding Per Vaginum Were Excluded. A Detailed Relevant History Was Taken On Preformed Questionnaire. All
Patients Were Subjected To Vulvar Cytology ,Hpv Pcr Test And Vulvoscopy. Vulval Biopsy Was Taken In Patients Who
Found To Be Positive On Either On Cytology Or Colposcopy.
Results: Mean Age Of Patient Was 39.1 Yr. Most Common Complaint Was Pruritus Vulva Followed By Discharge Per
Vaginum. On Inspection Vulva , 18 Patients Had Abnormality But Cytology Detected Abnormality Was Found In 10
Patients, Colposcopic Abnormality Was Positive In 30 Patients(12 More Subclinical Cases) And Hpv Pcr Test Was Positive
In 18 Patients. 34 Patients Were Subjected To Biopsy And Abnormality Found In 28 Patients. Out Of These 28, Cytology
Was Positive In 6, Colposcopy Positive In 28 , Hpv Pcr In 12 Patients. Sensitivity, Specificity, Ppv & Npv Taking
Histopathology As A Gold Standard I.E. 33.3% ,97.5% ,75%, 86.95% Of Cytology,89%, 97.6%, 89%, 97.6% Of Colposcopy,
50%, 96.4%, 75%, 90% Of Hpv Pcr Respectively
Conclusion: Vulvovaginal Cancers Are On Rise, Thus Increase The Importance Of Early Detection Of Premalignant And
Malignant Lesions. Cytology Vulva Has A Limited Role But High Sensitivity And Specificity Of Colposcopy Vulva And Hpv
Pcr Indicates Its Role In Detecting Cases Which Often Missed On Naked Eye Examination. Women With Persistent
Vulvovaginal Complaints Should Be Screened And Keep In Scrutiny For Follow Up As They Are The Potential Candidates
For Vulvovaginal Malignancies.

***************

Caesarean Delivery At Maternal Request In A Rural Medical College Hospital.

Author: Prof. Narayanaswamy Mariyappa
Co Author:

Objective: To Find Out The Reasons Behind Women Preferring Caesarean Section In The Absence Of Obstetric And
Medical Indications.
Materials And Methods: This Is A Prospective Study In Women Who Came For Delivery At R.L. Jalappa Hospital And
Research Centre, Kolar, A Tertiary Level Teaching Hospital. All Women Who Underwent Caesarean Delivery For Maternal
Request Were Included In This Study.
Results: The Total Number Of Deliveries During The Study Period (One And Half Year) Was 3639. There Were 1877 (52%)
Vaginal Deliveries And 1762(48%) Caesarean Sections. Among 1877 Caesarean Deliveries, 44(2.5%) Had Maternal Request
As Their Indication. Majority(54.5 %) Of Them Were In The Age Group Of 20 25 Years. Multigravida Opted For
Caesarean Section More Than Primigravida, (30 Versus 14). Most(61.3%) Of Them Have Finished Their Primary School.
Majority Of Them (56.8%) Were In Class Iv Socioeconomic Status Of KuppuswamyS Scale. The Various Reasons For
Women Requesting Caesarean Delivery Were Refusal Of Vbac (Vagina Birth After Caesarean Section), Simultaneous
Tubectomy, Painless Delivery, Prolonged Infertility, Afraid Of Neonatal Outcome And Astrological Concerns.
Conclusion: Many Of The Women Opted Caesarean Delivery In Our Study Were For Preventable Reasons Like Painless
Labor And Simultaneous Tubectomy Which Would Have Been Avoided By Prior Counselling Started From Antenatal Period
And By Providing Labor Analgesia. Proper Education Of The Patient And Personal Involvement Of The Treating
Obstetrician In Counselling The Patient And Her Supporters Can Reduce Caesarean Delivery For Maternal Request.
Key Words: Caesarean Delivery, Maternal Request, Painless Labor.

***************

Transvaginal Sonographic Evaluation Of Anal Sphincter Defects Following Instrumental Deliveries

Author: Dr. Swaramya Chandrasekaran
Co Author: Dr. Jayalakshmi D.1, Dr. Dilip Kumar Maurya2, Dr. Deepak Barathi3,

Objective: To Identify Anal Sphincter Defects And Their Type, If Any, Using Transvaginal Ultrasound At 48 Hours, 6 Weeks
And 3 Months; To Evaluate For Symptoms Of Anal Incontinence At 6 Weeks And 3 Months And To Identify Association Of
Sphincter Defects With Symptoms Of Anal Incontinence

Methods: This Was A Prospective Clinical Study, Cross-Sectional With Longitudinal Follow-Up Done Among 290
Primiparous Women Following Instrumental Deliveries. A Detailed Vaginal And Rectal Examination Was Done
Immediately Following Delivery. Transvaginal Ultrasound Was Performed At 48 Hours, 6Weeks And 3 Months And Defects
Were Classified According To Starck Score. Saved Sonographic Cine Loops Were Reviewed By A 2Nd Observer. Symptoms
Of Anal Incontinence Were Elicited By An Oral Questionnaire At 6 Weeks And 3 Months And Quantified Using Wexner
Score.

Results: In This Study, 9.7% Of The Women Had Sonographically Detectable Anal Sphincter Defects At 48 Hours, Of Which
7.8% And 2% Were Persistent At 6 Weeks And 3 Months Respectively. Eas Defect Was The Predominant Type Of Injury
Detected At 48 Hours, With Significant Resolution Over 6 Weeks (P=.004) And 3 Months (P=.000). Resolution Of Ias
Injuries Was Significant Only By 3 Months (P=.016). There Were No Newly Detected Injuries During Follow-Up. Overall,
25% Of Women Had `Symptoms Of Anal Incontinence At 6 Weeks And 8.5% At 3 Months. There Was Significant
Association Between Anal Sphincter Defects At 48 Hours And Anal Incontinence At 6 Weeks (P=.024), Particularly Eas
Defects (P=.023), But Not At 3 Months (P=.132).

Conclusion: Eas Defects Were The Predominant Type Of Injuries Detected At 48 Hours And Showed Significant Resolution
Over 6 Weeks And 3 Months. Most Women Had Minor Symptoms Of Flatus Incontinence. Anal Sphincter Defects At 48
Hours, Particularly Eas Defects Were Significantly Associated With Anal Incontinence At 6 Weeks.

***************

Umbilical Coiling Index Marker Of Perinatal Outcome

Author: Dr. Janani Alagiriswamy
Co Author: Dr.Deepthi Sharma1, Dr.Radhamany K2,

Objective: To Study The Correlation Of Umbilical Coiling Index ( Uci ) To The Perinatal Outcome

Methods: One Hundred And Eighty One Antenatal Women Were Studied And Umbilical Coiling Index Calculated At The
Time Of Delivery. A Coil Was Defined As A Complete 360 Degree Spiral Course Of Umbilical Vessels. Uci Was Calculated
By Dividing The Total Number Of Coils By The Umbilical Cord Length In Centimeters. Hypocoiled Cords Were Those Having
Uci Less Than 10Th Centile (0.12 ), And Hypercoiled Cords Those Having Uci More Than 90Th Centile (0.36 ).Its Association
With Various Maternal And Perinatal Risk Factors Were Studied. Statiscal Analysis Was Done By Chi Square Tests And
Anova Test And P Value Of Less Than 0.05 Was Regarded As Statistically Significant.

Results : The Mean Umbilical Coiling Index Is 0.21 +/- 0.08 ; Hypocoiling Was Significantly Associated With Pre Eclampsia
, Oligohydramnios , Fetal Heart Rate Abnormality And Low Apgar At 5 Min (<7) ; Low Birth Weight And Nicu Stay Was
Significantly Associated With Both Hypocoiling And Hypercoiling.

Conclusion - Abnormal Umbilical Coiling Index Is Associated With Several Antenatal And Perinatal Adverse Features

***************

Comparison Of Newborn Apgar At 5Th Min Between One Loop & (2) Loops Of Umbilical Cord Around New Born
Neck
Author: Dr. Chirimala Yadala
Co Author: Dr.Chirimala Yadala1,

Objective:
Comparison Of Newborn Apgar At 5Th Min Between One Loop And & (2) Loops Of Cord Around Neck.

Methodology:
It Was A 6-Months Case Control Study Involving 120 Parturients Whose Babies Presented With Loops Of Cord Around
Neck From January 2014 To June 2014.. The Patients Admitted To Labor Room With Period Of Gestation >37Wks Were
Included In Present Study.

The Variables Of Interest Were:

Maternal Age, Parity,Gestational Age

Ultrasound During Pregnancy

No. Of Umbilical Cord Loops

Type Of Nuchal Cord(Tight Or Loose)

Foetal Weight

5Th Min. Apgar Score

Liquor Status (Meconium Stained Or Clear)

Setting:
Government Maternity Hospital, Tirupathi.

Results:
Interested Variables Are Noted And Compared Between Single Loop Of Umbilical Cord And 2 Loops Of Cord. Here
Apgar <7 Is Taken As Clinical Asphyxia At 5Th Min And The Results Are:
Of The 120 Parturients, 86 Parturients Presented With Single Loop Of Umbilical Cord Around Foetal Neck. Of This 86
Parturients 7 New Born Presented With Clinical Asphyxia I.E Apgar <7 At 5Th Min. Of Birth And The Incidence Is 8.1%.
Of The 120 Parturients, 34 Parturients Presented With 2 Loops Of Cord Around Neck. Of This, 3 New Born Presented
With Clinical Asphyxia I.E Apgar <7 At 5Th Min. Of Birth And The Incidence Is 9.1%.

Conclusion:

In The Presence Of Tight, Multiple Loops Of Nuchal Cord Associated With Meconium Stained Liquor, Perinatal Mortality
And Morbidity Are High (Apgar < 7).. Identification Of These Risk Factors Is Useful In Early Decision Making When Facing
A Single Term Pregnancy With Tight Nuchal Cord Before Delivery.

***************

Surgical Emergencies In Ectopic Pregnancy

Author: Dr. Vijya Jyothula
Co Author: Dr.Soumini.G Associate Professor1, Dr.Lavanya Kumari.S Professor Of Obstetrics&Gynaecology2,

Objective:
Ectopic Pregnancy Continues To Be A Leading Cause Of Maternal Morbidity And Tubal Rupture It Is Still A Life Threatening
Complication With Inevitable Loss Of Pregnancy &Reduced Childbearing Potential Among Women Of Reproductive
Age.The Objectives Of Present Study Are To Evaluate Maternal Obstetric Related Risk Factors And Maternal Outcome

Methods:
In This Observational Study Of 55 Cases Of Ectopic Pregnancies [ 5 Per 1000 Pregnancies] In One Year From August 2013
To July2014 At Government General Hospital, Kakinada, Attached To Rangaraya Medical College ,A Teaching &Referral
Hospital, Who Underwent Emergency Surgical Intervention Were Analysed For Obstetric Risk Factors, Clinical
Presentation ,Gestational Age,Surgical Procedures And Maternal Outcome. Diagnosis Is Done By
Paracentisis,Culdocentesis,Usg,Urine Pregnancy Test.
Results:
The Most Common Age Of Women Was Between 21-25Yrs In 50%. The Gestational Age With Ruptured Tube Was 7.2 +/2.2 Weeks In 61%.Pain Abdomen And Bleeding Pv Were Common Symptoms In 96%. Tubal Rupture Was Encountered
More Often In Women With At Least One Child Than In Childless Women33.3% History Of Ectopic Pregnancy Was Found
In 35% Tubal Rupture With History Of Ectopic Pregnancy In This Series 3.7% And In Those With At Least One Child Of
Women 33.3% With A Ruptured Tube. Ampullary Ectopics Accounted To 46.29%. Post Tubectomy 20 %.There Were No
Cases On Infertility Evaluation And Treatment
Conclusion:
This Suggests That Ectopic Pregnancy Is Less Suspected In These Women. High Degree Of Suspicion,Timely Recognition
,Decision Making And Intervention Are Required In Obstetric Ectopic Emergencies To Reduce Maternal Morbidity And
Mortality.

***************

Title: Endoscopic Management Of Adenomyoma: Series Of Fourteen Cases At A Single Tertiary Care Centre. Authors:
Monica Gupta, Alka Kriplani, Garima Khadgawat, Reeta Mahey.
Author: Dr. Monica Gupta
Co Author: Alka Kriplani1, Garima Khadgawat2, Reeta Mahey3,

Objective:
To Present A Series Of Fourteen Consecutive Women With Adenomyomas Who Were Successfully Managed With A
Standard Treatment Strategy Endoscopic Excision. To Elucidate The Feasibility And Effectiveness Of Endoscopic
Management Of Adenomyomas.

Materials And Methods:

It Was A Cross-Sectional Case Series Of Fourteen Women Who Presented To Obstetrics And Gynecology Department Of
A Tertiary Academic Hospital And Endoscopic Unit Between 2010 To 2014. The Fourteen Cases Described In This Report
Were Nonpregnant Women Of Reproductive Age (Mean Age, 28.5 Years Old; Range, 16-35 Years) And Presented With
Infertility (Six Patients), Dysmenorrhea And Menorrhagia (Seven Patients), And History Of Pregnancy Loss (One Patient).
Thirteen Patients Underwent Laparoscopic And One Hysteroscopic Excision Of Uterine Adenomyoma.

Result(S):
The Average Operating Time Was 100.5 Minutes, And The Average Estimated Blood Loss Was 163 Ml. No Event
Complicated The Intraoperative And The Postoperative Course Of These Cases, And No Case Was Converted To
Laparotomy. Six Patients Were Found To Have Juvenile Cystic Adenomyoma Intraoperatively. The Mean Follow-Up Was
13.7 Months, With Complete Regression Of The Symptoms.

Conclusion(S):
Excision Of Adenomyomas Presents Intraoperative Peculiarities Involving Difficulties In Their Dissection And
Manipulation. Endoscopic Management Of These Lesions Appears To Be Safe And Feasible With Good Follow-Up Results
And Limited Recurrence Rates.

***************

Perinatal Outcome In Fetuses With Single Umbilical Artery

Author: Dr. Ruta Patel
Co Author: Dr. S. Suresh1, Dr. Ruta Patel2, Dr. Yuvabalakumaran3, Dr. Aparna Yethirajyam4, Dr. Sulbha R. Tupe5

Objective:
To Review The Perinatal Outcome Of Fetuses With Isolated Single Umbilical Artery ( Sua)
Comparing It With Those Fetuses Having Sua And Associated Structural Malformations.

Methods:
All Fetuses Diagnosed Antenatally With Single Umbilical Artery From Jan Dec 2013 Were Identified. A Retrospective
Study Was Performed On The Ultrasound Records Of These Pregnancies, Determining The Presence Of Congenital
Abnormalities Associated With Sua And Its Outcome And Comparing Their Outcome With Fetuses Having Isolated Sua.
Delivery Data Were Collected To Include Gestational Age At Delivery, Birth Weight, Mode Of Delivery, Fetal Gender, Nicu
Stay.
Results:
242 Pregnancies Were Identified With Fetuses Having Single Umbilical Artery, Of Which Outcome Data Were Available
For 152. Among Them 90 (59%) Cases Were Identified As Having Isolated Single Umbilical Artery (Including Cases With
Growth Restriction). 62 (41%) Cases Had Other Congenital Abnormalities. Among Those Cases, Multisystem (28%),
Cardiac (21%), Genitourinary (14.7%), Skeletal (13.3%), Central Nervous System (10.7%), Gastrointestinal (6.7%), Others
(2.7%), Face (1.3%), Respiratory (1.3%) Anomalies Were Detected. Live Birth Rate In Isolated Sua Was 83% Whereas Sua
Associated With Other Congenital Abormalities Had Only 34% Live Birth Rate. Prognosis Was Significantly Poor In
Associated Sua (66%) As Compared To Isolated Sua (17%). There Was No Significant Difference Observed In Terms Of
Low Birth Weight, Preterm Delivery And Cesarean Delivery In The Two Groups.
Conclusion:
Pregnancies With Isolated Single Umbilical Artery Had Better Perinatal Outcome With Respect To
Live Birth Rate , Compared To Pregnancies Having Sua With Other Congenital Abnormalities.
Pregnancies With Isolated Sua May Be Associated With Growth Restriction , Thus Mandating Close
Follow Up And Monitoring.

***************

Perinatal Outcome In Fetuses With Single Umbilical Artery

Author: Dr. Ruta Patel
Co Author: Dr. S. Suresh1, Dr. Ruta Patel2, Dr. Yuvabalakumaran3, Dr. Aparna4, Dr. Sulbha Tupe5

Objective:
To Review The Perinatal Outcome Of Fetuses With Isolated Single Umbilical Artery ( Sua)
Comparing It With Those Fetuses Having Sua And Associated Structural Malformations.
Methods:
All Fetuses Diagnosed Antenatally With Single Umbilical Artery From January To December 2013 From Mediscan Systems
(Chennai) Were Identified. A Retrospective Study Was Performed On The Ultrasound Records Of These Pregnancies,
Determining The Presence Of Congenital Abnormalities Associated With Sua And Its Outcome And Comparing Their
Outcome With Fetuses Having Isolated Sua. Delivery Data Were Collected To Include Gestational Age At Delivery, Birth
Weight, Mode Of Delivery, Fetal Gender, Nicu Stay.
Results:
242 Pregnancies Were Identified With Fetuses Having Single Umbilical Artery, Of Which Outcome Data Were Available
For 152. Among Them 90 (59%) Cases Were Identified As Having Isolated Single Umbilical Artery (Including Cases With
Growth Restriction). 62 (41%) Cases Had Other Congenital Abnormalities. Among Those Cases, Multisystem (28%),
Cardiac (21%), Genitourinary (14.7%), Skeletal (13.3%), Central Nervous System (10.7%), Gastrointestinal (6.7%), Others
(2.7%), Face (1.3%), Respiratory (1.3%) Anomalies Were Detected. Live Birth Rate In Isolated Sua Was 83% Whereas Sua
Associated With Other Congenital Abormalities Had Only 34% Live Birth Rate. Prognosis Was Significantly Poor In
Associated Sua (66%) As Compared To Isolated Sua (17%). There Was No Significant Difference Observed In Terms Of
Low Birth Weight, Preterm Delivery And Cesarean Delivery In The Two Groups.
Conclusion:
Pregnancies With Isolated Single Umbilical Artery Had Better Perinatal Outcome With Respect To
Live Birth Rate , Compared To Pregnancies Having Sua With Other Congenital Abnormalities.
Pregnancies With Isolated Sua May Be Associated With Fetal Growth Restriction , Thus Mandating
Close Follow Up And Monitoring Till Term.

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Extra-Amniotic Saline Infusion Versus Intracervical Dinoprostone Gel For Cervical Ripening And Induction Of Labour
A Pilot Study.
Author: Dr. Steffi Rodrigues
Co Author: Dr. M.K.Swamy1, Dr. Kamal Patil2, Dr. Pramila Koli3,

Objective:To Compare Extra-Amniotic Saline Infusion To Intracervical Dinoprostone Gel For Improvement Between PreInduction And Post-Induction BishopS Score.

Method: Women With Bishop Scores Less Than 5 Were Assigned Randomly To Either Extra-Amniotic Saline Infusion Or
Intracervical Dinoprostone Gel For Preinduction Cervical Ripening And Induction Of Labour At KleS Dr.
PrabhakarS Kore Charitable Hospital & Mrc.

Results:The Number Of Women Achieving A Favorable Bishop Score After 24 Hours Was Greater With Intracervical
Dinoprostone Gel Than With Extra-Amniotic Saline Infusion.

Conclusion: Induction Of Labour And A Favorable BishopS Score At 24 Hours Was Achieved More In Women With
Intracervical Dinoprostone Gel As Compared To Extra-Amniotic Saline Infusion.
***************

Prediction Of Mode Of Delivery In Term Pregnancies Development Of Scoring System

Author: Dr. Swathi Kotha
Co Author: Pralhad Kushtagi1, Radhakrishnan Krishnapriya 2,

Objective:To Develop And Validate A Scoring System To Predict Mode Of Delivery.

Material And Methods:The Prospective Observational Study Involving 835 Term Pregnancies In Laborafter Excluding
Multiple Gestation, Placenta Previa And Previous Caesarean Delivery Was Conducted.
Multiple Logistic Regression Analysis Was Carried Out In 600 Women To Identify The Factors Independently Associated
With Vaginal Or Caesarean Delivery And Logistic Coefficients Were Determined To Provide Weightage. The Total Score
Was Calculated For Each Subject. Sensitivity And Specificity Were Calculated For Different Total Scores.
The Validity Of The Scoring Was Studied Both Retrospectively And 235 Laboring Women Prospectively Recruited After
The Development Of Score.
Results: Of 600 Women, 61.2% Had Vaginal Deliveries. The Significant Facilitating Factors For Vaginal Delivery Were
Found To Be Maternal Age Of 20-35 Years , Multiparity , Unscarred Uterus , Rhesus Positivity , Expected Baby Weight Of
2.5-3.5 Kg , And With Cephalic Presentation, Bishop Status> 4, Spontaneous Onset Of Labor, Clear Liquor And No Fhr
Abnormality.
Contributors To High Weightage Of Score Were Body Mass Index < 18.5, History Of Infertility , Expected Baby Weight >
3.5 Kg , Bishop Score < 3, Meconium In Liquor And Fhrabnormality.
The Total Score For A Labouring Woman Ranged From 16 To 54.5 And The Cutoff At 21 Provided Sensitivity Of 80%,
Specificity Of 65% And Predictive Values Of 70 And 76%, Positive And Negative Respectively.
On Revalidation Ofthe Score In Two Settings Showed That Sensitivity Remained Similar(71-74%) Whereas Specificity And
Both Predictive Values Were Higher For The Prospectively Studied Latter Group (88, 91 And 63% Respectively).
Conclusion: The Facilitating Score Obtained From This Scoring Scheme Predicted Vaginal Delivery With High Precision.
The Proposed Score Will Be Of Great Help To Obstetricians When Counselling And Communicating On Arrival Of Women
In Labour About Possible Mode Of Delivery.

***************

Study Of Maternal And Perinatal Outcomes In Antepartum Haemorrhage

Author: Dr. Sneha Raj
Co Author: Dr Sneha Raj1, Dr Sowbhagya R Koujalagi2, Dr Lakshmi Devi K3, Dr Khan Saima4,

Objectives : This Study Reviews The Perinatal And Maternal Outcome In Case Of Antepartum Hemorrhage At A Teaching
Institute, In Order To Determine The Causes Of Aph, To Study Mode Of Delivery, Maternal Morbidity And Mortality,
Perinatal Morbidity And Mortality In Patients With Aph.

Method : A Prospective Study Was Undertaken On Maternal And Perinatal Outcome In Women With Aph In 100 Cases
Attending The Hospitals Attached To Jjm Medical College, Davangere, Karnataka From April 2012 To April 2014.

Results : Abruptio Placenta Formed The Largest Group(55%) Followed By Placenta Previa(40%). Cesarean Section Was
The Commonest Mode Of Delivery(55%) In Patients With Aph. Maternal Mortality Was 1%. Perinatal Mortality Was 27%.
Maternal And Perinatal Morbidity Was Quite High.

Conclusion : Ante-Partum Hemorrhage Is An Important Cause Of Maternal Morbidity And Mortality, Despite Modern
Development In Obstetric Practice And Transfusion Service. The Initial Management Of Ante-Partum Hemorrhage Should
Concentrate On Resuscitation And Accurate Diagnosis. The Most Important Causes Are Placenta Previa And Abruption.
Every Unit Should Have A Clear Protocol For The Management Of Massive Hemorrhage, Which Should Be Regularly
Updated And Rehearsed.

Keywords : Antepartum Hemorrhage, Abruptio Placenta, Placenta Previa, Unclassified Hemorrhage

***************

A Study Of Pregnancy Related Acute Kidney Injury Requiring Dialysis At A Tertiary Care Centre
Author: Dr. Vishal Kamate
Co Author: Dr. M. G. Hiremath1, Dr. Venkatesh Moger2,

Objectives : To Determine The Incidence, Etiological Factors, Associated Complications, Perinatal And Maternal Outcomes
In Pregnancies Complicated With Acute Acute Kidney Injury Requiring Dialysis.

Methods : A Retrospective Study Was Done Of All Pregnancies Complicated With Acute Kidney Injury Requiring Dialysis
Over A Four Year Period From August 2010 To July 2014, Managed At Karnataka Institute Of Medical Sciences, Hubli
Which Is A Referral Centre For Eight Districts Of North Karnataka.

Results : Incidence Of Acute Kidney Injury Requiring Dialysis Was 0.1% Amongst The Pts Delivered In Karnataka Institute
Of Medical Sciences. 13.2% Women Requiring Dialysis During This Period Had Pregnancy Related Acute Kidney Injury.
Preeclampsia, Sepsis And Hemorrhage Were The Causes For Pregnancy Related Acute Kidney Injury In Majority (94%) Of
The Patients. Average Age Of The Pts Was 24.1 Years And It Was Most Commonly Seen In Primigravidas In The Post
Partum Period. 86 % Had Associated Anemia And 80% Had Thrombocytopenia. 17 Pts(47%) Developed Disseminated
Intravascular Coagulation To Varying Extents. Hyperkalemia Was The Most Common Electrolyte Abnormality Seen.

Conclusion : Incidence Of Acute Kidney Injury Requiring Dialysis Was 0.1% Amongst The Pts Delivered In Karnataka
Institute Of Medical Sciences. Preeclampsia, Sepsis And Hemorrhage Were The Most Common Etiological Factors For
Acute Kidney Injury. Anemia, Thrombocytopenia, Hyerkalemia Were Commonly Associated Complications. Maternal And
Periantal Mortality Is Very High In Pregnancy Related Acute Kidney Injury Requiring Dialysis.

***************

Clinical Study Of Cardiac Disease Complicating Pregnancy

Author: Dr. Kavya Sharma
Co Author: Prameela1,

Objectives : To Evaluate Maternal And Fetal Outcome Of Pregnancies Complicated By Cardiac Disease .
Materials And Methods : A Retrospective Analysis Of 61 Pregnant Women With Cardiac Disease From August 2013
August 2014 At Cheluvamba Hospital , Mysore .
Results : In The Present Study , Incidence Of Cardiac Disease Is 0.43% .Rheumatic Heart Lesions Constituted 73.2% And
Congenital Heart Disease Constituted 26.2% .Out Of The Rhd Cases 37.7% Of Cases Had Involvement Of Single Valve
Whereas 45.9% Had Multiple Valves Lesions .70.49% Of Cases Belong To Nyha Grade 1 , 14.75% Cases Were Nyha Grade
3 And 1.63% Belong To Nyha Grade 4 . Prior Surgical Correction Was Seen In 19.6% Of Cases. 24.59% Cases Were
Complicated By Anemia And 6.55% Cases Complicated By Pih . 62.2% Cases Delivered Spontaneously Vaginally , 11.47%
Of Instrumental Deliveries And 21.3% Cases By Caesarean Section .7 Cases Complicated With Congestive Cardiac Failure
, Acute Pulmonary Edema , Atrial Fibrillation . There Were 16.3% Nicu Admissions With Perinatal Mortality Of 3.27% And
Mean Birth Weight Of 2.5 Kg . One Maternal Death Was Seen .
Conclusion : Heart Disease In Pregnancy Is A High Risk Condition And Has Major Impact On Pregnancy . Early Diagnosis
By Proper Antenatal Care And Intervention Could Be The Key To Prevention Of Complications .

***************

Indiscriminate Self Medication With Mtp Pills - A Study

Author: Dr. Sukanya Suresh
Co Author: Dr Srinivas K1, Dr K V Malini2, Dr Radhika3,

Objectives : To Study The Consequences Of Indiscriminate Self Medication With Mtp Pills

Study Design: Prospective Observational Study

Duration : From June 2014 October 2014 (Ongoing)

Material And Methods : Data Was Collected From Patients Who Had Come With Complications Attributable To Self
Medication Of Mtp Pills Purchased Over The Counter.
Results : Data Was Collected In 40 Patients With History Of Self Medication With Mtp Pills. More Than Half (65%) Were
In The Age Group Of 25-35 Years And All Were Married. 25 (62.5%) Women Had Incomplete Abortion, 4 (10%) Women
Had Complete Abortion, 2 (5%) Woman Had Missed Abortion, 2 (5%) Women Had Blighted Ovum, 1 (2.5%) Woman Had
A Live Gestation With Cardiac Activity And 3 (7.5%) Women Had Ectopic Pregnancies. Moderate Anemia Was Found In
10 Women (25%) And Severe Anemia In Another 6 Women (15%). Blood And Blood Products Were Required In 15
Women(37.5%). 8 Women (20%) Presented With Features Of Shock And 2 Women (5%) Presented With Sepsis. Surgical
Curettage Was Done In 31 Women (77.5%). 3(7.5%) Women Had Ectopic Pregnancies Laparotomy Was Done In 2 Of
Them And Other Was Managed Medically. 1 Woman (2.5%) Had Uterine Rupture For Which Subtotal Abdominal
Hysterectomy Was Done. Maternal Death Occurred In 2(5%) Women.

Conclusion : Although Medical Abortion Is Safe It Is Imperative That It Be Prescribed And Supervised By Approved
Authorities

***************

The Correlation Between Full Biophysical Profile And Rapid Biophysical Profile In Antepartum Fetal Surveillance
Author: Dr. Akshay Prabhu
Co Author:

Objectives To Determine The Correlation Between The Rapid Biophysical Profile (Rbp) And The Full Biophysical Profile
(Fbp) And To Compare The Individual Scores With Pregnancy Outcomes.
Methods A Prospective Study Was Performed In 153 Singleton Pregnancies With No Fetal Anomalies Between 34-42
Weeks Of Gestation. All Participants Received Both The Standard (Fbp) And The New Rbp. Abnormal Fetal Test Was
Defined As Having A Score Of 6 For Fbp Or 2 For Rbp. The Main Outcome Measured Was SpearmanS
Correlation Coefficient (Rs) Between Both Examinations And Also Between Each Examination And Pregnancy Outcomes
Measured In Terms Of Apgar Scores And Nicu (Neonatal Intensive Care Unit) Admissions
Results The Data Showed A Positive Correlation Between The Two Tests (Rs = 0.62; P < 0.0001). Out Of The Individual
Biophysical Variables, Only Nst (Non Stress Test) Had A Positive Correlation With Rbp. The Sensitivity, Specificity, Positive
Predictive Value And Negative Predictive Value Of Rbp In Predicting Adverse Outcomes Was Found To Be 71.4%, 87.1%,
35.7%. 96.8% Respectively.
Conclusions The Statistically Significant Positive Correlation Between Rbp And Fbp Has Been Revealed. Due To Its
Simplicity, Rapidity, And No Need For Experienced Interpreter, The Rbp May Be Alternatively Used As A Primary Screening
Antepartum Fetal Test In The Overcrowded Obstetric Center.

***************

Study Of Serum Insulin Level And Lipid Profile In Pregnancy Induced Hypertension
Author: Dr. Neha Pansari
Co Author: Dr Priti Bala Sahay1,

Objectives
To Evaluate The Role Of Insulin Resistance In The Pathogenesis Of Pih And To Compare The Lipid Profile In Normal And
Hypertensive Gravidas.

Method(S)
This Study Was A Randomized Case-Control Study Conducted In The Department Of Obs & Gynae, Rims, Ranchi. 50 Cases
Of Pih (All Grades) With Gestational Age > 20 Weeks, Admitted To Labour Room Emergency Were Selected And Fasting
Insulin And Lipid Levels Determined. The Levels Were Compared To That Of Normotensive Gravidas Of Same Age And
Parity.

Result
S. Insulin Level In Pih Cases Was Found To Be Significantly Higher Than Normal Pregnant Women. 60% Of Pih Cases Had
Levels > 9 Miu/L Compared To Only 22% Of Normotensive Gravidas. The Levels Correlated Positively With Both Systolic
And Diastolic Blood Pressure (R = 0.55, P = 0.001 And R = 0.64, P = 0.001 Respectively). With Increasing Levels Of Insulin,
The Severity Of Pih Appeared To Increase.
Lipid Profile Was Found To Be Profoundly Deranged In Cases Of Pih. Total Serum Cholesterol, Ldl Cholesterol And Serum
Triglyceride Levels Were Significantly Higher In The Pih Group (P = 0.0135, P = 0.0188, P = 0.0001 Respectively). No
Significant Difference Was Noted In Other Lipid And Lipoprotein Levels.

Conclusion
Hyperinsulinemia And Hyperlipidemia May Play A Role In The Pathogenesis Of Pih, As A Picture Similar To Syndrome
X (In Genetically Susceptible Women);Insulin Resistance Being The Primary Pathology. Further Research With
Serial Lipid Level Monitoring And Insulin Sensitivity Measurements At Different Stages Of Pregnancy May Establish Their
Definite Role And May Help In Developing Strategies For Prevention And Early Diagnosis Of This Ill-Understood Disorder.

***************

Indications For Hysterectomy

Author: Dr. Kola Sasikala
Co Author: Dr.M.Kavya1, Dr.Swarnasree.G2,

Objectives: Analysis Of Indications For Hysterectomy And Their Outcome .

Method : Retrospective Cohort Study Of 600 Hysterectomy Cases In Private Hospitals From June 2009 To July 2013.

Results :
Out Of 600 Hysterectomies, 498 Were Lavh(83%), 16 Tah (2.6%),73 Svh (12.1%),13 Tlh(2.1%).Overall 291 Cases Had
Fibroid (48.5%),132 Had Adenomyosis (22%),24 Had Endometriosis(4%),8 Had Endometrioid Adenocarcinoma(1.3%),96
Were Operated For Aub(16%), 27 Had Prolapse(4.5%), 22 Had Adnexal Mass(3.6%). Lavh Was Done On 12-28 Weeks
Uteri, Weighing Between 200-1500Gms.The Duration Varied From 40 Min To 2.5 Hrs. Blood Loss Between 100Ml - 750
Ml. 3 Patients Required Blood Transfusion. Complications Were - 2 Bladder Injuries, 1 Stomach Injury. Out Of Tah, 1 Had
Carcinoma Of Ovary, 3 Had Concomitant Incisional Hernia . 1 Had Recurrent Fibroids, 1 Had 28 Week Fibroid .Weight Of
Uteri Was Between 700G-1Kg .Tah Duration Was 1.5 - 2 Hrs. Blood Loss 200 - 500Ml. 1 Required Blood Transfusion.
Svh Were Done On 12 - 16 Wk Uteri , Weighing Between 200 - 700 Gms. The Duration Was 40 Min 1.5 Hrs. Blood
Loss Was 200 - 350Ml. Complications Were 1 Bladder Injury And 1 Rectal Injury .

Lavh Was Preferred Because 1) Its Easy To Operate On Previous Laparotomy Patients 2)Tubes Are Removed In Large
Uteri Without Compromising Ovarian Function 3)Less Blood Loss Due To Initial Clamping Of Ovarian Ligament And Uterus
Removed Piecemeal By Morcellation 4) Patient Preference. Tah Preferred In Complicated Cases, Ovarian Cancers,
Recurrent Peritoneal Fibromatosis, Uterine Cancers. Svh For Prolapse And Pelvic Floor Repair Cases But There Is
Increased Blood Loss Compared To Lavh.

Conclusion:
Lavh Has Decreased Morbidity And Improved The Quality Of Life In Women. Using Special Surgical Techniques For
Transvaginal Volume Reduction, Gynaecologists Preferred Lavh Mostly.

***************

Study Of Effectiveness Of Colposcope In Detection Of Cervical Intraepithelial Neoplasia And Its Correlation With
Histopathological Examination Report
Author: Dr. Kavitha Podugu
Co Author: Dr.G.C.Prabakar1, Dr.M.Vijaya Sree2, Dr. B. Kavitha3,

Objectives: 1.To Stydy The Effectiveness Of Colposcopy In Detecting Cervical Intraepithelial Neoplasia
2.To Correlate The Findings With Histopathology Report Of Cervical Biopsy

Materials And Methods:

Source Of Data: This Study Was Conducted In The Department Of Obstetrics And Gynaecology At Mamata
Medical College, Khammam.

Methods Of Collection Of Data:

Study Design: Prospective Study

Study Period: From August 2013 To July 2014

Sample Size: 100 Cases Who Fulfilled Selection Criteria

All Women Enrolled In The Study Underwent Pap Smear, Colposcopy And Colposcopic Directed Biopsy Simultaneously.
Results Were Tabulated And Analysed Using Appropriate Statistical Method.

Results: The Sensitivity And Specificity Of Pap Smear Was Found To Be 54.3% And 96.2% Respectively And That Of
Colposcopy 76.1% And 96.2% Respectively. Colposcopy Showed Higher Sensitivity Than Pap Smear. The Specificity And
Positive Predictive Value Of Pap Smear And Colposcopy Was Comparable, Where As The Accuracy Of Colposcopy Was
Higher Than That Of Pap Smear.

Conclusion: Majority Of Women Were In The Age Group 31-40 Years. The Commonest Symptom Was Recurrent White
Discharge Per Vagina. Colposcopy Was Useful In Detecting Cervical Intra Epithelial Neoplasia. Colposcopy And Cytology
Used Together In Patients With Cervical Lesions Have A Relatively Higher Chance Of Detecting Squamous Intraepithelial
Lesions/Malignancy As Compared To Either Procedure When Performed Alone.Colposcopy Findings Were Comparable
With Histopathology Report.
***************

Periodontitis As A Risk Factor For Preterm Labour And Low Birth Weight A Case Control Study
Author: Dr. Saranya A C
Co Author: Dr.Sendhil Coumary A1, Dr.Saravana Kumar R2, Dr.Lopamudra B.John3,

Objectives: The Purpose Of This Study Was To Find Out A Causal Association Between Periodontitis And Preterm Labour
Or Low Birth Weight.
Study Design: A Case- Control Study.
Study Setting: This Study Was Conducted In Mahatma Gandhi Medical College And Research Institute, Puducherry
Between February 2013 To June 2014.
Statistical Analysis: Student T Test, Chi-Square And Fisher Exact.
Subjects And Methodology: A Total Of 200 Women Were Included In The Study With 100 Women In Each Group (Cases
And Controls). Cases Included Women Who Had Spontaneous Preterm Labour Or Threatened Ptl (Gestational Age 28- 36
Weeks) Or Women Who Had Delivered A Baby With The Birth Weight Being Less Than 2.5 Kg. Controls Were Patients
Who Had A Normal Labour With The Gestational Age Of More Than 37 Weeks With Birth Weight Of The Baby More Than
2.5 Kg. Periodontal Examination Was Done For Both Cases And Controls.
Outcome Measures: Periodontal Factors Like Plaque Index (Pi), Bleeding Index (Sbi), Probing Pocket Depth (Pd) And
Clinical Attachment Level (Cal) Were Examined For Both Groups.
Results: In The Present Study, Plaque Index And Bleeding Index Was Significantly More In Cases Than Controls With A P
Value Of 0.009 And 0.035 Respectively. Evidence Of Periodontitis Was Seen In 86% Of Cases And 76% Of Controls
Respectively Which Was Also Statistically Significant With A P Value Of 0.071.Moderate Periodontitis Was Found In
Significant Number Cases And Was Statistically Significant With A P Value Of <0.001.
Conclusion: This Suggests That There Exists An Association Between Moderate Periodontitis And Preterm Labour And
Low Birth Weight.

***************

Gestational Diabetes Mellitus- Then And Now...

Author: Dr. Tahmina S
Co Author: Mary Daniel1, B. Pavithra Devi2,

Objectives: To Compare The Prevalence Of Gdm; Maternal And Perinatal Outcomes In Women With Gdm Diagnosed By
Carpenter-Coustan Criteria And By The International Association Of The Diabetes And Pregnancy Study Groups (Iadpsg)
Criteria.
Materials & Methods: Retrospective Analysis Of Women Diagnosed As Gdm At Pondicherry Institute Of Medical Sciences
Between April 2006-March 2007 (Using Carpenter-Coustan Criteria: Group 1) And April 2013-March 2014 (Using The
Iadpsg Criteria: Group 2). Maternal Outcomes Studied Were Polyhydramnios, Hypertensive Disorders In Pregnancy, Mode
Of Delivery And Shoulder Dystocia. Neonatal Outcomes Included Birth Weight, Apgar Scores, Respiratory Distress
Syndrome And Hyperbilirubinemia. For Categorical Variables, Data Was Compiled As Frequency And Percent. For
Continuous Variables, Data Was Calculated As Mean Sd. Data Was Analyzed Using Chi-Square Test.
Results: 500 Pregnant Women Were Screened Between April 2006-March 2007 And 36 Were Included In Group 1. 733
Women Were Screened Between April 2013- March 2014 And 167 Were Included In Group 2. The Prevalence Of Gdm
Was 7.2% In Group 1 And 22.78% In Group 2 (P < 0.001). Majority Of Women Were Primigravidae And Mean Age Of
Women Was Similar (~26 Yrs) In The Two Groups. There Was No Statistically Significant Difference In The Number Of
Women Who Developed Hypertension And Polyhydramnios Among The Two Groups. Operative Vaginal Delivery (16.67%
Vs.6.5%), Mean Birth Weight (3.100.55 Kg Vs. 2.970.47 Kg, P=0.1556), And Large For Gestational Age Neonates
(11.11% Vs. 4.8%, P=0.1443) Were Higher In Carpenter-Coustan Criteria Group Than The Iadpsg Group.
Conclusions: The Overall Maternal And Neonatal Outcomes Seem To Be Better When The Newer Iadpsg Criteria Were
Applied For Diagnosing Gdm, Which Is Reiterated By Adoption Of These Criteria By The Who In 2013. However, Absence
Of Statistically Significant Differences Has Left The Decision Of Adoption Of Either Of The Criteria To The Discretion Of
The Obstetrician.
***************

Uterine Rupture: A Retrospective Study At Government Medical College, Haldwani

Author: Dr. Neha Chauhan
Co Author: Prof. R C Purohit1, Prof. Geeta Jain2, Dr. Usha Rawat3, Dr. Purnima Upreti4,

Objectives: To Determine Prevalence, Etiology, Trend, Management, Maternal And Fetal Outcome Of Uterine Rupture In
Government Medical College And Hospital, Haldwani.

Methods: This Study Was Conducted At The Department Of Obstetrics And Gynaecology, Government Medical College,
Haldwani, Uttarakhand From June 2013 To May 2014.
All Cases Of Ruptured Uterus, Were Included In The Study. Patients Having Ruptured Uterus Due To Congenital
Abnormality Were Excluded From The Study. Demographic Data, Details Of Predisposing Factors, Type And Site Of
Rupture, The Management, Maternal And Fetal Outcome Were Taken Into Consideration For Analysis.

Results: The Total Number Of Deliveries During The Year From June To May 2014 Were 2560. There Were 21Cases (0.82%)
Of Uterine Rupture. Out Of These Only Three (14.28%) Were Booked. Most Of The Patients Presented Between The Ages
21-30 Years. Majority Of Uterine Rupture Occurred In Para 2-4 (57.14%).Commonest Cause Of Uterine Rupture Was
Previously Scarred Uterus. Previous Caesarean Section Scar Was Found In 15 Cases (71.42%). Hysterectomy Was
Performed In 12 Cases ( 57.14%).Bladder Repair Done In 3 Cases Out Of Which One Had Vvf Postoperatively. There Were
Zero Maternal (0%) And 17 Intrauterine Deaths (80.95%). Live Birth Rate Was 19.04%.

Conclusion: This Study Showed That Previously Scarred Uterus Is The Main Cause Of Uterine Rupture Followed By
Neglected Obstructed Labor. Proper Antenatal Care, Appropriate Counseling Of Patients With History Of Previous
Caesarian Section For Hospital Delivery, Training Of Skilled Birth Attendant Can Reduce Mortality And Morbidity Due To
Rupture Uterus.

Key Words: Rupture Uterus , Obstructed Labor , Caesarian Section.

***************

: A Study Of Effectiveness Of Various Treatment Modalities For Perimenopausal Dysfunctional Uterine Bleeding ,
In Central Kerala, Kochi .
Author: Dr. Chaithra M
Co Author: Dr Rajesh Panicker1, Dr Ambica Bai2,

Objectives: To Observe The Effects Of Various Treatment Modalities (Medical And Surgical Line) For Perimenopausal Dub
.
Methods: An Observational Study Was Conducted In Gynecology Department Of Snims In Central Kerala Over A Period
Of 3 Years. 62 Perimenopausal Women Of Age Group 40-55 Years Who Sought Treatment For Dub/ Hmb Of Endometrial
Origin Between September 2011 And September 2014 Were Included In The Study. The Base Line Data Was Collected
Using Hospital Records And Structured Questionnaire. Major Outcomes Studied Were Impact Of Various Treatments On
Menstrual Bleeding At Time Point After 6Months And 12Months, Changes Over Time In Treatment Line Sought, Impact
Of Treatment On Quality Of Life, Activity Limitation And Sexual Functioning.
Results: Majority Of Women Presented With Anovulatory Dub At This Age(40-55Yrs) And Had Disordered Proliferative
Endometrium With Et Of 8-20 Mm Range. Total Number Of Bleeding Days Per Year Decreased By 68% On Medical Line
Of Treatment Alone.70% Reported Disappearance Of Clots Within 3Months Of Medical Line Of Treatment. Recurrent
Menorrhagia Was Seen In 6/20 (30%) Patients On Ormeloxifene At The End Of One Year Whereas Irregular Spotting Was
Seen In All The Ten Patients On Levonorgestrol Intrauterine System For The First Six Months. 12/62 (20%) Of Them
Underwent Hysterectomy For Failed Medical Line Of Management Within An Average Of 6Months. 68% Had Satisfactory
Lifestyle On Medical Line Of Management Including Sexual Functioning.
Conclusion : Medical Line Of Treatment Is Effective In Improving Blood Loss Of Abnormal Uterine Bleeding Of Endometrial
(Aub E) Origin , With Good Acceptance Rate And Minimal Side Effects. It Should Be The First Line Treatment Offered
To The Patient Guided By The Type Of Endometrium In Perimenopausal Age Group.

***************

Cervical Cancer Management In Rural India: Are We Really Living In 21St Century Or Focus On Health Education Of
Doctors
Author: Dr. Sujata Mittal
Co Author:

Objectives: To Study Cases Of Cervical Cancer Managed / Unmanaged In Rural India And To Analyze The Reasons For Poor
Outcome.

Methods: This Is A Retrospective Study Of 218 Cases Of Cervical Cancers Between 2008-2013 With Resultant Outcome In
Terms Of Treatment Or Absence Of Treatment In Spite Of Diagnosis. Reasons For Not Taking The Treatment Have Been
Analyzed. Also, Analysis Of 21 Cases Of Simple Hysterectomy With Resultant Complications Like Vvf, Rvf Has Been Done.
Indications Of Surgery, Operating Surgeon, Availability Of Preoperative/ Postoperative Hpr, Slides/ Blocks, Discharge
Summary And Disease Status At The Time Of Referral Was Done.

Results: 44% Refused To Take Treatment In Spite Of Stage Iii Diagnosis Citing Financial Constraints, Travel Distance Daily
For Rt And Apathetic Attitude Of Family Towards Females. 20.65% Opted For Other Hospitals. 29.8 % Took Complete
Treatment. 80% Of Females Were Illiterate And Dependent. 9.7% Had Simple Hysterectomy For Invasive Disease. 95% Of
Simple Hysterectomies Were Performed By General Surgeons In Private Setups Resulting In 19% Of Complications Like
Vvf, Rvf. 100% Cases Of Simple Hysterectomy Did Not Have Pre-Operative Biopsy. Only 50% Cases Had Post-Operative
Biopsy Report And In None Of The Cases Were Slide / Blocks Available For Review As Trained Pathologists Were Not
Available. General Surgeons Who Had Performed Surgery Were Neither Trained In Doing P/V Examinations Nor Aware Of
Staging Of Cervical Cancer.

Conclusion: Illiteracy, Poverty And Absence Of Implementation Of Cancer Control Programs Are The Major Hurdles In
Control Of Cervical Cancer. The Study Highlights The Absence Of GovernmentS Will To Control Cervical Cancer In
Rural India. It Emphasizes On The Need Of Intensive Training And Health Education Of Gynecologists And Surgeons At
District / Rural Level, Lack Of Which Is A Primary Factor For Violation Of Medical Ethics By The Doctors.
***************

A Study Of Prevalence Of Vitamin D Deficiency Among Pregnant Women & Its Impact On Feto Maternal Outcome
Author: Dr. Shailaja Nageshu
Co Author: Shailaja Nageshu1, Dr.L.Krishna2, Dr.Kirtan Krishna3,

Objectives: To Study Prevalence Of Vitamin D Deficiency In Pregnant Women.

To Study Maternal And Fetal Outcome In Pregnant Women With Vitamin D Deficiency.
Methods: : A Study Was Done Including 100 Pregnant Women. Measurement Of Maternal Plasma 25-Hydroxyvitamin D
Concentrations Was Done In Pregnant Women During Third Trimester Who Attended To Antenatal Care And Delivery In
Pesimsr, Kuppam, Excluding The Pregnant Women With Pre-Existing Medical Disorders. Outcome Variables Were
Maternal Outcome Due To Vitamin D Deficiency Like Pre-Eclampsia, Gestational Diabetes And Fetal Outcome Due To
Vitamin D Deficiency Like Effect On Birth Weight, Neonatal Seizures And Respiratory Infections.
Results: Out Of 100 Pregnant Women 11(13.8%) Had Deficiency And 43(53.8%) Had Insufficiency & 26 (32.5%) Had
Vitamin D In The Range Of 20 -30 Ng/Ml. Pregnancy Complications Like Abruption (2), Pih (4), , Prom (16), Gdm (1). Fetal
Complications Like Low Birth Weight (14), Intrauterine Growth Restriction (1), Nicu Admission (7), Were Noted In The
Insufficient & Deficient Ladies. However, 2/3Rd Of Subjects With Reduced Vitamin D Level Had Uneventful Pregnancy.
Conclusion: Prevalence Of Vitamin D Deficiency Was 13.8% And That Of Insufficiency Was 53.8%. The Difference In
Maternal & Perinatal Adverse Outcome In The Two Groups Was Not Statistically Significant.

***************

Analysis Of Predictability Of World Health Organisation And Asian Indian Body Mass Index And Waist Circumference
In Adverse Maternal And Perinatal Outcomes A Single Centre Prospective Study
Author: Dr. Sharadha Sakthirajan
Co Author: T.K.Renuka Devi1, T.A.Sridevi2, Binayak Debbarman3, Punithavathi Nallaiyan4,

Objectives:
To Compare The Asian Indian Bmi (Body Mass Index) And Wc (Waist Circumference) With World Health Organisation
(Who) Bmi And Wc In The Prediction Of Adverse Maternal And Perinatal Outcome In Overweight And Obese Women.
Materials And Methods:
Prospective Analysis Of 239 Women Booked Within 8 Weeks Of Pregnancy And Followed Till Delivery At Our Centre Was
Done. Women With Bmi 18 Were Excluded. Antenatal, Intrapartum, Neonatal And Postnatal Outcomes Were
Analysed.
Results:
The Mean Age Of The Study Group Was 26.08 Years, Of Which Elderly Gravida Was 1.3%. Overall, 17.6% (42/239) Were
Overweight, 29.7% (71/239) Were Obese And 42.7 % Had Abdominal Obesity As Per Asian Indian Bmi And Wc Cut Off
Whereas Only 8.5% Were Obese And 14.2 % Had Abdominal Obesity As Per Who. Among The Maternal Complications,
Anaemia Was Commonest (15.06%) Followed By Gestational Diabetes (12.9%), Preterm Labour/ Prelabour Rupture Of
Membranes ( 12.1%) And Preeclampsia And Its Complications(6.7%). Compared To Who, Asian Indian Bmi Cut-Off Has
Statistically Significant Predictability For Miscarriage, Gestational Diabetes, Preeclampsia And Its Complications,
Prelabour Rupture Of Membranes, Intrauterine Growth Restriction, Need For Labour Induction And Caesarean Section.
On The Other Hand, Asian Wc Has The Best Predictability Only For Preeclampsia And Its Complications. Sensitivity,
Specificity And Negative Predictive Value Of Asian Bmi Was 82%, 55% And 96% When Compared With 60.7%, 72.3% And
92% Of Who Bmi.
Conclusion:
Categorising Women Using Asian Bmi, An Increase In The Prevalence Of Obesity By Three Fold Is Noted. Asian Bmi And
Wc Has High Sensitivity In Predicting Adverse Maternal And Foetal Outcomes, And Should Be Widely Implemented In
Obstetric Practice.

***************

Optimizing Outcomes Of Vaginal Vault Prolapse With Surgery And Physiotherapy: Analysis Of 4 Cases
Author: Dr. Nidhi Sharma
Co Author: Professor K Jayashree Srinivasan1,

Optimizing Outcomes Of Vaginal Vault Prolapse With Surgery And Physiotherapy: Analysis Of 4 Cases
Duration: 2 Years
Name Of The Investigator: Dr Nidhi Sharma
Name Of The Mentor: Professor K Jayashree Srinivasan, Dr Pratap
Aims: Analysis Of Retroperitoneal Mesh In Comparison To Uterosacral Ligament Suspension In Cases Of Vaginal Vault
Prolapse.
Methodology: Nonrandomized Interventional Prospective Qualitative Assessment Of Surgery And Quality Of Life
Back Ground: Post Hysterectomy Vaginal Vault Prolapse Always Requires A Surgical Correction. In The Last Two Years,
Three Cases Of Post Hysterectomy Vaginal Vault Prolapse Were Done By Abdominal Sacral Colpopexy. One Case Of Post
Hysterectomy Apical Prolapse Repair Was Done By Abdominal High Uterosacral Ligament Suspension.
Results: The Suspension Of Vagina In The Hallow Of Sacrum To The Anterior Longitudinal Ligament Of First Sacral Vertebra
Has Been Shown To Be An Effective Treatment Of Vault Prolapse.
Peritoneum Over Vaginal Apex Was Opened To Identify The Endopelvic Fascia . A Continuous Covering Of Endopelvic
Fascia Was Created Around The Vaginal Epithelium. Nonabsorbable Sutures Were Used To Suspend The Vagina Along
With Endopelvic Fascia To The Uterosacral Ligaments Or Sacral Periosteum.
The Repair, In All Cases Of Vault Prolapse, Was Covered With Peritoneum Stitches. Post Operative Quality Of Life Was
Assessment Was Done By Oral Questionnaire Using Friedman Serial Test. Follow Up Is Available. No Recurrence And
Complications Are Noted.

***************

Bilateral Hydro Thorax As The Only Manifestation Of Ohss In A Patient Of Pcod On Antagonist Protocol
Author: Dr. Sangeeta Jain
Co Author: Dr. Vipin Jain1, Dr. Surbhi Jain2,

Ovarian Stimulation Is An Important Part Of The Ivf Treatment. Some Degree Of Ovarian Hyperstimulation Occurs In All
Women Who Respond To Ovulation Induction, But This Should Be Distinguished From The Clinical Entity Of Ovarian
Hyperstimulation Syndrome (Ohss)(2) .
Past Literature Well Demonstrates That Pcod Patients Are Exposed To A Greater Risk Of Developing Ohss Than Are
Normoinsulinaemic Patients (10). The Aim Of This Review Was To Report An Unusual Post-Stimulation Presentation Of
Bilateral Hydrothorax As The Only Manifestation Of Ovarian Hyperstimulation Syndrome (Ohss) In A Patient With
Polycystic Ovary Disease (Pcod) On Antagonist Protocol Undergoing In-Vitro Fertilization (Ivf) Treatment.
Although No Pharmacological Intervention That Fully Prevents The Development Of Ohss Is Yet Available, Several
Measures Can Be Adopted To Limit The Occurrence Of This Complication By Prompt Diagnosis Of This Condition Based
On Empirical And Symptomatic Approaches, And Appropriate Management Given For Quick Recovery Of The High Risk
Patients.

Background

The Induction Of Ovulation By Gonadotrophins Is One Of The Major Advances In The Modern Treatment Of Infertility
(1).Some Degree Of Ovarian Hyperstimulation Occurs In All Women Who Respond To Ovulation Induction, But This Should
Be Distinguished From The Clinical Entity Of Ovarian Hyperstimulation Syndrome (Ohss) (2). The Clinical Course Of Ohss
May Involve, According To Its Severity And The Occurrence Of Pregnancy, Electrolytic Imbalance, Neurohormonal And
Hemodynamic Changes, Pulmonary Manifestations, Liver Dysfunction, Hypoglobulinaemia, Febrile Morbidity,
Thromboembolic Phenomena, Neurological Manifestations, Adnexal Torsion, And Accumulation Of Massive
Extravascular Exudate Combined With Profound Intravascular Volume Depletion And Hemoconcentration. Also Various
Studies Have Demonstrated That Ohss Is More Frequent In Patients With Pcod (1,2,4,5). Bilateral Hydrothorax As The
Only Manifestation Of Ohss Caused By Viral Infection In A Patient With Pcod Is A Rarity That We Felt Was Worth
Documenting Through This Paper.
To Date, No Methods Are Available To Completely Prevent The Complication Of Ohss , Except For Withholding Hcg And
Gonadotrophins And Continuing Gnrh Agonist In Down-Regulated Cycles(2). In Gonadotrophin-Only-Stimulated Cycles,
Even Withholding Hcg Does Not Completely Prevent The Development Of Ohss. Out Of The Several Stimulation Protocols
Used For Ivf Cycles E.G. Low Dose Gonadotrophins, Gnrh Agonist Protocol, Fsh Protocol, Gnrh Antagonist Protocol ; The
Antagonist Protocol Was Followed In The Reported Case. Although The Use Of Antagonist Protocol Is Possibly Associated
With A Low No. Of Patients Developing Ohss As A Complication , There Are As Yet No Studies Which Provide The Highest
Level Of Evidence To Suggest The Use Of Antagonist Protocol In Preference To Other Strategies. Therefore Attempts
Should Be Made To Standardize The Criteria Used And Identify High-Risk Patients Early On , In Particular Pcod Patients
And Use Prompt And Appropriate Conservative Measures. Extra Precaution After Stimulation In Concrete Fact May Help
The Patient A Great Deal, As It Did In This Case. Quick Reporting, Diagnosing And Treating Can Avoid Serious Potential
Complications That Could Otherwise Crop Up. Despite Extensive Published Research, Case Studies, And Protocols Many
Aspects Of Ohss In Pcod Patients Remain An Enigma, Empirical And Symptomatic Approach Is Rather Safe To Take.

Case Presentation

We Report An Unusual Post-Stimulation Presentation Of Bilateral Hydrothorax As The Only Manifestation Of Ovarian
Hyperstimulation Syndrome (Ohss) In A Patient With Poly Cystic Ovary Disease (Pcod) Having A Concurrent Clinically NonEvident Viral Infection,, On Antagonist Protocol Undergoing In-Vitro Fertilization (Ivf) Treatment. Prompt Diagnosis And
Management Based On Empirical And Symptomatic Approaches Was The Key To Avoiding Complications And Obtaining
Quick Recovery.
Our Patient Is A 28 Years Old Asian Indian Female, With A Five Years History Of Infertility. Before Opting For Ivf, She Had
Undergone Several Cycles Of Ovulation Induction (Oi) And Intra Uterine Insemination (Iui).
The Patient Was Declared As An Established Case Of Pcod Through Endocrine Assessment And Transvaginal
Ultrasonography (Tvs) That Are Currently Considered As The Gold Standard For Diagnosing Pcod. After Discussing And
Informing The Patient About The Possibilities And Risks Of Ohss Especially In The Cases Of Pcod, We Obtained
PatientS Consent And Started Following The Antagonist Protocol For Ivf. We Found That The Patient Was Developing
About 16 Follicles Per Ovary. Her Estradiol Levels (E2) Were Found To Be >4000 Pico Grams On The Day Of Ovulation
Trigger. So, Ovulation Trigger Was Given With Gonadotrophin Releasing Hormone (Gnrh) Agonist. Since Her E2 Levels
Were High, After Discussing The Potential Implications With The Patient, We Postponed The Embryo Transfer, And
Obtained Her Consent For Cryopreservation Of All The Resulting Embryos. Consequently The Patient Was Also Started
On 0.5Mg/Day Dose Of Caberbolin For A Post Ovum Pick-Up Period Of Seven Days.
Three Days After The Ovum Pick-Up, The Patient Showed Up With Congested Throat And Running Nose. Based On The
PatientS Examination And Negative Lab Tests For Bacterial Infection, A Viral Infection Was Kept As Diagnosis Of
Exclusion. The Patient Was Advised Steam Inhalation, Decongestants, And To Immediately Contact The Doctor Should
The Condition Not Improve Or Worsen.
Despite Extreme Precautions, PatientS Condition Did Not Improve Rather Deteriorated As The Next Day She Showed
Up With Disproportionate Cough And Breathlessness.
Ovarian Stimulation Is An Important Part Of The Ivf Treatment. However It Can Lead To Supraphysiologic Responses
Causing Iatrogenic Complications.
Ovarian Hyperstimulation Syndrome (Ohss) Is A Serious Complication Of Ovarian Stimulation, Which Could Be LifeThreatening. The Clinical Course Of Ohss May Involve, According To Its Severity And The Occurrence Of Pregnancy,
Neurohormonal And Haemodynamic Changes, Especially Accumulation Of Massive Extravascular Exudate Combined With
Profound Intravascular Volume Depletion And Hemoconcentration. (2,4,5)
Also It Is Well Established In Literature That Ohss Is More Frequent In Patients With Pcod Than In The Normoinsulinaemic
Patients (Schenker And Weinstein, 1978; Bider Et Al., 1989; Aboulghar Et Al., 1992; Navot Et Al., 1992; Rizk And Smitz,
1992).
Bilateral Hydrothorax As The Only Manifestation Of Ohss Caused By Viral Infection In A Patient With Pcod Is A Rarity That
Was Worth Documenting Through This Paper.
As Is Already Well Documented , Elevated Lh Levels Are Responsible For High Androgen Levels Which In Turn May
Adversely Affect The Development Of Follicles. Theoretically, The Blockade Of Endogenous Lh Secretion By Antagonists
Combined With Ovulation Induction Can Thus Result In Improved Follicular Development(Diedrich K , Diedrich C, Santos
E Et Al. May 1994)(12). Early Assessment Of Elevated Lh Levels Along With Early Diagnosis Of Pcod Through
Ultrasonography Findings Indicative Of Increased Number Of Antral Follicles And The `Necklace' Or `Ring Of Pearls'
Appearance Of The Ovaries During The Early Follicular Phase In Our Patient Made Us Alert For Complications.

Extra Precautions Served As A Good Forcing Function In Timely Diagnosing And Successfully Managing This Case. Thus
The Identification Of High-Risk Patients, And In Particular Pcod Patients And The Use Of Early And Appropriate

Conservative Measures Have An Important Role In The Prevention Of Ohss. Prompt Diagnosis And Appropriate
Management Based On Empirical And Symptomatic Approaches Is The Key To Avoiding Complications And Obtaining
Quick Recovery.

Learning Points/Take Home Messages

1.
Concurrent Infections Can Exacerbate Manifestations Of Ohss. Therefore, After Stimulation, Extra Precautions
Should Be Observed To Avoid Any Infections (Viral Or Otherwise). Especially, Any Hydrothorax Symptoms Should Be
Carefully Watched For, And Quickly Treated.

2.
Ultrasound Guided Thoracocentesis Is A Good Option In The Cases Of Hydrothorax Due To Ohss. The Procedure
Should Be Repeated Till PatientS Condition Clearly Improves.

3.
Despite Extensive Published Research, Case Studies, And Protocols Many Aspects Of Ohss In Pcod Patients
Remain An Enigma. Emperical And Symptomatic Approach Is Rather Safe To Take.

***************

Ovhira Syndrome
Author: Dr. Neha Saxena
Co Author: Dr. Anahita Chauhan1,

Ovhira Syndrome
Authors Dr. Neha Saxena, Dr. Anahita R Chauhan
Department Of Obstetrics And Gynaecology, Seth Gs Medical College And Kem Hospital, Mumbai
Introduction
A Rare Congenital Mullerian Anomaly Which Includes Uterus Didelphys, Obstructed Hemivagina And Ipsilateral Renal
Anomaly Is A Well Recognized Entity Described As Ohvira Syndrome Or Herlin Werner- Wunderlich Syndrome, First
Reported By Wilson In 1925. Mullerian Anomalies Include A Spectrum Of Developmental Defects Ranging From Uterine
And Vaginal Agenesis To Duplication Of The Uterus And Vagina To Minor Uterine Cavity Abnormalities. Mullerian
Anomalies Are Frequently Associated With Renal Anomalies. The Incidence Rate Ranges From 0.2 To 7.4%. It Is A
Challenging Diagnosis As The Patient May Have Normal Menses.

Case Report
A Case Report Of A 14 Year Old Girl Came To Our Outpatient Department With Complaints Of Irregular Menses, Pain In
Abdomen And Dysmenorrhoea Since Last 3 Months And Diagnosed As Ohvira Syndrome (Didelphic Uterus With Right
Hematocolpos Due To Right Hemivaginal Obstruction And Associated Right Renal Agenesis) Is Presented Here.
Ultrasonography (Abdomen And Pelvis) Was Done Which Was Suggestive Of Bicornuate Uterus With Hematocolpos Of
Approximately 8.64.63.6 Cm With Absence Of Right Kidney In Right Renal Fossa ?Agenesis ?Ectopic Kidney And A
Simple Cyst In Right Ovary. Her Magnetic Resonance Imaging (Mri) Was Done To Confirm The Diagnosis Which Revealed
Didelphic Uterus With Hematocolpos Of Right Side And Absent Right Kidney. A Final Diagnosis Of Case Of Ohvira
Syndrome Was Made As There Was Obstruction Of Right Hemivagina And Ipsilateral Renal Anomaly Was Present.
Clinical Relevance
Rare Is The Association Of Didelphic Uterus With Obstruction Of Unilateral Vagina And It Is Frequently Associated With
Ipsilateral Renal Agenesis. This Is Also Known As Ohvira (Obstructed Hemivagina With Ipsilateral Renal Anomaly)
Syndrome, That Was Evident In Our Case.

***************

Pancreatic Carcinoma Complicating Pregnancy

Author: Prof. Sumathi N
Co Author:

Pancreatic Carcinoma Complicating Pregnancy

Author :

Dr.N.Sumathi Md., Dgo., Ficog., Professor Obstetrics &

Gynaecology, Govt. Rajaji Hospital, Madurai

Case Report:
Mrs. Bhagyalakshmi 25Yrs P1L1 On 19.07.2008 Diagnosed As Pseudo Papillary Tumour Intail Of Pancreas Of Size 12.5 X
8.6 X 9.2 Cm Mass With Mixed Echogenicity. As The Tumour Mass Inoperatable Patient Completed Six Cycles Of
Chemotherapy. Ct On 21.03.2009 Showed Reduction In Size Of Mass To 6 X 4.1 Cm On 26.10.2009 Showed Well Defined
Lesion.
This Patient A Case Of Previous Lscs Came With H/O 4 Months Of Amenorrhoea With Lmp 25.08.2012. Usg On 22.12.2012
Showed Single Fetus Of Ga 17 Wks With Maternal Abdomen Showing 16 X 14 X 12.4 Cm Cystic Lesion With Internal
Echoes And Mixed Vascularity Interspersed Between Tail Of Pancreas, Spleen, Left Kidney Oncologist Opinion Obtained.
Planned To Continue Pregnancy With Explained Risk Of Fetal Anomaly.
Serial Usg, Lft, Serum Amylase Level Monitored. The Size Of Lesion In Pancreas Was Not Increasing. Elective Repeat Lscs
Was Done And Delivered An Alive Term Male Baby Wt. 3Kg With No Anomaly And Good Apgar. Patient In Now On Follow
Up With Oncologist.
This Case Has Been Presented For Its Rarity.

***************

Post Partum Septicemia With Portal Vein Thrombosis

Author: Dr. Aparna Peruboina
Co Author: Dr. Aparna Peruboina1, Dr. Chandrakala Magudapathi2,

Paper Presentation
Post Partum Septicemia With Portal Vein Thrombosis
Dr. Aparna Peruboina 1, Dr. Chandrakala Magudapathi 2
G. Kuppuswamy Naidu Memorial Hospital, Coimbatore

Abstract
Background
Portal Vein Thrombosis Is A Rare Occurrence In Postpartum Women. Etiologies Are Thrombophilias. Pregnancy And
Puerperium Constitute Significant Risk .

Case Report
24 Year Old Lady, P2L1, Iud At 35 Weeks, Had Vaginal Delivery Outside Is Referred In View Of Oliguria, Fever, Abdominal
Pain And Vomiting On 3Rd Postnatal Day. She Is A Known Case Of Evans Syndrome On Low Dose Steroids. Usg Abdomen
Revealed Mild Ascites With Retained Placental Bits, Underwent Suction Evacuation, Culture Revealed Multidrug Resistant
E.Coli And Enterococcus, Started On Meropenem And Linezolid. Patient Was Improving Symptomatically, But Suddenly
Became Dyspnoeic With Acute Abdominal Pain On 7Th Postnatal Day, With Acute Massive Ascites. Ct Revealed Splenic
And Portal Vein Thrombosis, Sparing The Ivc. Hereditary Thrombophilia Screening Revealed Protein S Deficiency, Started
On Warfarin And Continued. Postnatal Follow Up At 12Th Week Revealed Recanalisation Of Portal And Splenic Vein.

Discussion
The Incidence Of Protein S Deficiency In Venous Thrombosis Is 1 In 1000, Caused By Mutations In The Pros1 Gene. Protein
S Deficiency Can Be Divided Into Types I, Ii And Iii.
Pregnancy, Surgery, Trauma And Sepsis Aggravate Underlying Proteins S Deficiency. Spontaneous Recanalisation Of
Portal Vein Is Rare But Rapid Initiation Of Anticoagulation Therapy Results In Either Complete Or Partial Recanalisation.
In Patients With Proven Systemic Thrombophilia, Life Long Anticoagulation Therapy May Be Warranted. Portal Vein
Thrombosis May Lead To Mesenteric Infarction, Ivc Extension, Embolic Complications, Liver Cirrhosis And Esophageal
Varices.

Conclusion
Prompt Diagnosis And Early Anticoagulation Was The Cornerstone For Preventing The Maternal Mortality And Morbidity.
Evaluation For Factor S Deficiency Is Essential For Thromboprophylaxis In High Risk Situations In The Future. We Report
This Case For The Early Diagnosis, Evaluation And The Workup Done For Portal Vein Thrombosis.

***************

Paraovarian Cyst Causing Ovarian Torsion A Rare Complication

Author: Dr. Nita Singh
Co Author: Dr. Nalini Arora.1, Dr. Raja Pal2,

Paraovarian Cyst Causing Ovarian Torsion A Rare Complication

Authors: Dr. Nita Singh, Dr. Nalini Arora, Dr Raja Pal.
Abstract:
Background: Paraovarian Cyst (Poc) Represents 10-20 % Of All Adnexal Masses. These Are Usually Asymptomatic And
Uncommon Among Adolescents. However, These Rarely Develop Complications As Torsion, Haemorrhage, Rupture,
Secondary Infection And Voluminous Size.
Case Report: A 13 Year Old Adolescent Girl Presented With Fever, Vomiting And Gradually Worsening Pain In Lower
Abdomen For The Last 3 Days. She Attained Menarche 4 Months Back And Had Irregular Cycles. Abdominal Examination
Revealed Tenderness With Muscle Guarding In Right Iliac Fossa & Hypogastrium. Her Hb% - 10.2Gm/Dl, Tlc
13,700/Cmm, Dlc - N82L16E2B0M0 And Normal Blood Biochemistry. Urine Showed Presence Of Albumin And Ketone
Bodies. Urine Pregnancy Test Was Negative. On Usg Showed Complex Mass Of 6.9Cm6.7Cm In Right Adnexa Having
Enhancing Areas With Fluid In Pelvis And Right Sub-Hepatic Region. Right Ovary Not Visualized, Uterus And Left Ovary
Were Normal. On Cect Abdomen A Soft Tissue Mass In Right Iliac Fossa With Ascites, Probability Of An Appendicular
Abscess Was Found.
On Exploratory Laparotomy: A Twisted Poc Of 11Cm 8.5Cm 5 Cm Size In The Broad Ligament Along With
Congested And Gangrenous Right Ovary With Right Fallopian Tube Stretched Over It. Excision Of Poc With Epsilateral
Fallopian Tube And Ovary Was Performed. As Appendix Was Found Inflamed And It Was Also Removed. Histopathology
Revealed Poc Wall Lined With Cuboidal Epithelium And Absence Of Ovarian Tissue In The Cyst Wall. Right Ovary Had
Hemorrhagic Degeneration. Appendix Showing Features Of Recurrent Acute Appendicitis. Peritoneal Fluid Cytology Was
Negative For Malignant Cells.
Conclusion: A Critical Evaluation While Managing Poc May Prevent Rare But Serious Complications And Help Preserving
Fertility In Young Girls.

***************

Bilateral Internal Iliac Artery Ligation For Massive Pelvic Hemorrhage

Author: Dr. Nagella Kavitha
Co Author: Dr. C. Raghava Rao1, Dr. Sandhya Rani2,

Pelvic Hemorrhage Is A Life Threatening ComPlication In Both Gynecology And Obstetrics; Has To Be Controlled
Immediately. Bilateral Internal Iliac Artery Ligation (Biial) Is A Time Tested, Easy Method; DoesnT Compromise The
Rest Of The Pelvic Blood Supply. An Emergency Biial Is A Highly Effective, Simple And Life Saving Safe SurGical
Procedure. Iial (Internal Iliac Artery Ligation) Is Technically Simple And Safe Minimum OperaTive Complications Short
Learning Curve. Obstetricians And Gynecologists Need To Adopt This Technique To Save Lives In Emergency Situations. It
Preserves Reproduction Capacity By Avoiding HysterecTomies In Obstetrics. Although Effective, The Procedure Is Not
Commonly Performed By Obstetricians And Gynecologists. It Is Also Helpful In Massive Broad Ligament Hematoma, In
Torn Vessels Retracted Within The Broad Ligament, And Even In Postoperative Hemorrhage After Abdominal Or Vaginal
Hysterectomy Where No Definitive Bleeding Point Is Detectable

We Report A Case A 45Year Old Female Presented To Ggh; Guntur With Profuse Bleeding Per Vagina, With Suspicion Of
Slippage Of Uterine Artery From Pedicle And Intraperitoneal Bleeding, For Further Management. On Investigating Her
Hemoglobin Was 4Gm % And On Cect Abdomen Showed Hemoperitoneum. After Resuscitation With Compatible Blood,
An Exploratory Laparotomy Was Done, Which Showed Retroperitoneal Hematoma And Active Bleeding Which Was
Controlled By Bilateral Internal Iliac Ligation .
Conclusion
An Early Biial Has Been Emphasized As A Life Saving Procedure; DeLay Leads To : An Irreversible Hemorrhagic Shock
And Multiorgan Failure And Higher Morbidity And Mortality.
Iial Is Technically Simple And Safe Minimum OperaTive Complication, Short Learning Curve.
Obstetricians And Gynecologists Need To Adopt This Technique To Save Lives In Emergency Situations. The PostGraduates Need To Be Trained In Performing This Life Saving Surgical ProceDure In Medical College Hospitals.

***************

Perimenopausal Menstrual Disorders

Author: Dr. Saraswathi K
Co Author: Dr Usha Nandini.S1,

Perimenopausal Menstrual Disorders

Aim
To Find Out The Cause For Menstrual Problems In Perimenopausal Women So That Appropriate Management Can Be
Planned And Carried Out.
Materials And Methods
50 Perimenopausal Women Who Reported With Menstrual Problems To A Private Hospital Were Evaluated For The
Cause.A Detailed History Was Taken ,Clinical Examination Done Appropriate Lab Investigations Done. Transabdominal
And Transvaginal Ultrasound Was For All Patients.Saline Infusion Sonography And Or Hysteroscopy Done If Needed
Biopsies Were Taken In Relevant Cases.All This Aided Us To Diagnose The Cause For The Menstrual Disturbances.
Results
Adenomyosis And Or Myomas Were Seen In 16 Patients.In 18 Patients Anovulation ,Endometrial Hyperplasia Or Polyps
Were Present ,One Of The Patients Had Complex Atypical Hyperplasia 4 Patients Had Cystic Ovaries .Two Patients Had
Copper T Causing The Problems Of Which One Had The Extrauterine In The Adnexa Vonwillebrands Disease Was Seen In
1 Patient And Endometrial Tuberculosis In 1 Patient.One Patient Had Cancer Cervix And 1 Had Cancer Vagina In 4 Patients
No Apparent Cause Was Found.
Conclusion
The Management Was Tailored To The Cause Of The Symptoms.Conservative Medical Management Or Hysteroscopic
Management Was Largely Successful In Many Of Them.Laproscopic Surgery Was Needed In 5 Patients Vaginal
Hysterectomy In 1 Fothergills Repair In 1 Patient.The 2 Patients With Genital Malignancy Received Appropriate
Management From The Oncologist.

***************

Placenta Previa Percreta-Surgical Strategies To Increase Safety

Author: Dr. Ratna Biswas
Co Author: Dr Bharti1,

Placenta Previa Percreta: Surgical Strategies To Increase Safety

Dr Ratna Biswas, Dr Bharti

Introduction: Cesarean Hysterectomy For Placenta Percreta Is Technically Challenging With An Inherent Risk Of
Complications Including Maternal Death. Aims & Objectives: To Analyze The Various Surgical Approaches Of
Management Of Placenta Previa Percreta, Potential Complications And Techniques To Reduce It . Material And
Methods: This Retrospective Observational Study Was Carried Over A Period Of One Year In A Tertiary Care Institute.
Total 60 Patients Were Operated For Placenta Previa In One Year, Out Of Which 20% Was Associated With Adherent
Placenta (Percreta And Increta). Previous Lscs Was The Single Most Important Factor Associated With Placenta Percreta.
The Different Surgical Strategies Were Analyzed With Respect To Blood Loss, Early And Late Complications And Maternal
And Perinatal Deaths. Observation And Results. The Different Surgical Strategies Applied Were Classical Cesarean
Followed By Cesarean Hysterectomy In 35% , Classical Cesarean Followed By Internal Iliac Ligation And Cesarean
Hysterectomy In 45%, Lscs With Cesarean Hysterectomy 15%, Lscs With With Internal Iliac Ligation 5%. Complications
Analyzed Were Blood Loss > 1 Litre In 100%, Admission To Icu-80% , Urinary Tract Injuries-30- 40 %, Dic And Maternal
Deaths -Nil. No Single Surgical Strategy Was Best Although Classical Cesarean Followed By Internal Iliac Ligation Followed
By Cesarean Hysterectomy Was The Safest Technique . Blood Loss On An Average Was 2-2.5 Litres And Massive Blood
Transfusion Was Required In Most Cases Of Placenta Percreta. Timely And Rapid Blood Transfusion In Ot Completely
Eliminated The Complication Of Dic And Maternal Deaths. Conclusion: Presence Of Senior Obstetricians , Performing
Classical Cesarean And Leaving Placenta Undisturbed Followed By Devascularization Procedures Prior To Cesarean
Hysterectomy, Careful Application Of Clamps Lateral To The Uterus To Minimize Rupture Of Placental Vessels And
Timely And Adequate Blood Replacement Prevented Maternal Mortality And Serious Maternal Morbidity. Bladder
Injuries Were The Most Common Complication Which Was Unavoidable Due To Bladder Invasion By Placenta Percreta.
All Urolologic Injuries Were Repaired And There Was No Long Term Sequelae.

***************

Post Hysterectomy Vault Prolapse Our Experience

Author: Dr. Manasa Yarlagadda
Co Author: Dr. Radha Bai Prabhu1, Dr. Damodhara Velayudham2,

Post Hysterectomy Vault Prolapse Our Experience

Introduction:
Post Hysterectomy Vault Prolase Is The Descent Of The Vaginal Vault Into The Vagina. Vault Prolapse May Present As
Isolated Vaginal Eversion Or As Complex Vaginal Eversion With Cystocoele And Rectocoele. In This Study, We Discuss Our
Experience Of Treating Ten Patients Who Presented With Vaginal Vault Prolapse.
Objective:
The Aim Of This Study Is To Analyse The Risk Factors, The Clinical Manifestations And The Outcomes Of Vault
Repair.
Methods:
This Is A Prospective Analytical Study Conducted At Meenakshi Medical College And Research Institute From
June 2011 To June 2014. Ten Patients Who Presented With Vault Prolapse Were Operated And Followed Up.
Results:
All Presented In The Postmenopausal Age Except One. Nine Patients Presented 15-20 Years After Abdominal
Hysterectomy And One Presented Within 5 Years After Vaginal Hysterectomy. Sacrospinous Vault Fixation Was Done In
Seven Patients, Abdominal Sacropexy In Two Patients And Cystocoele And Rectocoele Repair In One Patient. Two Patients
Had Post Op Gluteal Pain.
Conclusions:
Sacrospinous Fixation Is Effective For Massive Vault Prolapse And Has Minimal Complications While The
Abdominal Approach Is Best Suited For Young Women And In Patients With Aggrevating Factors.

***************

Association Of Chlamydia Pneumoniae Seropositivity With Preeclampsia Among Primgravidae And Role Of
Antichlamydial Treatment In Its Prevention.
Author: Dr. Lavi Sindhu
Co Author: Dr Aruna Batra1, Dr Achla Batra2, Dr Sangeeta Rastogi3,

Preeclampsia Is A Multifactorial Disease. Women Who Develop Preeclampsia Seem To Have An Inflammatory
Response More Intense Than That Of Healthy Pregnant Women And It Has Been Proposed That Preeclampsia Might
Be Caused By A Concurrent Or Preceding Inflammatory Stimulus Such As Infection. Recently Infectious Pathogen
Chlamydiae Pneumoniae Has Been Implicated In The Etiopathogenesis Of Preeclampsia.
Aim And Objectives:
To Determine The Prevalence Of C. Pneumoniae Igg Seropositivity Among Primigravidae, To Compare The Incidence Of
Preeclampsia Among Seropositive And Seronegative Women, And To Evaluate The Effect Of Antichlamydial Treatment
With
Azithromycin On Preeclampsia.
Materials And Method:
330 Consecutive Primigravidae Attending The Antenatal Clinic At 14-20 Weeks Were Tested For C. Pneumoniae Igg.
Seropositivity Was Found Among 108 Women Who Were Randomized Into Treatment Group (N=54) Who Received
Treatment With Azithromycin 500Mg Od Po X 3 Days And Non Treatment Group (N=54) Who Did Not Receive Any
Treatment. All Women Were Followed At Antenatal Clinic Till Delivery.
Results:
C. Pneumonia Igg Seropositivity Was Seen In 32.4% Primigravidae At 14-20 Weeks Of Gestation. The Incidence
Of Preeclampsia In The C. Pneumoniae Seropositive-Untreated Group Was 13% As Compared To 4% In The
Seronegative Group. The Difference Was Statistically Significant (P=0.02). Treatment Of C. Pneumoniae With Oral
Azithromycin Resulted In A Lower Incidence Of Preeclampsia (5.6%) In The Seropositive Treated Group Which Was
Almost Similar To The Seronegative Group (4.1%) And Quite Lower Than The Seropositive Untreated Group (13%).
Conclusion:
C. Pneumoniae Seropositivity Was Associated With A Significantly Higher Incidence Of Preeclamplsia Among
Primigravidae And Treatment With Oral Azithromycin Was Associated With A Reduced Incidence Of Pre-Eclampsia.

***************

Pregnancy After Surgery For Endometriosis

Author: Dr. Kavya M
Co Author: Dr.Sasikala K1,

Pregnancy Rate After Surgery For Endometriosis

Dr. M.Kavya, Dr.Sasikala Kola

Objectives:
Analysis Of The Conception Rate Post -Surgery In Endometriosis Cases.

Method :
Retrospective Cohort Study Of 70 Endometriosis Cases Surgically Managed At A Private Hospital, Between June 2002 To
July 2006 .

Results:
21 (30%)Out Of 70 Cases Conceived .There Were 55 Primary Infertility Cases And 15 Secondary Infertility Cases In Total
.16 Primary Infertility Cases Conceived (29%) And 5 Secondary Infertility Cases Conceived Post -Surgery (33%).Primary
Infertility With Chocolate Cysts Were 27(49%).Secondary Infertility With Chocolate Cysts Were 6 (40%).5 Patients
Conceived Twice.2 Patients Had Twins Following Art.1 Had Missed Abortion.6 Cases Were Lost To Follow Up.11 Cases
Had Recurrence Of Endometriosis(15.9%).32 Cases Did Not Conceive(45.7%)

Laparoscopy Is Preferred To Laparotomy As It Prevents Adhesions, Offers Better Chance Of Fertility Preservation.
Hysteroscopy Is Mandatory As There Is A Greater Percentage Of Concomitant Uterine Anomalies With Endometriosis.
Cervical Outflow Obstructions Should Be Corrected To Prevent Recurrence. Pregnancy Rate Following Surgery Are 40%,
50% And 60% In Mild, Moderate And Severe Endometriosis .Recurrence After Conservative Surgery Is 10.8% After 1
Year,15.8% After 2 Years,25% After 3 Years. Post- Operative Hormonal Therapy Is Required To Tackle Microscopic
Endometriotic Implants, Prevents Adhesion Formation And Recurrence . Pregnancy After Surgery Decreases Recurrence
Of Endometriosis. Art Is Planned For After Surgery In Tubal Pathology, Advanced Stages Of Endometriosis And Diminished
Ovarian Reserve.

Conclusion: Endometriosis Is An Enigmatic Disease Causing Significant Morbidity. Conservative Surgery Has Not Only
Given A Good Chance Of Conception But Also Improved Quality Of Life In These Women.

***************

Efficacy Of Intravenous Infusion Of Acetaminophen For Intrapartum Analgesia In Labor

Author: Dr. Sheeba Marwah
Co Author: Vijay Zutshi1, K Usha Rani2, Manjula Sharma3, Pratima Mittal4,

Presenting Author-Sheeba Marwah

Co-Authors-Vijay Zutshi, K Usha Rani, Manjula Sharma, Pratima Mittal

Background- The Intensity Of Pain Experienced By Women In Labor, Is Found To Affect Maternal Psychology, Labor
Progress And Fetal Well-Being. Adverse Effects Associated With Commonly Used Opioids For Providing Intrapartum
Analgesia Have Created A Need For An Alternative Non Opioid Drug.

Objective-To Evaluate Efficacy Of An Intravenous Infusion Of 1000 Mg Of Acetaminophen As An Intrapartum Analgesic

Material & Methods

A)Setting- Labour Room, Vmmc & Sjh, New Delhi.
B)Study Type Prospective Double Blind Placebo-Controlled Randomized Interventional Study.
C)Population- 200 Normal Pregnant Primiparous Women In Active Labour.
D)Methods-Women Were Randomised To Receive Either Intravenous 1000 Mg Of Acetaminophen (N=100) Or 100 Ml
Normal Saline (N=100), When They Requested Analgesia.

Outcomes Measured-Primary Outcome Was Efficacy Of Drug To Supply Adequate Analgesia, As Measured By A Change
In Visual Analogue Scale (Vas) Pain Intensity Score At Various Times After Drug Administration. Secondary Outcomes
Were Duration Of Labor, Need For Additional Rescue Analgesia And Presence Of Adverse Maternal Or Fetal Effect.

Observation & Results- There Was Significant Pain Reduction At 1 And 2 Hours In Both Groups (P<0.001). However, It
Was More Significant In The Pcm Group, Especially At 1 Hour. Duration Of Labour Was Shortened In Both The Groups
Without Any Maternal And Fetal Adverse Effects, Nine Women In Each Group Needed Further Analgesia.

Conclusion-Intravenous Acetaminophen Is An Efficacious Non-Opiod Drug For Relieving Labour Pain Without Any
Significant Maternal And Fetal Adverse Effects.
***************

Prevalence Of Genitourinary Symptoms And Metabolic Syndrome Among South Indian Postmenopausal Women
Attending Tertiary Care Centre.
Author: Dr. Jeyasheela Kamaraj
Co Author:

Prevalence Of Genitourinary Symptoms And Metabolic Syndrome Among South Indian Postmenopausal Women
Attending Tertiary Care Centre.
Abstract
Purpose
Menopausal Symptoms Are Major Concerns Of Postmenopausal Women. Menopause Is Associated With Increased
Prevalence Of Mets Which Predisposes To Cardiovascular Disease. The Objectives Of This Study Was(1) To Assess The
Prevalence Of Mets Among South Indian Postmenopausal Women, (2)To Study The Correlation Of Mets Vs Menopausal
And Lower Urinary Tract Symptoms
(3) To Study The Correlation Of Body Composition Among Women With Mets
Methods
We Recruited 154 Women Who Attended Menopause Clinic, Christian Medical College ,Vellore . Metabolic Syndrome
Was Diagnosed Using Idf Criteria.Menopausal Symptoms Were Assessed Using Menopause Rating Scale (Mrs)
Questionnaire. Lower Urinary Tract Symptoms Were Assessed Using Bristol Questionnaire.Blood Samples Were Drawn
To Assess Serum Fasting Glucose And Lipid ProLe, In All Participants. Dexa Whole Body Composition Was Performed
In 88 Subjects.
Results Of 154 Postmenopausal Women, 99 (64%) Women Had Metabolic Syndrome (Mets). Hot Flushes (P=0.03) And
Heart Discomfort (P=0.006) Were Greater In Women With Mets. However, There Was No SigniCant Difference Was
Observed In The Total Mrs Score Between Two Groups. High Triglyceride Levels And An Increase Of The Number Of
Components Of Mets Were Associated With A Higher Total Subscale Score Of Somatic Symptoms (P = 0.044).
Conclusions Prevalence Of Mets Among Our Study Population Is 64 %. There Was No Significant Difference In Menopausal
And Lower Urinary Tract Symptoms In Women With Mets And Without Mets. Further Studies With Larger Population
Group Are Warranted To Identify The Association Between Genitourinary Symptoms And Mets In Postmenopausal
Women.
Key Words: Post Menopausal Women, Metabolic Syndrome, Genitourinary Symptoms.

***************

Prevalance Of Stress Incontinence And Its Impact On Quality Of Life

Author: Dr. Priyadharshini Manoharan
Co Author:

Prevelance Of Stress Incontinence In Reproductive Women And Its Impact On Quality Of Life .
Dr.Priyadharshini.M, Dr.G. K. Poomalar

Introduction: Urinary Stress Incontinence Have A Significant Impact On The Physical, Psychological And Socio-Economic
Aspects Of Life. There Have Been Number Of Large Surveys Evaluating Incontinence But, It Is Important To Target The
Correct Group Of Patients With The Most Severe, Bothersome Incontinence To Allocate Proper Health Resources For
Research And Treatment.

Aims And Objectives: To Estimate The Proportion Of Women With Stress Incontinence In Reproductive Age Groups And
To Assess The Impact Of Stress Incontinence On Emotional And Social Wellbeing.

Materials And Methods: Cross Sectional Study Conducted In Smvmch On 404 Women Aged Between 20-45 Years,
Convenient Sampling Was Followed. Women Accompanying Patients In Opd And Ward Were Questioned. Data Such As
Socio Demographic Characters, Urinary Symptoms, Obstetric History, Height And Weight Measurements Were Recorded.
Those With Incontinence, KingS Health Questionnaire Was Used To Evaluate The Severity Of Affection.

Results: The Prevalence Of Stress Incontinence Was Found To Be 34.1% In Our Study. Out Of Them
73.2%,19.6%And7,2% Had Mild, Moderate And Severe Stress Incontinence Respectively. It Is More Prevalent In Women
With Parity 2. Prevalence Is Not Altered By The Age At First Birth And Intervals Between Pregnancy . It Is
Significantly More Prevalent In Those With Bmi < 18.5 & 30. Those With Stress Urinary Incontinence Had
Significantly More Amount Of Health Affection Than Those Without Incontinence. In People With Mild Incontinence 35
40% Had Role And Physical Activity Limitation Whereas >95% With Moderate Incontinence Had Both. In Those With
Severe Incontinence, 90% Had Physical Activity Restriction, Social Limitation, Emotional Affection And Sleep Deprivation.

Conclusion: Stress Incontinence Had Higher Impact On Emotional And Social Well Being. Awareness Has To Be Created
About Available Treatment Options.

***************

Primary Ovarian Ectopic Gestation Managed Conservatively.

Author: Dr. Dugyala Suchetha
Co Author:

Primary Ovarian Ectopic Pregnancy Is A Rare Form Of Ectopic Pregnancy , Accounts For 0.5 To 3% Of All Ectopic
Pregnancies. Preoperative Diagnosis Of This Extremely Rare Condition Is Challenging Because It Often Resembles Cysts
Of The Corpus Lutem. Risk Of Primary Ovarian Ectopic Gestation Is High Due To Increasing Use Of Intrauterine
Contraceptive Devices And Artificial Reproductive Techniques.
Presentation Is Similar To Tubal Ectopic Pregnancy, With Chronic Pelvic Pain Or Palpable Adnexal Mass But The Adnexal
Mass Is Frequently Confused With A Leaking Corpus Luteum . At Surgery , The Trophoblast Tissue Or The Embryo Can
Rarely Be Visualised Completely .
Final Diagnosis Is Made Only On Laparotomy (Tube Is Normal With Enlarged Ovarian Mass) And Histopathology On The
Basis Of Four Spigelberg Criteria .
Here, We Report A Case Of 30 Yr Old G3P2L2A1 With 6 Weeks Of Amenorrhoea Presented With Complaints Of Severe
Pain Abdomen And Bleeding Per Vagina Since 10 To 12 Days .
Her Urine For Pregnancy Test Was Positive And Transvaginal Ultrasound Showing No Intrauterine Gestational Sac, Left
Adnexal Mass And Free Fluid In The Pouch Of Douglas. It Was Diagnosed To Be A Left Ruptured Ectopic Pregnancy And
Was Confirmed Intraoperatively And Histopathologically As Primary Ovarian Ectopic Pregnancy . Intraoperatively Tube
Was Normal And Left Ovary Was Slightly Enlarged With The Cyst, With Ruptured Site Through Which Bleeding Was Seen
. As Obvious Ovarian Tissue Was Seen, We Planned Only For Localised Surgical Resection Of The Bleeding Mass With The
Conservation Of Rest Of The Ovarian Tissue.
Some Of The Facts Associated With Diagnosis And Management Of Ovarian Ectopic Pregnancy To Be Discussed.
***************

Ultrasonographic Evaluation Of Placental Thickness And Umbilical Cord Coiling Index In Second Trimester Of
Gestation And Pregnancy Outcome
Author: Dr. Richa Arora
1,
Co Author: Richa Arora Manjit Kaur Mohi2, Gurdip Kaur3, Manpreet Kaur4, Manoj Mathur5

Purpose: To Evaluate The Role Of Placental Thickness And Antenatal Umbilical Cord Coiling Index (Auci) Obtained During
Routine Second Trimester Ultrasound As A Predictor Of Perinatal Outcome.
Method And Materials: A Prospective Observational Study Was Carried Out At Gmc, Patiala. Fetal Ultrasound Of 100
Pregnant Women Was Done Between 18-24 Weeks Of Gestation To Find Placental Thickness And Auci. The Placental
Thickness Was Measured At The Level Of Insertion Of The Umbilical Cord. Antenatal Uci Was Calculated As A Reciprocal
Value Of The Distance Between A Pair Of Coils. Patients Were Followed Up Till Delivery For Perinatal Outcome. Placental
Thickness And Auci Were Correlated With The Following Pregnancy Outcomes: (1) Gestational Age (2) Mode Of Delivery,
(3) Presence Of Meconium-Stained Amniotic Fluid, (4) Apgar Scores At 1 And 5 Minute And (5) Birth Weight.
Results: The Mean Placental Thickness Was 2.46 Cm And Auci Was 0.57/Cm. Placentae <10%Cile Were Considered As
Thin Placenta And Placentae >90%Cile Were Considered As Thick Placenta. Thin Placenta Was Associated With Lbw (3%),
Preterm Delivery (2%) While Thick Placenta Was Associated With Lbw (2%), Preterm Delivery (2%). Similarly, Auci Was
Categorized As Hypocoiled, Normal Coiled Or Hypercoiled. Hypocoiled Cord Was Associated With Lbw (1%), Preterm
Delivery (1%) While Hypercoiled Cord Was Associated With Lbw (4%), Preterm Delivery (0%). No Statistical Difference
Was Found For Birth Weight, Gestational Age, Apgar Scores And Meconium-Stained Amniotic Fluid Between The Groups
With Normal And Abnormal Umbilical Cord Coiling Or Placental Thickness.
Conclusion: In Our Study, No Association Could Be Established Between Abnormal Placental Thickness Or Auci With
Higher Prevalence Of Interventional Delivery, Presence Of Msaf, Preterm And Lbw. Therefore More Specific Parameters
Need To Be Developed As Promising Prognostic Marker For Predicting Adverse Perinatal Outcome And Further Studies
Are Needed To Test This Hypothesis.

***************

Quadruplet Pregnancy Following Spontaneous Conception: A Rare Case Report

Author: Dr. Setu Rathod
Co Author:

Quadruplet Pregnancy Following Spontaneous Conception: A Rare Case Report

Dr. Setu Rathod*, Dr. Sunil Kumar Samal*
*Assistant Professor, Dept. Of Obstetrics & Gynaecology, Mahatma Gandhi Medical College & Research Institute,
Puducherry.

Background: This Case Report Is Being Presented In View Of The Increasing Number Of Multifetal Pregnancies Due To
Various Assisted Reproductive Techniques. This Case Is Unique Due To The Fact That Our Patient Conceived A Quadruplet
Pregnancy Spontaneously Following A Bad Obstetric History (3 Previous Term Intrauterine Fetal Deaths). One Fetus
Expired In Utero And The Pregnancy Continued Successfully Resulting In 3 Live Born Healthy Babies.
Case: A 32 Years G4P3L0 Was Admitted To Our Hospital At 27 Weeks Gestational Age With Chief Complaint Of Shortness
Of Breath And Lower Abdominal Discomfort Of One Week Duration. She Had Been Married For 6 Years With 3 Term
Intrauterine Fetal Deaths Expelled Vaginally In Hospital. She Was Diagnosed As A Case Of Quadruplet Pregnancy By
Ultrasound In First Trimester. On Ultrasound Examination At The Time Of Admission, She Was Diagnosed To Have One
Intrauterine Death With 3 Live Fetuses. She Was Managed Conservatively Till 35 Weeks Gestation With Regular
Monitoring Of Coagulation Parameters. Elective Caesarean Section Was Done At 35 Weeks Gestation And Quadruplets
Were Delivered, Among Which 3 Were Live Female Babies (Were Admitted To Neonatal Intensive Care Unit And
Discharged After 3 Days) And One Male Dead Fetus. Placenta Was Found To Be Quadrichorionic Quadriamniotic. Intra
Operative And Post-Operative Period Were Uneventful. Patient Was Discharged From Hospital With Three Live Babies
On Seventh Postoperative Day.
Conclusion: Multifetal Gestation Comprises A High Risk Pregnancy And Proper Antenatal And Intrapartum Care Results
In A Successful Maternal And Fetal Outcome As Seen In Our Case.

***************

Rare Cases Of Ectopic Pregnancy

Author: Dr. Sasikala Vennalaganti
Co Author:

Rare Cases Of Ectopic Pregnancy

V. Sasikala, B. Indira, B. Sumalatha, Prof. Hari Anupama

Department Of Obstetrics And Gynaecology,
Gandhi Medical College,
Secunderabad, Telangana.

Background:
Ectopic Pregnancy Usually Occurs In The Fallopian Tubes. Some Rare Forms Of Ectopic Pregnancy Are:
1) Pregnancy In Non-Communicating Rudimentary Horn.
2) Cervical Pregnancy.
3) Ovarian Pregnancy.

Case:
Pregnancy In Non-Communicating Rudimentary Horn Is Extremely Rare And Occurs Due To Trans-Peritoneal Migration
Of Spermatozoa Or Fertilized Ovum. We Report 3 Cases Of Pregnancy In Rudimentary Horn Which Were Diagnosed By
Ultrasound. Mri Was Used To Confirm The Diagnosis. Laparotomy And Horn Excision Were The Main Modality Of
Treatment.

Cervical Pregnancy Is Other Form Of Ectopic Pregnancy In Which Implantation Occurs In The Endocervical Canal. We
Report 2 Cases Of Cervical Pregnancy Which Were Diagnosed By Ultrasound. With The Help Of Interventional Radiologist,
We Did Embolisation Of Descending Cervical Artery.

We Report 2 Cases Of Ovarian Pregnancy, Presented As Abdominal Pain, Diagnosed As Ectopic Pregnancy By Ultrasound,
Which Was Confirmed Intra-Operatively As Ovarian Pregnancy And Managed By Salpingo-Oopherectomy.

Conclusion:
Diagnosis Of Rare Sites In Ectopic Pregnancies Like Rudimentary Horn, Cervical And Ovarian Should Not Be Forgotten.
Not All Cases Of Ectopic Pregnancy Need Surgical Intervention, Where In Certain Instances Cervical Pregnancies Can Be
Managed With Uterine Artery Embolisation.

***************

Structured Teaching Programme Improves Attitude Towards Reproductive Tract Infections

Author: Dr. Lola Ramachandran
Co Author:

Reproductive Tract Infections (Rti) Levy A Heavy Toll On Women In Developing Countries. We Conducted A Study To
Evaluate The Effect Of A Structured Teaching Programme (Stp) On The Knowledge And Attitude Towards Rti In Women.
Objectives: To Assess The Level Of Knowledge And Attitudes Regarding Rti Among Experimental And Control Groups,
Determine The Effect Of The Stp On Knowledge And Attitude Regarding Rti And Correlate It With Selected SocioDemographic And Clinical Data Variables.
Methodology: A Quasi Experimental Non Equivalent Pre Test And Post Test Control Group Design Was Used. The Study
Was Conducted In The Gynaecology Opd Of Jubilee Mission Medical College Hospital Among 50 Women Selected By
Purposive Sampling. We Used A Structured Knowledge Questionnaire And Attitude Rating Scale. Pre Test Was Conducted
On The First Day Followed By The Stp On Rti. Post Test Was Conducted After One Week. Statistical Analysis Was Done
Using Spss 17.
Results: In Pre Test 44% And 36% Women Had Inadequate Knowledge On Rti In Experimental And Control Groups
Respectively While 20% Had Unfavourable Attitude In Both The Groups. A Significant Increase In Post Test Knowledge
(P>0.001) And Attitude Score Was Found In The Experimental Group.
Therefore It Was Concluded That A Structured Teaching Programme Was An Effective Method To Improve The Knowledge
And Attitude On Rti Among Women.

***************

Retrospective Case Study Of Hysteroscopies Done Over A Period Of 2 Years

Author: Dr. Sanam Basheer
Co Author:

Retrospective Case Study Of Hysteroscopies Done Over A Period Of 2 Years

To Analyse Hysteroscopic Procedures Over A Period Of 2 Years Focusing On Indications, Findings And Complications.
Methods
A Retrospective Study Was Done Of 45 Diagnostic And Operative Hysteroscopic Procedures Performed From 2012
September To 2014 September. Indications, Results And Operative Procedures Were Analysed.
Results
The Common Indications For Hysteroscopy Were Infertility (62%), Abnormal Uterine Bleeding (24%) And Increased
Endometrial Thickness (17%).
The Common Operative Procedures Were Polypectomy, Endometrial Ablation Or Resection And Myomectomy.
The Complication Rate Was 2.35%.
Conclusion
Hysteroscopy Is A Safe And Reliable Diagnostic And Therapeutic Option That Can Be Successfully Employed For Various
Clinical Conditions.

***************

Risk Assessment Of Venous Thromboembolism In Obstetric Patients Using Scoring System

Author: Dr. Saranya G
Co Author:

Risk Assessment Of Venous Thromboembolism In Obstetric Patients Using Scoring System

Abstract
Objective:
To Assess The Risk Of Venous Thromboembolism In Obstetric Patients Using Risk Factor Scoring System
Design:
Prospective Observational Study Of Pregnant Woman Coming For Antenatal Visit To The Department Of Obstetrics And
Gynaecology In Sri Ramachandra University From July 2012 To June 2014. Data Collected Included The Following H/O
Thrombosis ,Age ,Bmi , Parity, Infection, Varicose Veins, Medical Diseases, Immobility, Ohss, Pre-Eclampsia, Hyperemesis,
Surgical Procedure In Pregnancy, Smoking ,Multiple Pregnancy. Each Patient Was Assigned A Score That Was Based On
The Risk Factors Identified Using The Green Top Guidelines No :37 A ( Nov 2009)
Results:
We Studied 2,000 Pregnancies, During Which There Were 4 Cases Of Deep Vein Thrombosis Diagnosed During Pregnancy.
Our Study Showed That The Incidence Rate For Venous Thromboembolism During A Pregnancy Was Reported To Be 0.2%
.Hyperemesis, Immobility, Age, H/O Thrombosis, Infection Are The Important Risk Factors For Venous Thromboembolism
During Pregnancy. No Case Of Pulmonary Embolism Were Documented During The Study Period.
Conclusion:
Pregnant Women With High Risk Factor Scores Were At Increased Risk For Venous Thromboembolism .
***************

Role Of Hysteroscopy In Evaluation Of Patients With Abnormal Uterine Bleeding

Author: Dr. Shilpa Nabapure
Co Author: Dr S.V.Nachiketha1, Dr M.G.Hiremath2,

Role Of Hysteroscopy In Evaluation Of Patients With Abnormal Uterine Bleeding

Dr Shilpa Nabapure 1, Dr S.V. Nachiketha2, Dr M.G. Hiremath3
1 Post Graduate, 2 Associate Professor,3 Professor And Hod,
And Gynaecology ,Karnataka Institute Of Medical Sciences ,Hubli

Department Of Obstetrics

Abstract:
Aims & Objectives: Abnormal Uterine Bleeding (Aub) Is The Most Common Complaint In Gynecology And An Important
Source Of Morbidity. The Objective Of This Study Is To Assess The Feasibility Of Hysteroscopy For Identifying Abnormal
Findings In Uterine Cavities Of Pre And Postmenopausal Women Presenting With Abnormal Uterine Bleeding And To
Correlate Hysteroscopic With Histopathological Findings.
Materials And Methods: It Is A Cross Sectional Study Done On 50 Patients Who Presented With Complaints Of Aub To
The Department Of Obstetrics And Gynecology, Kims, Hubli. These Women Underwent Panoramic Hysteroscopy
Followed By Directed Endometrial Biopsies. Data Was Collected And Analyzed.
Results: Aub Was More Common In 41-50 Yrs Age Group. The Most Common Presenting Complaint Was Menorrhagia.
Negative Hysteroscopic View Was Seen In 60% Cases.Abnormalities Seen Were: Endometrial Hyperplasia(16%),
Endometrial Polyp(12%), Submucous Myomas(6%), Endometrial Atrophy(6%).The Sensitivity Of Hysteroscopy Was
88.24% And Specificity Was 84.85%. Positive Predictive Value Was 75% And Negative Predictive Value Was 93.33%.
Conclusion: Hysterosopy Is A Highly Accurate Diagnostic Tool In Diagnosing Intrauterine Lesions Like Endometrial
Hyperplasia, Polyps And Submucous Myomas.
Keywords: Hysterosopy, Abnormal Uterine Bleeding, Histopathology.

***************

Ruptured Uterus Due To Scar Pragnancy

Author: Dr. Rama Naik
Co Author: Dr Shyama Kanungo1, Dr Mahija Sahu2, Dr Lopamudra Jena3,

Ruptured Uterus Due To Scar Pregnancy

Naik Rama Manjari, Kanungo Shyama, Sahu Mahija, Jena Lopamudra
IntroductionEctopic Pregnancy Within A Previous Caesarean Scar Is A Rare Condition, About 0.15% In Women With A Previous Cs
With A Rising Trend. Scar Pregnancy Is Potentially Life-Threatning If Not Diagnosed And Treated Early As It May Cause
Uncontrolled Haemorrhage & Uterine Rupture Requiring Hysterectomy Resulting In Subsequent Loss Of Fertility.
Case ReportA 20 Yr Primipara With Complaint Of Severe Pain Abdomen For 5 Hours Immediately Following Sexual Intercourse, Was
Admitted In Emergency Hour With H/O Caesarean Section 7 Months Back & 2 Episodes Of Spotting 2 Months Back. On
Examination She Had Tachycardia , Hypotension, Moderate Pallor, Abdomen Was Soft & Tender. P/S Slight Bloody
Discharge ,P/V And Bimanual Examination- 12 Wk Size Uterus, Parous Os With Cervical Motion Tenderness. Urine
Pregnancy Card Test Positive And Paracentesis Confirmed Internal Hemorrhage. After Resuscitation Laparotomy Was
Done. About 2 Litres Of Fresh Blood And Clots Suctioned Out, There Was A Rent Of 5 4 Cm On The Anterior Wall Of
Lower Part Of Uterus At The Previous Cs Scar Site Which Was Repaired. Intact Gestational Sac (6 Cm Diameter) With The
Fetus Was Found Inside The Peritoneal Cavity. B/L Tubes & Ovaries Were Healthy. Patient Was Transfused With Two
Units Of Blood And Post Operative Period Was Uneventful.
ConclusionAn ObstetricianS Foresight Regarding The Possibility Of Scar Pregnancy In Those Women With Prior Caesarean
Section And Timely Usg May Lead To Early Diagnosis And Hence A Chance Of Conservative Management Or Else She May
Land In Catastrophic Complications Even Requiring Hysterectomy As A Life Saving Measure.

***************

Hysterolaparoscopic Evaluation Of Infertile Women

Author: Dr. Sangeetha K
Co Author:

Sangeetha. K, Usharani .G, Syamala.O, Rukshana

Department Of Obstetrics And Gynaecology
Sriramachandra Medical College And Hospital
Porur Chennai.

Aim: To Identify The Incidence Of Various Pathological Conditions In The Female Reproductive Tract Leading To
Primary And Secondary Infertility Using Hysterolaparoscopy

Materials And Methods: Source: Cases For The Study Include Infertile Women Coming For Infertility Work Up
To The Department Of Obstetrics And Gynaecology Sri Ramachandra Medical College And Hospital.

Study Type -Prospective Study

Results: A Total Of 200 Women Underwent Combined Diagnostic Laparoscopy And Simultaneous Diagnostic
Hysteroscopy. Age Ranged From 21 Years To 45 Years And A Mean Age Was 28.4 Years. Bilateral Tubal Patency Was
Demonstrated In 141(71%) Patients. Bilateral Tubal Blockage Found In 38(19%) And Unilateral Tubal Occlusion Was
Present In 21 (9.5%) Cases. Myomas Were Found In 22(11%). Endometrial Polyps Were Revealed In 36 (18%) And
Asherman Syndrome In 8(4%) Patients On Diagnostic Hysteroscopy.Uterine Anomalies Were Found In 30 (15%) Septate
Uterus In 11(5.5%) Partial Septum In 16(8%) Bicornuate Uterus In 3(1.5%). Of Total, 35 (17.5%) Were Found To Have
Endometriosis. Pelvic Adhesions Were Found In 15 (7.5%) Patients. As A Whole Pelvic Pathologies Were Confirmed In
122(61%) Patients And Intrauterine Pathology In 85(42.5%) By Simultaneous Diagnostic Hysteroscopy And Laparoscopy

Conclusion: Diagnostic Hysterolaparoscopy Is A Valuable Investigation For The Assessment Of Female Infertility.

***************

Screening For Breast Cancer : Study Of 5 Years At Igims, Patna

Author: Dr. Sangeeta Pankaj
Co Author: Dr Vijayanand Choudhary1, Dr Simi2,

Screening For Breast Cancer : Study Of 5 Years At Igims, Patna

Dr.Sangeeta Pankaj, Dr. Vijayanand Choudhary, Dr. Simi

Background

Breast Cancer Is The Most Common Form Of Cancer In Developing Countries With Incidence Of 27% Annually. Its Growing
Incidence As Well As The Increasingly Early Age Of Diagnosis Has Led Us To Carefully Analyze Its Possible Causes And The
Preventive Measures To Be Taken. Deaths From Breast Cancer Could Be Avoided If Cancer Screening Rates Is Increased
Among Women At Risk. Mammography Are Underused By Women Who Have No Regular Source Of Health Care

Aims And Objective

A Study For 5 Years From Clinical Histories, Clinical Breast Examinations And Mammograms In Patients With Mastalgia
And Breast Lump Was Done In Gynaecological Oncology , Rcc Igims Patna To Screen And Detect Breast Cancer At Early
Stages.

Methods
In This Study, We Analyzed 4600 Of Female Patients, 1570 Years Of Age, Who Had Reported With Mastalgia And
Breast Lump At Gynaecological Oncology , Rcc Igims Hospital In Patna. Relevant Data (Age Of Diagnosis, Period Of
Lactation, Family History Of Cancer, Obesity, Alcohol Consumption And Smoking Habits) Were Collected From The Clinical
Histories Of Each Patient And Analyzed.
Result Andconclusion
Our Study Concluded That Breastfeeding For Over Six Months Not Only Provides Children With Numerous Health Benefits,
But Also Protects Mothers From Breast Cancer, And Around 9-10% Cases Of Breast Cancers Can Be Detected By Screening
And Awareness, Save Your LifeGo For Screening.
.

***************

Serum Beta-Hcg In Early Second Trimester As Predictor Of Pregnancy Induced Hypertension

Author: Dr. Sinduja T.P
Co Author:

Serum Beta-Hcg In Early Second Trimester As Predictor Of Pregnancy Induced Hypertension

Dr.T.P.Sinduja, Post Graduate; Dr.Nazira Sadique, Additional Professor;
Sri Ramachandra Medical College And University, Chennai.
Abstract:
Introduction: Pregnancy Induced Hypertension(Pih) Affects 5 - 12 % Of Pregnancy.In Spite Of Improved Antenatal Care
And Perinatal Care The High Morbidity And Mortality Rates Pose An Unending Challenge To Obstetricians. If Prediction
Becomes Possible , Then Prevention Becomes Easy. Pih Is A Trophoblastic Disorder And Human Chorionic Gonadotropin
Is Secreted From Trophoblast, We Sought To Determine Whether Measurement Of Serum Human Chorionic
Gonadotropin Can Predict The Risk Of Developing Pih Disorders In Pregnancy.
Aim : Testing The Hypothesis That Women With High Serum B-Hcg Levels In Early Second Trimester(14-20 Weeks) Have
Risk Of Developing Pregnancy Induced Hypertension.
Materials And Method :Prospective Study . Serum B-Hcg Estimation Was Done For 324 Antenatal Women At Srmc And
Was Followed Up Till Delivery.
Result : Total Of 324 Pregnant Women Were Studied.41 Cases Developed Pih While 283 Remained Normotensive. 85 %
Patients Had A Raised Bhcg Among The Pih Group. The Negative Predictive Value Was 96.6 %.
Conclusion : A Significant Positive Correlation Between Second Trimester Serum Beta-Hcg And Development Of
Preeclampsia Was Observed (P<0.001).
***************

Sexual Assault---How Far It Is True

Author: Dr. Lavanya Sarella
Co Author: Dr.Lavanya Kumari Sarella1,

Sexual Violence Is Increasing In The Society. Sexual Assault Is Different From Other Assaults Where 99% Of The Offenders
Are Men And 90% Of Victims Are Women. Assault May Not Cause Physical Injury, But Will Always Cause Psychological
Trauma. Young People Are The Most Frequent Victims Of Sexual Violence.
Aim ----- In The Context Of Increased Reporting Of Sexual Assault The Aim Of Our Study Is To Understand How Far It Is
True That All Cases Reported As Sexual Assault Are True And The Factors Leading To It.
Methods -----An Analysis Of Secondary Data Obtained From The Records Of Government General Hospital, Kakinada,
Andhra Pradesh For A Period Of One Year Was Done. The Demographic Profile, Physical Examination Findings And The
Interval Between Actual Assault And Reporting Have Been Analyzed After Obtaining Permission From The Hospital
Superintendent.
Results ------ Of The 78 Cases Analyzed 41[52.56%] Were In The Age Group Of 11-20Yrs And 4 [5.12%] Were Below 10Yrs
Of Age. Most Of The Cases 36 [46.15%] Belonged To Scheduled Caste. 40 [51.28%] Were Unemployed, 18 [23.07%] Were
Students The Educational Level Being High School Drop Outs For 38 [48.71%]. In 55 [70.51%] Cases The Victim Is BoyFriend. On Examination Signs Of Physical Violence Were Found In Only 1 [1.28%] Case And One Case Reported Within
One Day Of Occurrence Of Assault.
Conclusions ---- Our Analysis Revealed That Most Of The Teenage Girls With Low Levels Of Education And From Weaker
Sections Of The Community Are The Victims Of Elopement And Had The Sexual Contact Willfully Under The Promise Of
Marriage. When The Circumstances Are Turning Odd They Are Filing A Case. Proper Education About Sexual Life And
Cultural Values Has To Be Taught To The Adolescent Girls Through Media And Also In Schools.

***************

Role Of Thyroid Stimulating Hormone Estimation And Oral Glucose Tolerance Test Screening In Pregnancy Induced
Hypertension
Author: Dr. Shefali Wadhwani
Co Author: Preet Kamal Bedi1, Manu Sharma2, Navjot Kaur3,

Shefali Wadhwani Preet Kamal Bedi Manu Sharma Navjot Kaur

Aim And Objectives
To Evaluate The Prevalence Of Hypothyroidism And Diabetes Among Patients Of Preeclampsia And Maternal And Foetal
Outcome In These Patients.
Materials And Methods
A Total Of 200 Pregnant Women Were Recruited In This Case-Control Study And Were Divided Into Two Groups Of 100
Each. In Both The Groups Serum Thyroid Stimulating Hormone And Oral Glucose Tolerance Test Were Done And Cases
And Controls Were Compared. The Study Was Conducted In The Department Of Obstetrics And Gynaecology In
Government Medical College, Amritsar.
Results
It Was Concluded That Out Of 100 Cases 38% Had Mild Preeclampsia, 30% Had Severe Preeclampsia And 13% Of Women
Had Eclampsia. The Mean Tsh Value Was Significantly Higher In Preeclamptic Group Than In The Control Group (P Value
0.0001). 39% Women In Preeclamptic Group And 13% Women In Control Group Had Abnormal Tsh Titre (>3Miu/Ml). 33%
Women In Case Group And 8% Women In Control Group Had Diabetes (P Value 0.0033) This Difference Between The Two
Groups Are Statistically Significant. Of The 52 Pregnant Women With Hypothyroidism, 39 (75%) Had Preeclampsia
Whereas Only 61 (42.1%) Out Of 148 Euthyroid Pregnant Women Had Preeclampsia. Of The 41 Pregnant Women With
Diabetes 33(71.45%) Had Preeclampsia Whereas Only 67(46.51%) Of 159 Euglycaemic Pregnant Women Had
Preeclampsia. This Difference In Two Groups Is Found To Be Statistically Significant.
Conclusions
To Conclude Women With Hypothyroidism And Diabetes Have Increased Risk Of Pregnancy Induced Hypertension And
Vice-Versa.
***************

Sonographic Screening Of Deep Vein Thrombosis In Pregnancy And Puerperium

Author: Dr. Pooja Singh
Co Author: Prof. Nisha Rani Agrawal1,

Sonographic Screening Of Deep Vein Thrombosis In Pregnancy And Puerperium

1.

Dr Pooja,

2.

Prof. Nisha Rani Agrawal

Department Of Obstetrics And Gynecology.

Institute Of Medical Sciences, Banaras Hindu University, Varanasi, 221110

Aims And Objectives This Study Aims To Screen Sonographically For Deep Vein Thrombosis With Colour Doppler
Ultrasound To Know The Incidence Of Deep Vein Thrombosis In Pregnant And Postpartum Females. The Risk Factors For
Deep Vein Thrombosis Were Analyzed And General Characteristics Of Patients With Deep Vein Thrombosis Were Studied.
Materials And Method It Was A Prospective Cohort Study Conducted In Department Of Obstetrics And Gynecology
In Sir Sunder Lal Hospital Banaras Hindu University Between July 2012 To June 2014.
208 Pregnant And Postpartum Females With/Without High Risk Factors For Deep Vein Thrombosis Were Included In The
Study.
Colour Doppler Sonography Of Bilateral Lower Limbs And Pelvis Was Performed On All The Subjects And Deep Vein
Thrombosis Was Diagnosed.
Results Age Of The Patients Ranged From 19 To 37 Years. 96.6% Of The Population Was <35 Years Of Age. Only 14.9%
Of The Patient Had Body Mass Index >30. 2(1% Of Total) Patients Had Lack Of Compressibility On Colour Doppler
Ultrasound In Postpartum Group. Absence Of Colour Doppler Flow Was Seen In 3 Patients (1.44% Of Total). Thrombus
Was Visualized In All The 3 Patients (1.44% Of Total Cases) With Deep Vein Thrombosis.
Conclusion - In Our Study The Incidence Of Venous Thromboembolism In Pregnant And Postpartum Came Out To Be
1.4%.Total Of Three Cases Came Out To Be Positive For Features Of Deep Vein Thrombosis On Colour Doppler
Ultrasonography. All Three Patients Belonged To Postpartum Group And Were High Risk For Dvt. In Patients High Risk Of
Clinical Suspicion For Deep Vein Thrombosis Ultrasound Showed Subcutaneous Edema Of Lower Limbs.

***************

Splenectomy During Pregnancy - An Uncommon Case

Author: Dr. Shreyaa Sriram
Co Author: Dr U T Bhosale1, Dr R Shriwastav2,

Splenectomy Is Accepted As A Gold Standard In The Treatment Of Different Hematologic Diseases, But There Are Only
Sporadic Reports About Its Use In The Trauma Patients. If The Spleen Is Ruptured (As A Result Of Trauma), The Organ
Needs To Be Removed Due To Stem Blood Loss Due To Internal Hemorrhage Which Could Quickly Become Fatal If Left
Untreated. An Emergency, Life-Saving Treatment May Be Seen As A Benefit Of Removal Of The Spleen .
A 22 Year Female Who Was 35 Weeks Pregnant Came To Bharati Hospital,Sangli With History Of Fall On Left Side And
Complaints Of Pain In Abdomen Since Then. On Examination , Patient Was Hemodynamically Stable, Per Abdomen Uterus
Was 32 Week Size, Relaxed, Fhs Was Present. Abrasions And Tenderness Was Present Over The Left Lower Side Of The
Chest. Per Vaginal Examination Revealed That Patient Was Not In Labour, Her Routine Investigations And Usg Obstetrics
And Abdomen Was Done, Which Revealed Spleen Shows Haemorrhagic Laceration At Mid Pole With Subcapsular
Collection, Gross Collection In Peritoneal Cavity, S/O Hemoperitoneum And Single Live Intrauterine Pregnancy Of
32Weeks. Her Hemoglobin Was 10.1Gm% So We Decided To Manage The Rupture Conservatively But Later When We
Repeated The Cbc After 6 Hours There Was A Drop In Hemoglobin It Was 7.5Gm% And Patient Suddenly Developed
Hypovolemic Shock Hence Emergency Splenectomy Was Done. Post Op Patient Was Kept In Icu And Went Into Labour
After 2 Days And Delivered A 2Kg Female Baby Vaginally And Doing Well.
Splenectomy In Ruptured Spleen Is Feasible And A Safe Procedure Even In The Pregnant Patients With Sustained Blunt
Trauma. It Requires Adequate Experience In Surgery And Great Technical Care, But Offers Major Clinical Advantages.

***************

Stand Alone WomenS Hospital: Bridging The Gap

Author: Dr. Ragini Agrawal
Co Author: Dr Ragini Agrawal1, Dr. Anupamabahadur2, Dr. Chandankachru3, Dr. Manjudagar4,

Stand Alone WomenS Hospital: Bridging The Gap

Dr. Raginiagrawal*, Dr. Anupamabahadur, Dr. Chandankachru, Dr. Manjudagar
Director-Medical Services*, W-Hospital By Pratiksha, Sector 56, Gurgaon

Abstract
Aims & Objectives: We Need A Multi-Disciplinary Approach To The Holistic Care Of Women. For This A Dedicated Hospital
Is Required To Fulfil The Need Of Health Care Of Urban Women In The Private Sector With Emphasis On A Comprehensive
Range Of Routine Obstetrics And Gynecology Services To Patients Of All Ages.
Materials & Methods: On Evaluating The Lacunae In Multi-Speciality Hospitals We Realized That There Is A Scarcity Of
Speciality Hospitals That Think A Woman Is Special.The Emphasis Should Be On Safety And Quality As Well As Providing
Premier Health Services To Women And Ensure That You Are Always In Safe Pair Of Hands In The Hospital.
Results:Specialty Hospitals Are Not A New Phenomenon. They Have Existed In Various Forms For Several Years As
ChildrenS Hospitals, Psychiatric Hospitals, Rehabilitation Hospitals, Eye And Ear Hospitals, And Others. Only Recently,
Specialty Hospitals Have Begun Focusing On Cardiovascular/ Orthopedic Surgery/ General Surgery And Now WomenS
Health. Most Of These Hospitals Have Been Conceived And Financed By Physicians Whose Expertise And Knowledge Of
Their Specialty Provides A Valuable Guidance To Enhance Patient Experience And Improve Outcomes.
Conclusion: Dedicated WomenS Hospital Must Provide A Comprehensive Range Of Routine Obstetrics And
Gynecology Services To Patients Of All Ages. Women Must Be Offered Individualized And Compassionate Healthcare For
Women From Adolescence Through Menopause. Treatment Within Women'S Health Is One Of The Most Rapidly
Advancing Technological Areas Of Medicine.

***************

Study Of Mullerian Anomalies And Endometriosis

Author: Dr. T.Ramani Devi
Co Author: Dr. C. Archana Devi1,

Study Of Mullerian Anomalies And Endometriosis

Dr.T.Ramani Devi Md;Dgo;Fics;Ficog; Dr.C.Archana Devi Md;
Ramakrishna Nursing Home, Vivekananda Nagar, Trichy,Tamil Nadu.
Aim And Objectives:
This Study Was Conducted To Find The Association Of Endometriosis And Mullerian Anomalies.Early Correction Of
Mullerian Anomaly Prevents The Progression Of The Endometriosis And Infertility.
Methods And Materials:
This Prospective Study Was Under Taken At Ramakrishna Nursing Home During The Period Of 2011 January To 2014
June.End Point Is Either Relief From Pain Or Pregnancy.Patients Having Mullerian Anomaly Who Were Infertile And Having
Pain Were Included In The Study.
Endometriosis Was Ranging From Mild To Severe Among These Patients Undergoing Laparoscopy. 664 Cases Were
Selected And 68 Cases Were Found To Have Mullerian Anomalies.
Following Parameters Were Analysed:
Age, Marital Status,Symptoms,Type Of Anomaly By Usg And Mri, Findings Of Laparoscopy & Hysteroscopy, Presence Of
Endometriosis, Treatment Given And Outcome Of The Treatment.
Results:
Incidence Of Mullerian Anomaly Was (68/664)10.3%.Age Group Was Between 13-31 Years.5/68 Cases Were
Unmarried.Presenting Symptoms Amenorrhea In 2/68.Dysmenorrhoea 39/68.Infertility 60/68.All Patients Had Usg And
Mri Was Done In 4 Patients.Diagnostic Hysterolaparoscopy Done For All Patients.Findings Are 2/68 Mrkh Syndrome.6/68
Had Unicornuate Uterus. 3/68 Had Uteri Didelphys.2/68 Had Bicornuate Uterus.55/68 Had Septate Uterus.Endometriosis
Was Present In 75% Of Uteri Didelphys And Bicornuate Uteri
No Endometriosis In Unicornuate And Mrkh Syndrome
20% Of Septate Uteri Had Endometriosis.Stage Of The Endometriosis Mild(38%)Moderate(42%)And Severe(20).One Case
Of Herlyn Werner Wonderlich Syndrome Was Diagnosed. All Patients Underwent Laparoscopy.Dysmenorrhoea Resolved
In Unmarried Girls.Overall Conception Rate Was Around 36%.
Coclusion:
Mullerian Anomalies Have 20% Incidence Of Endometriosis.The Incidence Was Higher In Patients Who Had Outlet
Obstruction.When Diagnosed Earlier And Treated,There Is Excellent Symptomatic Relief And Favourable Fertility
Outcome.
***************

Successful Repair Of Ureterovaginal Fistula Following Lower Segment Caesarean Delivery: A Case Report
Author: Dr. Nallamilli Sujatha Reddy
Co Author: Dr. Ashwini N1, Dr. Kanumury Ramesh2, Dr. Vandana K3, Dr. P.Manjula Devi4, Dr. M.Syam Mohan Rao5

Successful Repair Of Ureterovaginal Fistula Following Lower Segment Caesarean Delivery: A Case Report
Dr.Nallamilli Sujatha Reddy, Dr.Ashwini N, Dr. Kanumury Ramesh (Urologist),
Dr.Vandana K, Dr.P.Manjula Devi, Dr. M.Syam Mohan Rao (Hod)
Background: Urinary Incontinence Following Gynaecological Or Obstetric Surgery Is A Dreaded Complication Due To The
Formation Of Urogenital Fistula. It Has Significant Morbidity, With Social And Psychological Aspects Aggravating The
Clinical Situation. The Commonest Urogenital Fistula Is The Vesicovaginal Fistula. Ureterovaginal Fistula Is Rare To Occur
Especially Following Caesarean Section. This Is The Most Distressing Condition. The Main Aim Of The Treatment Of
Ureterovaginal Fistula Is The Resolution Of The Urinary Leakage, Prevention Of Urosepsis And Preservation Of Renal
Function.
Case: A 25 Year Old Woman Who Underwent Caesarean Section Three Weeks Back, Presented With Continuous Vaginal
Discharge Was Referred To Asram Hospital. The Discharge Was Clear, Consistent With Urine. The Classical History Of
Continuous Urinary Incontinence Along With The Normal Act Of Micturition Is Present. Preliminary Investigations
Including Complete Blood Count, Complete Urine Examination And Urine Culture, Random Blood Sugar, Serum
Electrolytes, Renal Function Tests Were Carried Out. For Diagnostic Purposes, Methylene Blue Three Swab Test,
Ultrasonography Of Abdomen And Pelvis And Intravenous Urography Were Performed. Case Managed With Boari Flap
Reconstruction. Patient Recovered With Complete Cessation Of Urinary Fistula, Restoration Of Renal Function And Near
Complete Restoration Of Urinary Anatomy.

Conclusion: Although Ureteric Injury Is Relatively Uncommon, It Is A Serious Event That Can Result In Intra-Abdominal
Sepsis And Renal Failure. Most Injuries Are Iatrogenic And Remain Undiagnosed Until The Patient Presents With
Symptoms Postoperatively. These Complications Can Be Prevented By Good Surgical Technique, Anticipation And High
Index Of Suspicion Of Ureteric Injury, Appropriate Investigations And Early Intervention. Meticulous Documentation Of
Pre Op., Intra Op. And Post Operative Events Is Very Important.

***************

Symphysis Pubis Dysfunction-Locomotor Difficulty In A Parturient Woman

Author: Dr. Thamilkothai Rajaram
Co Author: Dr.Krishnaveni Mgog Postgraduate Tvmc 1, Dr.Ramalakshmi Mdog Associate Professor Tvmc2, Dr.Meena Md
Dgo Dnb Professor And Hod Tvmc3,

Symphysis
Pubis
Parturient Woman

Dysfunction

(Spd)

Locomotor

Difficulty

In

Background:
Pregnancy Leads To Altered Pelvic Load, Lax Ligaments, Hormonal, Biochemical Alterations And A Weakening
Of Musculature. In Combination Leads To Spino-Pelvic Instability, Most Commonly Manifest As Symphysis Pubis
Dysfunction. Spd Occurs Where The Joint Is Sufficiently Relaxed Allowing Instability Of The Pelvic Girdle. When The Gap
Increases To More Than 10 Mm Is Known As Diastasis Of Symphysis Pubis. Incidence Of Diastasis Of Symphysis Pubis Is
1 In 800.
Case Report:
25 Years Old Para2, Live2, Delivered Via Naturalis In A Phc And Was Referred As? Cvt Admitted On The Second
Postnatal Day With Complaints Of Inability To Walk. On Examination, She Was Conscious, Oriented, Anemic With Stable
Vitals. Per Abdominal Examination Revealed Firm Uterus But With Severe Pain Over Symphysis Pubis Shooting, Stabbing
And Radiating To Lower Abdomen And Thighs Up To Knee Joint. The Ranges Of Hip Movements Are Limited Particularly
During Abduction. Continuous Disabling Pelvic Pain When Turning In Bed, Standing And Walking. Her Basic Blood
Investigations Were Within Normal Limits Except For Mild Anemia. Imaging By Plain X-Ray Pelvis Ap View Showed
Diastasis Of Symphysis Pubis. She Was Treated With Analgesics, Physiotherapy, Ted Stockings And Gradual Mobilization.
Conclusion:
Spd Is Relatively Common And Debilitating Condition Affecting Parturient Women With Significant Impact
On Qol. High Recurrence Rate Of 68-85% In Future Pregnancies. Long Term Morbidity Can Be Reduced If Diagnosed Early.

***************

A Rare Presentation Of A Fetal Intra Cranial Teratoma In Mid Trimester A Case Report
Author: Dr. Vijayalakshmi K
Co Author: Dr. Sathiya. S.1, Dr.Famida. A .M.2, Dr.Sailatha Ramanujam3, Dr. Abu Backer Sulaiman4, Dr. Rajesh Kanna5

Teratoma Is A Benign Germ Cell Tumour Arising From Totipotential Germ Cells . It Most Commonly Arises From The
Ovary. Teratoma Arising During The Fetal Period Is Mostly Seen In The Sacro Coccygeal Region. It Is A Tumour That Grows
To Mammoth Proportions. Intra Cranial Teratoma Is An Extremely Rare Entity.
Mrs. S, 26 Years G2P1L1 Presented To Our Outpatient Department On 6/9/14 With H/O Six Months Amenrrhoea And
Difficulty In Breathing Since One Week. Examination Revealed Normal Systems And On Obstetric Palpation, Uterus Was
Over Distended And Corresponding To 36 Weeks Size With Severe Polyhydramnios. Ultrasound Showed A Fetus With A
Solid Echogenic Space Occupying Lesion In The Cranium Causing Macrocephaly With A Bpd Of 12Cms And Causing Loss
Of Normal Brain Architecture. The Rest Of The Fetal Biometry Corresponded To 25- 26 Weeks. Polyhydramnios Was Seen
With An Afi Of 28Cms. After Informed Consent Was Obtained Explaining The Extremely Poor Prognosis For The Fetus A
Hysterotomy Was Done And A Stillborn Female Fetus Was Delivered Weighing 1.6Kgs . The Fetus Showed Macrocephaly
And The Mass Extending Into The Left Side Of The Neck And Positional Abnormality Of The Legs. No Other Gross
Structural Congenital Anomaly Was Detected. A Ct Scan Of The Fetus Was Done Post Delivery Which Showed A Large
Intracranial Solid Lesion Occupying The Entire Carnial Region And Extending Into The Neck With Areas Of Calcification
And Fat Attenuation Suggestive Of Teratoma. The Fetus Was Subjected To Autopsy. It Revealed An Intracranial Immature
Teratoma With Extension Into The Neck Region. Post Operative Period Was Uneventful For The Patient And She Was
Advised Pre Pregnancy Work Up Prior To Next Conception.

***************

Outcome Of Post Caesarean Pregnancy In A Tertiary Care Centre

Author: Dr. Sathya Prabha J
Co Author: Dr.Amutha Giridhar1,

The Optimum Management Of The Woman Who Has Undergone A Previous Caesarean Delivery Has Been Debated For
Over 100 Years.

Aims & Objectives

To Provide Evidence Based Information To Choose The Mode Of Delivery Following A Single Caesarean Section In A
Tertiary Centre.

To Study The Success Rate Of Vbac (Vaginal Birth After Caesarean).

To Assess The Safety And Efficacy Of Vbac By Comparing The Maternal And Perinatal Outcome With The Ercs
(Elective Repeat Caesarean Section).
Materials And Method:
Over A Period Of One Year, 211 Women Who Satisfied The Inclusion Criteria Were Recruited Into The Study.

Patients Who Preferred Ercs Were Taken Up For Elective Section After Completion Of 38Weeks.

In Patients Who Preferred Tolac(Trial Of Labour After Caesarean) , We Waited For Spontaneous Onset Of Labour.
Induction After 39 Weeks Was Done In Women Who Did Not Go Into Spontaneous Labour. Women Who Abandon Trial
Of Labour Halfway Were Taken Up For Emergency Caesarean Section In View Of Maternal Request.
Result:
Success Rate Of Vbac Was Found To Be 47.9%. About 15% Of Failed Vbac Was Due To The Tendency To Abandon A
Tolac Midway. The Success Rate Of Vbac Was Found To Be Increased In The Spontaneous Labour Group (P=0.002) And In
Those Who Had Previous Vaginal Deliveries. (P=0.001).
Although The Maternal Complications Were Found To Be Higher In Tolac ,It Was Not Found To Be Statistically
Significant(0.347). There Was No Increased Risk Of Neonatal Morbidity And Mortality In The Tolac Group When
Compared To Ercs (P=0.814).
Conclusion :
Vbac Is Found To Be Safe With No Significant Risk Of Maternal And Perinatal Complications. Hence Vbac Should Be
Encouraged In All Tertiary Care Centres Following Hospital Guidelines.

***************

A Novel Technique Of Cervicovaginoplasty With Sigmoid Graft Done In A Case Of Primary Amenorrhoea With
Cervicovaginal Agenesis
Author: Dr. Amrita Jain
Co Author:

The Reconstruction Of A Neovagina Is Indicated For Cases Of Congenital Absence Of Vagina.The Ideal Surgical Technique
For Vaginoplasty Is The One That Can Provide The Patient With A Vaginal Vault Of Sufficient Size, Adequate Introitus And
An Acceptable Cosmetic External Appearance .Several Surgical Techniques Were Described For Vaginal Replacement.
Depending On This Principle, Wallace Used The Sigmoid Colon Successfully In 1911.
26 Yrs Unmarried Referred To Our Institute In Nov 13 From Gmc Nanded With Primary Amenorrhoea And Cyclical
Abdominal Pain With Usg S/O Haematometra , B/L Haematosalpinx And B/L Ovarian Endometrioma With H/O Attempted
Vaginoplasty And Laparotomy With Myomectomy Done 1 Yr Back At Nanded And Advised Hysterectomy As A Last Resort.
On Examination
Secondary Sexual Characters-Breast Tanner Stage Iii,Pubic And Axillary Hair +
P/A-Soft,Scar Of Laparotomy And Laparoscopy +
P/S-Small Blind Vaginal Pouch, Approx. 2Cm
P/V-Blind Vaginal Pouch, No Cervix Felt
P/R-Ut 14Wks , Restricted Mobility,Non Tender, Felt In Continuity With Right Adnexa
20/06/14-Usg(A+P)-Ut
11.2X6.9X7.3Cm.4.5X4.4X4.4Cm
Collection
In
Endometrial
Haematosalpinx/Hydrosalpinx. B/L Ovarian Endometriotic Cyst Rt-6.9 X6.3 Cm Lft-6.2 X5.2Cm.

Cavity.

B/L

3 Cycles Of Gnrh Analogues Given.

Nov 13-Mri Done S/O Ut 8.3X8.1X6.4Cm. A 4.1 X5.5X4.6Cm Hematometra Seen . B/L Haematosalpinx Seen Rt-27Mm Lft17Mm.B/L Ovaries Enlarged With Multiple Cystic Lesions.
B/L Ovarian Endometriotic Lesions Rt-3.9X6.9X7.4Cm Lft-5.7X7.02X7.5Cm Few Subcutaneous Non Necrotic Ln. No Hn/Hu.
05/07/14-Exploratory Laprotomy With Drainage Of B/L Chocolate Cyst, Haematometra And Haematosalpinx With
Adhesiolysis With Cervicovaginal Sigmoid Graft By Gynaecologist And Surgeon.
Pt Got Spontaneous Menses After One Month Of Surgery.

Clinical Relevance- Our Case Revealed That Sigmoid Vaginoplasty Can Provide The Patient With A Functional Neovagina
Of Adequate Size. It Has A Low Complication Rate And A Low Incidence Of Introital Stenosis With No Need For Daily
Vaginal Dilatation Or Vaginal Stenting By Vaginal Moulds. Moreover, The Reported Functional Outcome Is Excellent.

***************

Health Education On Life Style Modification In Improving Art And Pregnancy Outcomes In Obese Infertile Population
Author: Dr. Shekinah Madadha
Co Author:

The Rising Prevelance Of Obesity Has A Profound Impact On Female Reproductive Health. Increased Body Mass Index
(Bmi) Is Associated With Anovulatory Subfertility And Anovulatory Infertility. Over Weight And Obese Women Has Poorer
Outcomes Following Fetility Treatment. Obese Patients Needs Higher Doses For Ovulation Induction And Superovulation.
Fertilisation Rates Are Poorer In Women Are Obese. Pregnancy Rates In Some Studies Show Lower Rates In Obese Group
And There Is Increased Risk Of Early Pregnancy Loss.
Aim And Objective: This Study Aims In Focussing By Health Educating Obese Infertile Patients By Life Style Modification
In Improving Art And Pregnancy Rate Outcomes.
Material And Methods: This Is A Prospective Case Control Study Conducted From 2012-2014 In 300 Patients Attending
Art Clinics In Visakhapatnam. The Criteria Was Based On Their Body Mass Index (Bmi) , Infertility Duration, Prior Art
Treatment Procedures. Health Education Was Given On Life Style Modification Regarding Diet, Exercise And Behaviourial
Modification.
Result: Significant Improvement Was Observed In The Group By Improving Their Art And Pregnancy Outcomes. Significant
Results Were Seen In Those With Repeated Art Techniques Failure.
Conclusion: Educating Obese Infertile Patients Regarding Life Style Modification Attending Infertility Clinics Not Only
Improves Art And Pregnancy Outcomes But Also Effects Long Term Healthy Life Style.
***************

Theca Lutein Cyst In Normal Singleton Pregnancy

Author: Dr. Chandra Ponnuswamy
Co Author: Dr Mythili1, Dr Madhumitha2,

Theca Lutein Cysts Are Benign Neoplasms Of The Ovary Known To Be Associated With Vesicular Mole , Choriocarcinoma
,Multiple Pregnancy, Erythroblastosis Foetalis And During Ovarian Stimulation In Ovulation Induction ( Iatrogenic ). Very
Rarely It Is Associated With Normal Singleton Pregnancy. Spontaneous Regression Of These Cysts Occur Following
Delivery. There Is No Need For Any Interference Unless Any Acute Emergency Like Torsion Or Rupture Of The Cyst Occurs.
In Few Published Cases Bilateral Oophorectomy Were Done For These Cysts. Awareness About The Postpartum
Spontaneous Regression Of These Cysts Would Help To Avoid Such Situations. In My 30 Yrs Of Obstetric Experience And
25 Yrs Of Sonology Practice, I Have Never Come Across These Type Of Cases.Two Cases - One Primigravida Another Multi
Gravida. Both With Theca Lutein Cysts Are Presented For Its Rarity. Though Alarming At The First Sight The Innocuous
Nature Of The Cysts And Spontaneous Regression Of These Cysts Make Us To Wait And Observe Carefully.
***************

Vault Prolapse In The Perimenopausal Women

Author: Dr. Lavanya G
Co Author: Dr.Srinivas.K, Assistant Prof,Bmcri1, Dr.Malini.K.V., Prof &Hod,Bmcri2,

There Is An Increase In The Number Of Women Undergoing Hysterectomy At A Young Age And Hence At Risk Of
Complications Including Vault Prolapse As Women Live Longer.

Objective: To Study The Clinical Parameters Of Patients Of Vault Prolapse, Pre-Op And PostOp Symptoms, Treatment
Provided At Vani Vilas Hospital, Bangalore Medical College.

Methodology: A Combined Retrospective And Prospective Descriptive Study Of 40 Cases Treated In Vvh From 2004 To
2014 Particularly In The Age Group Of 35-50 Years(N=40). Data Collected From Patients And Their Hospital Records.
Improvement In Symptoms Or Recurrence Were Noted At 1 Year Follow-Up.

Results: Mean Age At Vault Prolapse Was 43.9 Years And Mean Age At Hysterectectomy Was 35Years. The Mean
Duration Before Symptoms Developed Following Hysterectomy Was 9 Years. Nearly 80% Of Our Patients Had Undergone
Total Abdominal Hysterectomy For Indications Like Fibroid Uterus In 40%, Abnormal Uterine Bleeding In 40% And
Uterovaginal Prolapse In Only 20 %.None Of These Patients Had Been Offered Any Other Treatment Option Before
Hysterectomy. Most Common Symptom Was Difficulty In Voiding Urine(80%). Straining At Stools Was Seen In Fewer Than
30% And Sexual Dysfunction Was Seen In 75%. 40% Of Our Patients Underwent Sacrospious Fixation By Vaginal Approach
Along With Site Specific Repair While 40% Of Them Underwent Site Specific Repair Alone Which Was Mainly Cystocele
Repair. Abdominal Sacrocolpopexy Was Performed On 8 Patients (20%) Using Prolene Mesh. >90% Expressed Subjective
Improvement In Symptoms At 1Year Follow Up.Post Op Outcome Was Similar In All Types Of Surgery.

Conclusion : Vault Prolapse Is Fairly Common Especially If Hysterectomy Was Done At An Early Age. Careful Selection Of
Patients And Perhaps A Trial Of Non Surgical Methods Of Treatment Before Deciding On Hysterectomy Is The Need Of
The Hour.

***************

Think Ectopic-Series Of Ectopic Pregnancy Cases With Variable Presentation

Author: Dr. Brajbala Tiwari
Co Author:

Think Ectopic - Series Of Ectopic Pregnancy Cases With Variable Presentation

Dr. Brajbala Tiwari

Ms, Fics, Micog

Director, Life Care Hospital, Indore

Aims & Objective To Report Unique Cases Of Ectopic Gestation To Highlight Learning Point Out Of It.

Material & Method - Retrospective Study Of Series Of Unique 6 Cases Of Ectopic Pregnancy Form July-2013 To July-2014
Done At Life Care Hospital, Indore.

Results Incidence Of Ectopic At Lch During Study Period Was About 4%. In The Series. Of 6 Cases - They Were After
Tubal Ligation,After Tubal Recanalisation,After I Pill Use ,After Low Dose Oc Pill Use. One Case Of Heterotopic Pregnancy
With Twin Intrauterine Pregnancy, An Unmarried Girl With Adnexal Mass . Lastly A Very Interesting Rare Case Of Ectopic
In Post Abdominal Hysterectomy Patient .

Conclusion Think Ectopic In Any Case Of Acute Abdomen .In History It Is Important To Enquire About
Amenorrhoea,Scanty Flow, I Pill Use, Low Dose Oc Pill Use & History Of Contact Even In A Unmarried Girl . Predisposing
Factors Like Tubal Ligation & Recanalisation Increase The Risk Of Tubal Ectopic. Faintly Positive Upt Or Negative Upt Dose
Rule Not Ectopic Gestation. Adnexal Mass Or To Mass Need Proper Evaluation. The Old Dictum think Ectopic Has
To Change Think Heterotopic Even If You See Intrauterine Pregnancy Specially In Infertility Patient. Very Rarely In Post
Hysterectomy Women Of Reproductive Age Ectopic May Occur .High Index Of Suspicion Is Needed For Correct & Timely
Management To Prevent Maternal Morbidity And Mortality Associated With Ectopic Gestation.
***************

A Case Report Of Rupture Endometrioma Presenting As Acute Abdomen With Raised Serum Ca-125 Levels
Author: Dr. Leelavathi Gajulapalli
Co Author: Dr Sbobha N Guidi (Hod Obg)1, Dr Namratha (Consultant)2, Dr Leelavathi (Dnb Resident)3,

Tietle-A Case Report Of Rupture Endometrioma Presenting As Acute Abdomen With Raised Serum Ca-125 Levels
Authors

Dr. Leelavathi(Dnb Resident)

Dr. Namratha(Consultant Obg)
Dr.Shobha N Gudi(Hod Obg)

Endometriomas Are Cystic Endometrial Lesions Which Are Contained Within The Ovaries. Incidence Of
Endometrial Cyst Is 1-22% In General Population.Spontaneous Rupture Of Endomertiotic Cyst Is Very Rare.The Rupture
Of The Endometriotic Cyst Is One Of The Acute Gynaecological Condition Which Is Manifested By Acute Abdominal Pain
And Haemodynamic Changes.We Are Here Discussing A Similar Case Managed At Our Institution.Mrs X 27Yr Old
Nulligravida Presented To Us With Diffuse Lower Abdomen Pain Radiating To Right Shoulder With Vomiting And Fever
.On Examination Pallor Present.Per Abdomen Diffuse Tenderness Present 10X10Cm Mass Felt ,Per Vaginally Cervix
Deviated To Left, Right Forniceal Tenderness Plus Fullness Present .Differential Diagnosis Included Torsion Ovarian Cyst
,Ruptured Ovarian Cyst ,Secondary Carcinoma Of The Ovaries And Endometriomas.
Clinical Laboratory Evaluations Revealed A Bilateral Ovarian Mass With Solid And Cystic
Components With Leak Into Peritoneum With Raised Serum Ca-125 Levels. She Underwent Emergency Laparotomy
With Endometrial Cyst Removal With Adehesiolysis Done. Hrct With Pulmonary Angiogram Done It Showed Plural
Effusion With Lower Lobe Atelectasis Treated With Antibiotics And Supportive Care .Post Operatively Patient Developed
Pulmonary Embolism Treated With Warfarin, Pt-Inr Monitoring Done. Patient Recovered Well.
Conclusion:Ovarian Endometrioma Should Be Considered As A Acute Condition And Early Intervention Needed To
Save The Patient Life.

***************

Amh-A New Marker For Diagnosis Of Pcos

Author: Prof. Shikha Singh
Co Author: Saroj Singh1, Rekha Rani2, Hari Singh3,

Title - Amh (Anti Mullerian Hormone) A New Marker For

Diagnosis Of Pcos.

Authors- Shikha Singh, Saroj Singh, Rekha Rani, Hari Singh

Aim, Materials & Methods, Results & Conclusion.

Aim:- To Evaluate The Role Of Amh As A Diagnostic Marker In Comparison With Pco-M By Ultrasound.
Material & Methods: A Total Of 200 Women In The Age Group 21-30 Yrs With Diagnosis Of Pcos By RotterdamS
Criteria Were Included In The Study. Amh Levels Were Done In These Cases On Fasting Venous Blood Samples Irrespective
Of Cycle Day. Amh Levels Above 10Ng/ Ml Were Taken As Diagnostic For Pcos.

Results: Amh Based Diagnosis Showed Sensitivity Of 96.5 And A Specificity Of 98.5.

Conclusion: Serum Amh Levels Are A Promising Marker For Diagnosis Of Pcos Especially In Cases Where Usg Tvs
Facilities Are Not Available Or Not Possible.

Author: Dr. Shikha Singh,

Associate Professor, Snmc, Agra
Address:

23, Jaipur House Agra- 282010 (Up)

Registered In Aicog 2015 (Receipt No 545)

Registration Number In Agra Society (Fogsi) Life Member - Lm/ Ao Gs/ 072
Email Id: Drshikhasingh.Shikha@Gmail.Com

***************

Five Interesting Cases Of Non-Obstetric Cns Problems In Pregnancy

Author: Dr. Raji Chinniah
Co Author: Dr.E.Kalarani1,

Title : Five Interesting Cases Of Non Obstetric Cns Problems In Pregnancy

Authors: Dr.C.Raji, Assistant Professor In O&G, Dr.E,Kalarani ,Thanjavur Medical College
Abstract:
Background: Cns Disease In Pregnancy Is Very Rare.Neurological Symptom Appear For The First Time Must Be
Distinguished From Pregnancy Complications.We Report Five Cns Problems Occurred During Pregnancy.Three Cases
With Intracranial Mass Lesions,One With Infection And One With Trauma.
Cases: 1.Meningioma:23 Years Third Gravida In 34Weeks Gestation Had Increased Ict Symptoms & Diagnosed To Have
Right Parietal Falx Meningioma .Since Patient Developed Coning, Lscs Followed By Right Parieto-Occipital Parasagittal
Craniotomy With Excision Of Tumour Done Successfully.
2.Brain Abscess:23 Years Primi In 37Weeks Gestation,Admitted With One Episode Of Seizure Two Days Back With
Headache And Vomiting .Ct Showed Left Temporal Sol. Emergency Lscs Followed By Left Parieto-Occipital Craniotomy
With Excision Of Brain Abscess Cavity Done Successfully.
3.Von-Hippel Lindau Disease:33Years Second Gravida ,29Weeks Gestation Admitted With Headache, Nausea, Vomiting
And Giddiness .Fundoscopy Showed Papilloedema Mri Showed
Haemangioblastoma, Hydrocephalus &
Haemangioma Liver. Vp Shunt Done. Two Weeks Later Patient Developed Same Symptoms. Emergency Lscs And
Hemicraniotomy With Subtotal Excision Of Tumour Done.
4.Meningitis:26 Years Second Gravida,37Weeks Gestation Admitted With Fever For 10Days.While On Treatment She
Became Disoriented. Ct&Mri Were Normal. Lscs Done. Fever Continued &Developed Status Epilepticus And Died
5.Trauma:25 Years Second Gravida Admitted With History Of Fall And Became Unconscious With Stable Vitals. Patient
Delivered And Connected To Ventilator. Ct Showed Bilateral High Parietal Haemorrhagic Contusion. Gc Did Not Improve
& Died
Conclusion: The Clinical Presentation Of Increased Ict Could Be Misdiagnosed As Eclampsia. With Abnormal Fundus, Focal
Fits, Localizing Neurological Deficit And Visual Impairment Support The Diagnosis Of An Intracranial Mass Leision.It Should
Be Promptly Furthur Investigated With Mri To Confirm The Diagnosis.Team Approach Of Obstetrician,Neurophysician
,Neurosurgeon And Anaesthesiologist Could Save Lives Of Our Three Patients.

***************

Efficacy Of Lng Iucd In Aub Patients

Author: Dr. Renuka Malik
Co Author: Jagriti Gupta1,

Title : Efficacy Of Lng Iucd In Aub Patients

Aim And Objectives

1.

To Study Efficacy Of Lng Iucd In Aub Patients

Material And Methods

This Was A Six Month Prospective Observational Study. 50 Patients Were Selected Form Gyane Opd Of Rml
Hospital, New Delhi Suffering From Aub.
The Inclusion Criteria Were: 1) Age 35-45 Years 2) Pbac >=100 3)Uterus Size >=12 Weeks 4)Wanting Contraception
The Exclusion Criteria Were 1) Any Suspicion Of Malignancy 2)Uterus > 12 Weeks 3) Fibroid> 12 Weeks 4 ) Not Wanting
Contraception Or Ligated 5 )Serious Medical Disorder
Patients Had Hb, Serum Ferritin, Pbac And Ultrasound And Eb At Enrollment And Were Followed Up At 1,3 And 6 Months
Period After Lng-Iucd Insertion. The Insertion Was Done Meeting The Manufactures Guidelines On 5Th Day Of Period.
Any Side Effects Or Expulsion Was Checked For

Results
There Was Marked Improvement In Hb And Serum Ferritin Levels . There Was No Expulsion Or Perforation. No Patient
Asked For Removal Of Iucd.

Conclusion
Lng- Iucd Is An Highly Acceptable Treatment Of Aub With High Efficacy. This Can Be Used To Treat Patients With
Adenomyosis And Small Fibroids Also. The Side Effects And Compications Are Very Few . Many Unnecessary
Hystrectomies Can Be Avoided In Patients Of Aub With The Use Of Lng- Iucd.

***************

Study Of Prophylactic Sacrospinous Suspension[Sss]In Iiird Degree Uterine Prolapse

Author: Dr. Prabha Desai
Co Author:

Title : Study Of Prophylactic Sacrospinous Suspension[Sss] In Iiird Degree Uterine Prolapse

Dr. Prabha Desai, Ms(Obgy), Mumbai, Fcps(Obgy), Dgo, Pgdmls. Cosultant Obstetrician & Gynaecologist At Vaatsalya
Hospital, Csi Hospital Gadag Karnataka
Aim And Objective:1.To Prevent Vault Prolapse After Hysterectomy In Iiird Degree Prolapse.
2.To Maintain Self Esteem And Feminine Quality Of Life Even After Hysterectomy In These Patients.
3. To Confirm The Safety Of Prophylactic Sss Procedure During Primary Surgery For Iiird Degree Prolapse.
Material And Method:
This Is Prospective Study From 2009 2013 , 20 Cases Of Prophylactic Unilateral Sacrospinous Suspension During
Prolapsed Surgery; Varying Between 35 64 Yrs Age, All Were With Apical Prolapse Of Grade Iii & Above With
Cystorectocele; One With Sui Which Needed Tot.
Result: Only One Patient Has Intra Op Bleeding Not Requiring Blood Transfusion. Avarage Two Years Follow Up Showed
4 Patients With Small Cystocele, None Of Others Has Vault Prolapse Or Sui. It Maintained The Vaginal Length In Adding
The Feminity By Helping To Maintain Sexual Life. Success Rate Of 80%
Conclusion: Prophylactic Unilateral Sacrospinous Suspension Can Be Recommended For Routine Use In Cases Of Apical
Pelvic Prolapse Of Grade Iii & Above. It Is Inexpensive, Quick, Easy To Perform.

***************

Comparison Of Hysteroscopy And Power Doppler Sonography In The Diagnosis Of Abnormal Uterine Bleeding
Author: Dr. Shuchita Batra Goyal
Co Author: Prof. R.C. Shukla1, Prof. Anuradha Khanna2,

Title Comparison Of Hysteroscopy And Power Doppler Sonography In The Diagnosis Of Abnormal Uterine Bleeding
Dr. Shuchita Batra* , Prof R.C.Shukla** , Prof Anuradha Khanna*
Abstract
Aims And Objectives
Detection Of Abnormal Uterine Pathology By Ultrasound With Power Doppler And Hysteroscopy And Its Comparison
With Histopathology
Materials & Methods
One Hundred Women With Abnormal Uterine Bleeding Were Evaluated Between July 2012 And July 2014. They
Underwent Basic Evaluation Followed By Ultrasound With Power Doppler And Hysteroscopy.

Results
According To Palm-Coein Classification In Our Study, We Have Found Among Palm, That We Had Maximum Cases
In Leiomyoma (15%), Followed By Polyp (9%), Then Adenomyosis(5%), And Lastly Malignancy (4%). Among Coein, We
Had Maximum Cases In Not Yet Classified (31%), Ovulatory Dusfunction (14%), Endometrial Pathology (10%),
Iatrogenic (2%) And Coagulopathy (1%).

In Our Study, Hysteroscopy Is 80% Sensitive And 96% Specific In Diagnosing Endometrial Hyptraerplasia; For Polyp
Sensitivity And Specificity Is 100%And For Carcinoma, It Is 75% Sensitive And 100% Specific.
Power Doppler Is 66.66% Sensitive, 100% Specific In Diagnosing Endometrial Hyperplasia. Whereas, Sensitivity And
Specificity Of Polyp Is 100%, And That Of Carcinoma Is 75% And 100% , Respectively

Conclusion
Our Study Showed Good Correlation Between Findings In Power Doppler Ultrasound & Hysteroscopy And
Histopathology Of Endometrial Polyp, Endometrial Hyperplasia, Malignancy, Molar Pregnancy & Atrophy, Fibroids And
Adenomyosis. Histopathology Taken As Gold Standard.
So, We Can Take Tvs With Power Doppler Is A Good Tool As A Non- Invasive, Highly Accurate For Diagnosis Of Aub.
Hysteroscopy Is Also Highly Accurate But Is Invasive And Costly; So It Should Be Done When Required As In Doubtful Cases
Or To Rule Out Malignancy,

***************

Episiotomy Repair By Rapidly Absorbable Polyglactin Or Chromic Catgut?

Author: Dr. Simi Aggarwal
Co Author: Dr M.Dasgupta1, Dr. S K Saha2, Dr. Monimala Murmu3,

Title: Episiotomy Repair By Rapidly Absorbable Polyglactin Or Chromic Catgut?

Abstract:
Aims & Objectives:
To Compare The Short Term Morbidity Following Episiotomy Repair By Rapidly Absorbed Polyglactin And Chromic Catgut.
Materials & Methods:
This Prospective Longitudinal Study Was Conducted In The Department Of Obstetrics And Gynaecology, Medical College,
Kolkata From 1St July2008 To 30Th June 2009. 100 Primigravida Who Delivered With Episiotomy Were Divided Into 2
Groups Group I (N=50) Repaired With Rapidly Absorbed Polyglactin And Group Ii (N=50) Repaired With Chromic Catgut
And They Were Compared With Respect To Pain, Wound Complications, Fever, Uti And Perineal Edema, -Immediately,
On 2Nd Day, At 6 Weeks And 3 Months.
Result:
With Regard To Postoperative Complications Like Pain, Fever, Uti, Perineal Edema And Wound Discharge, Infection And
Resuturing, Polyglactin Was Significantly Better Than Chromic Catgut. Moreover, Dyspareunia Was Only 8% In Polyglactin
Group Compared To 86% In Chromic Catgut Group Even At 6Weeks.
Conclusion:
The Short- Term Morbidity Following Episiotomy Repair With Rapidly Absorbed Polyglactin Is Less When Compared To
Conventionally Used Chromic Catgut Suture, And May Replace Catgut As The Preferred Suture For Episiotomy Repair.

Word Count 184

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Study Of Primary Caesarean Section In Multipara

Author: Dr. Rupal Samal
Co Author: Rupal Samal1, Pallavee P2, Seetesh Ghose3,

Title: Study Of Primary Caesarean Section In Multipara

Aim:
Caesarean Section Is Becoming An Increasingly Common Method For Delivery Of Fetus In The Recent Era. One Of The
Primary Causes Of Rising Trend In The Rates Of Cesarean Section Is The Increase In Number Of Cesarean Sections In
Primigravida. However, An Upward Trend Of Primary Cesarean Among Parous Women Has Also Contributed To The
Elevated Rates Of Cesarean Sections. Primary Caesarean In Multipara Means First Caesarean Section Done In Patients
Who Had Vaginal Delivery Once Or More Before.The Aim Of This Study Was To Evaluate The Indications For Primary
Cesarean Section In Parous Women And To Assess The Maternal And Fetal Outcomes.
Method:
This Was A Prospective Hospital Based Study Where Multiparous Women Who Underwent Cesarean Section During The
Period Of June 2013 To June 2014 Were Enrolled After Informed Consent .All Multiparous Women With Singleton
Pregnancy And Previous Normal Delivery Were Included In The Study.

Results:
The Mean Age Was27.433.76 Yrs. 97.1% Cases Were Booked. Majority Of The Patients Were Between 37-40 Weeks.
94.1% Cases Were Taken As Emergency Caesarean.Among The Various Indications For Caesarean Section In Multipara,
Fetal Distress(42.6%) And Malpresentations(25%) Were With The Higher Incidence.

Conclusion:
Previous Vaginal Delivery Gives False Sense Of Security To The Patient As Well As To The Relatives. Caesarean Section
Becomes Mandatory In Some Situations. Multiparous With Previous Vaginal Delivery Is Regarded As An Optimistic
Historial Fact, Not A Diagnostic Criteria For Spontaneous Delivery In Next Pregnancy.

***************

Comparison Of Maternal And Perinatal Outcomes In Pregnancy Complicated With Sickle Cell Hemoglobinopathies In
Endemic Western Part Of Orissa.
Author: Dr. Prosun Bera
Co Author: Dr Arati Behera1, Dr Nihar Bhoi2, Dr Puspanjali Khuntia3,

Title:Comparison Of Maternal And Perinatal Outcomes In Pregnancy Complicated With Sickle Cell Hemoglobinopathies
In Endemic Western Part Of Orissa.

Authors : Prosun Bera1,Arati Behera2 Nihar Bhoi3, Puspanjali Khuntia4 ,

Pgt1, Pgt2,,Senior Resident3, Asso Prof4
Ph No: 08763599542
Email :Prosunbera@Rediffmail.Com

Aims & Objectives:

To Compare The Fetomaternal Outcomes In Patients With Sickle Cell Hemoglobinopathies With Similar Patients Having
No Haemoglobinopathies.

Material & Methods

This Is A Hospital Based, Prospective, Study Done In The Dept Of Obs & Gyne, Vssmch From Oct 2012 To Aug 2014. Study
Group (Subjects) Consisted Of 156 Pregnant Women With Sickle Cell Disease/ Sickle Cell Trait Who Were Attending The
Antenatal Clinic Or Were Admitted In Obstetric Wards And Followed Up Till 7Th Day After Delivery. The Control Group
Consisted Of 1270 , Age And Gravidity Matched Pregnant Women Who Did Not Have Sickle Cell Disease / Trait Recruited
From The Same Hospital.

Results

Statistically Significant Complications During Pregnancy Included Anemia(100% Vs 48.98%,P<0.001), Pneumonia(9.1% Vs

0.64%,P<0.001), Cardiac Failure(9.1% Vs 0.79%,P<0.001), Postpartum Haemorrhage(27.27% Vs 3.93%,P<0.001), Blood
Transfusion(72.72% Vs 8.89%,P<0.005),Crisis(45.45% Vs 0%)And Toxemia(27.3% Vs 4.23%,P<0.005) Are Seen..
Incidence Of Preterm Deliveries(36.36% Vs 11.02%,P<0.05), Adverse Fetal Outcome In Terms Of Still Births(27.27% Vs
6.98%,P<0.005)), Early Neonatal Deaths(18.18% Vs 4.1%,P<0.005), Perinatal Mortalities(45.45% Vs 11.05%,P<0.001) And
Low Birth Weight(2.22+/-0.41 Vs 2.8+/-0.41,P<0.05) Were Significantly Higher In The Study Group Than In The Control
Group.

Conclusion(S) :

The Increased Fetal Loss And Maternal Morbidity In Mothers With Homozygous Sickle Cell Disease Is Confirmed. Risks
Are Highest In Late Pregnancy, During Delivery, And In The Postpartum Period. However, The Entire Pregnancy Is A HighRisk Period That Warrants Close Monitoring.

Key Words : Pregnancy Outcome, Sickle Cell Disease, Sickle Cell Trait, Sickle Cell Hemoglobinopathy

***************

Construction Of Customized Symphysio Fundal Height (Sfh) Growth Curves And Its Impact On Fetal Growth
Classification
Author: Dr. Shakun Tyagi
Co Author: Dr Shakun Tyagi1, Dr Reva Tripathi2, Dr Bharti Pant3, Dr Y M Mala4,

Title:Construction Of Customized Symphysio Fundal Height (Sfh) Growth Curves And Its Impact On Fetal Growth
Classification.
Authors:, Dr Shakun Tyagi, Dr Reva Tripathi, Dr Bharti Pant, Dr Y M Mala
Institute: Maulana Azad Medical College
Methodology
Longitudinal Prospectively Collected Clinical Data From 167 Low Risk Pregnant Women With Ultrasound Confirmed Dates
Was Studied. The Factors That Determined Birth Weight Were Used To Derive A Regression Equation To Generate
Customized Symphysiofundal Height Curve. Consequtive 1216 Low Risk Pregnancies Were Screened For Growth
Deviation Using Population And Customised Sfh Charts.
Results
At The Time Of Delivery 23.85%(285/1216) Of Babies Were Low Birth Weight Using Population Standards. In Our Study
31/32 Neonates Who Were Dignosed As Sga Using Customized Sfh Chart Were Also Sga Using The Standard Chart When
10Th And 90Th Percentile Were Used For Detection Of Fetal Growth Restriction. But Sensitivity Was Only 30%. However
The Detection Rate Of Deviant Fetal Growth Increased To 78% When 25Th And 75Th Percentile Of Customized Sfh
Were Used As Cutoffs For Sga And Lga.
Conclusion
Use Of Customized Growth Curve Detects The Constitutionally Small And Large Babies Due To Maternal Anthropometric
And Obstetric Characteristics And Reduces Interventions Due To False Diagnosis Of Growth Abnormality. Cutoff Of 25Th
And 75Th Percentile For Customized Sfh Increase The Sensitivity For Detection Of Deviant Fetal Growth
(Abbreviations- Sfh: Symphysiofundal Height; Lga: Large For Gestational Age, Sga: Small For Gestational Age; Aga:
Appropriate For Gestational Age.)
Acknowledgement: Department Of Science And Technology

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Ncd Screening
Author: Dr. Vijaya Subramanian
Co Author: Prof.Dr.S.Vijaya1, Dr.T.E.Balaji2,

To Analyse The Importance Of Ncd Screening As A Valuable Tool In Tamilnadu Health

System Project

Aims And Objectives:

To Analyse The Impact Of Ncd Screening At Various Levels Of Health Care System ,Particularly In
Tertiary Care Hospital, Particular Focus On Premalignant Lesions Of Cervix
Methods:
Value Of Ncd Screening At A Tertiary Care Hospital For A Period Of Two Years From 2012 To 2014 Were
Analysed .Total Number Of New Cases Of Hypertension,Diabetes Mellitus ,Premalignant ,Malignant Lesions Of Cervix,Any
Mass In The Breast And Associated Risk Factors Were Analysed For A Period Of Two Years From 2012 To 2014 In A Tertiary
Care Hospital,Iso & Govt.Kgh Chennai At Out Patient Clinic
Results
Overall Screening For A Period Of Two Years (2012-2014) Showed 5% Of Cases Were New Hypertensives,7 %
Of Cases Were Newly Detected Diabetes Mellitus,10% Premalignant Lesions,5 % Cancer Cervix.Lump Breast 8%,Ca
Breast 1%
Conclusions
Thus Ncd Screening Serve As Valuable Tool To Improve Health Care At All Levels By Early Detection Of
Noncommunicable Diseases And Facilitate Management

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Trans Vaginal Cervical Length Between 11-14 Weeks Of Gestation In Prediction Of Preterm Labor
Author: Prof. Sheela C N Nagaraja Rao
Co Author: Dr Sheela C N1, Dr Ramya K S2,

Trans Vaginal Cervical Length At 11-14 Weeks Of Gestation In Prediction Of Preterm Labor.

Aim: To Evaluate The Predictive Value Of Trans Vaginal Cervical Length At 11-14 Weeks Of Gestation In Preterm Labor.
Material And Methods:
Study Design: Prospective Observational Study.
One Hundred And Thirty Women Attending The Opd At St JohnS Medical College And Hospital Between 11-14 Weeks
Of Gestation Were Included In The Study. Cervical Length Was Measured Trans Vaginally. These Women Were Followed
Up Till Delivery. The Outcome Measures Were The Mean Cervical Length At 11-14 Weeks, Correlation Of This Mean
Cervical Length With Gestational Age At Delivery And The Predictive Value Of Cervical Length At 11-14 Weeks For Preterm
Delivery.
Results: Mean Gestational Age At Measurement Of Cervical Length Was12.17+/-0.89 Weeks. Mean Cervical Length In
Those Who Had A Preterm Delivery (<37 Weeks) Was 3.28+/-0.36Cm, Whereas The Same Was 3.89+/-0.36 In Those Who
Delivered At Term (P Value <0.001).Using The Area Under Roc Curve, Best Cut Off Of Cervical Length At 11-14 Weeks For
Preterm Delivery Is 3.6Cm, With A Sensitivity Of86.94%, Specificity Of 79.36%, Ppv Of 81.94% And Npv Of 84.74%.
Conclusion: Trans Vaginal Cervical Length At 11-14 Weeks Of Gestation Has A Good Predictive Value For Preterm Labor.

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A Study On Fetomaternal Outcome In Twin Gestation In A Tertiary Rural Health Centre

Author: Dr. Bhavana S Shivalingappa
Co Author: Dr.Bhavana ,S1, Dr,Gopal2,

Twin Pregnancy Is Considered As A High Risk Pregnancy ,Accounting For Approximately 1% Of All Pregnancies. They Are
Associated With A Variety Of Maternal And Fetal Complications And Has Been Reported To Be Responsible For 10% Of
Perinatal Mortality . Aims And Objectives :To Study The Maternal Risk Factors,Complications And Perinatal Outcome In
Twin Gestation In Rural Health Setup Materials And Methods: Included Retrospective Analysis Of 30 Twin Pregnancies
Admitted In Aims ,B.G.Nagara, During 24 Months Study. Here The Maternal Factors Like Parity, Age, Antepartum Risk
Factors, Mode Of Delivery And The Neonatal Characteristics Like Birth Weight, Need Of Nicu Admission, Perinatal
Mortality And Its Causes Were Studied . Results :In Our Study ,60% Were Multigravida.76.6% Had Spontaneous
Conception , 23.3% Had Ovulation Induction. About 73.3% Were In Age Group Of 20-25 Years.60% Had Dichorionic
Diamniotic Twins. 50% Of Them Were Complicated With Anaemia,30% With Hypertension. 76.6% Had Preterm Deliveries
And 23% Term Deliveries.47% Had Spontaneous Vaginal Delivery Versus 53% Caesarean Section. Mean Gestational Age
At Delivery Was 35.4 Weeks.Of The 60 Babies ,57 % Weighed Between 1.5-2.5 Kg.50% Needed Nicu Admission, Perinatal
Mortality Being 13 ( 21%),2 Were Still Births,7 Due To Prematurity And Lbw. No Maternal Mortality Noted. Conclusion:
Multiple Pregnancy Is A Significant Risk Factor For Maternal And Perinatal Morbidity And Mortality. The Knowledge Of
Maternal And Fetal Complications Helps In Better Surveillance And In Prevention Of The Morbidity And Adverse Outcome.
Hence The Need For Better Obstetric Care, Neonatal Care, Health Services To Get A Better Fruitful Outcome.
Key Words: Twin Gestation, Anaemia, Prematurity, Respiratory Distress Syndrome

***************

Twin Reversed Arterial Perfusion A Case Study

Author: Dr. Pallipuram Bhageerathy
Co Author: Dr. Ruby Jose1,

Twin Reversed Arterial Perfusion A Case Study

Bhageerathy P S, Ruby Jose
Christian Medical College, Vellore

Background
Twin Reversed Arterial Perfusion (Trap) Or Acardiac Twinning Is A Unique Vasculogenic Complication Of Monochorionic
Twin Pregnancy. Here, The Circulation In The Fetus With No Heart (Acardiac Fetus) Is Maintained By The Normal Or The
Pump Twin Through Large Arterio-Arterial Anastomoses. The Pump Twin Eventually Ends Up With Cardiac Failure
Due To Excess Burden .We Present A Rare Case Of Trap Sequence That Was Diagnosed At 23 Weeks Of Gestation .The
Patient Was Successfully Treated With Needle Laser Cord Coagulation.
Case
A 29 Year Old Second Gravida With No Living Issues Was Referred To A Tertiary Care Centre At 23 Weeks Of Gestation As
A Case Of Monochorionic Twin Pregnancy With Single Fetal Demise. With Typical Ultrasonic Features, We Came To The
Diagnosis Of Acardiac Twinning Or Trap Sequence. She Underwent Needle Laser Cord Coagulation And Concurrent
Amnioreduction At 24 Weeks Of Gestation And Is Currently On Weekly Follow Up. The Pump Twin Shows No Evidence Of
Cardiac Failure With Normal Umbilical And Middle Cerebral Artery Doppler Studies. We Are Planning To Deliver Her By
34 Weeks Of Gestation.
Conclusion
The Perinatal Mortality Of The Acardiac Twin Is Almost100%. The Treatment Of The Trap Sequence Is Focused On
Improving The Outcome Of The Pump Twin.The Survival Of The Pump Twin In Trap Sequence Is 80-90 % After In-Utero
Procedures Like Laser Therapy When Compared To Conservative Management Which Is Associated With A Pregnancy
Loss Rate Of 50-75%.

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Un Usual Presetation Of Primary Hypothyroididim Leading To Massive Ovarian Enlargement

Author: Dr. Gonnabaktula Vasantha Lakshmi
Co Author: Dr .G.N.Vasanthalakshmi1, Dr.Pushpalatha2, Dr Sirisha3, Dr .Abdul4, Dr .Keerthi5

Un Usual Presentation Of Primary Hypothyroidisim Leading To Massive Ovarian Enlargement

Background: Large Ovarian Cysts Are One Of The Commonest Indication For Gynaecological Surgery.However Some
Ovarian Cysts Are Direct Result Of Endocrine Disorder . Hypothyroidisim Is A Common Endocrine Abnormality Associated
With Ovarian Hyper Stimulation
Here We Present Two Case Reports Which Describes Massive Ovarian Enlargement Occurred In Women With Profound
Hypothyroidisim .
Both Of Them Were Presented With History Of Abdominal Distention And Discomfort .On Clinical Examination They
Were Short Statured And Abdominal Mass About 20Wks Size.
On Evaluation , Tsh Was Elevated And Ultrasound Showed Enlarged Bilateral Ovarian Masses And Was Treated With Oral
Thyroxine .
After 3Weeks One Women Showed Regression Of Ovarian Mass But Developed Ovarian Torsion And Had Ovariotomy.
Other Women Continued Treatment With Oral Levothyroxine For 3Months. After 3Months On Examination Abdominal
Mass Is Not Palpable ,Ovarian Size Reduced To Normal Size In Ultrasound And Tsh Levels Became Normal.
These Case Reports Illustrates That Health Providers Should Have A High Suspicion For Hypothyroidisim In Women With
Multiple Ovarian Cysts, These Symptoms Can Be Completely Reversed With Initiation Of Thyroid Replacement, Avoiding
Unnecessary Surgery.
Conclusion : Primary Hypothyroidisim Can Cause Massive Ovarian Enlargement . In Absence Of Ovarian Torsion, Surgery
Can Be Avoided As Thyroid Hormone Replacement Leads To Clinical Resolution Of Ovarian Cysts Within 3Months.

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Clinicosonological& Serological Evaluation Of Ovarian Tumors&Its Correlation With Histopathological Findings In

Perimenopausal Age Group
Author: Dr. V. Sreelekha
Co Author:

V.Sreelekha Swetha.V Archana Singh B.Indira H.Anupama

Dept.Of Obstetrics&Gynecology,Gandhi Medical College ,Secunderabad,Telangana, India

Aim: The Study Has Been Initiated Using Parameters Like Clinical Examination, Serum Levels Of Ca-125, Ultrasound,
Doppler For Preoperative Differentiation Between Benign & Malignant Ovarian Tumors & The Findings Were Compared
To Histopathology. These Parameters Were Studied Individually As Well As In Combinations To Detect The Most Specific
Diagnostic Factor For Ovarian Malignancies Preoperatively

Type Of Study: Analytical

Sample Size: 52 Cases

Setting: Dept. Of Obtsterics & Gynecology, Gandhi Medical College, Secunderabad

Duration:2Years

Methodology: All Patients With Mass Per Abdomen Were Evaluated Clinically , Ultrasonologically,Serologically With Ca125 & Compared With Postoperative Histopathology

Results: Sensitivity & Specificity Of Clincal Examination Are Observed To Be 75% & 82% Respectively. This Parameter Has
The Least Contribution When Compared To All Other Parameters.

Sensitivity& Specificity Of Ca-125 In This Study With Regarding To Ovarian Tumors Is Determined To Be 80% & 78%
Respectively

Doppler Study With Central Vascularity Is A Good Predictor Of Malignancy With Sensitivity Of 80% & Specificity Of 87%

Gray Scale Imaging Parameter Is Found To Be Superior When Compared With All Other Parameters With A High Sensitivity
Of 90% & Good Specificity Of 87.5%

Conclusoin: Grayscale Imaging Parameter Is Found To Be Most Superior Diagnostic Factor In This Study Of Preoperative
Evaluation Of Ovarian Tumors With A High Sensitvity Of 90% & Good Specificity Of 87.5%

One Intresting Case Of 45 Year Old Woman With Previous Four Laprotomies Had Simultaneous Development Of Ovarian
Malignacy In Both Ovaries Of Different Histopathological Types & Carcinoma Insitu Of Cervix Has Also Been Mentioned

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Vaginal Electromechanical Morcellation Following Laparoscopic Myomectomy

Author: Dr. Cyriac Pappachan
Co Author: Dr. Cyriac Pappachan1, Dr. B. Ramesh2,

Vaginal Electromechanical Morcellation Is More Cosmetic, Less Painfull, Faster Post Operative Recovery, Cost Effective
And No Port Closure Required. The Disadvantages Are That It Can Be Done Only By Expertise As The Orientation Is
Different. The Other Disadvantages Are Long Handle Morcellator Is Required, Morcellation Of Bigger Fibroids Become
Difficult. Injury To Ureter, Rectum And Sacral Vessels Can Occur. Pelvic Inflamatory Disease Can Occur. Video Presentation
With Steps.
***************

Vaginal Hysterectomy For Big Uterus Feasible ?

Author: Dr. Malini Venkappa
Co Author: Dr. Srinivas K.1, Dr. Sunanada K. M.2,

Vintroduction: Hysterectomy Is The Classical Method Of Treating Benign Lesions. Hysterectomy Can Be Done Either
Abdominally, Vaginally, Laparoscpically Or By Robotic Assisted Surgery. Vaginal Hysterectomy As Compared To All Other
Methods Is The Most Cheap And Has The Least Complications As Evidenced By Value Study Conducted In Uk.Inspite Of
These, Only 20-30% Of The Hysterectomies Are Performed By Vaginal Route As Observed By Acog Committee Opinion.
Various Challenges Influence The Route Of Surgery.
Aim Of The Study: To Analyse The Difficulties Faced By Surgeon While Performing Vaginal Hysterectomy For Big Uterus
And To Find Solutions.
Material And Methods: All Patients Admitted To Vani Vilas Hospital Bangalore Over A Period Of 5 Years From Aug 2010July 2014 Needing Hysterectomy Were Offered Vaginal Route. In Challenging Situations Where The Volume Was More ,
Various Debulking Procedures Were Used And The Same Was Videographed. Biclamp A Vessel Sealing System Was Used
In Few Cases.Time Taken For Surgery , Haematocrit Before And After Surgery, Post Operative Morbidity, Hospital Stay
Were Noted.
Results : About 2500 Hysterectomies Were Done During Study Period. 61 % Was Through Vaginal Route.There Was Not
Much Difference In Haematocrit Value Before And After Surgery. Duration Of Hospital Stay Varied From 3-5 Days. The
Biggest Uterus Removed Weighed 950 Gms. Calcified Fibroid, Subserous Fibroids , Broad Ligament Fibroids And
Adenomyosis Were The Most Difficult Challenges. Usage Of Biclamp Not Only Reduced The Operating Time And
Peropearative Blood Loss, It Also Reduced Postoperative Pain And Recovery Period. It Is Very Useful In Difficult
Adnexectomy.
Conclusion:When Hysterectomy Is Decided Every Gynaecologist Should First Consider Vaginal Route. Various Debulking
Procedureds And Usage Of Biclamp Help The Surgeon To Overcome The Challenges

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Vitamin D Deficiency In Women With And Without Polycystic Ovarian Syndrome And Its Association With
Hyperandrogenism And Insulin Resistance
Author: Dr. Saurabh Patil
Co Author: Saurabh Patil1, Rekha Bharti2, Savita Verma3, Manjula Sharma4,

Vitamin D Deficiency In Women With And Without Polycystic Ovarian Syndrome And Its Association With
Hyperandrogenism And Insulin Resistance
Aim: To Determine The Proportion Of Pcos (Polycystic Ovarian Syndrome) And Non Pcos Women With Vitamin D
Deficiency. To Study Association Of Vitamin D Deficiency With Hyperandrogenism And Insulin Resistance In These
Women.
Material & Methods: A Total Of 50 Pcos And 50 Age And Bmi Matched Non Pcos Women Between 20-40 Years, Without
Thyroid Disorders, Congenital Adrenal Hyperplasia, Androgen Secreting Tumours And Diabetes Mellitus Were Recruited.
Women Were Assessed For Acne Clinically, Hirsutism By Ferriman Gallwey Score Of 7, Biochemical
Hyperandrogenism By Serum Total Testosterone, Dheas And Insulin Resistance By Fasting Blood Sugar, Fasting Serum
Insulin, Homa-Ir, Homa- & Quicki. Vitamin D Level Measured And Labelled As Deficient If 25(Oh)D < 20 Ng/Ml.
Results: There Was No Significant Difference In The Proportion Of Women With Vitamin D Deficiency In Study And Control
Group, P=0.288. However, Difference In The Median Vitamin D Levels In Both Groups Was Statistically Significant,
P=0.031. There Was No Significant Association Of Hypovitaminosis D With Acne( P=0.118 And P=1.000) And
Hirsutism,(P=0.754 And P=1.000) And Biochemical Hyperandrogenism.(Testosterone And Dheas In Women With And
Without Vitamin D Deficiency In Both Pcos And Non Pcos Women Were Comparable P=0.469 & P=0.166 And P=0.279 &
P=0.196, Respectively.) There Was No Association Of Vitamin D Deficiency With Insulin Resistance (Ir) In Women With
And Without Pcos. Median Levels Of Fasting Blood Sugar, Fasting Serum Insulin, Homa-Ir, Quicki And Homa In Women
With And Without Vitamin D Deficiency Were Comparable In Both Pcos (P>0.05) And Non Pcos Women (P>0.05)
Conclusions: There Is No Association Of Vitamin D Deficiency With Hyperandogenism And Insulin Resistance In Women
With Pcos. However Pcos Women Have Lower Levels Of Vitamin D Compared To Non Pcos Women.

***************

Vit D Levels In South Indian Women Of The Reproductive Age Group

Author: Dr. Tarun Joseph
Co Author: Dr Sajeetha Kumari1, Dr.Tarun Joseph2, Prof.Sivathalam3,

Vitamin D Has Emerged As A Trendy Topic In The Medical World. We Are Beginning To Learn That It Plays A Much Wider
Role In Health And Disease Prevention. Studies From All Over India Have Drawn Attention Towards Wide Prevalence Of
Vitamin D Deficiency In Our Country. A Finding, That Is Unexpected In A Tropical Country With Abundant Sunshine.
This Study Primarily Aimed To Examine Vitamin D Adequacy In Women Of The Reproductive Age Group Using Serum
25(Oh)D And Explore Lifestyle Characteristics (Sun Exposure , Diet, And Economic Indicators) Associated With Serum
25(Oh) D Levels.
Methods
Women In The Reproductive Age Group Will Be Enrolled In The Study And Vit D Level (25-Hydroxy Vitamin D) Measured
To Assess The Rate Of Vit D Deficiency. They Were Asked To Fill Out A Questionnaire To Assess Various Characteristics.
Results
This Study Found A Incidence Of Vit D Deficiency Of 83.5% Among The Studied Population. Patients Likely To Have
Deficiency Are Vegetarians (P Value - 0.001), Sedentary Lifestyle With Decreased Exposure To Sunlight (P Value
0.0001) And Dark Skinned Patients (P Value 0.041)
Conclusion
83.5% Of Indian Women Of The Reproductive Age Group Had Inadequate Levels Of Vit D. The Levels Of Vit D Are
Associated To Diet , Exposure To Sunlight, Bmi , Skin Colour And Socioeconomic Status.

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Cesarean Scar Pregnancy-An Upcoming Nightmare

Author: Dr. Sathi S
Co Author:

With Rising Rates Of Caesarean Sections, We Are Now A Days Seeing More Of Rare Complications, One Of Them Is
Cesarean Scar Pregnancy (Csp). I Am Going To Present A Case Series Of Csp Presented In Our Department Which Is A
Tertiary Care Centre. Cesarean Scar Pregnancy (Csp) Is An Ectopic Pregnancy Implanted In The Myometrium At The Site
Of A Previous Cesarean Section Scar. It Is The Rarest Kind Of Ectopic Pregnancy And May Lead To Severe Complications,
Such As Uterine Disruption And Severe Hemorrhage. Thus, It Is Important That Early And Accurate Diagnosis Is Obtained
In Order To Avoid Complications And Preserve Fertility.
***************

A Rare Tumor Of Vulva

Author: Dr. Raja Ilavarasi Chinnadurai
Co Author: Dr.Sujani B.K1,

Background
Dermatofibrosarcoma Protuberans Is A Rare, Intermediate To Low Grade Neoplasm Of The Dermis With An Incidence
Of 1-5 Per Million Per Year. Its Occurrence In The Vulva Is Extremely Rare. A Locally Aggressive Tumor. Clinically Appears
To Be Encapsulated But Microscopically Has Tumor Projections Away From The Central Nodule. However, It Rarely
Metastasizes.
Case
Mrs V, 64 Years, Nulligravida , Presented With Vulvar Mass Since 10 Months, Which Progressively Increased To A 6X5Cm
Mass In The Skin Over The Mons Pubis And Another 54 Cm Mass At The Introitus On The Left Labia Majora. She
Underwent Total Abdominal Hysterectomy 14 Years Ago In View Of Fibroid Uterus. She Is A Type 2 Diabetic And
Hypertensive. History Of Similar Vulvar Mass 2 Years Ago. She Underwent Excision Of The Mass. Histopathological
Examination Showed Dermatofibrosarcoma Protuberans With Myxoid Areas Involving The Margins And Base.
Cect Thorax, Abdomen And Pelvis Was Done To Rule Out Metastasis. She Underwent A Repeat Wide Excision Of The
Tumor. Hpe Showed An Intermediate Grade Of Tumor And Resected Margins Were Free From Tumor. Patient Was
Discharged On Post -Operative Day 3 At Request. Patient Is Symptom Free Since 5 Months Post - Surgery.
Discussion
The Tumor Is More Common In 20 50 Years Of Age With Slight Male Predominance. The Cellular Origin Is Not Clear.
Associated With Reciprocal Translocation Of Chromosomes 17 & 22 And Supernumerary Ring Chromosomes. Most
Common Site Is The Trunk.
Conclusion
Even With A Recurrence Rate Of 20 49 %, If Wide Excision Of Tumor With Negative Margin Is Achieved, A Cure Rate
Of 90-100% Can Be Obtained. Metastasis Occurs In Less Than 5% Which Requires An Adjuvant Therapy. Therefore A
Multidisciplinary Approach And Close Follow Up Is Recommended.

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Cervical Aggressive Angiomyxoma With Its Infravaginal Elongation

Author: Dr. Iyswaria Surendran
Co Author: Dr. K. Saraswathi1,

Dr. Iyswaria * Dr.K.Saraswathi **

Sree Balaji Medical College And Hospital

Background:
Cervical Aggressive Angiomyxoma Is A Locally Infiltrative Non-Metastasizing Hypocellular Myxoid Tumour Of
Pelvicoperineal Region Occurring Mainly In Reproductive Women.
Here I Present A Case Of Cervical Aggressive Angiomyxoma With Infravaginal Elongation Of Cervix For Poster Presentation
Case:
A Fifty Year Old Postmenopausal Woman Was Admitted With Infravaginal Elongation Of Cervix With Ectocervical
Elongated Growth. Pap Smear Done Showed Low Grade Squamous Intraepithelial Lesion. Colposcopy Directed Cervical
Biopsy Showed Chronic Cervicitis With Low Grade Squamous Intraepithelial Lesion.Vaginal Hysterectomy With Pelvic
Floor Repair Was Done. Histopathological Examination Showed Cervical Angiomyxoma. This Is A Rare Case Of Aggressive
Cervical Angiomyxoma Presenting With Ectocervical Polyp.
Conclusion:
Aggressive Angiomyxoma Is A Distinctive Soft Tissue Tumour Of Pelvis And Perineum In Women Of Reproductive Age
With A Median Incidence In The Fourth Decade. Surgical Excision Is The Treatment Of Choice. As It Has High Local
Recurrence, Follow Up Is Required.

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Successful Outcome In Ventriculoperitoneal Shunt Complicating Pregnancy:A Case Report

Author: Dr. Revathy Krishnakumar
Co Author: Dr.Radhabai Prabu1, Dr.Velayudham2,

Abstract
Back Ground
Neurological Problems Complicating Pregnancy Are Very Rare. Tubercular Meningitis With Ventriculoperitoneal Shunt
Complicating Pregnancy Is Also Uncommon.
During Pregnancy Complications Such As Shunt Malfunction ,Intestinal Obstruction, Infection, Ascites, And Adhesion
Formation Are Reported. Most Women Have Successful Vaginal Delivery With Good Maternal And Perinatal Outcome .

Case
Here We Report A Case Of Successful Pregnancy Outcome In A Woman ,Who Had Tb Meningitis With Vp Shunt For
Hydrocephalus.
Mrs.E, 28 Years , Primi, An Old Case Of Tb Meningitis With Ventriculoperitoneal Shunt , Had Her Regular Antenatal Care
And Neurological Review. She Did Not Develop Any Antenatal Or Neurological Problems During Pregnancy . The Fetal
Growth Was Normal.At 38 Weeks Of Gestation,Ctg Showed Unprovoked Decelerations Upto 120 Bpm. In View Of The
Suspicious Ctg, She Was Induced With Dinoprostone Gel. After 2 Hours Of Induction ,She Went Into Labour. She Was
Given Prophylactic Inj.Levatiracetam And Antibiotics .First Stage Of Labour Lasted For 7.5 Hours And Second Stage For
15 Minutes. A Healthy Boy Baby Of 3.25 Kg Was Delivered Normally And Did Not Require A Forceps. She Had No
Intrapartum And Postpartum Complications. We Report This Case In View Of Its Rarity And Successful Outcome.

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A Very Rare Case Of Myomectomy On Pregnant Uterus

Author: Dr. Anusha Patel
Co Author: Dr.Anusha Patel1, Dr.U.Agnes Vijaya2,

Back Ground:Uterine Fibroids Are Commonest Tumors Of The Female Genital Tract With A Prevalence Varying From 2050%In Women Of Reproductive Age.Surgical Management Is Limited To Nonpregnant Uterus.Fibroid Coexisting
Pregnancy May Be Associated With Complication In 10-30% Of Cases Which Are Managed Conservatively.
We Present A Case Of Multiple(8-10 Sessile Subserous)Fibroid Complicating Pregnancy With One Huge
Subserosal Pedunculated Fundal Fibroid,Extending Upto Xiphisternum,That Necessitated Myomectomy At 18-20 Weeks
Gestation.
Case:A 32 Year Elderly Primigravida With Marital Life 10 Years ,With Regular Menstrual Cycles With
Asymptomatic Multiple Fibroids Conceived Spontaneously And Presented As Acute Abdomen At 16-18 Weeks
Gestation.And She Was Admitted,Investigated And Treated Symptomatically And Surgically(Myomectomy 18-20 Weeks
Gestation).
Conclusion:Post Myomectomy Pregnancy Reached Safely Upto Viability,Now In 32 To 34 Weeks Of
Gestation,Awaiting For Term And For Safe Feto-Maternal Outcome.

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Swyers Syndrome
Author: Dr. Afeefa Mogal
Co Author: Dr M.Anitha1,

It Is A Rare Condition Occurring 1 In 30,000 Live Births. These Patients Are Genotypically 46Xy With Pure Gonadal
Dysgenesis And Phenotypically Female With Normal External And Internal Genitalia With Dysfunctional Streak Gonads
Due To Lack Of Secretion Of Testosterone And Anti Mullerian Hormone By Dysgenetic Testis. Mutations In Sry Gene
,Nr5A1,Dhh Gene Are Responsible For Syndrome.Sry Gene On Y- Chromosome Which Transcribes Sex Determining Y
Protein Is Mutated .Apart From Sry Gene,Nr5A1 Transcribing Steroidogenic Factor 1 That Controls Production Of Sex
Hormones & Development Of Male Sexual Characters & Dhh Gene Member Of Hedgehog Protein Family Are Mutated
Impairing The Process Of Male Sexual Differentiation.
A 10 Year Adolescent Girl Attended Gynaec Opd With Complaint Of Stunted Growth. On Examination Vitals Stable.
Ht-116Cms,Wt-27 Ks,Bmi-20Kg/M2. Diagnosed As Swyers Syndrome As Mri Showed Hypoplastic Uterus With ?Streak
Gonads Adjacent To Iliac Vessels . Karyotyping Showed 46Xy. At 11 Yrs Of Age U/W Laparoscopic Gonadectomy.Hpe
Showed Immature Sex Cord Stromal Cells. Patient Was Kept On Recombinant Growth Hormone & Estrogens. Patient
Attained Menarche & Secondary Sexual Characters. Now She Is On Continuous Oc Pills For Regular Cycles. After 3 Years
Of Treatment Her Ht -136 Cms,Wt -38 Kgs,Bmi-20.54 Kg/M2.External Genitalia Were Normal But Infantile .P/RHypoplastic Uterus Less Than Normal Size .Provisionally Diagnosed As Swyers Syndrome.
Managing A Case Of Swyers Syndrome Involves Not Only Hormone Supplementation & Corrective Surgeries But Also
Proper Counselling Of Patient & Family Regarding Various Pubertal Issues To Optimize Their Reproductive,Sexual,Bone
Health & Overall Development.

***************

A Rare Case Report Of Postmenopausal Cervical Tuberculosis

Author: Dr. Reshma Thalluru
Co Author: Dr.M.Anitha1,

Tuberculosis(Tb) Of Cervix Is A Very Rare Condition,Accounts For 0.1-0.65% Of All Tb Cases & 5-24% Of Genital Tract
Tb.95% Of Female Genital Tract Tb Is Located In Tissues Other Than Cervix.It Usually Occurs In Child Bearing Age.Pelvic
Organs Are Infected By Primary Focus From Chest Either By Hematogenous,Lymphatics.Tb Cervix Is By Direct Infection
From Pelvic Organs. Macroscopically Lesions On Cervix Can Be Either Exophytic,Ulcerative Or Polypoidal.Primary Tb Cervix
Is Rare.Diagnosis Can Be Made Accurately Only By Biopsy.Microscopically,There Will Be Chronic Inflammation With
Caseating Or Noncaseating Granulomas.Isolation Of Mycobacterium Is Gold Standard For Diagnosis.Upto 1/3Rd Of
Patients Can Be Culture Negative.Molecular Probes Are More Sensitive Than Culture,But Have Reduced Specificity.Hence
Presence Of Granulomas Is Sufficient To Make Diagnosis After Excluding Other Causes Of Granulomatous Cervicitis Like
Schistosomiasis , Brucellosis , Tularemia,Sarcoidosis Or Foreign Body Reaction.
A 70Yr Old Postmenopausal Women Attended Gynaec Opd On 23Rd Oct 2013 With History Of Lower Abdominal
Pain And Foulsmelling Discharge Per Vaginum For Past 2 Months. On Examination, Cervix Is Unhealthy,Cauliflower Like
Growth Involving Whole Cervix ,Friable,Bleeding On Touch,Mucopurulent Discharge.Cervix Flushed With Vaginal
Vault,Uterus Atrophic.Fractional Curettage Done Under Coverage Of Antibiotics For 48Hrs.Histopathological Report
Shows Ectocervical Stratified Squamous Epithelium With Underlying Stroma,Endocervical Granulation Tissue,Chronic
Mononuclear Inflammatory Cell Collection With Caseous Necrotic Material And Epitheloid Granulomas With Langhans
Type Of Gaint Cells Provisional Diagniosis Of Tuberculosis Of Cervix Made.As Tb Cervix Is Rare Condition Occurring In
Postmenopausal Women Of 70Yrs, Clinically Diagnosed As Ca Cervix But Biopsy Turned Out To Be Cervical Tuberculosis.
Patient Was Started On Att (Isoniazid,Rifampicin,Pyrazinamide & Ethambutal) And Advised To Continue For 9
Months.Patient Was Regularly Followed Up Every Month And Showed Gradual Improvement Symptomatically.By The
End Of 9 Months Cervix Is Totally Healed And Became Normal Size.Patient Is Doing Good Now.

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Spontaneous Uterine Rupture In First Trimester In A Scarred Uterus

Author: Dr. Rekha Devi Rachamalla
Co Author: Dr.Rekha Devi1, Dr.Shantha Fernando2, Dr.Rukmani Bai3, Dr. Philomina Joseph4, Dr.Chithra Subramanian5

Background: Spontaneous Rupture Of Caesarean Scar Of Uterus During First Trimester Is Extremely Rare.
Case Report: 29 Year Old , G2P1L1 With Previous Caesarean Delivery Was Admitted From Casualty With Severe Lower
Abdominal Pain And Giddiness Since 6Am On 13/3/14.
Patient Had Regular Menstrual History With Flow Of 4-5 Days Every 28-30 Days. She Had Her Normal Period On December
30Th , Followed By Two Periods Which Were Scanty , Which She Ignored And Hence Urine Pregnancy Test Was Not Done,
Lmp Being 3/3/14.
Patient Underwent Lscs At Term For Failed Induction In October 2012 And Her Postoperative Period Was Uneventful.
O/E-Pallor ++, Bp-90/60Mmhg, Pr- 110/Min. P/A- Generalized Fullness, Rigid And Suprapubic Tenderness Present. P/VCervix Pulled Up, Fullness Of All Fornices Felt, Spotting Present.
Investigations Showed Hb-7 G/Dl And Sonography Showed Single Live Intrauterine Fetus Of 10 Wksga With Cardiac
Pulsation With Uterine Fundus Showing Discontinuity Of Myometrium With Adherent Mesentery ? Rupture Uterus.
Moderate Hemorrhage In Peritoneal Cavity.
Emergency Laparotomy Done And 2.5 Litres Of Blood And Clots Suctioned From Pelvic And Abdominal Cavity. A Rent In
Uterine Lower Segment Along Previous Scar Which Was Profusely Bleeding Was Observed. Fetus Was Retrieved From
Peritoneal Cavity. Uterus Found Adherent To Peritoneum And Anterior Abdominal Wall On Fundus And Left Lateral Wall
And The Same Released.Uterine Cavity Suctioned Through The Rupture And Rent Sutured With 1-0 Vicryl. In View Of
Extremely Thinned Out Lower Segment , Sterilization Done. Hemostasis Achieved And Abdomen Closed.5 Units Of A+Ve
Whole Blood Transfused.
Her Post Operative Period Was Uneventful.
Conclusion: Uterine Rupture In A Previous Caesarean Pregnancy Is Life Threatening Complication With An Incidence Of
0.3 To 1% . Maternal Mortality Ranged Between 1% And 13%. Early Diagnosis And Surgical Intervention, In Time, Is Key
To Successful Management In These Cases .

***************

Nulliparous Chronic Nonpuerperal Uterine Inversion: Correction By Haultains Procedure

Author: Dr. Lakshmi Sujani Chigurupati
Co Author: Dr.Durga Devi1, Dr. Syam Mohan Rao2,

Competing For: Fogsi-Dr.Jagdishwari Mishra Prize

Theme: Safe Surgery Saves Lives.

Nulliparous Chronic Nonpuerperal Uterine Inversion: Correction By Haultain'S Procedure

Dr.Lakshmi Sujani.Ch,
Dr.Durga Devi, Dr.Syam Mohan Rao.
Background: Uterine Inversion Is An Unusual Entity. Chronic Nonpuerperal Inversion Is Extremely Rare With Only About
100 Cases Reported In Literature Since 1940. It Is Usually Associated With Uterine Pathology Like Polyps Or Neoplasm.
This Is A Case Report Of A Nulliparous Young Lady With Chronic Nonpuerperal Uterine Inversion But With No Obvious
Fundal Pathology Making It A Unique Case. This Can Be Attributed To The Presence Of Any Congenital Connective Tissue
Defect.
Case: A 20 Year Old Nulliparous Lady Presented With Menorrhagia And Post Coital Bleeding. On Speculum Examination,
A 3X4 Centimeter Reddish Mass Was Seen Protruding Through Cervix With Cervical Lips Drawn Up. Bimanual Examination
Was Inconclusive. Ultrasound Report Was Given As Endometrial Polyp. But Uterine Sound Could Not Be Passed By Side
Of Polyp. Hence Diagnosed As Uterine Inversion. In Laparotomy , A Dimple With Constriction Ring Was Found In The Place
Of Fundus With Distal Ends Of Fallopian Tube And Round Ligaments Coming Through It. It Was Second Degree Inversion.
Huntingtons Procedure Failed. Hence Correction By Haultains Procedure Was Done. Later Plication Of Round Ligament
Was Done To Prevent Recurrence.
Conclusion: In Presence Of Any Tumour Protruding From Vulva Or Vagina We Must Consider Uterine Inversion.
Nevertheless Before Contemplating Polypectomy, Sound Test Is Mandatory To Rule Out Uterine Inversion. This Avoids
The Risk Of Uterine Perforation. When Laporotomy Done , Location Of Ureter Is Important As Cervical Dilation In Inversion
Can Alter Their Anatomy. Infection Should Be Suspected And Broad Spectrum Antibiotics Should Be Started While
Planning Surgery. If Associated With Fundal Mass, Biopsy Is Prudent As It Is Associated With Uterine Malignancy.

***************

Ovarian Tuberculosis
Author: Dr. Kiranmai R
Co Author: Dr.A.Kalaichelvi1,

Ovarian Tuberculosis

Background:
Tuberculosis (Tb) Remains A Significant Public Health Problem Worldwide. Although Genito-Urinary Disease Is Common,
Isolated Ovarian Tb Is Rare Although Genitourinary Tuberculosis Is Common, Reports Of Ovarian Tuberculosis Are Rare.
However, Its Presentation Can Mimick That Of An Ovarian Tumour
Case Report:
21 Yrs Old Mrs. Alima Was Admitted With Complaints Of Lower Abdomen Pain During Menses For 1 Year. She
Had No Associated Fever, Vomiting, Burning Micturition, Loss Of Weight Or Appetite. Married For 5 Years She Had Full
Term Normal Delivery 4 Years Ago. She Had No Past Illness And Her Family History Was Insignificant. O/E: Moderately
Built, Afebrile And Not Anemic. Cvs & Rs : Normal. P/A: Soft. S/E : Cervix Healthy . P/V : Uterus - Normal Size. Fornices
Free. Basic Investigations Were Within Normal Limits. Usg Pelvis Revealed A Multiloculated Cyst Of 60*35Mm In The
Right Ovary. Ca125 Was 143.5Iu/Ml. Ct Abdomen And Pelvis Revealed The Same Findings. Laparotomy Done On February
4, 2014 . Multiple Tubercles Found Over The Bowel, Uterus, Fallopian Tubes And Bilateral Ovaries. Dense Adhesions
Found. A Right Ovarian Cyst Of 5*4Cms Filled With Straw Coloured Fluid Is Seen Adjacent To Right Fallopian Tube. Rt
Ovary Was Removed With Cyst & Sent For Hpe That Revealed Multiple Tuberculoid Granulomatous Lesions In The Ovarian
Stroma . She Was Given Anti Tuberculous Treatment For 6 Months With Complete Resolution Of Her Symptoms.
Conclusion:
Ovarian Tuberculosis Is Most Common In Young Women Living In Endemic Zones. Ca-125 Can Be Raised In This Condition,
And Imaging Is Rarely Conclusive. Intraoperative Frozen Section Of Tissue Specimens Can Be Helpful If Available. Early
Diagnosis Of Ovarian Tuberculosis Is Vital As Untreated Disease Can Lead To Infertility.
***************

Pregnancy In Rudimentary Horn- A Rare Mimicker Of Ectopic Pregnancy

Author: Dr. Umadevi Nagarajan
Co Author: Prof.V.Kalaivani1,

Background:
The Incidence Of Mullerian Duct Malformations Is 4.3%. Unicornuate Uterus Is A Rare Mullerian Abnormality
With 0.4 % Incidence. Rudimentary Horn Pregnancy Occurs In 1/1,00,000 To 1/1,40,000 Cases.72 To 85% Of Rudimentary
Horn Are With Non Communicating Cavity.In 90 % Of Cases It Results In Rupture In The Second Trimester With Fetal
Demise.
Case:
Our Patient Is A Primigravida With Two Months Amenorrhoea .She Presented With Lower Abdomen Pain And
Bleeding Per Vaginum.Her Vitals Were Stable.On Per Vaginum Examination A Fullness Was Noted In Left Fornix.Her
Ultrasound Revealed Gestational Sac In Left Adnexal Region .There Was No Hemoperitoneum.A Provisional Diagnosis
Of Left Side Ectopic Gestation Was Made.The Final Diagnosis Of Unicornuate Uterus With Unruptured Left Sided Non
Communicating Rudimentary Horn Pregnancy Was Made Only At Emergency Laprotomy.
Conclusion:
The Failure Of Complete Development Of One Of The Mullerian Duct Or Incomplete Fusion With The
Contralateral Side Results In This Type Of Abnormality.The Rupture Of The Rudimentary Horn Is A Life Threatening
Situation.Our Case Is Unicornuate Uterus With Unruptured Non Communicating Rudimentary Horn Pregnancy Which
Was Managed With Rudimentary Horn Excision And Left Sided Salphingoophprectomy.

***************

Pain Abdomen In Pregnancy - A Diagnostic Dilemma

Author: Dr. Sharan Pal
Co Author: Bhavana Sherigar1, Sharadhi.C2,

Pain Abdomen In Pregnancy- A Diagnostic Dilemma

Dr Sharan J Pal 1 ,Dr Bhavana Sherigar 2,Dr Sharadhi.C 3
1. Assistant Professor, 2. Professor, 3.Junior Resident
Department Of Obstetrics And Gynecology
Kasturba Medical College

Abstract
Background: A Cornual Gestation Is One Of The Most Hazardous Of Ectopic Gestations And Accounts For 2-4% Of All
Ectopic Gestations With A Mataernal Mortality Rate Which Is 6-7 Times That Of Other Ectopic Gestations. Here We
Describe An Interesting Case Of A Patient At 9Weeks+ 5 Days Pog With Multiple Fibroids With Rupture Of Right Cornual
Ectopic Pregnancy.
Case: A 23Yr Old G3P1L1A1 At 9Wks + 5 Days Pog Was Referred As A Case Of Multiple Fibroids Complicating Pregnancy
With Pain Abdomen Since 12Hrs Associated With 7-8 Episodes Of Vomiting. On Examination Patient Was Pale Had A
Pulse Rate Of 144Bpm, With Tachypnoea. Abdominal Examination Showed Firm Irregular Contour Of Uterus
Corresponding To 18-20Wks Associated With Epigastric Tenderness. Provisional Diagnosis Of Red Degeneration Of Fibroid
Was Made Based On The Clinical Picture And Raised Total Counts Of 26,000 Cells/Cumm. Ultrasound Showed Multiple
Uterine Fibroids Distorting The Uterine Cavity And An Intrauterine Pregnancy With No Cardiac Activity Corresponding To
10 Wks With Hemoperitoneum. Exploratory Laparotomy Was Done With A Tentative Diagnosis Of Heterotopic Pregnancy
With Ruptured Tubal Ectopic And Missed Abortion Of Intrauterine Pregnancy.Intraoperatively Rupture Of Right Cornual
Ectopic Pregnancy With Hemoperitoneum And Multiple Intramural And Subserosal Fibroids, Largest Measuring 6X5 Cms
Was Noted. Right Cornual Rupture Was Repaired And Myomectomy Performed. D&C Was Done Which Was Negative.
After Transfusion Of Adequate Amount Of Blood Intra And Post Operatively Patient Was Discharged.
Conclusion:Ruptured Ectopic Gestation Should Be Considered In Every Patient In The Reproductive Age Group With Pain
Abdomen And Shock In Spite Of Other Co Existing Pathology.

***************

Unusual Presentation Of Cervical Fibroid Three Case Reports

Author: Dr. Manisha Laddad
Co Author: Dr Manisha Laddad1, Dr Digvijay Kadam2,

Abstract
Authors
Dr.Manisha M. Laddad ,Lecturer, Kims,Karad
Dr.Digvijay Kadam, P.G. Student,Kims, Karad
BackgroundUterine Myomas Are Commonly Present In The Body Of The Uterus, But In 1 To 2% Of Cases Fibroids Are Confined To
Cervix.. Three Cases Were Admitted In Our Institute With Unusual Presentation.
Case 1-50 Year Complaints Of Retention Of Urine, Pervaginal Bleeding With
Huge 24 Week Mass Arising From Pelvis, Firm To Hard In Consistency, On Pervaginal Examination Uterus Was 22 To 24
Weeks Size ,Our Diagnosis Was? Fibrosarcoma? Cervical Fibroid? Ca Cervix.Usg Showed Large 15Cm Hypo Echoic Solid
Mass In Relation To Uterine Cervix? Large Cervical Fibroid? Fibrosarcoma. At Laparotomy Large 22-24 Cm Central Cervical
Fibroid With Normal Fundus Sitting .Total Hysterectomy With Bilateral Salpingo-Ophorectomy Was Done
Case-2- 55 Years Old Complaints Of Lump In Abdomen, Excessive Pv Bleeding
On Examination Large 16 To 18 Wks Mass Arising From Pelvis Hard In Consistency ,On Pervaginal Examination 18 Wks
Uterus.Usg S/O Large Uterine Fibroid, Right Ovary With 9X8X6 Cm Well Defined Lesion With Septations?
Cystadenocarcinoma.Intraoperatively Findings Were Normal Uterus With Large Central Cervical Fibroid 18 To 20 Weeks.
Total Hysterectomy With Left Sided Salphingo Oophorectomy With Removal Of Right Ovarian Cyst And Cervical Fibroid
Was Done.
Case 3-A 40 Yr Women Came With Pv Bleeding ,On Examination 16 Wks Mass Palpated,Firm In Consistency, On Usg ?
Broad Ligament Fibroid Of 13X10 Cm ,Intraoperatively Large Central Posterior Cervical Fibroid Present, Abdominal Pan
Hysterectomy Done.
ConclusionWith The Help Of Usg, Laparoscopy, Doppler We Can Diagnose Cervical Fibroid Earlier And Accurately. Cervical Fibroid
Is Sometimes Very Difficult To Operate Because Of Distortion Of Pelvic Anatomy. Profuse Intraoperatively Bleeding May
Occur.
Key Words: Cervical Fibroid, Fibrosarcoma.

***************

Pregnancy In A Woman With Simultaneous Kidney-Pancreas Transplant The Challenges Faced

Author: Dr. Aruna Muralidhar
Co Author: Dr. Priyanka. K1,

Background

There Has Been Wide Experience In The Management Of Pregnancy Following Renal Transplant. However, Experience
With Pregnancy In Simultaneous Kidney-Pancreas Transplant Is Limited. The Effects Of Simultaneous Kidney-Pancreas
Transplantation On Pregnancy Can Be Multiple And Challenging. There Are Common Risks For Both Kinds Of Transplants
In The Fetus (Miscarriage, Preterm Labour Or Malformations), As Well As In The Mother (High Blood Pressure,
Preeclampsia And More Frequent Infections) And The Graft (Acute Rejection And Renal Function Worsening).

Case

We Present This 32 Year Old Primigravida With A History Of Type I Diabetes Mellitus With Multi-Organ Complications
Including Renal Failure. She Had A Simultaneous Kidney-Pancreas Transplant 11 Months Previously. She Also Had A
Spontaneous Pe In 2005 And Was Found To Be A Heterozygote For Factor V Leiden Mutation.
Her Pregnancy Was Complicated By Admissions With Clostridium Difficile Diarrhoea. Her Renal Function Worsened
Secondary To Dehydration Requiring Intensive Fluid Management And Treatment Of Hyperkalemia. She Also Had Bilateral
Vitrectomy For Vitreous Haemorrhage At 6 Weeks Gestation.
Blood Pressure And Renal Function Deteriorated Requiring Inpatient Care And Modification Of Antihypertensives. At 32
Weeks, She Became Symptomatic With Uncontrolled Hypertension. She Was Commenced On Labetalol Infusion.
Betamethasone Was Administered For Fetal Lung Maturation And Caesarean Section Was Performed Without
Complication. Postoperative Haemoglobin Was 6.6 Gms/Dl, Requiring Parenteral Iron. Blood Transfusion Was Withheld
Because Of Hyperkalemia. Recombinant Erythropoietin Was Not Administered Due To Recent Preeclampsia. The
Following Week, Blood Pressure And Renal Function Normalized. She Was Discharged On Oral Amlodipine With Intensive
Follow-Up Arranged.

Conclusion/ Clinical Relevance

The Experience Of Pregnancy In Simultaneous Kidney-Pancreas Transplant (Skpt) Is Limited Compared To That Of Renal
Transplant But Is Slowly Expanding. Optimal Management Involves Multidisciplinary Approach And Involves Appropriate
Drug Modification, Monitoring Of Graft Function, Correction Of Electrolyte Imbalance, Prevention And Treatment Of
Infections And Appropriate Thromboprophylaxis.

***************

Increasing Trends In Caesearean Section -Why?

Author: Dr. Lekshmi Pillai
Co Author: Dr.Lekhsmi Pillai.1, Dr.Radhika.2, Prof.Jamilahameed.3, Dr.Haseena.4, Dr.Narmada.5

Background:
Caesarean Rates Have Been Dramatically Increasing Over The Past Two Decades World Wide. Currently Caesarean Section
(C-Section) Is The Most Common Major Surgical Procedure For Women, Incidence Of Which Has Jumped From 1 In 20
Births (5%) To 1 In 4 Births (25%) & The Same Has Raised From 5% To 65% In Private Hospitals Since 2000 In India & The
Present Analysis Indicates That The Rate Of C-Section Is More In States Where Institutional Delivery Is High.
Aim:
To Explore Recent Levels & Trends In The Prevalence Of C- Section, Examine The Impact Of Socio-Demographic, Economic
& Spatial Characteristics And To Identify Opportunities To Lower The Same.
Method:
A Retrospective Cohort Study Of 800 Antenatal Cases From January 2013 To January 2014 Whose Information Like Age,
Education Qualification, Annual Income, Addresses Were Collected From 128 Patients Who Underwent C- Section At
Vmmc, Karaikal. Comparison Was Done By Statistical Analysis Of Data & P Value Estimated By Chi-Square Test(Ns
Non Significant, S - Significant) .
Results:
Total Caesarean Rate Obtained Is 16%. Among Them 45.3% Were Primiparous & 54.7% Multiparous Women. Comparing
Mothers On Different Characteristics Like Higher Education 39.34 %, Primary 7.9% & No Education 3.4 % (P Value 0.05 S).
Higher Economic Status 26.6% Middle 6.9% & Lower 1.8% (P Value 0.05, S). Mothers Older Than 25Years Were 14.5%,
Below That Age10.5% (P Value 0.05,S). Those With Regular Antenatal Checkups Were 78% & Irregular Checkups 22% &
Finally Urban Living Patients Of Karaikal 20.2 %, Rural 7.3% (P Value 0.04, S) Underwent C-Section.
Conclusion:
Increasing Trends In C Section On The Parameters Studied Show Patients With Higher Education, Economically Higher
Class, Women Older Than 25 Years, On Regular Antenatal Checkups & Living In The Urban Areas Of This Town Underwent
C Section More Than Others.

***************

Clinical Presentation, Management And Outcome Of Hydatidiform Mole At A Tertiary Care Hospital
Author: Dr. Shaivalini Kamarapu
Co Author:

Clinical Presentation, Management And Outcome Of Hydatidiform Mole At A Tertiary Care Hospital

Dr.K.Shaivalini1*, Dr.B.Kavita2, Dr.G.C.Prabhakar3

Objectives: To Analyze The Pattern Of Clinical Presentation Of Molar Pregnancy In A Tertiary Hospital. To Evaluate
Pattern Of Complications Presented With And The Complications That Arise During And After Treatment. To Evaluate The
Management And Follow Up At A Tertiary Hospital.
Methods: The Prospective Study Was Conducted In Mamata General Hospital, Khammam, Telangana State, From May
2012 To August 2014 Among 22 Patients, Diagnosed As A Case Of Molar Pregnancy.
Results: During The Study Period, The Mean Age Of The Patients Diagnosed As Gtd Was 207.3 (Range 18-36) Years. O
Positive Blood Group Was Prevalent (59%). Patients Presented With Amenorrhoea And Abnormal Vaginal Bleeding Were
45.4%. In Gtd, Complete Moles Occurred In 45.4%, Partial Mole In 13.6%, Invasive Moles In 31.8%, Choricarcinoma In
4.5% And Placental Site Trophoblastic Tumour 4.5%. Suction Evacuation Was Noted To Be The Preferred Method In All
Cases. Of Them Haemorrhage Was The Most Common Immediate Complication (54.5%) , Shock And Perforation During
Evacuation Was 9% And 4.5% Respectively. 1 Case Of Maternal Mortality Was Due To Ards . Total Abdominal
Hysterectomy Was Done In 8(36.3%) Patients. Single Agent Chemotherapy Methotrexate Was Employed In 63% Patients
And Was Well Tolerated. Mean Follow Up For These Patients Was 5.7 Months (Range 1-24Months).
Conclusion: The Incidence Of Gtd In Mamata General Hospital Was 15 Per 1000 Pregnancy. Early Diagnosis, Treatment,
And Follow-Up Play A Critical Role In Preventing The Morbidity And Mortality Associated With The Disease. The Incidence
Of Gtd Has High Recovery Rate With Adequate Treatment And Follow-Up.

***************

Smooth Muscle Tumour Of Uncertain Malignant Potential (Stump)

Author: Dr. Prathima Kamisetty
Co Author: Dr.B.Prasanna1,

Stump- According To Current Who Guidelines It Is A Rare Smooth Muscle Tumour Of Uncertain Malignant Potential Which
Cannot Be Categorised As Either Benign Or Malignant (Hpe).
Common Sites: Uterus, Periurethral, Prostate, Retroperitoneal
Benign Tumours:
1.Without Cytological Atypia.
2.Mitotic Figures < 4/10 Hpf.
3.No Tumour Cell Necrosis.
Malignant Tumours:
(Two Of Below Three Features Plus Clinical Evidence Of Malignancy)
1.Moderate To Severe Cytological Atypia
2.Mitotic Figures > 10/10 Hpf
3.Diffuse Tumour Cell Necrosis
Stump: Smooth Muscle Tumours That Do Not Fit Into These Categeories Are Diagnosed As Stump.
A 47Yr Old Female Patient P2L2 Came To Opd With Complaints Of Pain In Left Side Of The Lower Abdomen
Since 20 Days, Which Is Pricking In Nature, Radiating To Left Back , Aggrevated With Movement, Relieved By Analgesics.
Per Abdomen - Soft ,
No Palpable Mass,
No Evidence Of Any Free Fluid.
Per Speculum - Cervix, Vagina Healthy.
Bimanual Examination - Mass Of About 8X8 Cm Is Palpable In
Anterior And Left Fornix, Firm In Consistency,
Restricted Mobility, Mass Cannot Be Made Out Separately From Uterus. Uterus ? Size, Mobile, Rt Fornix Free.
Investigations :
Hb-12 Gm%, Cue-Normal,Rbs-128 Mg/Dl, Serum Urea- 18Mg/Dl, Serum Creatinine-0.84, Viral Screening- Negative,
Platelet Count-1,85,000 Cells/Mm3, Coagulation Profile-Normal Limits.
Specific Investigations : Ca-125 - 7.5U/Ml
Ultrasound Pelvis- Uterus- Normal Size,
Heterogenous Mass Of 8.5X5.6Cm Seen In Left Adnexa,
Both Ovaries Are Normal,

Left Ovary Is Visualised Separately From Mass.

Mri: Heterogenous Mass Of About 7.4X7.1 Cms Located In Left Adnexa Anterior To Uterus Extending To Abdominal
Musculature.
Provisionally Diagnosed As Broad Ligament Fibroid.
Management: Total Abdominal Hysterectomy With Bilateral Salpingoophorectomy Done And Specimen Sent For
Histopathology.
Histopathology Report: Stump (Mf<5, Focal Coagulative Necrosis,Without Atypia), , Uterus-Simple Endometrial
Hyperplasia, Chronic Cervicitis, Right Adnexa Normal.
Follow Up: Patient Is Followed Up For Every 6 Months To Detect Any Recurrence.

***************

A Rare Case Of Vaginal Atresia With Vestibular Fistula

Author: Dr. Ameya Dudhwadkar
Co Author: Dr Paras Kothari1, Dr Michelle Fonseca2,

18Year Old Female From Latur Was Brought By Mother With Complaints Of Primary Amenorrhea With Cyclical Abdominal
Pain.Patient Had Absent Anal Opening Which Was Discovered At Birth But Her Parents Did Not Consult Any Doctor. On
Examination Vestibule Showed Urethral Opening And A Common Opening For Vagina And Rectum. Mri Pelvis S/O
Tranverse Vaginal Septum With Hematocolpos With Rectovaginal Fistula With Common Opening For Rectum And Vagina.
Management: Examination Under Anesthesia Followed By Diagnostic Cystoscopy With Dye Study Performed Followed By
Rectovaginal Pouch With Abdominoperineal Pull Through Procedure With Hysterotomy With Resection Of Vaginal
Septum.

***************

Acute Tummies In Pregnant Mummies

Author: Dr. Varshini Purushotam
Co Author: Dr . Dhanalakshmi1,

3 Cases Of Acute Abdomen In Pregnancy Presenting As Pre Term Labour That Was Managed Surgically Is Reported In This
Article
All Three Patients Were Admitted At Sri Ramachandra Medical College And Research Institute With Complaints Of Acute
Pain Abdomen . Abdominal Ultrasonogram Done Identified Different Causes For Acute Abdomen In All The Three Patients
Such As Acute Appendicitis ( Peri-Appendicular Oedema With Probe Tenderness And Free Fluid In The Pelvis ) , Acute On
Chronic Cholecystitis ( Inflamed And Thickened Gall Bladder Wall) And Para Ovarian Cyst Torsion ( Cyst Of Size 5*4 Cms
With Absent Vascularity ) . Growth Profile Scan Was Normal In All The Above Mentioned Cases . Patients Were Taken Up
For Emergency Laproscopy ( Appendicectomy , Cholecystectomy , Para-Ovarian Cystectomy ) . Post Operatively , Patients
Were Under Intensive Monitoring With Higher Antibiotic Coverage Along With Tocolytics For Atleast A Week . Tertiary
Care Facilities And Immediate Surgical Intervention Helped The Pregnancies Continue Till Term Thus Avoiding Preterm
Deliveries .

***************

Post Partum Hemorhage On 31St Pod

Author: Dr. Sowganthika
Co Author: Sowganthika1,

A 21 Yrs Old Female Patient Presented With Bleeding Per Vaginum

On 31 St Post Operative Day Referral Hb As 4Gms
From Private Hospital. Emergency Lscs Done On11.08.2014. For Indication Failed Induction.No Immediate Post Operative
Complications And Discharged On 18.08.2014.At The Time Of Presentation In Casualty ,She Looks Pale Pulse Rate -90/Min
Bp-100/60.While Going To Bathroom At Home,She Noticed A Gush Of Bleeding Per Vaginum Followed By Which She
Fainted And Went A Pvt Hospital Where 1 Packed Cell Transfusion Given And Reffered To Rsrm. She Was Admitted Under
Critical Care , Iv Line Started ,Bladder Catheterised And Blood Taken For Grouping And Cross Matching.Hematological
Parameters Hb 7Gms Tc-8,300 Dc-P80% L28% E2% Pcv-21% Platelet-1,80,000Cells.Renal Parameters Sugar 108,S.Urea
24, S.Creatinine-0.6.S.Electrolytes Na-132 K-4.2. 1 More Packed Cell Transfusion Given.Urine Outpul 10-12Litres/Day.
Nephrologist Opinion Given As Polyuria For Evaluation/Acute Kidney Injury.Usg Abdomen -Uterine Cavity
Empty.Hormonal Assay -Free T3 T4 Tsh Normal. Fsh And Lh -Decreased.Acth-Normal,.Urine Osmolality 109. No H/O
Lactation Failure .Anterior Pituitary Function Restored.
Conclusion;Vasopressin
Challenge Test Done .Urine Osmolality-369.She Had Put On Tab.Desmopressin 0.1 Mg And Urine Output Reduced To 1500
Millilitres.
Differential Diagnosis -Sheehan`S Syndrome With Posterior Pituitary Dysfunction.
***************

A Case Report Of A Huge Fibroid Weighing 4.2 Kg

Author: Dr. Kalapala Adarsha
Co Author: Dr. G.C.Prabhakar1, Dr. B.Kavitha2,

A Case Report Of A Huge Fibroid Uterus Weighing 4.2 Kilograms

Background :
Leiomyomas Are Smooth Muscle Tumours Of The Uterus. They Are The Most Common Benign Tumors Of The Uterus And
Female Pelvis. They Can Vary In Size From Few Millimeters To Many Kilograms Being Symptomatic Or Asymptomatic With
No Relation To Their Size But In Relation To Their Site. Fibroid Might Cause Compression Of Bladder , Ureter Depending
Upon Site And Size. Large Asymptomatic Fibroids Are Rare In Modern Gynaecology.

Case :
I Am Reporting A Case Of 46 Year Old Multiparous Woman With Fibroid Uterus Corresponding To 36 Week Pregnant
Uterine Size. Patient Came With Complaints Of Mass Per Abdomen(15 Years) And Menorrhagic Cycles(3 Years) Associated
With Congestive Dysmenorrhea And Breathlessness. On Examination An Irregular Mass, Firm In Consistency , Occupying
All Quadrants Of Abdomen ,Felt Through All Fornices. Intravenous Pyelography Showed No Ureteric Compression. Iron
Deficiency Anemia Was Corrected. Laparotomy Done With A High Transverse Incision Where Enucleation Of Anterior
Wall Intramural Fibroid (800 Grams) Done Initially Followed By Total Abdominal Hysterectomy And Left SalpingoOophorectomy As The Left Fallopian Tube And Ovary Were Adhered To Uterus Along With Omentum And Jejunum Hence
Bowel And Omentum Salvaged. There Were Multiple Fibroids Of Intramural And Subserosal Types. Histopathological
Report Showed Multiple Leiomyomas.

Conclusion :
Large Fibroid Affecting Day To Day Life Of The Person Is A Rare Occurence Of Recent Times As It Is Rare For Them To Be
Asymptomatic For A Long Time.

***************

A Rare Case Of Luteoma Of Pregnancy With Abruption

Author: Dr. Janani Venkat
Co Author: Prof. Dr.Baby Vasumathi1, Prof .Dr.S.Vijaya2, Dr.A.Geethalakshmi3, Dr.E.Vijayalakshmi4,

A Rare Case Of Luteoma Of Pregnancy

With Abruption

Incidence Of Pelvic Masses In Pregnancy Is 0.5% To 2.2% Of Which Luteoma Is Very Rare With Only 200 Cases Reported
So Far. Mostly Luteomas Are Bilateral Associated With Androgen Production Causing Hirsuitism In The Fetus.

Ours Is A 26 Year Old 2Nd Gravida Previous Caesarean Section With Last Child Birth Two And A Half Years Back With
Regular Cycles, 32 Weeks Of Gestation And Admitted With Complaints Of Lower Abdominal Pain. Bowel And Bladder
Habits Were Normal. Mediscans Done At 4Th And 5Th Months Of Gestation Were Normal.

On Examination Her General Condition Was Stable, Per Abdomen Uterus Corresponded To 32 Weeks With Good Fetal
Heart Rate. On Per Vaginal Examination A Round Soft Mass Of 10 X 12 Cms Was Felt In The Middle Part Of The Posterior
Vaginal Wall Which Was Tender. The Patient Was Kept Under Observations With Vitals Monitoring. After Six To Eight
Hours Fetal Heart Rate Showed Repeated Variable Decelerations, Hence Decided To Terminate Pregnancy. But Patient
Progressed Spontaneously To Labour. There Was Maternal Tachycardia, Uterus Was Tense And Tender. In View Of
Abruption Lscs Done, A Fresh Dead Born Female Fetus Of 1.4 Kg Delivered With Rero Placental Clots Of 150 Gms.

Left Tube And Ovary Were Normal, There Was A Right Ovarian Mass Of 10 X 12 Cms Firm Bluish, Twisted Twice Around
Its Pedicle. Same Clamped Cut And Ligated And Sent For Histopathological Examination Which Turned Out To Be Luteoma
Of Preganacy.

***************

A Rare Case Of Persistent Gestational Trophoblastic Disease With Arterio-Venous Malformation

Author: Dr. Radhe Akang
Co Author:

A Rare Case Of Persistent Gestational Trophoblastic Disease With Arterio-Venous Malformation

Background:
Gestational Trophoblastic Disease With Arterio-Venous Malformation Of Uterus Is An Uncommon Disorder And Should
Be Considered In Patients With Unexplained Profuse Genital Bleeding. This Generally Is Associated With Molar Pregnancy,
Choriocarcinoma, Uterine Surgery Etc.
The First Line Of Therapy For Invasive Mole And Persistent Gtd Is Chemotherapy. Spontaneous Regression Have Also Been
Seen In Cases Of Invasive Mole. The Decision Of Observation Of Embolisation Depends On The Clinical Status Of Patient
Rather Than The Size Of Avm On Imaging. We Present A Case Of Persistent Gestational Trophoblastic Disease With Av
Malformation.
Case Report:
An 18 Year Old Female, A1 Was Admitted With Referral From Private Practitioner As? Hydatidiform Mole/ Retained
Product Of Conception With C/O Spotting P/V Continuously For 2 Months Following D & C Done 4 Months Back For ?
Incomplete Abortion.
On Admission, Patients Vitals Were Stable, Pallor + And 3 Units Packed Cell Was Transfused. On P/V, External Os Closed,
Uterus 12 Wks Size, Bleeding P/V +. With -Hcg Of 2,44,110 Miu/Ml, Clinical Diagnosis Of Vesicular Mole Was Made And
Suction Evacuation Performed. Hpe Report Confirmed Diagnosis Of Gtd. Post Evacuation -Hcg Level Were Persistently
High And Usg Showed Bulky Uterus With Prominent Myiometrial Vessels. Mri Pelvis Contrast And Colour Doppler
Confirmed Av Malformation. Medical Oncologist Opinion Obtained. Chemotheraphy Started With Methotrexate. Patient
Was Regularly Followed Up With Usg And -Hcg. After Chemotherapy, There Was Successful Fall In -Hcg Level. 6 Months
Later Patient Had Normal Usg And 1.2 Miu/Ml Hcg Level.
Conclusion:
Acquire Uterine Avm Are Rare And Life Threatening Condition That May Be Finding Of Persistent Gtd. Recurrent And
Severe Vaginal Bleeding Can Occur. D&C Worsens The Situation If Not Diagnosed Properly. High Index Of Suspicion Is
Important For Diagnosis And Treatment.

***************

Case Report A Rare Case Of Herniation Of Gravid Uterus Through Previous Caesarean Section Scar
Author: Dr. Sharmila Gudey
Co Author: Dr Neelima Choppala1,

A Report Of Rare Case Presentation Of Herniation Of Gravid Uterus Through Previous Caesarean Section Scar
Pffanenstiel Incision. Patient X Is A 25 Year Old G2P1L1 With Previous Caesarean Section. She Is A Booked Case With
Regular Antenatal Checkups And? Incision Hernia Since 2Nd Month Of Pregnancy. Her Antenatal Period Was Uneventful,
Planned For An Elective C.S And Incision Hernia Repair. On The Operative Table It Was Identified That The Posterior
Surface Of The Uterus Was In The Surgical Field. The Uterus Was Pushed To Its Normal Position And Caesarean Section
Was Performed. A Live Healthy Male Foetus Was Delivered And Incisional Hernia Repair Was Carried Out With Mesh.
Patients Post Operative Period Was Uneventful And Discharged On 10Th Pod. This Gives A Message Of Importance Of
Thorough Clinical Examination And Evaluation Of The Patient Before Taking Up For Surgery There By Reducing The
Incidence Of Iatrogenic Surgical Catastrophes And Emphasises On Multidisciplinary Approach. Here In This Case, Surgeon
Who Is Skilled In Repair Of Incision Hernia - Assistance Was Taken.

***************

Pregnancy Outcome In Adenomyosis With A.R.T

Author: Dr. Asha Rao
Co Author: Dr.Damodar.R.Rao1, Dr.Padmashri2, Dr.S.R.Rao3,

pregnancy Outcome In Adenomyosis With A.R.T

Author: Dr.Asha.R.Rao, Dr.Damodar.R.Rao, Dr. Padmashri, Dr. S.R Rao

Rao Hospital, Centre For Assisted Reproduction & Endoscopy (C.A.R.E), Coimbatore, Tamil Nadu

Aim: To Evaluate The Pregnancy Rate & Outcome In Women With Adenomyosis Undergoing A.R.T

Materials & Methods: Retrospective Study Done At Art Unit Of Rao Hospital, Care Between 2009 Aug To 2013 Aug. Total
Of 51 Patients With Adenomyosis Who Underwent Art Were Taken Up For Study. Diagnosis Of Adenomyosis Was
Established By Transvaginal Sonography(2D & 3D) & Type And Size Of Adenomyosis Were Assessed. Most Of The Patients
Were Subjected To Gnrh Analogue Suppression Followed By Art; Some Patients Had Combined Surgical And Medical
Management Followed By Art; Pregnancy Outcome With Clinical Pregnancy Rate (Cpr), Live Birth Rate, Miscarriage Rate
Were Analysed.

Results: Out Of 51 Patients With Adenomyosis Who Had Art, 32 Patients Had Medical Management With Gnrh Depot
Injection For 3 To 6 Months; 6 Patients Had Adenomyomectomy Combined With Gnrha Suppression. 26 Out Of 51
Patients Conceived With A Clinical Pregnancy Rate Of 51%. Pregnancy Rate Was 63% In Ovum Donation Cycle And 27.7%
In Ocr & Et Cycles. Out Of 26 Pregnancies, 13 Delivered At Term, 2 Delivered At 30 & 32 Weeks Giving A Live Birth Rate
Of 68%; 4 Are Ongoing. Out Of 26 Pregnancies 7 Had Abortions Giving A Miscarriage Rate Of 26.9%.

Conclusion: Adenomyosis Is A Challenging Condition. Medical Management Of Adenomyosis Followed By Art Has Given
Impressive Pregnancy Rate And Good Reproductive Outcome.
***************

An Unusual Case- rudimentary Horn Pregnancy"

Author: Dr. Neha Gupta
Co Author: Dr.Neelu Soni1,

Abstract Poster Presentation

Rhp Is A Rare Clinical Entity Associated With Serious Consequences. The Risk Of Rupture Of The Gravid Horn
Is A Major Concern. Prophylactic Resection Of The Horn Along With Its Tube Should Be Considered If It Is Detected.
Incidentally During Evaluation Of Infertility Or During Adnexal Evaluation At The Completion Of Caesarean Section.

I Am Going To Give A Poster Presentation On Unusual Case Of Pregnancy In Rudimentary Horn In 35 Yr Lady
With G3P1L1A1,Referred To Our Hospital, At 13 Weeks Of Gestation In Emergency With An Outside Ultrasound Report
Showing A Single Live Intrauterine Gestation Of 8+ 5Eeks And A 15X16 Mm, Solid Appearing, Right Adnexal Mass.

***************

Second Trimester Uterine Rupture- A Rare Case

Author: Dr. Keval Patil
Co Author: Dr Aruna S Nemagouda1, Dr S R Bidri2, Dr S R Mudanur3, Dr Neelamma Patil4,

Abstract

Background:
Second Trimester Abortions Constitute 1015% Of All Induced Abortions Worldwide But Are Responsible
For Two-Thirds Of Major Abortion-Related Complications. Most Of The Cases Of Rupture Of Uterus Occurs In The Third
Trimester Of Pregnancy Or During Labour. Here We Report One Of The Rare Case Of Second Trimester Uterus Rupture.

Case:
A 32 Years Old Women P2 L2 A2 On Immediate Post Abortal Day With Previous Two Ceserrean Section And
Lcb- 7 Months Was Admitted In Labour Room Of Shri B M Patil Medical College, Hospital And Research Centre, Bijapur,
India With Complain Of Per Vaginal Bleeding And Acute Abdominal Pain Following Medical Termination Of Pregnancy
And Dilatation And Evacuation Showing Clinical Signs Of Shock. Haemoperitoneum And Retained Products Of Conception
Was Discovered On Emergency Ultrasound. Emergency Laparotomy Was Carried Out And It Revealed Haemoperitoneum
Due To Spontaneous Rupture Of Uterine Fundus Through Which Retained Products Of Conception Were Extruded Into
Peritoneal Cavity.
Conclusion:
Though Spontaneous Fundal Rupture Is Very Rare In Early Second Trimester Of Pregnancy, It Should Be Taken
Into Consideration In Differential Diagnosis Of Per Vaginal Bleeding With Acute Abdominal Pain In Pregnancy If There Is
Predisposing Factors.

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A Case Report Of Uterine Rupture At Fundal Region In Pregnancy With Previous Lower Segment Cesarean Section
Author: Dr. Myneni Pujita
Co Author: Dr. T. Usha Rani1, Dr. B . Kavitha2, Dr. G. C. Prabhakar3,

Abstract

Background:
Uterine Rupture In Pregnancy Is A Rare And Often Catastrophic Complication With A High Incidence Of Fetal And Maternal
Morbidity. It Can Either Occur In Women With An Unscarred Uterus Or A Uterus With A Surgical Scar From Previous
Surgery. Uterine Rupture Is Full-Thickness Disruption Of The Intact Uterine Wall That Also Involves The Overlying Visceral
Peritoneum (Uterine Serosa). In Contrast Uterine Scar Dehiscence Involves The Disruption And Separation Of A
Preexisting Uterine Scar With Intact Visceral Peritoneum. Spontaneous Uterine Rupture Of A Scarred Uterus At An
Unusual Site Is A Rare Complication In Pregnancy. I Am Reporting An Unusual Case Of A Multigravida, With Multiple
(Twin) Pregnancy With Uterine Rupture At Fundal Region With Intact Previous Lower Segment Cesarean Section Scar.
Case Report:
A Case Of G3P1L1A1 With Multiple Pregnancy And Previous Lower Segment Cesarean Section Complained Of Sudden
Agonizing Abdominal Pain. She Was Taken Up For Emergency Laparotomy. At Laparotomy A Transverse Incomplete
Rupture Was Found At The Fundal Region With Intact Previous Lower Segment Cesarean Section Scar. It May Have
Occurred Due To Over Stretching Of Uterine Muscle Due To Twin Pregnancy Along With Polyhydramnios In A Multiparous
Lady. There Was No History Of Trauma Or Instrumental Evacuation Or Surgery Except Previous Lower Segment Cesarean
Section In First Pregnancy.
Conclusion:
In Pregnancy With Previous Lower Segment Cesarean Section It Is Usually Assumed That Rupture Occurs At The Site Of
The Scar. But In Above Case Previous Lower Segment Cesarean Section Scar Was Intact And Rupture Site Was Unscarred
Portion Of The Upper Uterine Segment.
***************

A Case Report Of Un Ruptured Rudimentary Horn Pregnancy

Author: Dr. Vineela P
Co Author: Dr. Kavitha1,

Abstract
Back Ground
Unicornuate Uterus With A Rudimentary Horn Is One Such Anomaly Of Uterus Occurring Due To Fusion Defects.
Conception In The Rudimentary Horn Is Very Rare, Arises Either From Small Communication With Uterine Cavity Or By
Transperitoneal Migration Of The Ovum From Contralateral Side. The Incidence Of Mullerian Duct Malformations In The
General Population Is Estimated To Be 4.3% While That Of Unicornuate Uterus Is About 0.4%. Rudimentary Horn
Pregnancy Occurs In Approximately 1/76000 To 1/150000 Pregnancies. None-The-Less Most Cases Remain Undiagnosed
Until It Ruptures And Presents As An Emergency.
Case Report
A 17 Years Old Primigravida Presented With Amenorrhoea Of 52 Days With Left Iliac Fossa Pain. There Was No History Of
Bleeding Per Vagina. On Examination, Pallor Present, Pulse Rate 100/Min, Blood Pressure Was 90/60 Mm Of Hg. Per
Abdominal Examination There Was No Palpable Mass And No Tenderness. On Bi Manual Examination Uterus Was Soft, 6
Weeks Size Tenderness Was Present In Left Fornix, And No Adnexal Mass Was Felt. Cervical Movements Were Painful.
Urinary Pregnancy Test Was Positive. Transvaginal Sonography Was Done Which Was Reported As Unruptured Left
Adnexal Ectopic Pregnancy. Emergency Laparotomy Was Done.
Intra-Operative Findings Were - Rudimentary Horn With Gestational Sac Of 5X5Cm Attached To Left Superior Border Of
Uterus Was Noticed. Left Tube And Round Ligament Were Seen Attached To The Rudimentary Horn. Resection Of The
Horn Was Done.
Histopathology Report:
1. The Gross Specimen Showed A Fetus With A Crown-Rump Length Of.8Mm
2. Section Findings Were Consistent With Uterine Horn Gestation.
Conclusion
Above Case Highlights The Need For High Index Of Suspicion To Diagnose Rudimentary Horn Pregnancy. Early Diagnosis
And Prompt Management Was Done Before Rupture. Early Diagnosis Is Crucial To Save The Patient From Catastrophic
Events.

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Case Report On Traumatic Uterine Rupture - A Rare Case Of Neonatal Survival

Author: Dr. Sravanthi Sadu
Co Author:

Abstract
Background:
Uterine Rupture Is A Potentially Catastrophic Complication With Serious Maternal And Fetal Outcomes. We Describe A
Rare Case Of Traumatic Transfundal Uterine Rupture With Posterior Extension, With Intact Lower Segment Scar And The
Neonatal Survival After Expulsion Into The Abdominal Cavity.
Case:
A Parous Woman G3P1L1A1, With One Previous Caesarean Section, Had A H/O Fall At 8Th Month Of Amenorrhoea. She
Came With C/O Pain Abdomen After Fall But Her Vitals Are Stable. Emergency Ultrasound Done Revealing A Live
Intrauterine Fetus Of 33Wks Ga, Placenta Low Lying And Anterior, No Evidence Of Free Fluid In The Abdomen. Emergency
Laparotomy Revealed About 6X4Cm Transfundal Uterine Rupture With 8Cm Posterior Extension With Fetus Lying In The
Peritoneal Cavity. Upon Delivery, The Baby Was Alive Of Wt 2Kg With Apgar 8-10 Without The Need Of Any Resuscitation.
Rent Repair Was Done. Intraoperatively One Unit Of Blood Transfusion Given. Postoperative Period Uneventful And She
Returned Home With Her Healthy Baby.
Conclusion:
Traumatic Uterine Rupture Is Rare And May Occur Without Conventional Signs. Good Maternal And Fetal Outcome Is
Possible With High Degree Of Suspicion For Early Diagnosis
And Prompt Coordinated Team Response.

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Clinical Auditing In Gynaecology And Standardised Registration Of Surgical Complications In Gynaecological

Procedures Using The Clavien-Dindo Classification
Author: Dr. Phijam Dhaneshwor
Co Author: Prof Aruna Kekre1,

Abstract
Introduction
Any Surgical Procedure Has An Inherent Risk Of Complication. The Registration Of The Complications Carries An Important
Aspect In The Evaluation Of Surgical Procedures. The Objective Of The Present Study Was To Audit The Incidence Of
Morbidity And Mortality Associated With Gynaecological Surgery As Well As The Severity Of The Complications In A
Standardised Manner Using The Clavien-Dindo System In Our Tertiary Referral Set Up Over A Period Of 2 Years.
Materials And Methods
Altogether 2865 Surgeries Were Performed On 2829 Patients From August 2012 To July 2014. Target Variables Collected
Were Type Of Surgery, The Demographic Characters, Preoperative Morbidity, And Surgical Negative Outcomes.
Results
Abdominal Hysterectomy Was The Most Common Procedure Performed (24.1%). Most Patients Were Less Than 40 Years
Of Age (46.4%) And Belong To American Society Of Anesthesiologists (Asa) Physical Status I And Ii (69.7% And 28.1%
Respectively). 47.3% Received Transfusion Intraoperatively (Vs 33.1% Postoperatively). There Was 24 (0.8% Of 2865
Surgeries) Intraoperative Complications (4 Ureteric Injury, 13 Bowel Injury, 4 Bladder Injury, And 3 Major Vessel Injury)
Excluding Intraop-Excessive Blood Loss Requiring Transfusion. 433 (15.1%) Postoperative Complications Were Recorded.
Overall Complication Rate Was 16.0%. Of These, According To The Clavien-Dindo Classification, 17.3% Were Mild
Complications (Cv Grade I-Ii) And 2.2% Severe Complications (Cv Grade Iii-V). Most Common Complication Were
Nonspecific Fever And Urinary Tract Infection (4.9% And 4.7% Respectively).
Conclusion
The Clavien-Dindo Classification Appears To Be A Practical Way To Standardise The Complication Registration System.
There Is A Strong Need To Emphasise To Utilize This Standardised System For Recording Surgical Complications In
Gynaecology Field. In This Audit The Major Complications (Class Iii-V) Following Gynecologic Procedures Were Rare.

***************

Bilateral Ovarian Cystic Lymphangioma With Chylous Ascitis In Pregnancy -A Rare Case Report With Review
Author: Dr. Archana Daddenavar
Co Author: Dr Vikas M Daddenavar1, Dr Sumangala M Daddenavar2, Dr M S Daddenavar3, Dr Rashmi Patil4,

Abstract
Lymphangioma Is Usually Asymptomatic And Unilateral, Presenting As An Incidental Finding During Routine Gynaecologic
Procedures. It Is Made Up Of Aggregates Of Lymphatic Spaces In Ovarian Stroma And The Endothelial Cells Lining These
Spaces. We Report This Rare Lesion Managed Successfully.
Case Report
28 Years Old Primigravida Presented With 37 Weeks Of Gestation With Acute Distension Of Abdomen And Respiratory
Distress. Vitals Were Stable. On Examination- Abdomen Was Over Distended, Tense, Size Of The Uterus Could Not Be
Made Out, Fetal Heart Rate Was 146/Min On Doppler. On Ultrasound Examination, Massive Ascites Compressing Over
Gravid Uterus Seen With A Single Live Intrauterine Pregnancy Of 35 Weeks Of Gestation. Left Ovary Was Enlarged,
Measuring 16X12 Cm With Multiple Cystic Lesions Of Variable Size And Right Ovary Measured 5X4 Cm With Small Cysts.
Emergency Caesarean Section Done. Intra Operatively 3 Litres Of Chylous Fluid Suctioned Out And Sent For Analysis. A
Live Male Baby Of 2400 Grams Was Delivered. Left Ovary Was Massively Enlarged With Multiple Cystic Components And
Was Removed. Right Ovarian Biopsy Taken. Both The Specimen Sent For Histopathology. Patient Withstood The
Procedure Well. Ascitic Fluid Analysis Confirmed Chylous Nature And Histopathology Revealed Bilateral Ovarian Cystic
Lymphangioma.
Clinical Relevance
Bilateral Lymphangioma Of The Ovary Being An Extremely Rare Lesion, With Chylous Ascites And Full Term Pregnancy,
This Is The First Ever Case In The World To Be Reported. Chylous Ascites With Pregnancy Only 5 Cases Have Been Reported
Earlier. And Above All, Only 20 Cases Of Ovarian Lymphangioma Are Reported In The Literature So Far.

Keywords Lymphangioma, Ovary, Chylous Ascites, Pregnancy.

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Oeis Complex - A Rare Fetal Anomaly

Author: Dr. Neelamma Patil
Co Author: Dr. S.R. Mudanur1, Dr. Aruna Biradar2, Dr. Shridevi Kori3, Dr. Lubna Lahori4,

Abstract:
Introduction: Oeis Complex ( Omphalocele, Extrophy Of Bladder/Cloaca, Imperforate Anus, Spinal Defects) Is A Rare
Constellation Of Malformations Involving Multiple Organs In Humans. It Is The Most Serious Manifestation Of ExtrophyEpispadias Sequence. The Exact Aetiology Of This Condition Is Not Known. It Is Sporadic But Genetic Associations Have
Also Been Hypothesised. It Results From Defective Blastogenesis Leading To Improper Closure Of Anterior Abdominal
Wall And Defective Development Of Cloacae And Urogenital Septum. Incidence Ranges From 1 In 2, 00,000 To 1 In 4,
00,000.

Case: We Had An Undiagnosed Case Of This Complex Presenting To Us In Advanced Labour, But A Timely Ultrasound
Helped In The Diagnosis And Avoided An Unnecessary Caesarean Section Which We Would Have Done For An Elderly
Primigravida With Breech Presentation.

Conclusion; Prenatal Diagnosis Of Oeis Complex Can Be Done By Anomaly Scan Between 18 To 22 Weeks Of Gestation. It
Carries A Poor Prognosis. Survival Is Nil Or Very Less. Even If Baby Survives It Requires Multiple Surgeries With Many
Potential Complications. So All Patients Should Have A Compulsory Anomaly Scan Which Will Prevent Them From Facing
Such Problems Late In Pregnancy

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Dilemma In The Diagnosis And Management Of Adnexal Masses

Author: Dr. Nupur Mishra
Co Author: Dr.Jyothi1, Dr.Asha Swaroop2,

Adnexal Masses Are Commonly Encountered In Gynaecological Practice And Often Present Both Diagnostic And
Management Challenges. We Present A Series Of Three Cases Where We Had Similar Problems.
Mrs. S. 24 Year Old Nulligravida Referred In View Of Bilateral Broad Ligament Fibroids. An Irregular Freely Mobile Nodular
Mass About 18-20 Weeks Size Of A Gravid Uterus Felt Per Abdomen .Usg Showed Multiple Heterogenous Lesions In The
Right Adnexa . Intra Operative Findings Showed Bilateral Broad Ligament Fibroids And Right Ovary Not Visualized. Right
Adnexal Mass Removed And Sent For Frozen Section. Frozen Section Came As Leiomyoma. Final Hpe Report Showed Also
The Right Ovary In The Mass Removed, Which Came As Benign Serous Cystadenoma Of Ovary.

Mrs. S 47 Years Old P3L2 Came With History Of Excessive Bleed Pv Since 6 Months. Uterus 12 Weeks Size. Imaging Studies
Showed Fibroid Uterus. Planned For Hysterectomy. Intra Operative Findings Showed Uterus To Be 14-16 Weeks Size.
Multiple Seedling Fibroids Present Along With Posterior And Fundal Fibroid Measuring 5X4 Cm . Left Sided Ovarian Cyst
Of 10X7Cm With Smooth Surface And Capsule Intact. Right Tube And Ovary Normal. Frozen Section Showed Serous
Cystadenoma With Focal Low Grade Atypical Changes. Final Hpe Came As Serous Cystadenocarcinoma Of Ovary . Staging
Laparotomy Done And Right Ovary Removed. Hpe Came As Benign Lesion. Patient Received Chemotherapy For 6 Cycles.

Mrs. R. 40 Yrs Came With History Of Amenorrhoea Of 6 Months Duration. History Of Primary Infertility Present.Mass P/A
Incidentally Detected. Cect Showed Complex Ovarian Cyst Which Was Excised. Frozen Section Showed Changes Like
Stratification. Hpe Showed Juvenile Granulosa Cell Tumour, Which Is Rare.
Incidentally Discovered Ovarian Cysts Are Common And Most Are Benign, But A Minority Can Represent Ovarian Cancer
Which Is Difficult To Detect Before It Has Spread And Often Has A Poor Prognosis.

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Education For Empowerment -Imparting Family Life Skills To School Girls

Author: Prof. Madhuri Chandra
Co Author: Prof. Dr Rashmi Dwivedi1, Ms Shabana2,

Aim And Objectives Qualitative Analysis Of Perceptions Of Adolescent Girls Regarding Family Life Education Imparted
By Dishayen.
Material And Methods - Adolescent Research And Resource Centre dishayen At Gandhi Medical College, Bhopal
Has Been Functioning Since 2000. It Serves As A Training Centre For Arsh To Doctors, Teachers & Counselors. Daily
Outpatient Services Include Growth Monitoring, Nutrition Assessment & Counselling, Reproductive & Sexual Health
Services, Screening For Sti/Rti, Mental Health Assessment, Counselling For Behavioural Problems. Outreach Activities
Conducted By Centre Are Sessions On Family Life Education At Aganwadis, Schools And Colleges.
Results The Family Life Sessions Provide Uniform Skilled Advice On Nutrition, Prevention Of Anemia, Hygiene
(Menstrual), Problems Of Growing Years, Career Counselling To School Girls And For Older GirlS Sessions On Avoiding
Rti/Stis, Safe Sex, Contraception, Teenage Pregnancy And Exclusive Breastfeeding. A Questionnaire Was Provided To The
Girls After The Formal Sessions To Get Their Views On The Quality And Usefulness Of The Sessions And The Knowledge
Imparted To Them. The Perceptions Of The Girls Will Be Presented.
Conclusions Education Per Se Helps Adolescents Deal With Body Image Issues, Menstrual Problems, Understand
Themselves Biologically, Delays Marriage And Helps Prevent Them Falling Victim To Sexual Abuse.

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Unwanted Pregnancy In Unmarried Adolescents And Young Adults - Need For Gender Education And Contraceptive
Counseling.
Author: Dr. Richa Singh
Co Author: Dr. Punam Yadav1, Dr. Roopa2,

Aim And Objectives: To Analyse The Social Factors Influencing Unmarried Pregnancies In Young Girls. To Determine The
Awareness Of Sexual And Reproductive Health In Adolescent Girls.
Material & Methods; This Was A Case Control Study Conducted Over A Period Of Three Years From Jan 2011 To Dec 2013.
Data Was Collected By Interview Of 102 Unmarried Abortion Seekers And 102 Unmarried Non Pregnant Controls
Attending The Outdoor Department Of Obs. & Gynae., S. N. Medical College ,Agra.
Results : Statistical Analysis Showed A Significant P Value (<0.001) In Girls Belonging To Lower Socioeconomic Status.
There Was A Strong Correlation Between Unmarried Adolescent Pregnancy And Poor Family Relationship (Or = 5.12) Or
Problem Family (Or = 3.89) And Lack Of Parental Supervision (Or = 4.48). Other Factors Like Low Level Of Literacy And
Lack Of Work Also Had A Significant Impact (P<0.0001) And (Or= 4.4) And (Or= 7.4) Respectively. Lack Of Adequate
Knowledge About Sexual And Reproductive Health Was Responsible For A Significant Number(P<0.0001) Of Unwanted
Pregnancies(Or= 9.35).
Conclusion : This Study Suggests That Poor Family Relationship And Supervision Combined With Illiteracy And Ignorance
About Sexual And Reproductive Health Have Significant Role Leading To Unwanted Pregnancies In Young Girls. A Number
Of Such Pregnancies Can Be Prevented By Gender Education And Contraceptive Counseling. Adolescent Health Education
Programs And Counseling Of Parents Can Be Conducted In Schools And Anganwadi'S By Government And NonGovernment Organisations To Reduce The Burden Of Such Pregnancies And Hence To Promote A Healthy Adolescence In
Girls.
***************

Bad Obstetric History - A Prospective Study.

Author: Dr. Uma B
Co Author:

Aim:
The Aim Of The Study Was To Establish The Etiology And To Evaluate The Pregnancy Outcome In Women With Bad
Obstetric History

Objective:
To Identify Women With Bad Obstetric History
To Establish The Etiology For Bad Obstetric Outcome
To Evaluate The Future Pregnancy Outcome In Women With Bad Obstetric History

Materials And Methods:

This Was A Prospective Study Conducted In A Population Of 125 Women With Bad Obstetric History Who Were Pregnant
Or Otherwise Who Attended Meenakshi Mission Hospital And Research Centre, Madurai From 2012 To 2014. Women
With Adverse Obstetric Outcome In Previous Pregnancies Were Included In Study.Those Women Who Were Not Willing
To Participate In Study, Women With Normal Obstetric History, Primipara Were Excluded From Study.

Results:
Out Of The 125 Patients In The Study, It Was Found 33.6 % Had One Pregnancy Loss And 66.4% Had 2 Or More Pregnancy
Loss. 50 % Had At Least One First Trimester Loss And 20.8% Had At Least One 2Nd Trimester Loss, 41% Had At Least One
3Rd Trimester Loss. 30% Had Prothrombatic Factors, 8% Had Anatomical Factors And 8 % Had Cervical Incompetence.
25% Of Women In Study Group Had Preeclampsia, 44% Of Those With Preeclampsia Had Prothrombotic Factors, Who On
Treatment With Low Dose Aspirin And Low Molecular Weight Heparin Had Successful Next Pregnancy (92%)

Conclusion:
Bad Obstetric Outcome Is One Of The Most Frustrating And Difficult Areas In Reproductive Medicine Because The
Aetiology Is Often Unknown And There Are Few Evidence-Based Diagnostic And Treatment Strategies. When Evaluation
Of Women For Bad Obstetric History Is Done, An Underlying Contributing Factor Can Be Identified In 40-50%. If A
Contributing Factor Is Found And Treated, The Prognosis For Successful Pregnancy Outcome Is Typically Around 80%.
***************

First Trimester Ultrasound Screening For Foetal Anomalies

Author: Dr. Ramyasree Parvathareddy
Co Author: Dr.Jyothirmayee1,

Aims And Objectives: The Aim Of My Study Is To Screen And Diagnose Foetal Defects In Early Pregnancy (First Trimester)
In South Indian Population.
Materials And Methods: The Study Was Conducted In Shadan Institute Of Medical Sciences And Pg Research Center,
Hyderabad, India. This Study Is A Hospital Based Retrospective Study That Included 1340 Pregnant Women Who Attended
Antenatal Clinic Of Our Hospital From July 2013 To September 2014. After Taking Informed Consent, Women With
Gestational Age Of 11 Weeks' To 13+6 Weeks' Duration Were Screened By Ultrasonography For Various Parameters Like
Nuchal Translucency, Nasal Bone And Flow Through Ductus Venosus.
Results: 1340 Antenatal Women Were Included In The Study Out Of Which 26 Were Found To Present With Structural
Anomalies. First Trimester Scan Detected 14 Of 26 (54%) Structural Anomalies. 12 Were Identified By Second Trimester
Scan. Out Of Total 26 Structural Anomalies,18 Were Major. 12 Out Of 18 (67%) Were Detected By First Trimester Scan.
Conclusion: First Trimester Aneuploidy Screening Sonography Performed By Credentialed Sonographers Can Identify A
Substantial Proportion Of Major Anomalies. Since Some Anomalies Are Not Evident In The First Trimester, 18-20 Weeks'
Scan Remains The Gold Standard.

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Prevalence Of Periodontal Infection In Women With Preterm Labour

Author: Dr. Shweta Gupta
Co Author: Namita Budhiraja1, Narender Pal Jain2, Sanjeev Kumar Singla3,

Aims And Objectives: To Observe The Prevalence Of Periodontal Disease In Women With Preterm Labour Pains (Ptlp).
Materials And Methods: This Study Included 78 Women With Singleton Gestations Admitted To Labour Room With The
Diagnosis Of Preterm Labour (Between 26 And 35 Weeks Of Gestation). Clinical Measures Of Periodontal Parameters
Included Level Of Inflammation Of The Periodontal Tissues (Using A Bleeding Index Of 0-3), Calculus With Plaque,
Maximum Periodontal Pocket Depth (Ppd) In Mm, And Severity According To The Amount Of Clinical Attachment Loss
(Cal) In Mm Recorded At Six Sites On Each 20 Tooth.
Results: The Prevalence Of Periodontal Disease Was 44.8% (35/78). Bleeding On Probing Was Present In 67.9% (53/78)
Women Which Was Statistically Significant (P < 0.01). Calculus With Plaque Was Observed In 61.5% (48/78). Maximum
Periodontal Pocket Depth On Probing Was 5.2 Mm (Average 3.1 Mm). Significant Attachment Loss (> 3Mm) In At Least
60% Of The Sites Probed Was Observed In 48.7% (38/78).
Conclusion: Periodontal Disease Is A Significant Finding In Women With Preterm Labour. It Is Important For The
Obstetrician To Identify Women At Risk For Preterm Birth And To Address These Women For Periodontal Examination
And Treatment To Limit Adverse Pregnancy Outcomes.

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Deceptive Presentation Of Fibroid (Case Presentation)

Author: Dr. Vijaya Patnala
Co Author:

Author : Dr.P.Vijaya, Asst.Professor,Mgmh, Petlaburj

Co Authors: Dr. K. Aruna Kumari, Dr.E.Vanaja Reddy, Dr.Kssk. Madhavi, Dr.P.Sowmya, Dr.G.Pratibha
Ch. Padma Aged 40 Yrs W/O Venkanna, P3L3, Lcb 27 Yrs Was Admitted With History Of Heavy Bleeding Since 6 Months,
History Of Easy Fatiguibility, And Weakness Also Present. History Of Increased Bleeding During Periods For 5-6 Days For
Every 15 Days Elicited. She Received 3 Pints Of Blood Transfusions Previously. On Examination Patient Was Conscious ,
Pallor Present, H/L Nad, Vitals Normal, Pedal Edema Present.P/A Soft, Mass Of 14 Wks Felt. P/S Mass Occupied The Whole
Vagina Unable To Feel The Cervical Rim,? Fibroid Polyp,? Cervical Fibroid. Investigations: Hb 5.7Gms, Usg :Uterus Size
14X5.7X6.4 Cms, Hypoehoic Mass Noted In The Cervix 7.7X7.2 Cms And Also In Posterior Wall Of Uterus Intramural Fibroid
Of 3.2X2.4 Cms. Impression: Bulky Uterus With Cervical Fibroid And Posterior Intramural Fibroid With Left Mild
Hydronephrosis. Meanwhile We Were Correcting The Anemia Suddenly After 20 Days Patient Had Severe Vaginal
Bleeding So Emergency Hysterectomy Done. After Opening The Abdomen Flower Vase Pattern Of Fallopian Tubes
With Ovarian Ligaments Arising From The Depression On The Fundus Noted.
Conclusion: It Is A Case Of Chronic Inversion Of The Uterus.

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Cervical Ectopic Pregnancy A Rare Case

Author: Dr. Sanjay Kumar Patil
Co Author: Dr Sanjaykumar Patil1, Dr Shrikant Ohri2, Dr Yamini Patil3,

Authors
Dr. Sanjaykumar Patil, Associate Professor, Kims Karad
Dr. Shrikant Ohri, Postgraduate Student, Kims Karad
Dr. Yamini Patil, Associate Professor, Kims Karad
Abstract
Backgroung
Cervical Ectopic Pregnancy Is Extremely Rare, Accounting For Less Than 1% Of All Ectopic Pregnancies. In The Past, Cervical
Ectopic Pregnancy Was Associated With Significant Hemorrhage And Was Treated Presumptively With Hysterectomy.
Improved Ultrasound Resolution And Earlier Detection Of These Pregnancies Has Led To The Development Of More
Conservative Treatments That Attempt To Limit Morbidity And Preserve Fertility. Its Etiology Is Still Unclear. However,
There Are Reports Of Association With Chromosomal Abnormalities, A Prior History Of Instrumentation Of Endocervical
Canal And Damage Of The Endometrial Lining Such As Cesarean Section, Intrauterine Device, And In Vitro Fertilization
Case
23 Year Female 2Nd Gravida With A History Of Missed Abortion Of 9 Weeks For Which Suction And Evacuation Was Done
1 Year Back.
Now She Is A Diagnosed As A Case Of Cervical Pregnancy With The Help Of
Usg And Serial Hcg.
Treated With Injection Methotrexate 1Mg/Kg Im(1,3,5,7) Days And Folinic Acid 0.1Mg/Kg Body Weight(2,4,6,8) Days.
Later Patient Was Posted For Evacuation And Curettage.
After Evacuation A Foleys Catheter Was Inserted In The Cervical Canal And Inflated With 75Ml Normal Saline And
Removed After 24 Hours.
No Active Bleeding Was Recorded.
Intraoperative Procedure Was Uneventful.
Conclusion
Earlier Cervical Ectopic Pregnancy Was Treated Presumptively With Hysterectomy, Now Medical And Surgical
Management Are Available To Preserve Fertility.
Keywords
Cervical Ectopic Pregnancy, Methotrexate, Evacuation And Curettage

***************

Vertebral Haemangioma In Pregnancy 2 Cases

Author: Dr. Prameela Menon
Co Author: Dr Betsy Thomas1,

Back Ground
Low Back Ache And Paresthesia In Lower Limbs Often Ignored As Physiological , But Need Not Be Always. 2 Cases
Where These Innocent Looking Symptoms Led To Severe Morbidity.
Case
Case 1 21 Yr Primi At 38 Wks With Low Backache, Strain Walking. Power Right Leg 4/5. 1 Wk Later Inability To
Walk, Urinary Retention . Sensory Loss Below Mid Thorax , Bladder Atonic, Grade 2 Power , B/L Plantar Extensor.Mri
Altered Intensity Body And Posterior Elements Of D4 Vertebra With Paravertebral Soft Tissue Component Compressing
And Displacing Spinal Cord S/O Haemangioma. Planned For Emergency Lscs, But Developed Leaking And Progressed Fast
And Delivered By Vacuum . Underwent D4 Laminectomy With Tumour Decompression.Hpr Cavernous
Haemangioma Of Vertebra. Doing Well Now.

Case 2
25Yrs Primi, At 37 Wks With Low Backache And Numbness Right Leg. No Sensory Loss, Plantar Flexor, Reflexes Normal,
Power 4/5.After 2Wks Increased Numbness. Sensory Loss Both Feet, B/L Plantar Extensor, Ankle Clonus , Grade 3 Power
Both Lower Limbs. Mri D4 Spinalcord Compressing Lesion. Emergency Lscs And Microdecompression . She Gradually
Improved.

Discussion
Incidence Of Vertebral Haemangiomas 10-20%, 1% Is Symptomatic. Pregnancy Make Them Symptomatic By Pressure
Effect And Hormonal Action .Mainly Found In Upper Thoracic In Pregnancy. Begins As Low Backache/ Radicular Pain And
Leg Parasthesia Which Rapidly Progress To Paresis And Urinary Incontinence. Mri Low Signal Intake In T1 And High
In T2. X Ray Vertical Striations, Honey Comb Appearance. Treatment Depends On Gestational Age And Severity,
Severe Ones Requiring Decompression Irrespective Of Gestation. Other Modalities Are Radiation & Percutaneous Sclero
Therapy.
Conclusion
Vertebral Haemangiomas Are Well Known To Become Symptomatic In Pregnancy And Also Known For Its Rapid
Progression. If Found Out Timely Morbidity Can Be Minimised. Miscellaneous Symptoms In Pregnancy Can Be
Mischievous At Times.

***************

Case Of Broken Heart Syndrome In A Young Post Caesarean Mother. Case Study.
Author: Dr. Sadiqunnisa A
Co Author: Drmukhtarahmed D Bendigeri1, Dr Sathiq Ali2, Dr Victor C Rasquinha3, Dr Ragagopal .K4, Dr Rahul5

Back Ground
Takotsubo Cardiomyopathy Also Called As The Transient Left Ventricular Apical Ballooning Syndrome Or Broken Heart
Syndrome Is A Rare Phenomenon First Described In The Japanese Population In 19911. In The Medical Literature Cases
Of Tcm Have Been Described During Puerperium And Few During Pregnancy. This Report Discusses A Rare Case Of Broken
Heart Syndrome In Young Post Caesarean Mother.

Case Report
A 25 Yr Old G2A1At Term Was Induced With Cerviprime Gel For Oligo Hydramnios. Patient Underwent Caesarean Section
For Fetal Distress Under Spinal Aenesthsia. Five Hours Following Surgery Patient Developed Hypotension, Though CSection Was Uneventful With No Intra Operative Complications. . Ecg And Cardiac Enzymes Were Normal. Chest X Ray
Showed Bilateral Haziness Of Mid And Lower Zones. Echo Revealed Severe Hypokinasia Of Mid, Apical Septum, And Apex
With Ejection Fraction Of 30%. Patient Was Digitalized And Aspirin Was Added. A Multi Disciplinary Team Was Involved
In The Management Which Is Mainly Supportive In Nature. Her Repeat Echo Showed Marked Improvement In Her Lv
Function With An Ejection Fraction Of 54%. She Made A Good Recovery.
Conclusion: Takotsubo Cardiomyopathy Is Type Of Non Ischaemic Cardiomyopathy In Which There Is A Temporary
Sudden Weakening Of The Myocardium With Potentially Serious Sequele4. It Is A Reversible Rare Cardiac Condition That
Should Be Differentiated From Peripartum Cardiomyopathy And Ischemia. It Is An Increasingly Reported Phenomenon
Which Not Only Occurs In Cases Of Acute Emotional Or Physical Stress, But May Also Follow Iatrogenic Stress Due To
Common Medical Procedures. It Has An Excellent Prognosis With Early Multidisciplinary Management. The Environment
During Labour Should Be Calm And Pleasing. Acute Cardiac Complications Occur Less Frequently In Pregnancy And
Immediate Postpartum. Some Of These Cases Are Rare And They Pose A Diagnostic Challenge.

***************

Diagnostic Dilemmas And Management Perplexities In A Large Cervical Fibroid

Author: Dr. Padala Habitha
Co Author:

Back Ground: Out Of All Fibroids Of Uterus Cervical Fibroid Is Rare,A Large Cervical Fibroid Presenting As A Large Vaginal
Mass Creating Diagnostic Dilemmas Is Still Rare.
Case : A Patient X 35 Yr P2L1D1 With 1 Prev Lscs Presented With A Large Mass Per Vaginam Since 5 Months With Foul
Smelling Discharge P/V Since 1 Month With Difficulty In Walking ,Reducible On Lying Down,H/O High Grade Intermittent
Fever With Chills Since 1 Month,Had No Menstruation For Past 6 Months With Previous Hmb For 5 Months,On
Examination Patient Is Ill Looking,Moderately Built,Pale With Normal Vital Data With Per Abdomen Soft With No
Organomegaly,On Inspecting External Genetilia A Mass Of Size 5 X 5 Cms ,Round With Purulent Discharge With Necrotic
Changes Is Seen With No Visible External Os.Per Vaginal Examination And Bimanual Examination Couldn'T Be Done,Pt
Was Admitted ,Supportive Treatment Given,On Doing Usg Scan Abdomen And Pelvis Uterus Is Bulky With Normal Fundus
With Widened Cervical Canal With A Polyp With Pedicle Arising From Lower Uterine Segment Is Present,Ct Confirmed
The Report.Intra Operatively On Opening Abdomen Adhesions Are Present,Anatomy Is Disturbed,Bladder Is
Adherent,Sharp Dissection Done,Uterus Is Visualised With Difficulty Which Is Of Normal Size With A Mass Of Size 20X15
Cms Seen Arising From Cervix Which Is Effased And Dilated With Impacted Fibroid,Tah Is Done.
Conclusion:Large Cervical Fibroids Presenting As Mass Per Vaginam Create Lot Of Diagnostic And Management
Perplexities.
***************

Uterine Prolapse Complicating Pregnancy:A Rare Case Report

Author: Dr. Winnie Nimma
Co Author: Dr.G.C.Prabhakar1, Dr.Kavitha2,

Back Ground: Presentation Of Uterine Prolapse Is A Rare Event In A Pregnant Woman, Which Can Be Pre-Existent Or Else
Manifest In The Course Of Pregnancy. Fewer Than 300 Cases Have Been Reported In The Literature, Mostly Before The
1970S. Previous Estimates Have Put The Incidence Of Uterine Prolapse In Pregnancy At 1 In 10,000-15,000 Deliveries
Worldwide.
Case: A 26Yr Old Gravida 3 Para 0 Abortion 2 Presented To Our Hospital At 28 Weeks Of Gestation With 3Rd Degree
Uterine Prolapse And Cervical Incompetence. During Previous Two Pregnancies, She Developed Uterine Prolapse At 1013Wks Of Gestational Age And Was Advised Bed Rest And Kegel Exercises. But There Was No Improvement And Later
Both Pregnancies Spontaneously Aborted. During Her Third Pregnancy, Prolapse Recurred At 12 Weeks Of Gestational
Age And Gradually Progressed In Size. She Was Admitted In Our Hospital And Managed Conservatively With Bed Rest In
Trendenlenburg Position, Tamponade, Failing Of Which, Labial Suturing Was Employed .Pregnancy Continued Till 37
Weeks. Emergency Cesarean Delivery Was Done For Fetal Distress & Delivered A Live Baby. 4Weeks After Delivery, Cervix
Was At Level Of Introitus.
Conclusion: Prolapse That Exists Before Onset Of Pregnancy Usually Resolves Spontaneously By The End Of Second
Trimester.Prolapse That Develops During Pregnancy Is Usually First Noted In The Third Trimester, And Management
Consists Of Bed Rest In A Slight Trendelenburg Position. In These Cases Pessaries Will Not Remain In Place Or Prevent
Preterm Labour.Complications Resulting From Prolapse Of The Uterus In Pregnancy Vary From Minor Cervical Infection
To Spontaneous Abortion, And Preterm Labor ,Fetal Mortality As Well As Acute Urinary Retention And Urinary Tract
Infection. The Management Of Pregnancy Associated With Uterine Prolapse Is Highly Individualized And Varies According
To The Symptomatology, Clinical Findings, Age And PatientS Preferences.

***************

A Rare Presentationof A Foreign Body In Vagina (Wood Apple)

Author: Dr. Umamaheshwar Sindur
Co Author: Dr Julie Thomas, Prof, St. Philomena'S Hospital Bangalore 1,

Back Ground: Wood Apple Is Common Name For Several Trees With Edible Fruits Is A Native Of Bangladesh, India Or
Pakistan.The Fruit Is Bony 10 To 15Cms In Diameter. It Has A Very Hard Rind Which Can Be Difficult To Crack Open And
Contains Sticky Brown Pulp And Small White Seeds. The Fruit Was Used In The Previous Days For Temporarily Reducing
The Prolapse Of The Uterus .
Case: We Present A Rare Case Of 65 Year Women Presented With C/O Foul Smelling Vaginal Discharge, With Foreign
Body(Wood Apple) Inserted Per Vagina Since 20 Years For Prolapse.Pelvic Scan Suggested Large Foreign Body Of 10X11
Cm. Under Short Ga Wood Apple Of A Size Of Fetal Head In Vagina Removed With Obstetric Forceps With Episiotomy.
Conclusion: A Neglected Prolonged Foreign Body In Vagina Can Cause Septicemia
***************

Primary Ovarian Pregnancy Following Bilateral Tubal Ligation

Author: Dr. Gnanapriya Priya
Co Author: Gnanapriya1,

Back Ground:
Ectopic Ovarian Pregnancy Following Tubal Ligation Is Very Rare And Only A Very Few Cases Has Been
Reported So Far. Here We Report A Case Of Primary Ruptured Ectopic Ovarian Pregnancy Which Occurred Six Years After
Bilateral Tubal Sterilization.
Case Report:
A 34 Year Old Female Para3 Live3 With All Normal Vaginal Deliveries For Whom Bilateral Tubal Sterilization Has
Been Done Six Years Back Presented With Complaints Of Lower Abdominal Pain And Spotting Pv For 2 Days. Her Menstrual
Cycles Were Regular With Lmp 28 Days Back .On Clinical Examination Vitals Were Stable, Left Illiac Fossa Tenderness And
Cervical Motion Tenderness Were Present. Minimal Bleeding Pv Was Present. Left Fornicial Fullness With Tenderness
Was Present. Upt Was Positive. Beta Hcg Was 11084Miu/Ml. On Usg Abdomen Gestational Sac With Fetal Pole Were
Seen In Left Adenexa With Free Fluid In Pod. Uterus Was Empty. Since The Patient Was Progressively Becoming
Haemodynamically Unstable A Diagnosis Of Ruptured Ectopic Pregnancy Was Made And Emergency Laparotomy Was
Done. Intra Operatively Ruptured Gestational Sac Was Found Over The Left Ovary With Haemoperitonium. Left Sided
Salphingectomy With Oophorectomy Was Done. Evidence Of Tubal Ligation Was Seen On Right Side. Primary Ovarian
Pregnancy Was Confirmed Histologically.
Conclusion:
We Would Like To Emphasize The Fact That, Though Ectopic Tubal Or Ovarian Gestation Are Rare After Tubal
Ligation, One Has To Consider This Possibility When The Patient Comes With Typical Signs And Symptoms Of Ectopic
Gestation. Women Undergoing Sterilization Should Be Educated About Its Possibility, So That Early Interventions Can Be
Taken To Minimize Complications.

***************

Title - Silent Loss Of Kidney Due To Fibroid

Author: Dr. Hashmi Fakharullah
Co Author:

BackgroundFibroid Leading To Assymptomatic Total Renal Damage Is Rare.There Are Very Few Cases Reported In Literature Where
Nephrectomy Done Due To Fibroid Leading To Longstanding Obstruction And Permanent Kidney Damage.
Case
Mrx X,30 Yrs P1L1,C/O Of Continous Bleeding For 1 Month.Thin Built .O/E-16 Wks Mass Arising From Pelvis.Left Kidney
Palpable.
Usg-Large Fibroid Uterus In Posterior Wall.
Ct Scan Gross Left Hydroureteronephrosis With Thin Renal Parenchyma.Non Functioning Left Kidney ,Fibroid Uterus.
Renal Functions And Routine Investigations Normal.Proceeded With Tah+Bso With Left Nephrouretectomy.
Histopathology-Lefthydroureteronephrosis With Chronic Tubulointerstitial Inflammation Left Kidney.Leiomyomata Of
Uterus With Foci Of Adenomyosis ,One Tube Shows Foci Of Endometriosis.
Patient Asked For Follow Up After 6 Months.

Conclusion/Clinical Reference-

Obstruction Of The Urinary Tract By Uterine Fibroids Is Relatively Common But Leading To Assymptomatic Permanent
Renal Damage Is
Uncommon And Patients With Large Fibroids Should Have Proper Imaging To Identify This
Condition. Longstanding Obstruction Can Lead To Permanent Kidney Damage And Also This May Be Worsened By Other
Causes Of Renal Impairment.

***************

A Case Of Perforation Of Rectum Due To Self-Administered Enema In A Pregnant Woman

Author: Dr. Anjali Rani
Co Author: Dr Puneet1,

Background
Rectal Perforations Are Very Rare. The Morbidity And Mortality Is Very High In Rectal Perforation. Enema Should Never
Be Given In Case Of Impacted Stool. But Because Of Ignorance This Patient Applied Enema Herself. So, Simply Awareness
About Enema Indications And Contraindication Would Have Avoided This Problem And Unnecessary Mortality In A Young
Patient. A Little Knowledge Is A Dangerous Thing. So, Patient Education Should Be Done.
Case Report
A 23 Year Old Primigravida At 35 Weeks Gestation Presented With Pain Abdomen, Fever And Distension Of Abdomen.
Initially Patient Was Managed Conservatively At Peripheral Centre For Two Days And Then Reported To Our Hospital. An
Ultrasound Done Which Shows Collection Inside Peritoneal Cavity And Perforation Was Suspected. Decision Of
Laparotomy Was Done. First Caesarean Section Was Done And A Single Live Male Baby Born Weighing 2.4 Kg Born. Then
On Exploration A Small Perforation In Rectum Was Found And It Was Repaired By Surgeon. But They Found Two More
Perforations And Colostomy Was Done. On Taking Detailed History Patient Told That She-Herself Administered Enema
Because Of Constipation. In Post Op Period Patient Expired Because Of Septicemia And Ards.
Conclusion:
Rectal Perforation Leading To Death In A Young Patient Due To Self-Administered Enema Is Very Unfortunate. A Little
Ignorance Has Caused This Event. Once Peritonitis Develops Due To Rectal Perforation Death Is Inevitable. Then Proper
Referral In Time Should Be There. Patient Lost 2 Days In Delaying Treatment At Periphery And In Mean Time She
Developed Peritonitis And Which Caused Death In Patient. So In Acute Abdomen We Should Take A Detailed History
Which Can Help Us To Make Early Diagnosis And Timely Treatment.

***************

Thyrotoxicosis During Pregnancy-A Case Report

Author: Dr. Dhivya Sethuraman
Co Author: Dhivya S1, Noorjahan Sap2, Vanathi S3, Nirmala R4, Tamilselvi S5

Background
Hyperthyroidism Affects About 0.1-0.4% Of Pregnancies, And Thyrotoxicosis Can Occur As A Relapse Of Previously
Controlled Hyperthyroidism. GraveS Disease Is The Most Common Cause Of Hyperthyroidism In Pregnancy. Rates Of
Maternal And Perinatal Complications Are Directly Related To The Control Of Hyperthyroidism In The Mother.
Case
A 27 Yr Old G2P1L1, Previous Lscs, Known Hyperthyroid Patient On Treatment, Presented At 32 Weeks Of Gestation With
Thyrotoxicosis. She Had Stopped Anti-Thyroid Medication For Financial Reasons 10 Days Earlier. She Was Also Diagnosed
To Have Severe Pre-Eclampsia 5 Days Back..She Was Re-Started On Her Anti-Thyroid Medication And
AntiHypertensive Therapy Was Also Instituted. She Improved Symptomatically. However She Delivered A Stillborn At
34 Weeks By Repeat Lscs. Post Operative Period Was Uneventful. She Was On Anti-Hypertensives And Anti-Thyroid
Medications At Discharge And Continued On Regular Follow Up.
Conclusion
Pregnant Women With Hyperthyroidism Should Continue Their Anti-Thyroid Medication Diligently And Must Be
Monitored Frequently For Signs Of Fetal And Maternal Hyperthyroidism. Preconception Counseling, A Multidisciplinary
Approach To Care, And Patient Education Regarding Potential Maternal And Fetal Complications That Can Occur With
Different Approaches To Treatment Are Important.

***************

A Case Study Of Ttts

Author: Dr. Chithra A
Co Author: Professor Dr Vijaya1,

Background
Monochorionic Twins Have A Risk Of Developing Twin To Twin Transfusion Syndrome Between 10-15%.The Pathogenesis
Of Ttts Is Still Unknown And The Mortality Rate Reaches Upto 80-90%If Untreated. Ttts Is Characterised By The Presence
Of Multiple Placental Vascular Anastomosis. The Diagnosis Of Ttts Is Primarily By Usg Through Identification Of The
Peculiare Sign,No Intertwin Membrane, Same Sex, Polyhydromnios Of Recipient Twin, Oligohydramnios Of Donor Twin ,
Permanently Filled Bladder Of Recipient Twin,And Slightly Filled Or Empty Bladder Of Donor Twin.. The Severity Of The
Ttts Is Established By Quitero'S Staging.
Results
Ttts Is Treated By Several Options Like Fetoscopic Laser Coagulation Of Placental Vascular Anastomosis, Serial
Amniodrainage,Selective Feticide By Cord Coagulation, Septostomy,With Or Without Amniodrainage.
Case Discussion
We Present A Case Of Mrs X 26Yrs,Gravid-3 Para-1 Live -1,Abortion-1, Previous Lscs With Usg Finding Of Twin Gestation,
With Ttts, 26Weeks Of Gestation,Both In Breech Presentation, Came With C/O Draining Pervaginum ,Lower Abdominal
Pain For 3 Hours.
Twin A-Ga 25-26 Weeks, Efwt=951+_120Gms,With Ascites, Pleural Effusion,Pericardial Effusion, Scalp Edema,
Polyhydromnios, Full Bladder -Recipient Twin
Twin -B Ga 22 Weeks, Efwt 255+_41Gms Sga,Reduced Fetal Movements, Nil Liqour, Stuck Twin, Donor Twin.
In View Of Previous Lscs In Labour, With Scar Tenderness Emergency Lscs Was Done.The Usg Finding Were Confirmed
Conclusion
Timely Diagnosis Of Ttts Is Crucial Because, Delay In Diagnosis And Treatment Increase The Perinatal Mortality And
Morbidity. At The Moment The Best Treatment Seems To Be The Fetoscopic Laser Coagulation Of Placental Vessel
Anastomosis Which Showed Survival Rate Between 76 -88%.
Key Words
Twin To Twin Transfusion Syndrome, Ultrasonogram,Estimated Fetal Weight, Lower Segment Caesarean Section,
Intrauterine Growth Restrictions.
***************

An Unusual Presentation Of Carcinoma Cervix

Author: Dr. Pavani Jannu
Co Author: Dr Syammohan Rao1, Dr Manjula Devi2, Dr Aswini3,

Background : By Presenting This Case We Intend To Describe An Uncommon Complication Of Generalized Peritonitis
Following Spontaneous Pyometra Perforation In Undiagnosed Cervical Carcinoma

Case Report : This Case Report Describes A 70 Yr Old Postmenopausal Woman Presented With Clinical Features Mimicking
Intestinal Perforation And Was Later Diagnosed As Cervical Carcinoma With Pyometra Perforation At Exploratory
Laprotomy.The Patient Had Good Postoperative Recovery Following Drainage And Peritoneal Lavage And Was Treated
Later By Radiotherapy.
Conclusion: Spontaneous Pyometra Perforation In A Case Of Carcinoma Cervix Is A Rare Presentation, Yet It Should Be
Suspected And Kept As A Differential Diagnosis Of Acute Abdomen In Elderly Women
***************

Successful Management Of Cervical Ectopic Pregnancy

Author: Dr. Mrs Shweta
Co Author: Dr Sunita Samal1, Dr Porkoddi2, Dr Seetesh Ghosh3,

Background : Cervical Pregnancy Is A Rare, Life-Threatening Form Of Ectopic Pregnancy Occurring In Approximately
1:9,000 Pregnancies. As Majority Of Women With A Cervical Pregnancy Are Of Low Parity, The Current Treatment Trend
Is To Preserve Their Reproductive Function.
Case: Here We Report A Case Of Successful Management Of Cervical Ectopic Pregnancy In A Young Woman. A 29Yr Old,
G2P1L1 With Previous Caesarean Pregnancy Presented With Mild Bleeding Per Vagina For 5Days Following 7Wks Of
Amenorrhoea. Past Menstrual, Medical, Surgical And Family History Were Unremarkable Except The Previous Caesarean
Section. On Examination Vital Signs Were Normal But Pelvic Examination Revealed A Distended Cervix With Bulky Uterus,
No Adnexal Mass Or Tenderness And No Cervical Motion Tenderness. Further Transvaginal Sonography Showed A Live
Cervical Gestation Of 7+4Wks And Serum B-Hcg Value Of 1,03113Miu/Ml. Patient Received Conservative Treatment
With Combination Of Intraamniotic Potassium Chloride And Methotrexate And Suction Curettage.
Conclusion: With Conservative Approach, Emergency Hysterectomy And Blood Transfusion Could Be Avoided In A Case
Of Cervical Ectopic Pregnancy.

***************

Pericentric Inversion Of Chromosome 9 In Male Partner& Varied Fetal Outcome A Rare Case Report
Author: Dr. Sangeeta Kamra
Co Author: Dr Meena Jain1,

Background : Chromosomal Abnormalities Have Been Linked To Poor Obstetric Outcome, Be It Miscarriage Or Congenital
Malformations.These Abnormalities Can Be Numerical Or Structural. Inversion 9 Is Commonest Structural Abnormality.
It Is Thought To Be Normal Variant By Some Cytogeneticist Whereas Sporadic Case Reports Of Abnormal Outcome Have
Been Reported.
Case Report : A 30 Yr Old 2Nd Gravida With H/O 1St Trimester Spontaneous Abortion Was Referred At 32Wks For
Termination Of Pregnancy For Usg Diagnosed Multiple Congenital Malformations,Viz Cystic Adenomatoid Malformation
Of Lung ,Oesophageal Atresia,& Bilateral Hydronephrosis.H/O Severe Pedal Oedem Since 20 Wks & Severe
Polyhydramnios.Pregnancy Was Terminated Delivering A Phenotypically Normal Stillborn Female.
Patient Presented Again Next Year At 32 Wks For Termination For Multiple Congenital Anomalies Viz,Cleft Lip &
Palate,Diaphragmatic Hernia & Multiple Cysts In Lung. H/O Severe Pedal Oedema At 20 Wks & Severe Polyhydramnios .
Her Gtt & Triple Test In 2Nd Trimester Was Normal.Usg At 20 Wk Showed Single Umbilical Artery. Her Karyotype Was
Normal But Male Partner Showed 46 Xy,Inv (9);(P11;Q12). Pregnancy Terminated Delivering A Stillborn Male .Post
Mortem Showed Huge Hepatospleenomegaly, Dextrocardia With Other Malformations Noted In Usg.
In Her 4Th Pregnancy 14 Wks Amniocentesis Showed 46---Inv (9);(P11;Q12).There Was No Pedal Oedema ,No
Polyhydramnios Nor Any Anomaly On Usg , A Decision To Continue Pregnancy Under Close Supervision Was Taken After
Counseling. She Delivered Alive Female Weighing 2.7Kg Who Is 6 Years Old Now.
Conclusion : There Is Wide Spectrum Associated With Inversion Of Chromosome 9 From Normal Phenotype To Multiple
Congenital Anomalies. While Investigating A Case Of Boh ,Other Factors Are To Be Looked For . In Present Case After 3
Losses Due To Multiple Congenital Anomaly ,Patient Had A Phenotypically Normal Offspring Despite Having Inversion Of
Chromosome 9.Termination Of Pregnancy Should Not Be Advised Solely Based On Finding Inversion Of Chromosome 9
In Karyotype.

***************

Non Puerperal Uterine Inversion - A Diagnostic And Operative Challenge

Author: Dr. M Sirisha
Co Author:

Background : Non Puerperal Uterine Inversion Is A Rare Clinical Entity Encountered In A Gynaecologist'S Lifetime.It Usually
Results From A Tumor On The Fundus Of Uterus;Majority Of Them Being Submucous Leiomyomas.Chronic Uterine
Inversion May Become Infected And Necrotic.High Index Of Suspicion Is Required For The Diagnosis And Expertise In
Gynaecological Surgeries Is Required For Successful Outcome.
Case : A 50 Year Old Multiparous Woman Who Attained Menopause 1Year Ago Presented With A Gangrenous Mass
Protruding From Her Vagina.Combined Vaginal And Abdominal Approach Was Used For Confirmation Of Diagnosis And
Hysterectomy.We Would Like To Emphasise The Blood Loss Minimising Step Followed In Our Case.
Conclusion : Chronic Non Puerperal Uterine Inversion Is Uncommon And It Needs Clinical And Surgical Expertise For
Management.
***************

Ovarian Ectopic Pregnancy A Rare Case Report

Author: Dr. Sandhya Kotha
Co Author: Dr Ramadevi1,

Background :- Ovarian Ectopic Pregnancy Is A Rare Type Of Pregnancy. Incidence Less Than 3% Of All Ectopic Pregnancies.
Exact Etiology Is Difficult To Find. In Recent Years, The Incidence Is Increased Because Of The Assisted Reproductive
Techniques And Wide Use Of Intrauterine Contraceptive Use (Iud).

Case Report :- A 25 Yrs Old Nulliparous Women Presented With Pain In The Lower Abdomen And Faintness Since 2 Days.
She Was Admitted In Emergency Ward, Department Of Obstetrics & Gynaecology , Caims, Karimnagar, On 23Rd July2014. She Had No History Of Pelvic Inflammatory Disease, Abortions And Use Of Intrauterirne Devices. She Had, Surgical
History Of Appendectomy 4 Years Ago. On Examination, She Had Pulse Of 80 Per/Minute, Blood Pressure 120/80 Mm Hg
& Temperature Is Normal. Her General Condition Was Satisfactory. The Abdomen Was Extremely Tender In The Right
Illiac Fossa And Had Marked Rebound Tenderness.
Urine For Pregnancy Test Was Positive. -Hcg Was 8777 Iu/Ml. Tvs Shows A Right Ovarian Cyst And Evidence
Of A Right Adnexal Ring That Was Measuring About 18.5 X 15 Mm With A Live Fetal Pole Adjacent To Right Ovary And
Crown Rump Length (Crl) Measures 5 Mm Corresponds To 5-6 Weeks. The Patient Was Diagnosed As Right Ovarian
Ectopic Pregnancy.
On Laproscopy, There Was Bluish Unruptured Sac Seen In Right Ovary. A Transverse Incision Given Over Ovarian
Pregnancy. All The Products Were Removed, Flushed With Saline, Bleeders Were Cauterised, Preserving The Right Ovary.
On Hpe Confirmed Ovarian Ectopic Pregnancy.

Conclusion:
Future Fertility.

Nulliparous Patients With Ovarian Pregnancy, We Need Not Remove The Ovary In View Of Her

***************

Successful Pregnancy Outcome After HaultainS Repair For Uterine Inversion

Author: Dr. Gunjan Gulati
Co Author: Dr Banashree Das1, Dr Nikita Kumari2, Dr Kashika Gupta3, Dr Monika Rajput4, Dr Nilu Kumari5

Background : Uterine Inversion Is An Obstetric Emergency With An Incidence Ranging From 1:2500 To 1:20000 And If
Promptly Recognized, Manual Repositioning Of The Uterus May Be Successful. Conservative Surgical Management Is Ideal
In Chronic Cases, Especially If Woman Is Desirous Of Future Child Bearing. Records Of Fertility Following An Episode Of
Uterine Inversion Are Even Rarer, However The Literature Shows Possibility Of Uncomplicated Vaginal Delivery After A
Conservative Surgery.
Case Report: We Report A Case Of Successful Pregnancy Outcome In A Patient Who Underwent HaultainS Repair For
Subacute Uterine Inversion Following Delivery By Dai In The Previous Pregnancy. She Reported To Gynae Emergency Of
Safdarjung Hospital, New Delhi As P1L1 On Postnatal Day 3 With Subacute Uterine Inversion With Severe Anaemia Which
Was Managed Conservatively And Underwent HaultainS Repair After 3 Months. She Conceived Spontaneously Three
Years Later. Antenatal Period Was Uneventful. An Elective Caesarean Section Was Done At 34 Weeks After Steroid Cover
In View Of Upper Segment Uterine Scar And She Delivered A Healthy Male Baby Of 2Kgs.
Discussion: Very Few Cases With Successful Pregnancy Outcome And Delivery Have Been Reported In The Literature
After HaultainS Repair Being Watchful For Third Stage Complications Like Pph And Morbid Placental Adhesion
(Placenta Accreta). The Risk Of Recurrence Of Uterine Inversion In Future Pregnancies Managed In The Index Case By A
HaultainS Operation Does Not Seem To Be Increased, But The Uterus Should Be Considered As Scarred Organ In Case
Of Anterior Surgical Reduction Imparting The Risk Of Uterine Rupture In Subsequent Pregnancy.

***************

Backache In Pregnancy
Author: Dr. Anantha Lakshmi
Co Author:

Background :
Backache In Pregnancy Is A Common Physiological Condition Which Is Often Ignored By The Patient , Attenders And Even
To Some Extent By The Doctors In This Case. A Well Educated Female Presented With Backache After A Long Period Of
Suffering As She Was Considering It Normal For Pregnancy. But Was Diagnosed As Pott'S Spine After Investigations.

Case:
An 26 Year Old Indian Female Primigravida Presented With Backache In 24 Wks After Having Treated Herself For
Backache Since 1 Month .Initially Only Analgesics Were Prescribed But Later When She Presented With Tingling And
Numbness In The Great Toe Of Left Leg,She Was Completely Investigated And Was Diagnosed As Pott'S Spine In Mri.She
Was Put On Att Which Completely Releaved From Her Backache .Pregnancy Was Carried On Till 36 Wks When She Sets
In Labour And C -Section Done For Contracted Pelvis.

Conclusion:
This Case Illustrates The Potential Benefit Of Excluding Various Other Pathologies For Even Common Symptoms Of
Pregnancy.Early Institution Of Treatment Could Save Both Mother And Baby For Severe Morbidities By Anticipating And
Excluding The Pathologies.
***************

Pemphigoid Gestationis With Postpartum Flare - Up : A Case Report

Author: Dr. Vulese Sai Sharanya
Co Author: Dr.Shobha1, Dr.Ananthalakshmi2,

Background :
Pemphigoid Gestationis Also Known As Herpes Gestationis Is A Rare Auto Immune Disease With An Incidence Of 1 : 50000.
This Condition Typically Develops During The Second And Third Trimester Of Pregnancy. Mothers Immune System Starts
Reacting Against Her Own Skin Causing The Skin To Split And Form Blisters. Currently It Is Suggested That Some Of The
Placental Tissue Enters The Blood Stream And Cause Her Immune System To Activate And Attack The Skin. Symptoms
Generally Abate At The End Of Pregnancy But Rarely Dramatic Flares Can Occur At Or Immediately After Delivery.

Case :
A 25 Years G3P2L2 With Term Gestation With Known Case Of Hypothyroidism Since 4 Months On Treatment Presented
Initially With Papules On Abdomen,Chest And Lower Back Which Developed Into Intensly Pruiritic Erythematous Plaques.
After Few Hours Of Delivery She Presented With Vesicles And Blisters On Entire Abdomen , Hands, Forearms, Chest ,Back
And Thighs Sparing The Sole ,Hair, Scalp And The Mucosa. We Report A Well Documented Case Of Pemphigoid Gestationis
Which Flared Up In Post Partum Period , It'S Diagnostic Dilemmas And The Need For Early Diagnosis And Management
To Prevent The Complications.

Conclusion :
Pemphigoid Gestationis Is A Rare Auto Immune Pregnancy Specific Dermatosis Which Occasionally Flares In Post Partum
Period. The Sudden Emergence Of The Disease, Its Clinical Appearance And The Course Create Great Stress For Pregnant
Women And The Fetus. The Disease Has Been Associated With Premature Delivery And Small For Date Babies Also. Early
Diagnosis And Management May Help To Prevent These Complications.
***************

A Rare Case Of Foreign Body In Vagina Posing A Diagnostic And Therapeutic Challenge
Author: Dr. Sunanda N
Co Author: Dr Akhila1,

Background :Vaginal Discharge May Result From A Variety Of Causes. A Long Standing Intravaginal Foreign Body Can Pose
Both Diagnostic And Therapeutic Challenges In All Age Groups.
Case:We Report A 19 Year Old Presenting With History Of Foul Smelling White Discharge Per Vaginum Since 2 Months
Associated With Itching. She Was Subsequently Evaluated And Treated For Everything From Vaginitis To Septic Abortion
To Suspected Cervical Carcinoma. Patient Lost Follow Up For 4 Months And Was Referred Back To Us Now Revealing
History Of Having Inserted A Battery Shell Into Her Vagina As Part Of Foreplay. Copious, Purulent, Foul Smelling Discharge
Persisted. Plain X- Ray Pelvis Did Not Reveal Any Abnormality. Ultrasonography Showed Hyperechoic Soft Tissue Mass In
The Cervix -? Cervical Polyp. Ct Scan Was Done Which Showed A Tubular Foreign Body Measuring 34*24 Mm Noted In
The Upper Vagina And Lower Uterine Segment With Pockets Of Air Within And Outside The Foreign Body- Infected
Foreign Body. After Treating Her With Antibiotics, Patient Was Posted For Laparohysteroscopy. On Laparoscopy, Uterus
And Adenexa Were Normal. Hysteroscopy Revealed A Foreign Body, But The Exact Location Could Not Be Ascertained
Due To Excessive Granulation Tissue. Finally, Laparotomy Was Done. Posterior Vaginal Wall Was Opened By A Transverse
Nick Over The Vault. The Foreign Body, A Plastic Tube Of 3*3 Cm Was Removed And Vaginal Vault Closed With
Continuous Sutures. Post Operative Period Was Uneventful.

Conclusion:
Vaginal Foreign Body Should Be Considered In Any Young Female Patient Presenting With Recurrent Or Persistent Vaginal
Discharge. Detailed History And Clinical Examination Are Central To Diagnosis Although Imaging Modalities May Be
Required In Misplaced Objects.This
Article Highlights The Importance Of Early Diagnosis And Proper Management In Preventing Morbidity And Mortality
Resulting From Complications.

Keywords: Battery Shell. Vaginal Foreign Body,

***************

A Case Report Of Red Degeneration Of Fibroid Uterus In A Perimenopausal Woman

Author: Dr. Shyamala Kaitala
Co Author: Dr. G. Ratna Md,Dgo1, Dr V Indira Kumari Md, Dgo2,

Background :-We Report A Case Of Red Degeneration Of Fibroid Uterus In A Perimenopausal Woman. Carneous Or Red
Degeneration Of Fibroid Is Seen Mostly During Pregnancy Although It May Present In Women Over 40 Yrs As Painful
Myomas. The D/D Include Mainly Degeneration, Torsion Of Subserous Pedunculated Fibroid, Extrusion Of Polyp,
Infection Etc Or With Associated Pathology Endometriosis Or Pid. We Document Gross Appearance Of Specimen After
Tah And Confirmed By Biopsy Report.
Case :- A P2L2 Woman Aged 48 Yrs Reported To Op With C/O Severe Dysmenorrhea For Long Duration During Her Regular
Menstrual Cycle. Patient Was Admitted And Put On Analgesics And Antibiotics And Investigated. She Was Diagnosed Of
Having Fibroid Uterus. She Also Developed Fever In Ip Stay. Pain Subsided Following Analgesic Treatment. She Was Posted
For Tah In View Of Symptomatic Fibroid Of 14 Wks Size. Surgery Was Uneventful. There Was Haemorrhagic Fluid Of 5075Ml On Opening The Peritoneum. The Cut Section Revealed Uterus Enlarged To 12-14 Wks With Anterior Wall Fibroid
Which Was Beefy Red In Colour , Soft In Consistency. The Diagnosis Was Confirmed By Hpe Report.
Conclusion :- This Is A Case Report Of Carneous Degeneration Of Fibroid In Perimenopausal Age Group Woman.
Degeneration Is One Of The Cause Of Painful Myomas . Red Degeneration Is More Common During Pregnancy. Red
Degeneration Is Rare Presentation As Complication Of Fibroid In Perimenopausal Women. U/S Did Not Aid In Diagnosis
Due To Low Resolution In Our Hospital, Confirmed By Hpe Report.

***************

Uterine Artery Embolisation And Systemic Methotrexate Therapy In Cervical Pregnancy

Author: Dr. Indu Mathi
Co Author: Dr. Vasantha Lakshmi1,

Background- Cervical Pregnancy Is A Rare Form Of Ectopic Pregnancy Which Implants In The Lining Of The Endo-Cervical
Canal. Incidence Is Less Than 0.1 % Of All Ectopic Pregnancy. It Is Hazardous Because The Trophoblast Can Penetrate
Through Cervical Wall And Into The Uterine Blood Supply Causing Risk Of Profuse Haemorrhage, Often Requiring
Hysterectomy. We Describe A Case Of Cervical Pregnancy Successfully Managed With Bilateral Uterine Artery
Embolization And Systemic Methotrexate Therapy.

Case Report- 33 Year Old Woman Presented At 7 Weeks Gestation With Complaints Of Painless Vaginal Bleeding For 1
Week. Her Obstetric History Revealed 6 Previous First Trimester Abortions Which Had Necessitated Dilatation And
Curettage And Had 1 Caesarean Section At Term.
Scan Done Shows A Viable Ectopic Cervical Pregnancy With Fetal Pole Of Size 7.4 Mm And Colour Doppler Shows
Vascularity In The Periphery Of The Sac.
Day 0 Beta Hcg Value Was 1,00,123.6 Miu/Ml, Planned For Multiple Doses Of Methotrexate And Bilateral Uterine
Embolization. Methotrexate Was Given For 2 Days And Bilateral Uterine Artery Embolization Was Done. 48 Hours Later
Beta Hcg Value Decreased To 31,762 Miu/Ml. Our Patient Made A Complete Recovery. Patient Discharged On 9Th Day.
No Side Effects Were Noted. Post Procedure Beta Hcg Value Was Declining. Patient Is Doing Well On Follow Up.

Conclusion- Our Case Illustrates That Conservative Management Of Cervical Pregnancy With Systemic Methotrexate And
Bilateral Uterine Artery Embolization May Avoid Major Surgical Procedure Like Hysterectomy.

***************

Clear Cell Carcinoma In Caesarean Scar Endometriosis

Author: Dr. Dasari Vasantha
Co Author: Dr. Vishnu Vandana1,

Background
Endometriosis Is Defined As The Presence Of Endometrial Glands And Stroma Outside The Uterine Cavity. Scar
Endometriosis Is A Well Established Entity Which Occurs Usually As A Result Of Previous Caesarean Section Or Abdominal
Hysterectomy. Scar Endometriosis As Well As Other Endometriosis At Extragonadal Sited Can Undergo Malignant
Transformation.
Case
A 43-Year-Old Lady Presented With A Foul Smelling Bosselated Suprapubic Mass 12X12Cm Over The Caesarean Section
Scar. Fnac Showed Endometriosis And Scanty Cellularity With Atypical Cytology. Usg Suprapubic Region Showed
Multicystic Lesion ? Scar Endometriosis. Ct Is Reported As Multiloculated Lesion Involving Midline Anterior Abdominal
Wall. F/S Of Scar Endometriosis. She Underwent Surgery. Histopathological Examination Revealed Malignant Neoplasm,
Suggestive Of Clear Cell Carcinoma. Adjuvant Chemotherapy Was Recommended, But Follow Up With The Patient Was
Lost.
Conclusion
As Malignant Transformation Of Endometriosis At Extragonadal Sites Is Very Rare, It Is Difficult To Establish A
Treatment Protocol. Main Line Of Treatment Is Surgery, Removing The Mass With Tumour Free Margins Followed By
Chemotherapy And Radiotherapy. Prognosis Is Variable From 10 To 100% Five-Year Survival, Depending On Histological
Type And Extent Of The Disease.

***************

Heterotopic Pregnancy - A Catastrophic Obstetric Emergency

Author: Dr. Sai Cherukuri
Co Author: Dr.Kavitha1, Dr.T.Usha Rani2,

Background
A Heterotopic Pregnancy Is Defined As Presence Of Combined Intrauterine And Ectopic Pregnancy. Heterotopic
Pregnancies Are Diagnostic And Therapeutic Challenges For Obstetricians. Clomiphene Citrate And Other Drugs Are Used
Liberally By Practioners For Induction Of Ovulation In Infertile Women. Heterotopic Pregnancy Should Be Suspected In
Any Patient Who Presents With Lower Abdominal Pain In Early Pregnancy Following Fertility Treatment. Interesting Thing
In Our Cases Is Continuation Of Intrauterine Pregnancies Even After Catastrophic Rupture Of Ectopic Pregnancies.
Case Reports
We Received 3Cases Of Heterotopic Pregnancy In The Past One Year. In First Case, Bicornuate Uterus With Live Pregnancy
In One Horn And Ruptured Tubal Pregnancy With Hemoperitoneum, Salpingectomy Was Done And Uterine Pregnancy
Continued Till Term And Delivered A Normal Healthy Baby. Second Case Was Triplet Intrauterine And Ruptured Tubal
Pregnancy, For Which Salpingectomy Was Done. Two Gestational Sacs Vanished And Other Intrauterine Pregnancy
Continued Upto 26Wks Of Gestation, When Iud Occurred, Pregnancy Was Terminated. Third Case Was Intra Uterine
Pregnancy And Ruptured Tubal Pregnancy With Hemoperitoneum, Salpingectomy Was Done And Intrauterine Pregnancy
Is Still Continuing.
Conclusion
Heterotopic Pregnancy Must Always Be Considered In Patients Who Present With Lower Abdominal Pain In Early
Pregnancy. High Degree Of Suspicion Is Required Following Infertility Treatment.

***************

Uterine Leiomyosarcoma In A Postmenopausal Woman

- A Case Report
Author: Dr. Geetha Kumararaj
Co Author: Dr Kalaichelvi Md Dgo Dip. Nb. Fics1,

Background

Leiomyosarcoma Is The Most Common Type Of Uterine Sarcoma (22.5-44%). Sarcomatous Change In
Leiomyoma Is Reported As 0.13% - 0.8%. It Is An Aggressive Tumour
With 5 Yr Survival Rate From 18.8 - 68%.

Case Report

60 Yr Old Postmenopausal Lady Presented With Abdominal Mass & Pain Of 10-15 Days Duration. Loss Of Weight
& Appetite For Past 6 Months. She Attained Menopause 15 Yrs Back.
O/E Pallor Present. P/A- Irregular Firm Mass 25 X 20 Cm Felt Occupying Umbilicus, Right Hypogastrium, Iliac &
Lumbar Quadrants And Tenderness Felt Over The Mass. No Ascites
P/V- Uterus Enlarged Up To 4Cm Above The Umbilicus More Towards Right Side, Right Fornix Fullness Present And Left
Fornix Free. P/R Same Mass Felt.
She Received 2 Units Of Blood Transfusion Preoperatively.
Ca 125- 34.6 U/ Ml.Usg Showed Large Abdominopelvic Mass Size 25 X 20 Cm Uterus Not Imaged Separately. Ovaries Not
Visualized.
Ct Abdomen & Pelvis- A Large Subserosal Fibroid With Multiple Discrete & Conglomerate Calcific Foci. No Ascites Or
Lymphadenopathy . Both Ovaries Atrophic.
Laparotomy Findings- Uterus Enlarged 28 X 20Cm Size With Soft, Cystic & Hard Areas. Serosa At The Fundus Was
Ruptured& Adherent To The Adjacent Bowel. No Ascites Or Peritoneal Deposits.
Tah With Bso Done & Adhesions Released.
Postoperative Period Uneventful.
Peritoneal Fluid Cytology Positive For Malignant Cells. Histopathological Examination Revealed Leiomyomasarcoma Of
The Uterus. Patient Referred To Medical Oncology Department For Further Management.

Conclusion

Evidence Is Lacking For Use Of Preoperative Imaging For Staging Purpose & Uterine Sarcomas Remain To Be Surgically
Staged. Total Hysterectomy Is The Cornerstone For Both Staging & Treatment. Routine Bso & Lymphadenectomy Do Not
Have Significant Prognostic & Therapeutic Value. The Other Treatment Modalities Include Radiotherapy, Chemotherapy
& Hormone Therapy.

***************

Benign Teratoma Of Ovary Infiltrating Into The Bladder, Presenting With Pilimiction A Rare Case
Author: Dr. Anuradha Prasannan
Co Author: Rema V Nair1, Usha Sadasivan2, Sreelakshmi Ajay3,

Background

Mature Ovarian Dermoids Are Common Lesions; Accounting For Up To 1025% Of All Ovarian Neoplasms.
Uncomplicated Dermoid Cysts Are Often Asymptomatic And Are Relatively Easy To Diagnose On Imaging And To Treat.
Symptoms Develop Once Complications Set In And These
May Cause Diagnostic Dilemmas. Torsion (16%) Is The Most Common Complication, While Rupture, Suppuration And
Malignant Transformation Are Relatively Uncommon. Of All These Complications, Spontaneous Rupture Into The Urinary
Bladder Is Least Common. The Diagnosis Of This Rare Condition Has Been Through The Use Of Cystoscopy Or Laparotomy
In All Cases Reported So Far.

Case

A 40-Year-Old Patient Presented With Complaints Of Hematuria, Dysuria And Passing Of Hair In Urine. Ultrasound
Examination Showed A Large Vesical Calculus And A Left Adnexal Mass. Further Evaluation Of The Calculus By Cystoscopy
Revealed An Area Of Linear Calcification In The Bladder Wall With An Area Showing Tufts Of Hair In The Posterior Wall.
Ct Abdomen Also Confirmed An Adnexal Mass And An Area Of Linear Calcification In The Bladder. Peroperatively The Left
Ovarian Tumour Was Found Invading The Posterior Wall Of The Bladder. Hysterectomy Was Done And Tumour Was
Removed By Excising Part Of The Posterior Wall Of The Bladder. Histoplathological Examination Reported It To Be Beningn
Cystic Teratoma Of The Left Ovary.

Conclusion

This Very Rare Presentation Of Benign Teratoma Of The Ovary With Bladder Invasion Is A Diagnostic Challenge
For Both The Clinician As Well As Radiologist. An Ovarian Tumour Invading The Bladder Need Not Be Malignant In All
Cases. An Extensive Review Of Literature Showed Very Few Cases Of Bladder Involvement In Ovarian Dermoids, Among
Which Full Thickness Perforation Of Bladder In Benign Teratomas Of Ovary Are Extremely Rare.

***************

A Case Of Torsion Of An Abdominal Mass Presenting With A Gynaecological Twist

Author: Dr. Rajesh Panicker
Co Author: Dr Rajesh Panicker1, Dr Ambika Bai2, Dr G Rajalakshmi3, Dr Chaithra C4, Dr S Shanthi5

Background

The Old Adage That The Abdomen Is A Pandorra'S Box Remains True Even Today, Though We Have Better And More
Informative Investigations Than We Had In The Past. Our Presentation Comprises Of A Case That We Were Asked To
Manage Where The Diagnosis Was Thought To Be Torsion Of An Ovarian Tumor.

Case

A 62 Yr Old Lady Presented To The Casualty With Acute Pain Abdomen.Patient Had A Large 36 Weeks Sized Abdominal
Mass Which Appeared To Arise From The Pelvis. Usg Findings Were Suggestive Of A Solid Ovarian Tumor That Had
Undergone Torsion. At Laparotomy She Was Found To Have A Large Gangrenous Solid Tumor That Had Undergone One
And A Half Twist Torsion And Was Ariding Fron The Sigmoid Mesocolon. The Mass Was Isolated And Excised And The
Histopathology Showed A Schwannoma.

Conclusion:

We Are Presenting This Case To Highlight The Fact That The Abdomen Is Still A Mystery Inspite Of The Advent Of Newer
And Better Imaging Modalities.
Moreover All Masses Which Appear To Arise From The Pelvis Need Not Be Gynaecological Masses
***************

An Innovative Approach To Control Hemorrhage In A Rare Form Of Ectopic (Cervical) Pregnancy ---'Condom-Foley
Catheter' Tamponade
Author: Dr. Reetu Hooda
Co Author: Dr Anjali Gupta1, Dr Smiti Nanda2,

Background
A Cervical Pregnancy Is An Extremely Rare Form Of Ectopic Pregnancy. Awareness Of It'S Emergency Management Is
Extremely Important In View Of The Associated Life Threatening Hemorrhage And Threat To Fertility.

Case
A 29-Year-Old G2P0A1 Was Referred To Our Obstetric Casualty Due To Uncontrolled Hemorrhage After An Attempted
Evacuation Of A 9-Week Cervical Pregnancy Which Was Misdiagnosed As An 'Intrauterine' Missed Abortion. She Was
Pale, Tachycardic Though Normotensive On Arrival. An Urgent Ultrasound Revealed A Dilated, Blood-Clot Filled Cervix
And A Normal Uterus. As Continuous Blood Trickled From Vagina Despite An Already Placed 'Intrauterine Pack' , An
Emergency Exploration In O.T. With 4 Units Cross-Matched Blood Was Undertaken. Hemorrhage From A Cervical
Pregnancy Was Revealed With Approx. 400C.C. Blood Clots Occupying The Ballooned-Up Cervix. Pack Removal And
Evacuation Of Blood Clots Was Followed By A 'Condom-Foley Catheter' Tamponade. This Modification Of Using A Condom
Fitted Over A Foley Catheter C.F. Foley Catheter Alone (Used In Previous Studies) Was Done Anticipating Greater Volume
Of Saline Needed For Tamponade And To Control Hemorrhage From The Grossly Dilated Cervix. Bleeding Stopped When
350C.C. Saline Was Instilled. A Tight Vaginal Pack Was Placed To Prevent Displacement. The Tamponade And Pack Were
Removed After 36Hours.Postoperative Period Was Uneventful. A Review Ultrasound Revealed Few Retained Products In
Cervix For Which Injection Methotrexate 50Mg/M2 Was Give Intramuscularly. She Was Discharged And Followed Up
With Serial B-Hcg And Ultrasonography. Complete Radiological Resolution Occurred In 2 Months.

Conclusion
A 'Condom-Foley Catheter' Tamponade Is An Effective, Easily Available And Conveniently Administered Conservative
Intervention For Managing Hemorrhage From A Cervical Pregnancy Especially In An Emergency Setting.
***************

Choriocarcinoma In A 45 Year Old Woman: A Case Report

Author: Dr. Sanjeev Behera
Co Author:

BackgroundChoriocarcinoma Is A Rare Malignant Tumor Of Trophoblastic Origin. Approximately One Half Of Cases Occur Following
A Hydatidaform Mole And The Remainder After Other Pregnancies, Including Normal Ones. Most Cases Present Within
One Year Of The Antecedent Pregnancy. Rarely, It Can Develop From Germ Cells Or From Dedifferentiation Of
Endometrial Carcinoma Into Choricarcinoma.. This Is A Case Of Choriocarcinoma With Vaginal Metastasis Developing
7Years After The Last Pregnancy.
CaseA 45 Year Old Multipara Hindu Female Came With Complaints Of Irregular Bleeding Per Vaginum Since 8 Months And
Lower Abdominal Pain Since 3Months And Excessive Bleeding Per Vaginum Since 8 Days. She Had An Irregular Purplish
Nodule Below The Urethral Orifice Which Bleeds On Touch. Her Usg Showed Mixed Echogenic Tissue With Cystic Areas
In The Cavity Of The Uterus. -Hcg Was Found To Be Raised. She Was Diagnosed As A Case Of Choriocarcinoma Of Uterus
With Figo Anatomic Stage Ii And Categorised In High Risk Group As Per Modified Who Criteria.
The Patient Was Decided To Undergo Multidrug Chemotherapy But Because Of Life Threatening Bleeding Per Vaginum
Total Abdominal Hysterectomy Was Done Along With Excision Of The Nodule. Histopathology Confirmed The Diagnosis
Of Choriocarcinoma. Chemotherapy As Per Ema-Co Regimen Was Given And Her -Hcg Levels Gradually Became Less
After Receiving 2 Cycles.
She Was Discharged Asymptomatic With Advice To Continue Chemotherapy And Regular Follow Up.
ConclusionChoriocarcinoma Can Present As Soon As 4Weeks After Antecedent Pregnancy And Latency Has Been Reported Upto 22
Years And Even After Menopause. Although It Can Be Treated Well With Chemotherapy, Hysterectomy Is Indicated In
Cases With Intractable Life Threatening Haemorrhage As Was In This Case. Survival Rate Can Be Improved By Both Early
Detection And Prompt Initiation Of Therapy.

***************

Case Report On Tubal Torsion

Author: Dr. Nithya Ramachandran
Co Author: Dr.Meenakshi Sundaram1,

Background
Isolated Fallopian Tube Torsion Is An Infrequent,Yet A Significant Cause Of Lower Abdominal Pain In Women,Which
Generally Presents In The Reproductive Age Group.Incidence Is 1 In 1.5 Million Women,Generally Unilateral,More On
The Right Side.It Should Be Considered As A Differential Diagnosis For Acute Abdominal Pain.Diagnosis Is Often
Established Intraoperatively.
Case
A 45 Year Old Multiparous Lady Presents To The Emergency With Acute Lower Abdominal Pain For A Day. Pain Was
Associated With Multiple Episodes Of Vomiting.She Was Clinically Stable And There Was Lower Abdominal
Tenderness.Ultrasound Was Suggestive Of Right Ovarian Torsion.With The Diagnosis Of Ovarian Torsion She Was Taken
Up For Surgery.On Laparoscopy,Left Sided Tube Was Found To Be Enlarged And Twisted Thrice And Looked Gangrenous.
Bilateral Salpingectomy Was Performed.
Conclusion
Torsion Of Fallopian Tube Is Extremely Rare, But Tubal Torsion Needs To Be Considered As A Differential Diagnosis In
Young Women. Early Surgical Intervention Is Recommended In Order To Salvage The Affected Tube And Preserve Fertility.

***************

A Rare Case Of Acute Of Cauda Equina Syndrome Due To Lumbar Disc Prosapse During Pregnency.
Author: Dr. Akila Vaidyanathan
Co Author: Dr.N.Gayathri1, Dr.S.Chitra2, Dr.Ramakrishna Easwaran 3,

Background
Low Back Pain Is A Common Complication Of Pregnancy That Has Been Reported In As Many As 56% Of Women During
Gestation. Symptomatic Lumbar Disc Herniation Is Rare, Occurring Approximately One In 10,000 Pregnancies And Fewer
Than 2% Of Patients Undergoing Surgery For Lumbar Disc Prolapsed Have Cauda Equina Syndrome Which Is Characterized
By Radiating Pain, Sensory Motor Defects And Sphincter Involvement.
Case
A 24 Year Old Primi Gravida With 30 Weeks Gestation Complained Low Back Pain Which Was Radiating From Left Buttock
To Thigh. She Could Not Void Urine And Had Constipation For Past Ten Days. She Was Referred For Neurological Workup.
Mri Revealed Large Central Prolapse Of L4- L5 Disc Causing Severe Thecal Sac Compression Causing Cauda Equina
Syndrome. Under General Anaesthesia And Continuous Fetal Heart Monitoring, Patient Was Placed In Prone Position
Over Raised Bolsters To Allow Space For Abdomen To Hang Free. She Underwent L4 L5 Fenestration And Micro
Lumbar Dissectomy. Post Operative Recovery Was Normal. She Had Good Relief Of Radicular Pain, Voided Urine Well
And Walked Without Support Before Discharge. Patient Delivered At 38 Weeks By Elective Ceasarean Section Under
General Anaesthesia.
Conclusion/ Clinical Relevance
Despite Low Back Pain Being Common During Pregnancy, Cauda Equina Syndrome Is Very Rare During Pregnancy. Cauda
Equina Syndrome Is A Surgical Emergency. Pregnancy At Any Stage Is Not Considered A Contraindication To Surgical
Intervention. Misdiagnosis And Delay In Treatment Can Cause Neurological Deficits Which Can Be Prevented By High
Index Of Suspicion And Prompt Neurological Workup And Referral.

***************

Interesting Case Of Primary Amenorrhea

Author: Dr. Poovizhi Kalliappan
Co Author: Dr.Poovizhi.K1, Prof.V.Kalaivani M.D.,Dgo2, Prof. Meena M.D3,

Background
Mayer-Rokitansky-Kuster-Hauser Syndrome Is An Rare Condition, With An Incidence Of One In 40005000 Female
Births And Is The Second Most Frequent Cause Of Primary Amenorrhea After Gonadal Dysgenesis. This Disorder Is A
Form Of MLlerian Agenesis Characterized By Vaginal Atresia, And Uterine/Tubal Abnormalities. The Patients Present
Karyotype 46,Xx And Normal Secondary Sexual Characteristics, As The Ovaries Are Present And Functional, But
Menstruation Is Absent.
Case Report
29 Year Old Female Presented With Primary Amenorrhea With No Other Clinical Disorder. On Clinical Examination Her
Secondary Sexual Characteristics Are Compatible With Her Chronological Age. At Gynaecological Examination Vagina Felt
As Dimple And Urethral Orifice Was Present. Trans Abdominal Ultrasonography Showed Absent Uterus With Normal
Ovaries. At Magnetic Resonance Imaging, The Uterus Could Not Be Visualized And Multiple Peripherally Placed Sub
Centimeter Follicle Present In Both Ovaries And Also, The Vaginal Canal Could Not Be Visualized. Diagnostic Laparoscopy
Showed Absent Uterus With Presence Of Right And Left Ovaries With Fallopian Tubes. Genetic Evaluation Revealed
Karyotype 46,Xx, Thus Determining The Diagnosis Of Mayer-Rokitansky-Kuster-Hauser Syndrome. The Patient Was
Submitted To Surgical Correction Of The Vagina.
Conclusion
Mayer-Rokitansky-Kuster-Hauser Syndrome Is A Congenital Abnormality Characterized By Absent Vagina With Variable
Abnormality Of Uterus And Urinary Tract But Functional Ovaries. Because Of The Typical Anatomic Alterations, This
Syndrome Generates Anxiety And Psychological Distress With Consequences On The PatientS Quality Of Life, Thus
Requiring A Multidisciplinary Approach In The Form Of Surgical Creation Of A Neovagina, Assisted Reproduction
Techniques And Psychological Support.

***************

Mixed Connective Tissue Disorder Presenting As Eclampsia In A Primigravida: Case Report

Author: Dr. Ankita Singh
Co Author:

BackgroundMixed Connective Tissue Disorder(Mctd) Was First Described As An Overlap Syndrome With Features Of Sle, Systemic
Sclerosis, Polymyositis And Rheumatoid Arthritis In Patients Who Had Antibodies To Extractable Nuclear Antigen And
Ribonucleoprotein(Rnp) Specificity. It Is Predominantly A Disease Of Females And Many Times Diagnosed For The First
Time During Pregnancy. The Incidence Of Mctd With Pregnancy Is 1 In 22,000 Pregnancies. Studies Describe Foetal
Wastage And 40%Prevalence Of Flares During Pregnancy.

CaseA 23 Year Old Primigravida Developed Bleeding Gums And Petechaei At 8Weeks Of Gestational Age With
Thrombocytopenia. Few Weeks Later She Had Synovitis And RaynaudS Phenomenon With Puffy Fingers.Ana
Screening Showed Her To Be Ana Positive With Coarse Speckled Pattern. She Was Strongly Positive For U1Rnp And Ro52.Hence She Was Diagnosed As A Case Of Mctd And Was On Regular Steroids Since Then.
At 30 Weeks Of Gestational Age Patient Got Admitted With Eclampsia And Had Ecchymotic Patches Over Left Arm And
Left Leg And Purpuric Spots All Over Body. Her Investigations Showed Anaemia With Thrombocytopenia, Elevated Esr
And Proteinurea.Usg Showed A Single Live Foetus Of Wt.1.5Kg.She Was Transfused Packed Red Blood Cells And Platelets.
After Giving Injection Magnesium Sulphate And Antihypertensives She Was Induced With Prostaglandins. She Delivered
Vaginally A Preterm Live Female Child Of Weight 1.5Kg.
After Delivery Her Blood Pressure Remained Under Control And She Was Discharged On Fifth Post Natal Day.
ConclusionThe Mechanism For Pregnancy Complications In A Case Of Mctd Is An Autoimmune Reaction Against Placental Tissue
Which Include Pre-Eclampsia, Preterm Labour, Foetal Growth Restriction, Eclampsia, Thrombocytopenia And Even
Maternal Death. With Early Diagnosis And Adequate Treatment With Steroids The Condition Cannot Be Cured But The
Patient Can Go Through A Pregnancy With Minimal Complications.

***************

Second Trimester Death Of Single Fetus In Twin Pregnancy Follow Up And Successful Outcome
Author: Dr. Aishwarya Yerram
Co Author: Dr. Yasmin Iqbal1, Dr. Suryakantam2,

Background
Multifetal Gestations Are High-Risk Pregnancies. The Death Of A Single Twin In The Second And Third Trimesters Is
Associated With Significant Morbidity And Mortality In The Co-Twin. We Report A Case Of Dichorionic Diamniotic
Pregnancy With Intrauterine Demise Of One Twin At Around 18 Weeks Of Gestation And Gestational Hypertension, In
Which There Was Successful Outcome In The Co-Twin.

Case
A 25 Year Old Primigravida Came With Two Months Amenorrhea. Urine Pregnancy Test Was Positive. The Viability Scan
Showed A Diamniotic Dichorionic Twin Pregnancy. Follow Up Scan At 15 Weeks Was Normal. Tiffa Scan At 22 Weeks
Revealed A Live Fetus With Normal Growth, And The Other Fetus Showed Intrauterine Demise With Parameters
Corresponding To 18 Weeks. The Mother Was Followed Up With Growth Scans And Coagulation Profile Weekly (Pt, Aptt,
Serum Fibrinogen And Platelet Count) And Weekly Doppler Study Was Done From 28 Weeks Onwards. The Fetus Showed
Normal Interval Growth. The Dead Fetus Showed Absence Of Liquor And Shrivelled Placenta. The Mother Developed
Gestational Hypertension With No Proteinuria Which Was Controlled On Alpha-Dopa 250Mg Thrice Daily. Betamethasone
Was Given And Planned Elective Caesarian Was Done At 34 Weeks. A Live Active Baby Of 1.87 Kgs Was Delivered.
Neurosonogram At The Time Of Discharge Was Normal. The Dead Twin Had No Obvious Anomaly And Weighed 150
Grams.

Conclusion
Incidence Of Death Of One Of Foetuses Of Twin Gestation, In-Utero Is 2.7% In Second Trimester And 6.7% In Third
Trimester. It Is Not An Indication For Termination. The Pregnancy Should Be Continued With Close Monitoring. In The
Absence Of Any Other Indication, It Should Be Terminated Around 34Th Week Of Pregnancy.
***************

Analysis Of 14 Cases Of Placenta Accreta In 18 Months In A Tertiary Care Centre

Author: Dr. Vidhyalakshmi Ramadoss Kabilan
Co Author: Dr. Sareena Gilvaz1, Dr. Sheethal Joseph2,

Background
Placenta Accreta Is A Potentially Life-Threatening Condition That Requires A Multidisciplinary Approach In Its
Management. It Occurs When Placental Trophoblasts Invade Into The Uterine Myometrium. The Incidence Has Increased
And Seems To Parallel The Increasing Caesarean Delivery Rate. Other Risk Factors Include Placenta Previa, Previous
Endometritis, Prior Uterine Surgery Etc. Diagnosing It Before Delivery Allows Good Planning In An Attempt To Minimize
Potential Maternal Morbidity And Mortality. Although Usg Is Specific And Sensitive Enough To Diagnose, Mri Is A Useful
Adjunct In Most Cases. The Recommended Management Is A Planned Preterm Classical Caesarean Hysterectomy. During
Surgery, It Is Useful To Leave The Placental Site Undisturbed To Reduce The Blood Loss. It Should Be Done In A Tertiary
Care Centre With Facilities For Blood Transfusion, Senior Obstetrician And Anaesthetist And With Multidisciplinary Help.
Cases
To Identify The Maternal Morbidities Associated With Placenta Accreta, A Series Of 14 Cases, That We Managed In A Span
Of 18 Months Are Taken. The Cases Are Analyzed In Terms Of Predisposing Contributory Factors, Diagnosing Modality,
Management And Associated Morbidity.
Conclusion
Placenta Accreta Is Associated With Increased Maternal Morbidity Some Of Which Are Life Threatening. We Found That
Prenatal Diagnosis With Adequate Planning, Particularly In High Risk Population And Multidisciplinary Surgical Approach
Helps In Reducing Such Adverse Maternal Outcomes.

***************

Twin Reversed Arterial Perfusion(Trap) Sequence- A Rare Case Report

Author: Dr. Ambika K
Co Author: Subha Periyasamy1, Vijaya.S2,

Background
Twin Reversed Arterial Perfusion (Trap) Sequence Is A Rare Malformation (1:35,000 Live Births) That Occurs In
Monochorionic Twin Pregnancies, Resulting In Coexistence Of A Normal pump Twin And An Acardiac Twin. The
Acardiac Twin Is Dependent Upon The Normal Twin For Circulation By Means Of Vascular Anastomosis. Arterial System
Of Acardiac Twin Is Perfused In Reverse With Deoxygenated Blood From Pump Twin. Many Of The Bizarre Defects Like
Absence Of Cranial Vault And Facial Structures, Holoprosencephaly, Amelia, Diaphragmatic Defects, Ventral Vault
Defects, Absence Of Heart&Lungs, Single Umbilical Artery Are Felt To Be Caused By Low Oxygen Tension And This Causes
Dramatic Alteration In The Twin Fetal Physiology And High Perinatal Mortality. The Acardiac Twin Is A Parasite, Putting
The Pump Fetus At Risk Of High Output Cardiac Failure. Overall Only 50% Of Pump Twins Survive.
Case
In Our Case In A Twenty Three Years Old Female, Gravida Two, Para One, Living One, Full Term Normal Delivery Admitted
With H/O 7 Months Amenorrhea And Labour Pain, Ultrasound Showed Monochorionic Diamniotic Twin Pregnancy With
Features Suggestive Of Trap Syndrome And Discordant Growth . Following Delivery, The Pump Twin Survived Only For
Two Days And The Acardiac Twin Was Stillborn With Features Of Trap Sequence.
Conclusion
The Obstetrician And Radiologist Should Be Aware Of This Anomaly Especially In Twin/Multiple Pregnancies So That
Timely Proper Measures Can Be Taken To Survive The Pump Twin.

Key Words:
Acardiac Twin, Fetal Anomaly, Twin Reversed Arterial Perfusion Syndrome.

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Spontaneous Uterine Rupture In First Trimester Pregnancy In Young Woman With Uterine Anomaly : Case Report.
Author: Dr. Amruta Ladke
Co Author: Dr. Nirlep Kaur1, Dr. Neena Singla2, Dr. Ritu Bassi3, Dr.Juhi Arora4,

BackgroundUterine Rupture Is A Rare, Life Threatening Event In Obstetrics. It Is Usually Associated With Prior Uterine Surgery,
Trauma, Abnormal Placentation, Or Induction Of Labor. Spontaneous Uterine Rupture In Early Pregnancy Is Very Rare
Complication And It Occurs Usually In Scarred Uterus. Uterine Anomalies Are One Of The Reasons For Spontaneous
Unscarred Uterine Rupture In Early Pregnancy.
Case:
A 20 Year Old Primigravida Presented At 10 Weeks1 Day Gestation With An Acute Pain In Abdomen And One Episode Of
Vomiting Followed By Loss Of Consciousness. At The Time Of Examination, Patient Was Conscious, Had Generalized
Abdominal Tenderness, Guarding And Rigidity Was Present. Ultrasound Revealed Intrauterine Pregnancy With Moderate
Amount Of Free Fluid In Peritoneal Cavity. Possibilities Considered Were Heterogenous Pregnancy Or Surgical Cause. On
Laparotomy, Hemoperitoneum Was Present Along With Fetus And Placenta In Peritoneal Cavity. It Was A Bicornuate
Uterus With A 2 X 3 Cm Complete-Thickness Rent Was Present At The Uterine Fundus . The Defect Was Repaired. Post
Operative Period Was Uneventful.
Conclusion:
Spontaneous Uterine Rupture Should Be Considered In Patients With Acute Pain In Abdomen Even Without Risk Factors,
Regardless Of Gestational Age. The Current Case Highlights Uterine Anomaly As A Risk Factor For Spontaneous Uterine
Rupture In The First Trimester Of Pregnancy. Clinical Signs Of Uterine Rupture In Early Pregnancy Are Nonspecific And
Must Be Distinguished From Other Acute Abdominal Emergencies.

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Nagrath S Vaginoplasty: A Noninvasive Innovative Novel Technique Of Vaginoplasty

Author: Dr. Priya Sharma
Co Author: Dr. Priya Sharma1, Prof. Arun Nagrath2,

Background: There Are Many Techniques Of Vaginoplasty, Having Their Own Advantages And Disadvantages. Motivated
By The Simplicity And Relative Noninvasiveness Of The VecchiettiS Operation, We Tried To Simplify The Procedure
By Offering A Pressure From The Perineum On The Vulva Rather Than Pull From The Upper Side Case : A 21 Year Old Girl
Presented In Our Hospital With Primary Amenorrhea And A Usg Showing Absence Of Uterus. The Patient Was About To
Get Married In 6 Months And Desired Construction Of Vagina With Consent Of Her Inlaws. On Local Examination Revealed
Introital Dimple And On Per Rectal Examination Uterine Bud Not Felt. Under Anaesthesia The Dimple Over The Vulva Is
Digitally Pushed Inwards ,Till The Tissues Tend To Give Way And Dilator Is Used To Stretch The Median Raphe To
Allow Application Of The Smallest Dilator In Place. This Dilator Is Fitted With Suspensory Tapes To A Belt Worn Around
The Abdomen So That A Constant Pressure Is Maintained. Every Week, The Dressing Is Changed, The Dilator Cleaned And
Larger Dilator Reapplied, Further Tightening The Suspensory Tapes To Increase The Pressure In The Neovagina Depth Of
The Vagina Ranging Between 2.0 Cm To 2.5 Cm Can Be Achieved In The First Week And After 3 Wks T Depth Of At Least
10 Cm Is Achieved. Thereafter Patient Allowed Continuing Manual Dilatation Trying To Exert Upward Pressure On The
Dilator From Below. Conclusion : Initially Showed Promising Result In 4 Patients. Advantages Being Non Invasive
Procedure Preventing Anterior And Posterior Fistula Formation The Neovagina Is Lined With Normal Vagina Mucosa, So
The Problem Of Dry Vagina Syndrome Or A Constant Messy Mucoid Discharge In Bowel Vaginas Is Overcome.
The Disadvantage That The Patient Needs Catheterization, Admission For An Extended Period, Forced To Remain On A
Liquid Diet.

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Successful Management Of Ovarian Torsion In First Trimester Of Pregnancy- A Case Report

Author: Dr. Loukya Madras
Co Author: Dr. Rama Devi1,

Background: Ovarian Torsion Encountered During Pregnancy Carries Significant Risk To A Pregnant Woman And
Intrauterine Foetus. The Risk Of Ovarian Torsion Rises By 5 Fold During Pregnancy. Incidence Is 5 Per 10,000 Pregnancies.
Case Report: A 21 Yr Old Primigravida With 10 Weeks Of Gestational Age Came To Antenatal Clinic In View Of Acute
Onset Of Excruciating Pain Abdomen And Vomiting Since 4Hours. She Described The Pain As Sharp Non-Radiating Type
Of Pain In The Right Iliac Fossa With Sudden Onset, With No Relieving Factors. She Gave No History Of Vaginal Bleeding
Or Discharge. There Was No History Of Diarrhoea, Constipation, Fever, Urinary Complaints Or Any Recent Illness. She
Conceived Spontaneously.
On Examination : Abdomen Was Soft, Tenderness Was Present In The Right Iliac Fossa, No Guarding Or Rigidity. Uterus
Was Anteverted, Bulky About 8-10 Wks Size, Mass Of About 5*5 Cms Felt Through Right Fornix, Mass Was Seperately Felt
From The Uterus, Forniceal Tenderness Present. Ultrasound Showed Right Ovary Enlarged, 6.0X5.6 Cm ,With Altered
Echotexture, With No Vascularity Noted In Ovary On Colour Doppler. The Patient Underwent Emergency Laparoscopy.
Intra Operative Findings: Hemoperitoneum Was Minimal. Right Ovary : Gangrenous With Ovarian Cyst Of About 6
6 Cm Was Present Along With Gangrenous Right Fallopian Tube. Gangrenous Ovary Along With The Tube Was Removed.
Postoperative Period Was Uneventful. Inj Hcg, Progesterone Supplement Was Given. Histopathology Showed
Hemorrhagic Infarction Of Right Ovary And Fallopian Tube. Pregnancy Was Followed Up And Eventually Delivered A Live
Male Baby At Term Vaginally.
Conclusion: Although The Safety Of Antepartum Surgical Intervention Has Been Accepted, Abdominal Surgery
Nevertheless Carries Some Risks To A Pregnant Woman And Unborn Fetus, And So The Choice Of Management
Necessitates A Weighing Of Risks Based On Characterization Of The Adnexal Mass And Gestational Age.

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46 Xy Pure Gonadal Dysgenesis With Swyer Syndrome Associated With Clitoromegaly And Hypoplastic Uterus
Author: Dr. Shreya Gowni
Co Author: Dr.G.Shreya1, Dr.G.B Madhavi2, Dr.V.Kavitha3,

Background: Swyer Syndrome Or Pure 46 Xy Gonadal Dysgenesis Is Described Classically As Female Phenotype With
Female Genital Appearance. The Patients Have Normal But Underdeveloped Uterus And Fallopian Tubes, And Bilateral
Rudimentary Streak Gonads Because Of Abnormality In Testicular Differentiation. The Condition Usually Presents As
Primary Amenorrhoea Due To The Fact That The Gonads Have No Hormonal Or Reproductive Potential. The Incidence Of
This Syndrome Is Estimated To Be About 1 In 1,00,000 Births.
Case: A 15 Year Old Girl Presented To The O.P.D With The Complaint Of Unattained Menarche. Breast Development
Started At 13 Years Of Age Followed By Pubic Hair And Scanty Axillary Hair. No Family History Of Similar Complaints.
Height 153 Cm, Weight 44 Kg. Breast Tanner Stage 2, Pubic Hair Stage 3, Axillary Hair Stage 2. No Turner Stigmata. Thyroid
Normal. No Hirsutism. Local Examination- Clitoromegaly Of 3Cm Present, Labia Majora And Minora Normal, Urethral
Meatus Normal. P/R- Uterus Not Palpable. Karyotyping: 46Xy. Serum Estrogen Was Low, Serum Lh And Fsh Were
Elevated. Serum Testosterone Was In The Female Range. Usg : Hypoplastic Uterus With Absent Gonads. Mri: Hypoplastic
Uterus With No Definitive Ovaries.
Diagnostic Laparoscopy Was Done And The Streak Gonads Were Removed. Pathology Reports Showed Fibrous Tissue
And No Evidence Of Malignancy.Patient Has Been Started On Low Dose Of Estrogen. It Has Been Planned To Supplement
Her With Progesterone After 6 Months.
Conclusion : The Diagnosis Was A Real Puzzle Because Of The Association Of Clitoral Hypertrophy Without Hirsutism,
Rudimentary Female Internal Genitalia, And A 46Xy Karyotype. Clitoral Enlargement Was Probably Due To Transient
Androgen Secretion By The Streak Gonads. A High Incidence Of Tumour Such As Gonadoblastoma And Germ Cell
Malignancies Have Been Reported (20-30%); Therefore, The Current Practice Is To Proceed With Gonadectomy Once The
Diagnosis Is Made.

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A Rare Umbilical Cord Anomaly As A Cause Of Fetal Death

Author: Dr. Reethu Varadarajan
Co Author: Dr.Suvarna Ramaswamy1,

Background: Unexplained Intra-Uterine Foetal Death Is Not Uncommon And Umbilical Cord Abnormalities Are Accepted
As One Of The Important Conditions Associated With Intrauterine Demise(Iud).Umbilical Cord Abnormalities Are
Numerous, Ranging From False Knots, Which Have No Clinical Significance, To Conditions Which Can Lead To Fetal Death.
Case: A 24 Year Old Women With 34 Weeks Of Gestation Presented With Complaints Of Pain Abdomen And Was
Subjected To Emergency Lscs In View Of Fetal Distress And Non Reassuring Nst. A Live Female Baby Was Extracted Which
Had A Weak Cry With A Birth Apgar Score Of 3/10 And Weight Of 1.1Kg. The Baby Succumbed Inspite Of All Resuscitation
Measures. The Umbilical Cord, Though Normal In Length, Showed A Constricted Area Towards That The Foetal End, At
The Insertion Of The Cord Into The Umbilicus And This Extended Over A Length Of 1.8Cms.The Cord Also Showed Evidence
Of Partial Torsion Just Above The Constriction. The Cord Showed Two Arteries And A Vein All Through Out The Length.
The Histopathology Examination Of The Umbilical Cord Was Performed By Taking Sections From The Normal Looking
Portion Of The Cord As Well As From The Constricted Area. The Histopathological Features From The Constricted Area
Of The Cord Showed Obvious Reduction In The Girth Of The Cord With The Diameter Being 0.7Cms. The Amount Of
WhartonS Jelly At This Site Was Reduced With Relative Increase In Thickness Of The Vascular Walls. There Were No
Other External Or Internal Anomalies.

Conclusion: Umbilical Cord Stenosis Is A Rare But Distinctive Condition That Can Cause Still Birth / Poor Neonatal
Outcome. This Condition May Not Be Diagnosed Prenatally And The Exact Cause Of This Condition Is Not Known.

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Krukenberg Tumor-Metastasis From Carcinoma Colon

Author: Dr. Naimisha Kasireddy
Co Author: Dr.Samantha Mascarenhas1,

Background:
Ovarian Metastases From Colorectal Cancer, Also Known As Krukenberg Tumors, Occur In About 3% Of All Colorectal
Cancer Patients And Make Up Between 5-10% Of All Colorectal Metastasis. It Is Named After Friedrich E. Krukenberg,
German Pathologist (1871-1946) Who First Described Them In 1896.
. Patients Usually Present With Abdominal Pain And Distention. The Time From Diagnosis Of The Primary To The
Development Of Ovarian Metastasis Is Variable, And Ranges From Several Months To >10 Years. Ultrasonography And Ct
Usually Reveal Bilateral, Solid Ovarian Masses But Cystic Masses Can Also Occur.
It Is Considered As Late Second Stage Disease And Prognosis Is Still Very Poor. Until Now Optimal Treatment Has Not
Been Established, And It Is Still Uncertain Whether Surgical Resection Of Ovarian Metastases Could Improve The
Outcome..
Case Report:
Mrs. M, 38-Yr Old, Came For The First Time To The Out-Patient Department Complaining Pain In The Lower Abdomen.
She Gives A H/O Hemicolectomy Done 1Year Back For Carcinoma Colon After Which She Was Given 4 Cycles Of
Chemotherapy. Per- Abdomen Examination Reveals 16Wks Sized Firm, Mobile Mass. On Bimanual Examination, 1618Weeks Size, Firm, Mobile Mass Felt With B/L Fornicial Fullness . She Was Sent For Routine Blood Investigations And
Ultrasound.
On Ultrasound, B/L Ovarian Mass Was Seen And Suggested Further Evaluation. Mri Was Suggestive Of Ovarian
Neoplasm(? Teratodermoid/Germ Cell Tumor). Tumor Markers - Ca-125, Afp, Ldh, -Hcg Were Normal. She Was Taken
Up For Laparotomy And B/L Ovarian Mass Was Noted. Hysterectomy With B/L Salpingo-Oophorectomy Was Done.
Histopathology Of The Specimen Revealed Krukenberg Tumor. 4 Cycles Of Chemotherapy Was Given.

Conclusion:
Krukenberg Tumors Are Relatively Uncommon And Account For Only One To Two Percent Of All Ovarian Tumors.
***************

A Rare Case Report Of Monochorionic Twins With Trap Sequence

Author: Dr. Srujana Palavalasa
Co Author:

Background:
Twin Reversed Arterial Perfusion (Trap) Sequence Is A Rare--1 In 35,000 Births, But Serious Complication Of MonoChorionic Multi Fetal Gestation. In The Trap Sequence There Is Usually A Normally Formed Donor Twin Who Has Features
Of Heart Failure As Well As A Recipient Twin Who Lacks A Heart (Acardiac) And Other Structures.
Case:
A 20 Year Old D. Laksmi, Primi Gravida With Twin Gestation With 33 Weeks Gestation Was Referred To King George
Hospital, Visakhapatnam With Complaints Of Decreased Fetal Movements Since 5 Days And Draining Per Vagina Of 16
Hrs. On Ultrasound It Was Diagnosed As Mono-Chorionic Di-Amniotic Twins With One Twin Iud And Other Twin Was
Acardiac Twin. At Admission--Uterus Was Over Distended With Multiple Fetal Parts With Absent Fhs. First Twin Was Iud,
Delivered Vaginally By Assisted Breech Delivery And Second Twin Was In Transverse Lie And Proceeded For Emergency
Lscs. Second Twin Was Acardiac Twin With No Head, Heart And Upper Limbs.
Conclusion:
Trap Sequence Is Caused By A Large Artery-To-Artery Placental Shunt. Within The Single Shared Placenta Arterial
Perfusion Of The Donor Twin Exceeds That In The Recipient Twin, Who Thus Receives Reverse Blood Flow Of
Deoxygenated Arterial Blood From Co-Twin. Management Depends On Gestational Age And Facilities Available.This Case
Is Presented Because Of Its Rarity.

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A Rare Case Of Use Of Hayman Stitch For Control Of Bleeding From Atonic Uterus In 8.3 Weeks Missed Abortion
Author: Dr. Unmesh Joshi
Co Author: Dr. Arun Ambadkar1, Dr. Hemant Deshpande2,

Background: Abortions Are Very Common (40-50%, Including Biochemical Pregnancy). Suction Curettage Is A Standard
Procedure For Missed Abortion. Minor Procedure Complications Such As Hemorrhage (0-3%), Perforation And Infection
Are Not Uncommon. Multiple Fibroids, Advanced Maternal Age, Prior Surgery On The Uterus Are High Risk Factors For
Increased Bleeding Due To Atonic Uterus.

Case: A 45 Year Woman, Primigravida, Conceived In The Third Cycle Of Ivf, Presented With 9 Weeks Of Missed Abortion
With History Of Open Myomectomy Done 5 Years Ago. Her Lab Reports Were Normal. She Was Taken For Dilatation And
Evacuation Under Short Ga. After Evacuation Of The Products Of Conception By Suction Cannula, There Was Torrential
Bleeding. Although The Uterus Was Completely Evacuated, There Was Increased Bleeding Which Did Not Respond To
Uterotonics And Bimanual Massage. Decision Of Laparotomy Was Taken In View Of Uncontrolled Bleeding And
Deteriorating Vitals. On Laparotomy, No Perforation Of Uterus Was Seen But The Uterus Was Extremely Flabby With
Multiple Small Fibroids In It. Uterus Was Flabby Even After Compression, So Intramyometrial And Intramuscular Injections
Of Pgf2-Alpha (Total 4 Doses) Were Given And Bilateral Uterine Arteries Were Ligated. Inspite Of Devascularisation Of
Uterus, Bleeding Continued Per Vaginally. Before Trying Internal Iliac Artery Ligation, We Decided To Take Two Hayman
Sutures With Catgut No. 1. Knots Were Tied Over The Fundus, 2 Cm Medial To The Utero-Tubal Junction And Bilateral
Cornu-Fundal Fibroids, Which Stopped The Bleeding Completely To Preserve The Uterus In This Patient With Bad
Obstetric History.

Conclusion: Bleeding From A Pregnant Uterus Is Not Uncommon At Term, But Post-Abortal Torrential Bleeding Is
Unexpected And Rare, Especially In First Trimester. This Rare Case Report Has Shown That The HaymanS Suture Is
Useful For The Control Of Bleeding Even In A First Trimester Atonic Uterus Where Other Major Measures Have Failed.

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Asherman Syndrome
Author: Dr. Fatima Anis
Co Author: Dr.Fatima Anis1, Dr.S Rahika2, Dr.Jameela Hameed3, Dr.Haseena4, Dr.Narmadha5

Background: Asherman Syndrome (As) Was First Described By Heinrich Fritsch In 1894, Characterized By A Gynecologist,
Joseph Asherman, In 1950. This Acquired Uterine Condition Is Characterized As Wide Range Of Adhesions Within The
Uterine Cavity .Its Incidence Is 1.5% Of World Population. Intrauterine Adhesion Frequently Occurs As A Result Of Trauma
To Basal Layer Of Endometrium Following Pregnancy Related Curettage , Incomplete Abortion & Postpartum
Hemorrhage . Genital Tuberculosis Is Also An Important Cause In India Accounting 24.4% Of Asherman Syndrome, 40%
Of Endometrial Biopsy Positive For Tuberculosis.
Case Characteristics: A 32 Yrs Old Female Presented With Primary Infertility And Oligomenorrhea, Active Married Life
Since 3Yrs, Non Consanguineous Marriage And Her Cycle Was Regular But Scanty Since 2 Years Post Menarche. The
General And Systemic Examination Were Normal. Routine Investigation Results Normal. Hormonal Profile Was Normal
To Raised. On Hysterosalpingography The Cervix End Was Blocked And Unable To Negotiate The Cervix, . On
Hysterolaproscopy Bilateral Tubes Were Beaded With Dense Peritubal Adhesion ,Uterus Normal Size ,Bilateral Ovaries
Normal. An Endometrial Biopsy Came Positive For Tb-Pcr. Patient Was Treated With Antitubercular Drugs(2Hrze+4Hr)
For 6 Months And After 6 Months By Redo Hysteroscopy Cervix Was Negotiated And Adhesiolysis Done, Bilateral Ostia
Visualized Found To Have Increased Adhesion Over Ostia. Patient Was Put On Cyclical Estrogen And Progestrone..
Conclusion: Asherman Syndrome Secondary To Pelvic Tuberculosis Was The Cause Of Infertility And Oligomenorrhea
Particularly In Our Country. Moreover Even If There Are Additional Infertility Factors In The Patients With Asherman
Syndrome For The Success Of Ivf Procedure It Is Important To Restore The Uterine Cavity And The Endometrium. It Is Also
Important To Realize The High Risk Involved In Such Cases During The Pregnancy Course And Careful Perinatal
Management Should Be Required.

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Beware Of The Uterine Ectopic!

Author: Dr. Divya Rajalakshmi Sunderrrajan
Co Author: Dr. Sareena Gilvaz1,

Background: Caesarean Scar Pregnancy Forms An Important And A Sinister Differential Diagnosis In First Trimester
Bleeding In Patients With Previous Caesarean Section. The Caesarean Birth Rates In Any Population Group Should
Optimally Range Between 5 And 15%,There Has Been Increased Incidence Of Caesarean Scar Ectopic In Our Region In
The Recent Months. Treatment For This Condition Has A Varied Spectrum Of Modalities. This Presentation Aiims To
Highlight And Discuss The Condition.
Case Presentation: Mrs X A 32 Year Old A G2P1L1 With Previous Lscs,( Done 6 Years Back For Fetal Distress) Now At
8Weeks Of Gestation Had Profuse Bleeding P/V With Severe Abdominal Pain For Which Dilatation And Curettage Was
Done Outside Inspite Of Which She Continued To Bleed And Was Referred To Us. A Diagnosis Of Caesarean Scar
Pregnancy Was Made After Transvaginal Sonography Which Showed An Intra Uterine Mass In The Anterior Part Of Uterine
Isthmus With Loss Of Healthy Myometrium Between The Bladder And The Gestational Sac And An Empty Uterine Cavity
And Cervical Canal. Methotrexate Rescue Regimen Was Started And There Was Good Response With Resolution Of
Bleeding Per Vaginum And Beta-Hcg Levels
Conclusion: Incidence Of Caesarean Scar Pregnancy Is On The Rise With Considerable Increase Over The Last Decade
With A Current Rate Of 1 In 1800 Pregnancies. A Simple Dilatation And Currettage For Incomplete Abortion May Turn To
Be An ObstetricianS Nightmare When It Turns To Be Caeserean Ectopic.Since The Scar Pregnancy May Mimic A
Relatively Benign Retained Products Of Conception If Not Carefully Suspected For, Awareness About The Same Is To Be
Spread Especially Amongst The Peripheral Centres Where Basic Obstetric Ultrasonogram Is Being Widely Used.

***************

Evisceration As An Alternative To Cesarean Section In A Moribund Foetus

Author: Dr. Kunta Reddy
Co Author: Dr J Venkateshwar Reddy1, Dr Lakshmi Rao2,

Background: Case Report Of A Foetus With Mesenteric Cyst Which Led To Obstructed Labour And Head Was Accidentally
Decapitated In An Attempt To Deliver The Foetus . Normal Vaginal Delivery Was Done After Mesenteric Cyst Was Drained
Out With Evisceration Scissors.

Case: 24 Years G2P1L1 ,32Weeks Of Gestation , Hbsag Positive ,Rh Negative Case Was Brought With Decapitated Head
.She Was Attended By An Untrained Dai And Forcefully Attempt To Deliver The Foetus Led To Decapitation .On
Examination She Was Exhausted , Febrile , Dehydrated But Her Vitals Were Stable .On Perabdominal Examination Uterus
Was Over Distended Mildly Acting .On Per Vaginal Examination Cervix 50-60% Effaced Os 5-6 Cm Dilated And Both Hands
Were Outside Introitus .Bedside Ultrasound Showed Anechoic Lesion Of Large Size Suggestive Of Mesenteric
Cyst.Pervaginally Evisceration Scissor Was Passed Through The Lowest Accessible Intercostal Space Into Abdomen After
Piercing Through Diaphram And Then Fluid Was Drained Out Which Led To Easy Deliver Of Remaining Foetal Parts . Post
Partum Period Was Uneventful

Conclusion : Destructive Procedures Are Absolete In Modern Obstetrics But Holds Good In Selected Conditions ,
Preventing Unnecessary Cesarean Section

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A Large Cervical Fibroid Presented During Pregnancy

Author: Dr. Swati Kapsikar
Co Author: Dr. Pradeep Gaikwad1, Dr. Binti Bhatiyani2,

Background: Cervical Fibroid Is Rare In Pregnancy And Has Unique Management Challenges. We Report A Case Of Cervical
Fibroid In G2A1 Patient Who Was Referred To Us For Management Of Cervical Fibroid With Pregnancy. Fibroid Grows
From 4Cm In Antenatal Period To 11 Cm In Course Of Pregnancy. When She Presented To Us At 37 Weeks She Was In
Labour With Transverse Lie.Emergency Lscs Was Performed. She Had Uneventful Postnatal Period And Post Puerperal
Myomectomy Was Planned For This Patient After Evaluating Fibroid Size.
Case History: 23 Years Old G2A1 Presented At 37 Weeks Of Pregnancy With Abdominal Pain And Transverse Lie. On Per
Vaginal Examination There Was Large 11Cm Cervical Fibroid. This Patient Was Married Since 3 Years Back And Had A
Miscarriage At 6 Weeks Of Pregnancy For Which Suction Evacuation Was Performed. She Then Underwent Follicular
Monitoring Without Ovulation Induction For 2 Cycle Following She Conceived. She Was Diagnosed To Have Cervical
Fibroid When Cervical Fibroid Measured 45Cm. As Pregnancy Advanced Fibroid Grown Till Size 11Cm.In This Patient
There Was No Problem In Delivering The Baby Or Excessive Haemorrhage.
Conclusion: The Aim Of Our Reporting Is Rare Case Of Large Cervical Fibroid In Pregnancy.

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Association Of Neonatal Respiratory Morbidity With Timing Of Elective Cesarean Delivery

Author: Dr. Shraddha Shetty
Co Author:

Background: Elective Cesarean Delivery (Ecd) Rates Have Increased In Both Developed And Developing Countries Due To
Obstetric Indications And Cesarean Sections On Request. Neonatal Respiratory Morbidity Is One Of The Complications Of
Ecd Performed Before 39 Weeks Gestation.
Aim: To Study The Association Of Neonatal Respiratory Morbidity With Timing Of Elective Caesarean Delivery.
Objectives:
To Determine The Incidence Of Neonatal Respiratory Morbidity In Ecd Performed At 37+0 To 38+6 Weeks Of
Gestation And Those Delivered 39 Weeks.
To Compare The Risk Of Neonatal Respiratory Morbidity After Ecd At 37+0 To 38+6 Weeks Of Gestation With Those
Delivered 39 Weeks.
Material And Methods: A Retrospective Study Was Conducted On All Pregnant Women Who Were Delivered By Elective
Caesarean At A Gestational Age Of 37+0 To 38+6 Weeks And Were Compared With Those Delivered At 39+0 To 41+6
Weeks. Maternal And Neonatal Characteristics, Neonatal Respiratory Morbidity Including: Respiratory Distress Syndrome
(Rds), Transient Tachypnea Of The Newborn (Ttn), Persistent Pulmonary Hypertension And Serious Respiratory Morbidity
Were Analyzed.
Results: Incidence Of Neonatal Respiratory Morbidity Was 15.8% And 6.3% In Neonates Delivered At 37+0 To 38+6 Weeks
And 39 Weeks Gestation Respectively.Combined Respiratory Morbidity Risk (Odds Ratio: Or 2.82; 95% Confidence
Interval Ci: 1.34 -5.94; P Value <0.05) Was Significantly Higher In The Neonates Delivered At 37+0 To 38+6 Weeks
Compared With Those Delivered 39 Weeks. Risk Of Ttn (Or 2.6; 95% Ci: 0.95-7.45; P Value-0.08) And Rds (Or 2.42;
95%Ci: 0.48-12.15; P Value-0.45) Increased By Two Fold In Neonates Delivered Before 39 Weeks.
Conclusion: Neonates Delivered By Elective Cesarean Delivery At 37+0 To 38+6 Weeks Gestation Are At Increased Risk Of
Developing Respiratory Morbidity Compared With Those Delivered Beyond 39 Weeks. Respiratory Morbidity In
Newborns Can Be Reduced By Delaying The Ecd Until 39 Weeks Of Gestation.

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Herlyn-Werner-Wunderlich Syndrome : Uterus Didelphys, Obstructed Hemivagina And Ipsilateral Renal Agenesis
A Rare Case Report.
Author: Dr. Gayathri Chellapan
Co Author: Dr Ashok Kumar1, Dr Vedavathy Nayak2,

Background: Herlyn-Werner-Wunderlich Syndrome Is A Rare Congenital Mullerian Ductal Anomaly Characterized By The
Triad Of Obstructed Hemivagina, Uterus Didelphys And Unilateral Renal Agenesis.
Case: A 13 Years Old Girl Was Admitted To Our Hospital With Acute Lower Abdominal Pain. She Had Attained Menarche
Four Months Back And Had Regular Cycles Since Then. On Per Rectal Examination, There Was A Boggy Mass Felt.
Ultrasound Examination Revealed A Haematocolpos And Haematometra. Mri Confirmed Herlyn-Werner-Wunderlich
Syndrome. At Examination Under Ga, Vaginal Septotomy Was Done; 200Ml Of Chocolate Coloured Fluid Was Drained.
On Follow Up, The Patient Was Menstruating Regularly With No Recurrence Of The Obstruction.
Conclusion: Early And Accurate Diagnosis Of Mullerian Duct Anomalies Including Hww Syndrome Is Necessary To Prevent
Complications And To Preserve Fertility. The Diagnosis May Be Difficult Due To The Infrequency Of This Syndrome And A
High Index Of Suspicion Is Required.
***************

Interesting Case Of Uterus Bicornis Bicollis

Author: Dr. Ravi Shankar
Co Author: Dr Anuradha1, Dr Anjalakshi Chandrashekar2,

Background: Herlyn-Werner-Wunderlich Syndrome Represents A Rare Disorder Of The Female Genital Tract Consisting
Of Uterus Diadelphys, Unilateral Vaginal Obstruction (Hemi Vagina With Haematocolpos) And Ipsilateral Renal Agenesis.
Case: A 15 Year Old Girl, Presenting With Complaints Of Pain Abdomen Since 1 Week.
Attained Menarche 3 Months Before The Symptoms Appeared.
On Further Evaluation The Patient Was Diagnosed As A Case Of Herlyn Werner Wunderlich Syndrome After Usg Showed
Characteristic Findings.
On Examination Only Single Vagina Could Be Demonstrated Hence Could Not Be Considered As A Case Of Herlyn Werner
Wunderlich Syndrome But A Case Of Uterus Bicornis Bicollis With An Incidental And Intriguing Finding Of Unilateral Renal
Agenesis.
Conclusion: Incidence Of This Rare Syndrome Is 0.1 To 3.8% And The Present Case Might Be A Variant Of The Same
Syndrome
***************

An Abdominal Sling Surgery For A Massive Irreducible Genital Prolapse In An Elderly Woman
Author: Dr. Veena Devadiga
Co Author: Dr. Veerendrakumar C.M1,

Background: Pelvic Oragan Prolapse Is A Common Gynaecological Condition In Parous Women Even Today. Nowdays,
Massive Irreducible Genital Prolapse Is Uncommon As The Most Women Present To The Clinicians With Early Signs And
Symptoms. Here We Present A Case Of 70 Year Old Postmenopausal Woman With Essential Hypertension And Type Ii
Diabetes Mellitus Presented With Mass Per Vaginum Since 20 Years And Acute Retention Of Urine And Managed By Total
Abdominal Hysterectomy And Purandare'S Sling Procedure.
Conclusion: Even In Elderly Patient With Co-Morbid Conditions, Quality Of Life Can Be Significantly Improved By Safe And
Skilled Surgery.
***************

Rare Complication Of Twin Gestation- Trap Sequence With Acardiac Acephalic Twin And Healthy Pump Twin
Author: Dr. Prathyusha Vemuri
Co Author: Dr. T. Radha1, Dr. M. Tripura Sundari2,

Background: Twin Reversed Arterial Perfusion [Trap] Is A Rare And Unique Complication Of Monochorionic Twins Seen
In 1 In 35000 Births .Trap Sequence Is Caused By Large Artery To Artery Placental Shunt Along With Vein To Vein Shunt .
The Donor [Pump ] Twin Supplies Blood To The Acardiac Twin Through Placental Arterial Vascular Anastamosis .
Case Report : A 23 Year Old G2A1 , Unbooked Patient With Unknown Dates Presented With Leaking Per Vaginum . On
Examination Uterus Was Overdistended , Multiple Fetal Parts Were Felt And One Fetal Heart Was Auscultated .On Vaginal
Examination Cervix Was Fully Effaced , 2 Cm Dilated And Membranes Were Absent With Clear Liquor Draining. Emergency
Bed Side Ultrasound Was Done .It Showed Monochorionic Monoamniotic Twin Gestation With 1St Twin In Breech [Pump
Twin ] And 2Nd Acardiac Twin With No Fetal Cephalic Pole.Afi Was 7 Cm. Emergency Lscs Was Performed, 1St Twin Was
Healthy ,Weighed 2.5Kg With No Anomalies And 2Nd Was Acardiac Acephalic And Weighed 1.75Kg.
Conclusion: In Trap Sequence Arterial Perfusion Pressure Of Donor Twin Exceeds That Of Recipient Twin .Recepient Twin
Receives Deoxygenated Blood Through Umbilical Arteries Which Goes To Iliac Vessels . Thus Lower Part Of The Body Is
Perfused Resulting In Development Of Lower Limbs And Abnormal Development Or Absence Of Other Organs. In Donor
Twin Risk Of High-Output Cardiac Failure Is High As It Has To Support Its Own Circulation And That Of Recipient Twin.
Accurate Antenatal Diagnosis Is Needed To Diagnose Trap Sequence In Early Trimesters. Treatment Is By
Disruption Of Vascular Anastamosis Between The Two Twins Which Helps Better Survival Of Donor Twin .

***************

Uterus Didelphus
Author: Dr. Vennila Magesh
Co Author: Prof.Santhi Md Og1, Prof.Chitra Md Og2, Dr .S.S.Gayathri Md Og3,

Background: Uterus Didelphus Is A Rare Disorder Due To Failure Of Lateral Fusion Of Mullerian Ducts. The Mullerian Ducts
Are Ordinarily Pulled Together By Subperitoneal Fibromuscular Tissue At 12Th And 16Th Week Of Pregnancy, And It
Is Suggested That A Defect In This, Is A Cause Of Uterovaginal Malformations. It May Be Associated With Renal Agenesis
And Transverse Vaginal Septum .

Case Report: The American Fertility Society Classifies The Didelphic Uterus As Class Iii Mullerian Anomaly. Various Signs
& Symptoms Of Uterus Didelphus Depends On The Age Of Presentation. It Can Be An Incidental Finding, Hematocolpos
In Adolescence And During Child Bearing Age As Dysmennorhea, Dyspaurenia, Hypertension, Recurrent Spontaneous
Abortions, And Malpresentations During Labour. Here I Am Presenting A Case Ofdidelphic Uterus With Asymmetric
Obstruction Of Vagina With Unilateral Renal Agenesis Presented With Haematocolpos In Adolescence. Diagnostic
Methods Include Hysterosalphingogram, Ultrasound, Ultrasound With Transvaginal Transducers. M.R.I Is A Useful
Complementary Tool For Assessing Urogenital Anomalies When Ultrasonography Is Inconclusive. Ultrasonogram Is The
Method Of Choice For Screening Uterovaginal Anomalies, And Diagnosis Is To Be Confirmed By Demonstrating Two
Separate Cervical & Endometrial Canals.

Conclusion: As Congenital Disorders Of Development Are More Common Than Previously Reported Because Of The Use
Of Sophisticated Instruments, And Correct Diagnosis Can Help To Ally Patients Anxiety To Conceive, And To Formulate
Appropriate Therapeutic Plan By The Gynecologist, Like Resection Of Vaginal Septum, Hysteroscopic Or Transabdominal
Metroplasty Depending On The Anatomic Features Of The Cervix And The Uterine Cavity.

Keywords: Mullerian Anomaly, Uterovaginal Malformation, Uterus Didelphus, Haematocolpos

Renal Agenesis, Resection Of Vaginal Septum

***************

O'Conner Repair With Omental Flap Interposition For 18 Year Old Longstanding Vesico Vaginal Fistula
Author: Dr. R Jyothirmayee
Co Author:

Background: Vesico Vaginal Fistula Is A Type Of Urogenital Fistula,It Is A Abnormal Fistulous Tract Communicating The
Bladder With Vagina Resulting In Continuous Urinary Leak Into Vagina. Most Common Cause Of Vvf In Developing
Countries Is Obstructed Labour. Incidence In Some Rural Areas Is As High As 5 -10/1000Deliveries. In Developed Countries
Most Common Cause Is Pelvic Surgery Of Which Most Common Is Hysterectomy . Incidence 0.8/1000 Hysterectomies. It
Is A Devastating Consequence Affecting The Patients Physical And Psychological Health And Making Her A Social Outcast.
Long Standing Vvfs Increase Operative Difficulties Due To Factors Like Fibrosis , Devascularization, Bladder Contracture
Etc
Case Report; A 60Year Old P2L2 Posthysterectomised Patient Came With Compliant Of Incontinence Of Urine And
Continuous Dribbling Since 18 Years. During Second Delivery There Was History Of Prolonged Labour (36 Hrs) Emergency
Lscs Done Converted Into Emergency Hysterectomy Done For Rupture Uterus-Delivered A Dead Male Baby, Since Then
She Is Suffering From Vvf. History Of Vvf Repair 5Yrs Back But Failed. O/E Her Vitals Were Stable , P/V Large 8*8Cms
Fistula Present. Tvsusg Post Hysterectomy Status. Cystoscopy - 6*6Cms Fistula Present In Left Side Of Posterior
Bladder Wall . OConnor Repair Trans Abdominal Approach Was Done With Omental Flap Interposition Under
Epidural Anesthesia.Spc Pvc Prevesical Drains Were Kept.Post Operative Period Uneventful.
Conclusion: Good Surgical Technique And Good Interposition Of Well Vascularised Tissues Like Omentum, Peritoneum ,
Martius , Gracilis Increases Success Rates And Improves Not Only Patients Physical Health But Also Regains Marital, Social
Life And Psychological Health.
Surgical Pictures Will Be Presented Highlighting The Operative Difficulties.

***************

Vulval Elephantiasis: A Diagnostic Dilemma

Author: Dr. Sunita Samal
Co Author: Dr Seetesh Ghose1,

Background:
Elephantiasis Is A Rare Disorder Involving Lymphatic Channels Of The Affected Part Of The Body. It Is
Characterised By Gross Enlargement Of The Particular Body Part And Commonly Affects Limbs, Scrotum, And Trunk.
Genital Elephantiasis, Also Known As Esthiomene, Is A Rare, Dramatic End Result Of Lymphatic Obstruction. Although
Mainly Associated With Filariasis And Sexually Transmitted Diseases Such As Lymphogranuloma Venereum And
Donovanosis, It Could Also Be An Uncommon Complication Of Tubercular Lymphadenitis. High Index Of Suspicion On
Microscopic Findings And Correlation With Relevant Diagnostic Tests Are Required To Reach The Correct Diagnosis.
Case:
A 40Yr Old Multiparous Woman Presented With Progressively Increasing Vulval Swelling Over A Period Of 34 Years. The Swelling Was Soft And Huge. She Was Managed Successfully By Surgical Excision With Vulvoplasty. Other
Possible Differential Diagnoses Were Excluded, And Ancillary Tests Were Performed To Reach A Probable Diagnosis Of
Vulval Elephantiasis On Histopathology.
Conclusion:
Vulval Elephantiasis Due To Filariasis Is Rare. Its Diagnosis On Histopathology Is More Often By Exclusion.

***************

A Rare Case Of Angiomyxoma Cervix With Leiomyosarcoma

Author: Dr. Anitha S
Co Author: Dr.Chellamma.V.K1,

Background:
Aggressive Angiomyxoma Is A Rare Benign Neoplasm Which Was First Described In 1983 By Steeper Et Al . This
Mesenchymal Tumor Arises From Connective Tissue Of Pelvic Cavity Or Perineum And Has A Locally Aggressive Course .
The Neoplasm Predominantly Affects Reproductive Age Group With Peak Incidence During Third Decade Of Life.There
Are No Pathognomonic Clinical Or Radiological Features. Hence They Are Diagnosed Histopathologically Characterized By
Multiloculated Poorly Delimited Myxoid Mass Composed Of Plump Spindle Cells,Numerous Thin Walled Blood Vessels
And Inflammatory Cells.

Case:
44 Year Old P3L3 Post Menopausal Lady Was Admitted With Complaints Of Abdominal Mass And Irregular
Bleeding Per Vagina. On Examination General Condition Was Good And Systemic Examination Was Within Normal
Limits.On Abdominal Examination There Was A Mass Of 24 Weeks Size Uterus ,Mobile And Firm In Consistency. Per
Speculum Examination Showed Cervix Unhealthy,Hyperemic With Erosions, With No Bleeding On Touch. Bimanual
Examination Showed Irregularly Enlarged Uterus Of 22-24 Weeks Size, Mobile,Fornices Free. Ultrasound Showed
Multiple Intramural And Subserous Fibroids Of Size 19.5 X 13.1 X 12.5 Cm.
Cervical Biopsy Was Taken Which Revealed Aggressive Angiomyxoma.Planned For Laparotomy. On Laparotomy
Uterus Irregularly Enlarged To 22 Weeks, Hard In Consistency. Ovaries Were Normal. Tah With Bso Done. Hpr Revealed
Leiomyosarcoma Uterus Which Is An Incidental Finding. Tumor Measured 14Cm In Diameter And Is Reaching Upto Serosa
And Extending Upto Ectocervix. The Patient Was Referred To Radiotherapy For Further Management.

Conclusion: .
This Case Is Unique In That, Patient Who Was Admitted With Uterine Fibroids, Diagnosed To Have An Associated
Aggressive Angiomyxoma Of Cervix And Leiomyosarcoma Which Was An Incidental Finding On Hpe.

***************

Spontaneous Endometriotic Cyst In Rectus Abdominous Muscle

Author: Dr. Niharika
Co Author: Dr.Geeta Doppa1, Dr.Ravikanth G O2,

Background:
Extra Pelvic Endometriosis Is Defined As Endometriotic Lesions Found Elsewhere In The Body, Including The
Cervix,Vagina,Vulva,Intestinal Tract,Urinary Tract,Abdominal Wall,Thoracic Cage And Lungs, Extremities, Previous Scars
And Central Nervous System.Differential Diagnosis Includes Abscess, Lipoma, Hematoma,Sebaceous Cyst, Suture
Granuloma,Desmoid Tumor, Sarcoma, Lymphoma And Primary Or Metastatic Cancer. We Are Presenting A Case Report
Of Infraumbilical Endometrioma.

Case:
A 24Yr Old P1 L1 Presented With Continuous And Localized Pain Abdomen Three Cm Left And Below Umbilicus Since
Four Months Which Increases Three Days Before, During And Four Days After Menses. Pain Abdomen Was Progressive
And Spasmodic In Nature.Patient Was Given Oral Contraceptive Pills For 3 Cycles Elsewhere Which DidnT Reduce Her
Pain.Patient Complains Of Nausea But Not Associated With Vomiting. Ultrasound Showed Well Defined,
Heteroechoic,Vascular Mass Lesion In Rectus Muscle Infraumbilical Region.An Ultrasound Guided Fnac Showed Features
Of Endometriosis. At Surgery An Incision Of About 2Cms Was Taken Over The Lesion And Subcutaneous Fat Was
Separated After Which On Palpation There Was A Nodule Of About 1.31.5 Cm. On Opening The Rectus Sheath A Bluish
Bulging Membrane Of The Cyst Was Opened To See Dark Brown Fluid.The Cyst Was Excised With 4Mm Of Surrounding
Tissue. Histopathological Examination Of Specimen Showed Features Of Endometriosis.Post-Operative Period Was
Uneventful.

Conclusion:
Abdominal Wall Endometriosis Occurs Spontaneously In The Umbilicus And Inguinal Canal, Usually Without Any
Associated Intrapelvic Endometriosis. Extrapelvic Endometriosis Is Rare And May Result From Vascular Or Lymphatic
Dissemination Of Endometrial Cells As In Our Case. It Causes A Swelling Which Becomes Bigger And More Painful About
The Time Of Menstruation. It Appears Blue From An Underlying Blood Cyst And Sometimes Discharges Blood. The Cyst Is
Not Encapsulated And Surrounding Tissue Is Indurated.

***************

A Rare Cause Of Mass Descending Per Vaginum In A Nulliparous Perimenopausal Women

Author: Dr. Kavitha Sambandam T
Co Author: Prof.Vijaya1,

Background:
The Occurrence Of Chronic Inversion Of Uterus In A Nulliparous Woman Is Rare : Only About 100Cases Have Been
Reported In Literature Since 1942. We Report Herewith The Case Of Chronic Non-Puerperal Inversion Of Uterus
Associated With A Fundal Submucous Myoma.
Case Report:
A 45Years Old Nulliparous Woman Presented With The Complaints Of Mass Descending Per Vaginum And Foul
Smelling Discharge For 1 Month Duration With Occassional Spotting ; On Examination Revealed A Mass Of 12*8Cm With
The Hour Glass Appearance Seen Which Bleeds On Touch; Cervix Was High Up; Uterine Sound Could Not Be Passed: Usg
Confirmed Uterine Inversion. Core Biopsy Of Vaginal Mass Taken. Histopathology Revealed Fibroid Polyp; Cystoscopy
Showed Bladder Trabeculations With Reduced Capacity. Antibiotics Given; Then Patient Was Taken For Definite Surgery;
Uterus Repositioned By Means Of Abdominal Haultein Technique After Excising Polyp. Since There Was Extensive
Necrosis Of Uterine Endometrium, Total Abdominal Hysterectomy Done.
Conclusion:
On Encountering A Prolapsed Fibroid One Should Suspect For Uterine Inversion And To Take Biopsy Of Mass In View
Of Its Association With Uterine Malignancy.
Key Words: Uterine Inversion , Nullipara , Fibroid Polyp
***************

Jaw Dropping Anomaly!- Fetal Oropharyngeal Teratoma Misdiagnosed Sonologically As Fetal Cystic Hygroma
Author: Dr. Samantha Mascarenhas
Co Author: Dr. Samantha Delia Mascarenhas1, Dr. Latha Sharma2, Dr. Naimisha Reddy3,

Background:
A Fetal Oral Mass Is An Uncommon Sonographic Finding That May Be Detected At The Time Of A Detailed Fetal Anomaly
Scan. Various Entities Have Been Reported To Account For Such Masses, With Most Being Extremely Rare. Congenital
Teratomas Have An Incidence Of 1 In 4000 Live Births And Those Arising From The Oropharyngeal Cavity Comprise Less
Than 2%.

In This Study, We Present A Case Of fetal Oropharyngeal Teratoma Which Was Misdiagnosed As cystic
Hygroma On Sonography.

Case Report:
Mrs. X, 19 Years Of Age, G2A1, Came For Her First Antenatal Visit To The Outpatient Department In Her 19Th Week Of
Gestation. 11-14 Weeks Scan Determined That Nt Was 1.4Mm. The Patient Had Undergone A Prior Miscarriage At 5
Months Of Gestation. There Was No History Of Any Congenital Anomaly.

Sonologic Examination Suggested a Single Live Fetus Of 18-19 Weeks Of Gestation With A Large Multilocular Cystic
Mass In The Anterior Surface Of The Face Suggestive Of Cystic Hygroma. The Patient Was Counselled Concerning The
Possible Post Natal Outcome However She Opted For Medical Termination Of The Pregnancy. Pregnancy Was Terminated
With Mifepristone And Misoprostol. She Expelled A 1125 Grams (Tumour Weight Inclusive) Male Fetus After 6 Hours.

Gross Examination Of The Abortus Revealed A 20 X 20 Cm Cystic Mass With A Bosselated Surface, Resting On The Chest,
Arising With A Pedicle From The Pharynx. There Were No Other Obvious Anomalies. The Tumour Was Sent For
Histopathologic Examination And Was Suggestive Of fetal Oropharyngeal Teratoma.

Conclusion:
This Case Was Reported As cystic Hygroma Since It Is The Most Common Head And Neck Anomaly Detected
Sonologically. The Lesion Being Cystic Was A Confounding Factor. Accurate Diagnosis Is Of Great Value For Further
Obstetric Management.

***************

Virilising Granulosa Cell Tumour- A Rare Case Report

Author: Dr. Prasanna Manda
Co Author: Dr.G.C.Prabhakar1, Dr.Kavitha.P2,

Background:
Granulosa Cell Tumours Are The Commonest Sexcord Stromal Tumours.It Is Of Two Types ,Adult Granulosa Tumour Seen
Often In Postmenopausal And Premenopausal Woman(95%),Juvenile Granulosa Cell Tumors (5%)Seen In Young Adults
And Prepubertal Girls.Usually It Results In Precocious Puberty . However, The Luteinizing Forms May Produce Androgens
Leading To Virilization. To Date, Less Than 50 Cases Of Virilizing Granulosa Cell Tumors Have Been Reported In Literature.

Case Report:
We Present A Case Of 19 Yr Old Girl With History Of Amenorrhoea (Secondary) Of 16 Months,Excessive Hair Growth And
Hoarsening Of Voice 3 Months Prior To Admission.On Examination She Had Male Pattern Hair Distribution ,External
Genitalia Were Normal .Per Abdominal Examination Was Normal.Per Rectal Examination-Uterus Felt .On Ultrasound
Examination Left Ovary Showed 6.3X8.5Cm Mass With Multiple Loculated Cysts.Ct Showed 9X9X8.5 Cm Well Defined
Cystic Lesion With Thin Enhancing Wall 1Mm Multiple Internal Septations Seen On Left Side Of Pelvic
Cavity.Investigatons Dheas -200G/Dl,Testosterone-358.47Ng/Dll,Free Testosterone-7Pg/Ml.She Was Subjected To
Staging Laparotomy ,Tumour Confined To One Ovary , And Oophorectomy Was Done.Histopathology Showed Juvenile
Granulosa Cell Tumour.

Conclusion:
When A Patient Presents With Amenorrhoea And Features Of Virilisation And Adnexal Mass Not Only Sertoli- Leydig Cell
Tumours But Granulosa Cell Tumours Should Also Be Considered.

***************

Non Immune Hydrops Fetalis

Author: Dr. Sree Lakshmi Garaga
Co Author: Dr.C.Anuradha1, Dr.P.Chandrashekar Rao2, Dr.Karuna3, Dr.Jhansivani4, Dr.Swarooparani5

Background:
Hydrops Fetalis Is An Excess Accumulation Of Fluid In The Fetus.The Incidence Is Approximately 1 In 2500 To 1 In 3500
Neonates.With The Introduction Of Widespread Immunoprophylaxis ,Nonimmune Causes Have Become Responsible For
Atleast 85% Of All Causes Of Fetal Hydrops.Neverthless In Developing Countries,The Incidence Of Immune Fetal Hydrops
Is Still High.The Hallmark Of The Disease Is The Excessive Accumulation Of Fluid In The Body Cavities Pleural,Pericardial
And Peritoneal And Soft Tissues. Major Causes Of Nonimmune Hydrops Fetalis Includes These Disorders Associated With
Cvs Defects,Fetal Anaemia And Chromosomal Anomalies.
Case:
A 29 Yr Old Antenatal Woman Gravid 1 Para 1 Live 1 Abortion 1 Non Diabetic,Rh Positive,Non Consanguineous With
Previous One Casarean Section And One Abortion At 3Rd Month Of Gestational Age,Now At 20 Wks Of Gestational Age
Came For Antenatal Checkups And Ultrasonography Showed Following Findings Single Live Fetus With 20 Wks Of
Gestational Age With Diffuse Thickening Of Skin And Subcutaneous Tissue,Cystic Septated Mass Over Posterior Neck
Which Is Cystic Hygroma, Gross Pleural Effusion With Collapse Of Lung Suggestive Of Hydrops Fetalis.Patient Advised
Termination And Ethacrydil Lactate Instilled Induction Abortion Interval Is 12 Hrs Fetus Weighs 500 Gms And Shows Cystic
Mass Over The Posterior,Right And Left Side Of The Neck Diffuse Edema Of Skin And Subcutaneous Tissue And
Ascites.Fetus Sent To Pathology For Karyotyping.
Conclusion:
This Is A Case Of Non Immune Hydrops Fetalis Due To Cystic Hygroma Suggestive Of Chromosomal Anomalies Which Is
TurnerS Syndrome.One Possible Cause Of Hydrops Is Cystic Hygroma Seen Most Commonly In The First Trimester.In
First Trimester Trisomies 21 ,18 And 13 Were Most Prevalent And In Second Trimester TurnerS Is Most Prevalent
.Early Diagnosis Can Be Done By Ultrasonography And Termination Can Be Done And Frequency Of Reccurence Should
Be Explained.

***************

Sertoli Leydig Cell Tumor:A Rare Case Report

Author: Dr. Jyothirmayi Kunam
Co Author: Dr.G.C.Prabhakar1,

Background:
Sertoli-Leydig Cell Tumor (Slct), Also Known As Arrhenoblastoma, Is A Rare Ovarian Neoplasm Which Belongs To The
Group Of Sex Cord-Stromal Tumors And Accounts For Less Than 0.2% Of All Primary Ovarian Neoplasms.It Is Mostly
Unilateral, And Confined To The Ovary.Nearly 75% Of The Tumors Presents In Early Stage And Are Seen During The Third
And Fourth Decades Of Life. Very Few Case Reports Have Been Documented In The Literature So Far.Here, We Report A
Case Of Pure Sertoli Leydig Cell Tumor.
Case Report:
History: A 17 Year Old Unmarried Girl Presented To The Depatment Of Obstetrics And Gynaecology,Mamata General
Hospital With History Of Hirsutism,Acne And Clitoromegaly About 18 Months Back And A Lower Abdominal Mass Two
Months Back.
On Examination: Breast Development Was Upto Tanner Stage 4.Per Rectal Examination Revealed A Mass Of 88 Cm In
The Left Iliac Region.
Investigations: Ultrasonography Identified A Mixed Echogenic Left Ovarian Tumor Of 10.37.3 Cm.Serum Testosterone
Was 253.3-Ng/Ml,Dhea-345.9 g/Dl And Ca 125 Was 6.8 Iu/Ml.
Laparotomy Findings: A Left Ovarian Tumor Of About 1010 Cm In Diameter Was Found With Increased Vascularity.The
Capsule Of The Tumor Was Intact.Both Fallopian Tubes And Right Ovary Were Normal.There Was No Ascites Nor There
Any Evidence Of Metastases.
Cut Section Showed Variegated Appearance.The Histopathology Report Showed Well-Differentiated Sertoli- Leydig Cells.
On Removal Of The Tumor Her Virilising Features Regressed And She Regained Her Menstruation.
Conclusion:
Slct Is Commonly Misinterpreted As Yolk Sac Tumor,A Serous Neoplasm Or As Amalignant Mixed Mesodermal Tumor
Where All Of Them Show Papillary Confuguration.Hence, Slct Should Always Be Considered In A Young Female Patient
Who Has Symptoms Of Virilization And An Ovarian Mass On Examination Or Investigation.

***************

Efficacy,Acceptability & Cycle Control- Contraceptive Vaginal Ring (Cvr) Vs Combined Oral Contraceptives (Coc)
Author: Dr. Ramya Ramadoss
Co Author: Dr.Ramya Ramadoss1, Dr.Radhika.2, Dr.Jamilahameed.3, Dr.Haseena.4, Dr.Narmada.5

Background:
Substantial Improvements Have Been Made In The Past 50 Years In Contraceptive Methods To Make It More Acceptable,
Effective And Available To Reduce Unintended Pregnancy. Even Though Coc Is Widely Used Method Of Birth Control It
Has Some Adverse Effects. This Study Is To Analyse Whether Cvr As A Better Method Of Contraception In Comparison To
Coc.
Aim:
To Assess The Efficacy, Acceptability, Cycle Control And Compliance Of Cvr Over The Coc.
Methods/Materials:
Prospective Studies Done In 265 Adult Healthy Women (20 -45 Years) In Our Institute From July 2013-July 2014 Who
Desired Contraception. Study Group (N=130) Includes Women Using Cvr (15g Of Ethinyl Estradiol And 120 g Of
Etonogestrel Daily For 21 Days Followed By 7 Days Of Ring Free Period) And Control Group(N=135) Includes Women Using
Coc ( 30 g Of Ethinyl Estradiol And 150 g Of Levonorgestrel Daily For 21 Days) .They Were Assessed On Each Visit
For Menstrual Regularity, Adverse Effects , Compliance , Incidence Of Pregnancy While Using Birth Control. Comparison
Done By Statistical Analysis Of Categorical Data And P Value (Ns-Not Significant; S-Significant) By FisherS Exact Test.
Results:
The Pearl Index For Cvr And Coc Were 1.53 And 1.48 Per 100 Women Years Respectively (P Value=1,Ns). The Percentage
Of Women In Itt (Intention To Treat) Population Who Completed The Trial Was 69.2 And 71.8 For Cvr And Coc (P Value
=0.85,Ns). The Incidence Of Break Through Bleeding Were 4% And 10% For Cvr And Coc (P Value=0.04,S). The Incidence
Of Systemic Side Effects Were 58% And 55.5% For Cvr And Coc(P Value=0.92,Ns). The Incidence Of Vaginitis , Leucorrhoea
Were 4%Higher In Cvr Than Coc (P Value=0.12, Ns).
Conclusion:
Cvr Offers Better Availability With Good Cycle Control, Convenient Monthly Administration And Easy To Use Making It
As An Excellent Choice Comparative To Coc.

***************

A Rare Case Report Of Mayer Rokitansky Kuster Hauser Syndrome With Family History
Author: Ms. Sudha Lagudu
Co Author:

Background:
The Mayer- Rokitansky-Kuster-Hauser (Mrkh) Syndrome Is A Rare Anomaly Characterized By Congenital Aplasia Of The
Uterus And Vagina In Women Showing Normal Development Of Secondary Sexual Characters And Normal 44 Xx
Karyotype. The Uterine And Vaginal Agenesis In These Karyotypic Females May Be Accompanied By Urogenital, Skeletal
Or Dental Defects And Other Dysmorphias. It Is A Rare Disorder Occurring In About 1 In 4000 To 5000 Female Births And
Is A Common Cause Of Primary Amenorrhea.
Case:
A 27 Year Old Mrs. Abc, With A Marital Life Of 3 Years Has Come With Complaints Of Primary Amenorrhoea And Difficulty
In Coitus And Has Been Admitted For Evaluation And Vaginal Reconstructive Surgery. She Was Delivered By Normal
Vaginal Delivery At Home With No Signs Of Asphyxia. Her Milestones Were Normal. Her Growth Spurt Was At The Age
Of Ten And Breast Development Started By 11.She Has Not Attained Menarche Yet. Family History Revealed Similar
Complaint In Her Elder Sister, Who Had Undergone Vaginal Reconstruction. On Examination She Is Phenotypically Female.
Her Breasts Are Of Tanner Stage 3 And Pubic Hair Tanner Stage 3. There Is Vaginal Atresia And Cervix Or Uterus Are Not
Palpable Per Rectally. Ultrasound Showed Absence Of Uterus And Presence Of Normal Ovaries. No Renal Abnormalities
Detected On Mri. She Underwent Vaginal Reconstructive Surgery.
Conclusion:
Mrkh Syndrome Is Usually Of Sporadic Onset With Occasional Reports Of Familial Cases. The Mode Of Inheritance Appears
To Be Autosomal Dominant With Variable Expressivity Suggesting Involvement Of Either Mutation In Developmental
Gene Or A Chromosomal Imbalance. Management Of The Mrkh Syndrome Consists Of Creating A Neovagina, Which Can
Be Offered To Patients When They Are Emotionally Mature And Ready To Commence Sexual Activity.

***************

A Rare Case Report Of Primary Vaginal Leiomyoma

Author: Dr. Saladi Manjusha
Co Author: Dr.P.Sailaja1, Dr.T.Padmavati2,

Background:
Vaginal Tumors Are Rare And Include Papilloma, Hemangioma, Mucus Polyp, And Rarely Leiomyoma. Vaginal
Leiomyomas Remain An Uncommon Entity With Only About 300 Reported Cases Since The First Detected Case Back In
1733 By Denys De Leyden. These Tumors Arise Most Commonly From The Anterior Vaginal Wall Causing Varied Clinical
Presentations. They May Or May Not Be Associated With Leiomyomas Elsewhere In The Body.

Case:
A Case Of A 30 Year Old Nulliparous Lady Presented With A Cauliflower Like Growth Outside The Introitus Covering The
External Genitalia.It Is A Firm Growth With A Short Pedicle Arising From The Anterior Vaginal Wall Close To The Urethral
Meatus.Biopsy From The Growth Revealed Diffuse Sheets Of Polymorphs,Lymphocytes And Congested
Capillaries.Excision Of The Growth Was Done And The Histopathological Examination Revealed Fibroleiomyoma.
Conclusion:
Leiomyomas Are Common Benign Tumors In The Uterus. However, Vaginal Leiomyomas Remain An Uncommon Entity.
Vaginal Leiomyomas May Present With A Variety Of Clinical Features And May Be Mistaken Preoperatively For Cervical
Fibroid. Surgical Removal Of The Tumor Through Vaginal Approach, Preferably With Urethral Catheterization To Protect
The Urethra During Surgery, With Subsequent Histopathological Examination Is Usually The Treatment Of Choice.

***************

Primigravida With 28 Weeks Of Pregnancy And Large Bilateral Ovarian Cysts

Author: Dr. Lavudiya Lavanya
Co Author: Dr.Rani1, Dr.Vijaya Krishna2, Dr.Radhika Ganesh3,

Background;
Benign Ovarian Tumors Occurs In 1 In 1000 Pregnancies,Ovarian Malignancy Is Reported 1 In 10,000
Pregnancies. Bilateral Ovarian Tumors In Pregnancy Are Very Rare,Only16% Of Ovarian Cysts In Pregnancy Are
Symptomatic Secondary To Torsion, Rupture, Malignancy Especially Borderline Ovarian Tumors Have Been Reported In
Up To 10% Of Cysts That Persists Up To Third Trimeister.
Recommendation For Surgery Includes Acute Abdomen,Ultrasound Features Of Malignancy And Large Cysts[>6Cm]Size
Especially If They Extend In To Pelvis And Are Likely To Cause Obstruction.Weighing The Risks Of Surgery And Anaesthesia
Versus The Risk Of Untreated Adnexal Mass Has Remained Dilemma And No Clear Guidelines Exists Regarding Timing Of
Surgery And Route Of Surgery.
Our Case Is A Very Rare Presentation Of Bilateral Ovarian Tumors In 28 Weeks Of Pregnancy And Helps To Illustrate
The Diagnostic And Management Ailments.
Case Report;
20 Years Old Primigravida At 28 Weeks Of Gestational Age Had Bilateral Ovarian Cysts Diagnosed On
Sonographic Studies. It Was Decided To Operate In View Of Large Size Of The Cyst, Increasing Size Of The Cyst And The
Possibility For Torsion Of Dermoid Cyst. The Patient Underwent Laparotomy And Bilateral Ovarian Cystectomy Under
Spinal Anaesthesia, The Usg Pictures And Surgical Pictures Are Presented Highlighting The Operative Difficulties.The
Perioperative Period Was Uneventful.
Conclusion;
Operative Intervention Is Required With Large Ovarian Cysts To Prevent Complications Of Torsion, Rupture,
Infection, Hemorrhage, Obstruction And Malignant Potential.
***************

Exaggerated Placental Site-A Placental Dilemma

Author: Dr. K Jayakrishnan
Co Author: Niranjana Jayakrishnan1,

Background-Exaggerated Placental Site (Eps) Reaction Is Defined As Exuberant Infiltration Of The Endometrium And
Myometrium At The Implantation Site By Intermediate Trophoblastic Cells. It Is A Relatively Rare, Benign Lesion Related
To Pregnancy. The Diagnosis Of Eps Depends Mainly On Pathologic Findings, And It Should Be Distinguished From
Placental Site Trophoblastic Tumor, Placental Site Nodule And Choriocarcinoma.
Case -We Encountered A Case Of Exaggerated Placental Site (Eps) Reaction Following Evacuation Of A Missed Abortion.
Eps Is A Miscellaneous Trophoblastic Lesion. There Have Been Few Reports Describing Its Clinical Course. We Present The
Findings Of Eps Together With Ultrasound, Hysteroscopic And Histopathological Observations.

***************

Abyss To Resurrection-A Case Of Maternal Collapse

Author: Dr. Asha Anand
Co Author: Hafeez Rahman1,

Background-Maternal Collapse Is An Acute Event Involving The Cardio Respiratory Systems And Or Brain Resulting In A
Reduced Or Absent Conscious Level And Potentially Death At Any Stage Of Pregnancy And Up To 6 Weeks After Delivery.
It Is A Rare Life Threatening Event With A Wide Ranging Etiology. We Are Presenting A Case Of Successful Resuscitation
Of A Woman Who Had A Collapse And Was Diagnosed To Have Amniotic Fluid Embolism.
Case-28 Year Old Second Gravida Who Had An Uncomplicated Antenatal Period Came To Labor Room With Spontaneous
Onset Of Labor Pains. She Had A Spontaneous Vaginal Delivery Of A Healthy Baby Without Augmentation. There Was No
Increased Bleeding After Delivery. Soon After, She Complained Of Discomfort And Collapsed Comatose. Resuscitation
Was Initiated Immediately With Ambu Bag As She Was Not Breathing Spontaneously. She Was Connected To Ventilator
Within 8 Minutes Of Collapse. She Developed Tachycardia And Hypotension And Had To Be Given Inotropic Support. A
Multidisciplinary Team Was Formed For Her Care. Her Aptt Was Prolonged And Trop I Was Negative. Ctpa Of Chest
Revealed Diffuse Opacities. She Had A Seizure Episode But Ct Brain Was Normal. Echocardiography Of Heart Revealed
Global Dyskinesia Of Left Ventricle With Relatively Preserved Right Ventricular Function And Mild Pah. Intra Aortic Balloon
Pump Was Inserted To Improve The Cardiac Function. Her Cardiac And Neurological Parameter Improved And Was
Weaned From Ventilator And Iabp And Is Now Leading A Normal Life.
Conclusion- Amniotic Fluid Embolism Or Severe Anaphylactoid Reaction Of Pregnancy Might Actually Result From
Anaphylaxis To Fetal Material Leaking Into The Maternal Circulation, Which Would Stimulate A Cascade Of Endogenous
Immune Mediators, Resulting In A Reaction Similar To Anaphylaxis. Timely Resuscitation, Multidisciplinary Care And
Routine Use Of Echocardiography In Patient With Afe For Evaluating Hemodynamic Changes Should Be Encouraged.

***************

Rare Site Of Fibroid

Author: Dr. Jayanthi Ravivarma
Co Author:

Background-Rare Case Of Tumour Presented In The Vaginal Wall

Case-45 Year 0Ld Multipara With Bleeding Pv And Mass Desending Pv,Admited For Gartner Cyst ,Cyst Removed . Hpe
Report -Leiomyoma.
Discussion-Vaginal Wall Tumours,Include Pappiloma,Heamangioma,Mucous Polyp,And Rarely Leiomyoma.Vaginal Wall
Tumours By Themselves Are Very Rare With Only 300 Cases Reported.This Is A Rare Casewhich Presented As An Anterior
Vaginal Wall Cyst,Where The Patient Was 45Year Old Multiparous Lady, Symptoms Of Mennoraghia , Mass Desending Pv
Past 2 Years.On Local Examinations There Was A Cyst About15X12Cm Seen In The Anterior Vaginal Wall Just Below The
External Urthral Meatus,Upper Limit Of The Mass Could Not Be Delineated,Lower And Lateral Limit Was Made Out.Cystic
In Consistency,Not Reducible. Cect Shows Mass In The Lower Part Of The Uterus With Variable Echogenicity.Provisional
Diagnosis Of Gartners Cyst Was Made Out.Under Sa The Cyst Was Removed In Toto,And Vaginal Hysterectomy Done,Both
Ovaries Are Normal,Hpe Report Was Leiomyoma With Cystic Degenerations.
***************

Bernard Soulier Syndrome-A Peculiar Platelet Problem In Pregnancy

Author: Dr. Sharanya S
Co Author:

Bernard Soulier Syndrome Is An Inherited Platelet Defect Predominantly Autosomal Recessive. It Manifests As Prolonged
Bleeding Time And Thrombocytopenia With Large Sized Platelets. The Condition Is Rare With An Estimated Prevalence
Of 1 In 10, 00,000 Population. Its Rarity And The Lack Of Fixed Protocol For Its Management Makes It A Challenging
Problem In Pregnancy.

We Present Two Cases Of Bernard Soulier Syndrome Associated With Pregnancy. A Multidisciplinary Team Comprising Of
Haematologist, Obstetrician And Anaesthetist Managed The Pregnancy For A Successful Outcome.

In The First Case, The Patient Had An Uneventful Antepartum Period. She Was Given 3 Units Of Platelets As Prophylaxis
At 38 Weeks. She Underwent An Emergency Lscs For Foetal Distress. She Was Transfused 7 Units Of Platelets And 1 Unit
Of Prbc And The Estimated Blood Loss At Caesarean Section Was 600Cc. She Was Given A Further 3 Units Of Platelets In
The Post Op Period And Her Recovery Was Uneventful.

In The Second Case The Patient Had An Uneventful Antenatal Period And Was Admitted For Delivery. Haematologist
Opinion Was Sought And She Was Transfused 2 Units Of Sdp. Labour Was Induced With 2 Doses Of Pge2 Gel. She Was
Transfused A Further 2 Units Of Sdp Prophylactically To Prevent Any Post-Partum Haemorrhage. Arm Was Done; The
Patient Progressed Satisfactorily In Labour And Delivered Normally A Healthy Female Baby. Patient Was Transfused 2
Units Of Sdp Soon After Delivery. She Had Raised Blood Pressure Which Was Managed Conservatively With
Antihypertensive Agents And Was Discharged On The 5Th Postnatal Day.

Anticipation Of Problems, Planning Of Management And Team Work Helped In The Successful Outcome Of These Two
Patients With Rare Platelet Problem In Pregnancy.

***************

Beware Of Adherent Placenta In All Trimesters !

Author: Dr. Sujata Bhat
Co Author:

Beware Of Adherent Placenta In All Trimesters !

3 Case Reports:

Background :

Adherent Placenta Is Due To A Deficient Decidua Basalis Resulting In Abnormal Invasion Of Placenta Into Myometrium
Leading To The Absence Of A Physiological Plane Of Cleavage For Placenta Separation.
The Risk Of Adherent Placenta Is Raised In Women Who Have Had One Or More Previous Caesarean Deliveries, Other
Uterine Surgeries (E.G. Curettage, Myomectomy ) And Placentaprevia. It Has Also Been Identified In Ivf Pregnancies And
In Women With Advanced Maternal Age ( >35 Year Of Age)

Cases :

Presenting 3 Cases Of Adherent Placenta In 3 Different Trimesters Of Pregnancy. Two Had History Of Curettage
As A Predisposing Factor And One An Unusual Risk Factor Of Advanced Maternal Age In An Unscarred Uterus

The Placenta Was Fundal ( Not Low Lying ) In Both Case 2 And 3.
Case 1 And 2 Had To Undergo Emergency Hysterectomies And Pathology Reports Confirmed The Findings.
The Uterus Could Be Saved In Case 3 As She Was Managed With Uae ( Mri Had Confirmed Placenta Increta)

Conclusion

3 Cases Of Adherent Placenta Occurring In Different Periods Of Pregnancy. Placenta Was Not Low Lying In Any Of The
Cases. No History Of Previous Caesarean Section But Case One And Two Had History Of Curettage. The 3Rd Case An
Elderly Primi With An Unscarred Uterus.

Clinical Relevance

Beware Of Adherent Placenta In Any Trimester.

With More And More Ivf Conceptions And Pregnancies After 35 Years Of Age There Should Be A High Index Of Suspicion
Of Abnormal Placental Invasion In These Patients Cases.
Overall It Would Be Wise To Note Retro Placental Space In Every Case During Obstetric Ultrasound
***************

Recurrent Ruptured Ectopic Pregnancy After Tubal Sterilization- A Case Report

Author: Dr. Bharathi Anjanappa
Co Author: Bharathi A1, Harshini V2, Tejaswini3, Sreelatha. S4, Renuka Ramaiah5

Bharathi A1, Harshini V2, Tejaswini2,Sreelatha S 3

Background: Tubal Sterilization Is Considered As A Permanent Method Of Contraception Because Of Its Low Failure Rate.
The Likelihood Of Ectopic Pregnancy After Sterilization Failure Is High And Account For Over 12% Of All Ectopics.
Case: A 34 Year Gravida 4 ,Para 2, Living 2 : Presented With 6 Weeks Of Amenorrhoea, Acute Lower Abdominal Pain,
Vomiting,Giddiness,Oliguria With Hypotension. She Had History Of Tubal Ligation 11 Yrs Back In A Camp Followed By
Laparoscopic Salphingectomy For Left Ruptured Ectopic Pregnancy 9 Yrs After Sterilization.On Examination, Patient Was
Pale,Restless,With Low Volume Pulse And Hypotension. On Abdominal Examination Distension And Abdominal
Tenderness Was Present. Pv Examination Revealed Rt Fornix Fullness And Tenderness.Ultrasound Revealed Ruptured
Right Ectopic Pregnancy With Hemoperitoneum.Patient Underwent Emergency Laparotomy With Right Salphingectomy
For Ruptured Right Ampullary Ectopic Pregnancy Distal To Previous Ligation With Two Liters Of Haemoperitoneum. She
Received 3 Pints Of Blood. Postoperative Period Was Uneventful. Hpe Confirmed Fallopian Tube With Products Of
Conception Consistent With Ectopic Pregnancy.
Conclusion:Although Ectopic Pregnancy After Tubal Ligation Is Rare, All Women Undergoing This Procedure Should Be
Informed About The Risk. Clinician Should Have High Suspicion Of Ectopic Pregnancy In Any Woman Of Reproductive Age
Group Even Many Years After Sterilization With Or Without Classical Symptoms And Signs Of Ectopic Pregnancy. Timely
Intervention Will Save The Mother.

Key Word: Ectopic Pregnancy, Tubal Sterilization, Laparotomy.

***************

Bilateral Internal Iliac Artery Ligation A Case Series

Author: Dr. Mutum Davison
Co Author: Dr Mutum Davison1, Dr Geeta Doppa2, Dr Ravikanth G O3,

Bilateral Internal Iliac Artery Ligation A Case Series.

Dr.Mutum Davison1, Dr.Geeta Doppa2, Dr.Ravikanth G.O3
Junior Resident1 , Professor And Hod, Department Of Obg2, Assistant Professor, Department Of Obg3.

Background: Pelvic Hemorrhage Is A Life Threatening Complication In Both Gynaecology And Obstetrics Cases And It Has
To Be Controlled Immediately. Bilateral Internal Iliac Artery Ligation (Biial) Is A Time Tested And An Easy Method And It
Achieves This Goal Without Compromising The Rest Of The Pelvic Blood Supply. It Is A Life Saving Procedure Which
Preserves The Reproduction Capacity By Avoiding Hysterectomies In Such Situations. A Comparative Review Of The
Effectiveness Of Biial In Different Situations Is Done And Alternative Modalities Of Treatment Are Considered.
.

Objective: Assessing The Outcome Of Bilateral Internal Iliac Artery Ligation While Controlling The Pelvic Hemorrhages In
The Obstetrics And The Gynaecology Cases.

Material And Method: Consecutive 9 Cases Of Emergency Biial Performed Between Jan 2013 And Aug 2014 In The
Obstetrics And Gynaecology Cases Were Taken For The Study. We Had Observed The Outcome Like Effective Control Of
Hemorrhage And Any Complications Occurred By Biial. The Approach Used To Reach The Internal Iliac Arteries And The
Additional Treatment Required (Eg Hysterectomy) To Control Hemorrhage Was Noted.

Results: In Seven Patients The Pelvic Hemorrhage Was Able To Control Successfully Treated With Biial But In Two Patients
Underwent Obstetric Hysterectomy.Among Which Two Cases Were Traumatic Pph, One Placenta Previa, Three Atonic
Pph Cases,Two Cases Of Wertheim Hysterectomy, One Case Of Primary Hemorrhage From Pedicle During Vaginal
Hysterectomy.

Conclusion: Pelvic Hemorrhage Whether Postpartum Or Related To Uncontrolled Hemorrhage During Pelvic Surgery Is
Associated With A Great Degree Of Morbidity And Mortality And Can Be Controlled With Biial.

Keywords : Postpartum Hemorrhage, Pelvic Hemorrhage, Hysterectomy, Internal Iliac Artery Ligation.

***************

Myometrial Implantation In Caesarean Scar -Is It Rare ?

Author: Dr. Susan William
Co Author: Dr. J.Chithra1, Dr.Jesin Leo Fency2,

Caesarean Scar Pregnancy Is Defined As An Ectopic Pregnancy Embedded In The Myometrium Of A Previous Cesarean
Scar. Develops As A Result Of The Presence Of A Microscopic Tract In The Scar Allowing The Blastocyst To Be Implanted
Deep In The Myometrium. Increased Frequency In Past Years Probably Due To Increased Surgical Intervention.
Case Report : 33 Years Old , P2L2 Previous 2 Lscs Was Referred To Us With Amenorrhoea Followed By Bleeding And Usg
Report Showing ? Hydatidiform Mole . Patient Was Evaluated And Beta Hcg:- 624.9Miu/Ml. With Prior Evaluation And
Consent Taken Up For Suction Evacuation, Yielded Only Blood Clots. Re- Evaluated With Ct Scan, Showing Heterogenous
Lesion Noted In Anterior Wall Of Uterus In The Lower Part. Patient Was Counselled , With Possible Diagnosis Of ?Scar
Pregnancy, Managed With Hysterectomy . The Hpe Report Was Endometrium Showing Degenerated Products Of
Conception With Extension Of Villi Upto The Serosa.
The Diagnosis Of Ectopic Intramural Pregnancy In A Cesarean Section Scar Is Possible With
Ultrasound And High Level Of Suspicion. Ultrasound Criteria For Diagnosis Of A Scar Pregnancy Would Include Empty
Uterus, Empty Cervical Canal And A Discontinuity On The Anterior Wall Of The Uterus Demonstrated On A Sagittal Plane
Of The Uterus Running Through The Gestational Sac. This Serious Complication Must Be Suspected When The Above
Criteria Are Seen In A Pregnant Woman With Previous Uterine Scar. Bleeding, Rupture Of Uterus, Adherent Placenta Are
Some Of The Possible Complications That May Endanger The Woman'S Life. Early Diagnosis Is Possible With High Level
Of Suspicion And With The Aid Of High Quality Ultrasound Scanning.

***************

Challenges In The Management Of Cardiac Arrthythmias Complicating Pregnancy

Author: Dr. Sonia Sehrawat
Co Author: Dr.Rajini Uday1,

Cardiac Arrhythmias In Pregnancy Can Occur De Novo Or Can Be Exacerbated By Pregnant State. Hyperdynamic
State(Increased Cardiac Output ,Increased Cardiac Contractility) And Altered Hormonal And Autonomic Milieu In
Pregnancy Can Promote Arrthythmogenesis.The Presence Of Underlying Heart Disease,Particularly Congenital Heart
Disease Is An Important Risk Factor.Incidence-4.5% In Women With Congenital Heart Disease And 1% In Women With
Recognised
Heart
Disease.
Increasing
Age
At
Pregnancy
,With
Associated
Diseases
Like
Diabetes,Hypertension,Atherosclerosis,Vascular Heart Diseases Are Contributing Risk Factors.They Present With
Symptoms Like Palpitations,Chestpain,Giddiness,Syncope And Breathlessness.Ecg And Echo Are Required To Rule Out
Structural Abnormalities.Hereby We Present 3 Interesting Cases.
Mrs.P,Aged 23 Years, Primigravida,Presented At 33 Weeks Pog With Breathlessness Since 1 Month,Recently Recognised
To Have Severe Mr With Pah. Echo Done Showed Severe Mr With Noncoaptating Mitral Leaflets With Severe
Pah.Cardiology Opinion Was Taken And Started On Heparin And Acitrom.Continuous Cardiac Monitoring Was
Done.Taken Up For Emergency Lscs Under High Cardiac Risk.Postoperatively Patient Shifted To Micu In View Of
Breathlessness And Palpitations-Severe Mr With Pah With Atrial Fibrillations.Was Put On Simv Mode Of
Ventilation.Constant Cardiac Monitoring Was Done.Extubated After 1 Day.No Further Complications Were Noted.
Mrs.U,Aged 29 Years,G3P2L1A1,37+4 Weeks Pog With C/O Palpitations Since 1Day.K/C/O Asd Diagnosed At 7 Months
When Evaluated For Palpitations.Ecg Was Done Which Showed Atrial Flutter With Tachycardia,Reverted With
Diltiazem.Continued On Sotalol And Verapamil.Inj.Amiodarone Started.Ie Prophylaxis Given And Taken Up For Lscs With
Bat With High Cardiac Risk.Constant Cardiac Monitoring Done.Discharged On Pod5.
Mrs.G, A Known Case Of Ms With Mr,.During Hospital Stay She Developed Tachycardia F/B Arrthymias.Termination Was
Advised In View Of The Cardiac Condition By Cardiologists.
Finally Prognosis Depends On Underlying Heart Disease, Degree Of Hemodynamic Compromise And The Speed With
Which Treatment Is Delivered.

***************

Primary Malignant Melanoma Of Vagina : A Rare And Aggressive Case

Author: Dr. Naheed Zia Khan
Co Author: Prof A.D. Dwivedi Md1, Prof Vivek Gupta Md2, Dr Shamima Bano Md3, Prof Madhu Srivastava Md4,

Case -Our Patient Is A 25 Years, Para 4+0, Lactating Since 5 Months Presented With Abnormal Vaginal Bleeding And A
Mass In The Perineum Since Last 5 Month.
On Examination There Was A 5X4 Cm Polypoidal, Nonulcerated Growth Arising From Lower 1/3 Of The Posterior Vaginal
Wall, 2 Cm From The Fourchette And Well Away From Cervix, Labia And Urethra. There Was No Change In Colour Of
Vagina And Or Vulva. Uterus Was Normal In Size Mobile With Free Adnexa Without Any Palpable Lymphadenopathy.
Routine Blood Tests And Imaging Was Normal. She Underwent A Wide Local Excision Of The Lesion Which Revealed
Vaginal Malignant Melanoma With No Clear Surgical Margins. The Histologic Diagnosis Was Confirmed By Positive
Immunochemistry Staining With Hmb-45. The Final Diagnosis Was Vaginal Primary Malignant Melanoma With No Clear
Surgical Margin. Patient Denied Any Additional Surgical Interventions And Was Lost To Follow Up For 6 Weeks, When She
Came Back With Pain In Left Inguinal Area With Enlarged Left Inguinal Lymph Node. Her Vaginal Examination Revealed
Healing Of The Wound Site With Induration. Her Metastatic Workup In The Form Of Computerized Tomography (Ct)
Chest, Abdomen Was Normal. Ct Pelvis Showed Involvement Of Left Inguinal And External Iliac Lymph Nodes Which Was
Confirmed By Fnac. Patient Was Treated With External Beam Radiotherapy With Palliative Intent To The Tumour Bed.
The Patient Is Doing Well At 6 Month Of Follow Up
Conclusion - Vaginal Melanoma Is A Very Aggressive Tumour With A Very Poor Prognosis Despite The Various Treatment
Modalities, Because Most Of The Patients Are Diagnosed At Late Stage. As In Our Case Patient Was Noncompliant She
Had Pelvic Metastasis And Receiving Palliative Radiotherapy.
***************

Catch Them In Perimenopause ,Will Be Stronger In Post Menopause,Will Reduce Fracture Risk !
Author: Dr. Rajendrasing Pardesi
Co Author: Dr.Kalpana Pardeshi1, Dr.Ajay Mane2, Dr.Laxmi Rachkonda.3, Dr.Swati Shiradkar.4,

Catch Them In Perimenopause ,Will Be Stronger In Post Menopause,Will Reduce Fracture Risk !
1Dr.Rajendrasing Pardeshi.
Shiradkar

2Dr.Kalpana Pardeshi .

3Dr.Ajay Mane. 4Dr.Laxmi Rachkonda 5Dr.Swati

1 & 2 & 3 Jijai Menopause & Osteoporosis Management Centre,

12-Chaitanya Chs, Near Gajanan Maharaj Temple,
Garkheda, Aurangabad.(Maharashtra)431005
Email: Varadsing@Yahoo.Co.In
4 &5 Mgm Medical College, N-6, Cidco, Aurangabad (Maharashtra) 431005
Aims & Objectives: To Evaluate Bone Health Status In Perimenopause & Their Impact On Postmenopausal Status & Hence
To Diagnose,Prevention & Management Options.
Material & Methods:We Studied The Effect Of Perimenopausal Status And Risk Factors On Lumbar Bone, Hip Bones &
Radial Bone Mineral Densisty (Bmd) In 32 Women Of 4047 Years Of Age, Oligoamenorric & Perimenopausal. Family
History Of Osteoporosis, Reproductive History, Menopausal Status, Calcium Intake, Amount Of Physical Activity And The
Consumption Of Tobacco And Alcohol Were Assessed.Serum Estradiol, Fsh, Calcium & Bmd With Dexa (Ge) Done .
Excluded The Causes Of Secondary Osteoporosis.
Results: Serum Fhs Was Increased Or Slightly Raised In Cases,Estradiol Was Reduced Or On Lower Limit In Cases Or
Normal .Bmd Was Osteopenic ,Osteoporotic Or On Lower Side In Some Cases But Was Inadequate As Per Their
Age.Lumbar Bmd & Hip Bmd Affected More Than Radial.
Conclusion: The Prevalence Of Osteopenia In Our Study Was Found To Be High In Perimenopausal Women. There Was A
Significant Positive Correlation Between Increasing Age, Bmi, Low Calcium Intake, Lack Of Exercise, And Low Bmd. Thus,
High Prevalence Of Osteopenia In Perimenopausal Women Is A Major Health Concern, Which We Can Prevent At This
Age Hence To Prevent Osteoporosis In Future.

***************

Chronic Nonpuerperal Inversion Of Uterus

Author: Dr. Monali Deshmukh
Co Author: Dr.P.S.Junghare1,

Chronic Nonpuerperal Inversion Of Uterus

Dr.M.P.Deshmukh*, Dr.P.S.Junghare**

Abstract

Introduction: Chronic Nonpuerperal Inversion Of Uterus Is Rare.

Case Presentation: A 60 Year Old Indian Female Presented To The Out Patient Department Of Our Hospital With
Bleeding Per Vaginum Since Last One Day , Which Was Sudden In Onset. Evaluation Under Anesthesia Was Conducted
And Was Diagnosed As Chronic Inversion Of Uterus. After An Unsuccessful Attempt Of Reduction, Laprotomy Was
Done. Findings Of Inverted Uterus Were Confirmed On Laprotomy And She Subsequently Underwent A Total Abdominal
Hysterctomy With B/L Salpingoophorectomy Under Spinal Anesthesia.

Conclusion: In The Presence Of A Tumor Protruding From Vagina Or Vulva, We Must Consider Uterine Inversion.
Nonpuerperal Uterine Inversion May Be Due To Malignancies, Therefore Preoperative Diagnosis Especially In Chronic
Uterine Inversion Would Aid In Planning Proper Treatment.

*Resident, ** Professor And Hod.

***************

Collision Tumor Of Ovary

Author: Dr. Porkkodi Panneerselvam
Co Author: Sunitha Samal1,

Collision Tumors Of Ovary: A Rare Phenomenon

Background:
Ovarian Collision Tumors Are Rare Entities And Represent A Coexistence Of Two Adjacent But Histologically Distinct
Tumors, Without Histologic Admixture In An Organ. It Most Commonly Consist Of A Benign Mature Ovarian Teratoma
And An Ovarian Cystadenoma Or Cystadenocarcinoma, But Other Histologic Combinations Have Been Also Reported With
The Mechanism Of Origin Still Uncertain.
Case:
A 17Yr Old Yr Girl Presented To Our Out Patient Department With A Complain Of Mass Lower Abdomen Associated With
Pain For 5 To 6 Months. Her Menstrual Cycle, Past Medical And Surgical History Was Uneventful. On Abdominal
Examination There Was A Mass Of 24Wk Size In Lower Abdomen Which Was Cystic In Nature , Nontender And With
Restricted Mobility .Ultrasonography And Ct Scan Both Revealed A Unilocular Cystic Mass Of 15*12Cm With Solid
Component In Left Ovary And Contralateral Ovary And Uterus Was Normal. All Tumor Markers Were Within Normal
Limit. Patient Underwent Laparotomy Which Showed A Left Ovarian Cyst Of 15*15 Cm Without Any Free Fluid In
Peritoneal Cavity And Contralateral Ovary ,Tube And Uterus Was Normal. Left Ovarian Cystectomy Was Performed. On
Cut Section There Was Presence Of Serous Fluid And One Locule Of 4*5Cm Contained Hair With Sebaceous Material. The
Specimen Was Sent For Histopathological Study Which Confirmed It To Be A Collision Tumor Containing Both Serous
Cystadenoma And Dermoid Cyst.
Conclusion: Though Collision Tumors Have Been Reported In Various Organs, Its Occurance In Ovary Is A Rare Entity And
Combination Of Serous Cystadenoma With Teratoma Is Rarer.
Author-Porkkodi , Sunita

***************

Prenatal Diagnosis Of Cdh In Second Trimester With Successful Perinatal Outcome

Author: Dr. Deepthi Ravindranath
Co Author: Dr.Pushpalatha1, Dr.Vasantha2,

Congenital Diaphragmatic Hernia Is A Developmental Discontuinity Of The Diaphragm That Allows Abdominal Viscera To
Herniate Into Thorax Resulting In Pulmonary Hypoplasia And Pulmonary Hypertension Which Are Most Often Fatal.It
Occurs In Approximately 1 In 2200 Pregnancies And Accounts For 8% Of All Major Congenital Anomalies With High
Mortality Rate Of 45%.Its Prognosis Is Dependent On Factors Like Gestational Age At Onset Of Herniation,Associated
Chromosomal Abnormalities/Congenital Defects,Delivery At Tertiary Care Centre With Multidisciplinary Approach,Etc.
Here We Report A Case Of 22 Years Old Prima Gravida Diagnosed At 23Weeks With Fetal Cdh With Migration Of Stomach
And Bowel Loops Into The Thorax Compressing And Displacing Heart Contralaterally,Patient After Multidisciplinary
Counselling Decided On Continuing Her Pregnancy.She Was Electively Induced And Delivered Vaginally At 35 Weeks And
6 Days Of Gestation In View Of Iugr With Doppler Changes.Baby Was Electively Intubated At Birth And Was Managed By
The Neonatal Team.Baby Underwent Successful Laproscopic Hernia Repair On 12Th Postnatal Day And Baby Was
Discharged On Day 28 Of Birth.Now He Is One Year And One Month Old,Alive And Healthy.
***************

Rare Congenital Anamoly -Cyclops

Author: Dr. Ch Pg
Co Author:

Cyclops[One Eye Monster]A Case Report From Kurnool Medical College-Kurnool

Dr.Hasini (P.G), Guide: Dr.S.Manikya Rao Associate Professor
Abstract:
Background:
Cyclops Or Monster Is A Rare Congenital Abnormality. Incidence 1 In 13000 Live Births Or 1 In 2,500 That End Up In
Miscarriage.
Severe Form Results In Children Being Born With Just One Eye Or Synophthalmia In Which Two Globes (Right And Left)
Are Partially Fused In Median Position. Typically Cyclopia Presents With Nose Either Missing Or Replaced With NonFunctioning Nose In The Form Of A Proboscis.
We Report A Case Of Cyclopia In Kurnool Medical College, Kurnool.
Case Report:
A 28 Yrs Old Female G2P1L1, With Prior Cesearian Section Had One Antenatal Check Up At 5 Months Later
She Was Lost To Follow Up. At 5 Months Gestation Ultrasound Revealed Microcephaly .She Had H/O Unknown Herb
Ingestion In First Trimester For Vomiting .H/0 Consanguity Was Noted. At 28Wks Of Gestation She Spontaneously
Delivered A Still Born Baby Prematurely By Normal Vaginal Delivery With Birth Weight Of 1.25 Kgs.
Multiple Congenital Abnormalities Were Apparent At Birth With Single Centrally Located Eye, Absence Of Nose In Normal
Position And Replaced By Proboscis Above Eye. Mouth Presenting As Only Slit Without An Opening. Underdeveloped
Genitalia Representing As A Phallus.
Conclusion:
Cyclops Deformities Have Been Recognised For Centuries Mentioned In Greek Mythology. Multifactorial Theory Has Been
Proposed For Cyclopia Development. It Usually Has Multiple Congenital Anomalies Which Is Incompatable With Life So
Many Are Still Born.
It Is A Rare Anomaly Which One May Never Have An Opportunity In A Lifetime To Witness.
***************

Difficult Second Stage Deliveries: Retrospective Study In A Secondary Care Centre

Author: Dr. Nagapriyanka Alluri
Co Author: Dr.Shashikala1, Dr.Parvati Bhat2, Dr.Krupa Shah3, Dr.Asha Kamath4,

Difficult Second Stage Deliveries: Retrospective Study In A Secondary Care Centre

Priyanka Alluri, Shashikala Bhat, Parvati Bhat, Krupa Shah, Asha Kamath

Aim : To Study The Maternal And Perinatal Outcomes In Difficult Second Stage Deliveries.

Material And Methods : A Retrospective Observational Study Was Conducted From January 2011 To June 2014 In Dr.Tma
Pai Hospital, Udupi, Which Is A Secondary Care Centre Under Manipal University. Data Collection Was Done After
Retrieving The Files Of Difficult Second Stage Deliveries. Maternal And Perinatal Outcomes Were Noted And Statistical
Analysis Was Done Using Spss V16.

Results : Of The 4749 Total Deliveries From January 2011 To June 2014 In Our Hospital, There Were 218 (4.5%) Difficult
Second Stage Deliveries. Among Them, 189 (86.7%) Were Assisted Vaginal Deliveries And The Remaining 29 (13.3%) Were
Second Stage Emergency Cesarean Deliveries. 122 (64.5%) Of The Assisted Vaginal Deliveries Were By Forceps Application
And 67 (35.5%) Were Vacuum Assisted Deliveries. There Were 85 (69.6%) Outlet Forceps And 37 (30.3%) Were Low
Forceps Deliveries. Most Common Indication Observed Was Poor Maternal Effort, Followed By Non-Reassuring Fetal
Heart Pattern And Arrest Of Descent. Common Maternal Complications Noted Were Vaginal Lacerations And Perineal
Tears In 4.5% And Traumatic Post Partum Hemorrhage In 4.5% Of Difficult Second Stage Deliveries. Use Of Forceps Was
More Likely To Result In Vaginal Delivery But Was Associated With More Vaginal And Perineal Tears And Lacerations
Compared To Vacuum. Perinatal Complications Included 13 Neonates With Low Apgar Scores And 2 Perinatal Deaths.

Conclusion : Careful Antepartum And Intrapartum Management Cannot Always Predict Difficulties In Second Stage Of
Labour. Periodic Simulation Drills Should Be Conducted To Facilitate Better Decision-Making Regarding Patient Selection
And Choice Of Mode Of Delivery, Improve Teamwork Readiness, Enhance Communication Skills And Train The Residents
In The Art Of Using Instruments, Especially Obstetric Forceps.

***************

Case Report- Unusual Case Of Dermoid Cyst With Twisted Mucinous Cystadenoma
Author: Dr. Pragati Trigunait
Co Author:

Dr. Pragati Trigunait Case Report- Unusual Case Of Dermoid Cyst With Twisted Mucinous Cystadenoma
S.M.S Medical College, Jaipur
Abstract: This Is A Unusual Case Of Twisted Mucinous Cystadenoma In Right Ovary With Dermoid Cyst In Left Ovary. A 20
Year Old Girl Presented With Sudden Onset Left Flank Pain. A Large Mass Noted In Pelvis And Abdomen Of Approximately
22 Weeks Gestation.
Usg Showed- Left Adnexae-65X45 Mm Cystic Leision With Floating Echoes- ?? Dermoid
Right Adnexae- 108X64 Mm Multiloculated Cyst With Internal Septation-?? Nature
Ct-Scan Showed Bilateral Ovarian Masses
Pateint Had Negative Cytological Findings On Vaginal/ Cervical Smear.
Ca-125 Level Is 28.7Iu/Ml, B-Hcg, A-Fetoprotein Level Was Also Normal
Pateint Underwent Laprotomy With Left Sided Cystectomy And Right Sided Removal Of Twisted Ovarian Cyst With
Ovarian Conservation Approach.
On Histopathological Examination Showed Mature Cystic Teratoma Of Left Side With Skin,Suncutaneous Tissue And Hair
Tuft
Right Sided Mass Showed Areas Oh Haemmorhage With Necrosis Along With Multiloculated Cysts Filled With Mucinous
Secretion Suggestive Of Mucinous Cystadenoma.

***************

Abdominal Ectopic Pregnancy: A Rare Case Report

Author: Dr. Nitin Kshirsagar
Co Author: Dr Nitin Kshirsagar1, Dr Rita Nayak2,

Dr.Nitin Kshirsagar : Professor Obgy Department,Kims , Karad.

Dr. Rita Nayak: Pg Student At Kims Karad
Abstract:
Background:
Abdominal Pregnancy Is An Extremely Rare And Serious Form Of Extrauterine Gestation .Abdominal Pregnancies
Account For Almost1% Of Ectopic Pregnancies .It Has Reported Incidence Of1 In 22,000 To 1 In 10,200 Of All Pregnancies.
The Gestational Sac Is Implanted Outside The Uterus, Ovaries, And Fallopian Tubes. The Maternal Mortality Rate Can Be
As High As 20%. This Is Primarily Because Of The Risk Of Massive Hemorrhage From Partial Or Total Placental
Separation.The Placenta Can Be Attached To The Uterine Wall, Bowel, Mesentery, Liver, Spleen, Bladder And Ligaments.
It Can Be Detach At Any Time During Pregnancy Leading To Torrential Blood Loss.
Case:
The Patient Was A 26-Year-Old Woman, Gravida 4 Para 3 With A Vaginal Delivery 6 Years Prior,Followed By Tubal
Ligation 2Yr Back.She Was Referred With History Of 2Month Amenorrhea With Acute Pain In The Lower Abdomen And
Minimal Vaginal Bleeding.Patient Was Heamodynamically Stable.Laboratory Parameters Were , With A Hb Concentration
Of 5.3 G/Dl.A Transabdominal Ultrasound Examination Demonstrated Live Primary Abdominal Ectopic Pregnancy Of
10Wk Forming Adenexal Mass In Upper Pelvis With Hemoperitoneum Of 4Liters.

Under General Anesthesia, A Laparotomy Was Performed And A Severe Amount Of Intra-Abdominal
Hemoperitoneaum Was Evident And Fetus Was Adhered To The Right Abdominal Sidewall. Bilateral Salphingectomy
Was Done,Placenta Removed.Bloood Was Transfused Intraoperatively ,Patient Was Discharged On 7Th Post Operative
Day.

Conclusion: Ultrasonography A Useful Tool To Diagnose And Confirm Abdominal Pregnancy,Important For Timely
Intervention For Minimize Maternal Mortality And Morbidity.

***************

Dilemma In Diagnosis Of Ectopic Pregnancy - A Rare Case Of Ectopic Pregnancy In Rudimentary Horn
Author: Dr. Srividya Raparthy
Co Author:

Dr.Srividya, Dr.Shoba, Dr.Rajani- Gandhi Medical College, Secundrabad

Introduction
Ectopic Pregnancy Is A One In Which Fertilized Egg Implanted Outside The Uterus. Pregnancy In Rudimentary Horn Is
Rare Carries Grave Consequences For Both Mother And Fetus. Incomplete Development Of One Mullerian Duct Result In
Rudimentary Horn. Incidence: 1 In 76,000 To 1 In 1, 50,000.

Case Details
22Yr Primi 6 Wks Amenorrhea Referred In View Of Ectopic Pregnancy Gandhi Hospital With Complaint Of Spotting Vagina
10 Days, Pain In The Lower Abdomen 1 Week. Patient Stable Except Pallor, Tenderness In Rt. Iliac Fossa. Uterus Ns Av
Soft, Cervical Movement Tender, Rt. Fornix Full, On Usg There Gestational Sac 2.1Cms With Fetal Node In Rt. Adnexa
Without Fetal Cardiac Activity Which Corresponds To 6 Weeks. Rt.Ovary Not Visualized, Left Tube & Ovary Was Normal.
No Free Fluid In Pod. Planned For Medical Management As Beta Hcg Was About 31,379Miu/Ml Which Corresponds To 6
Weeks Iul. Reviewed The Diagnosis Of Iup, Heterotrophic Pregnancy, Pregnancy In Rudimentary Horn, Ectopic Molar.
Rescan Done To Confirm Diagnosis. Emergency Laporotomy Done There Was Ruptured Ectopic Pregnancy Rudimentary
Horn Rt. Side & Hemoperitonium Of About 200 Ml.

Discussion
Pregnancy In Rudimentary Horn Occurs Through Transperitoneal Migration Of Sperm Or Fertilized Ovum. 83%
Rudimentary Horn Is Non Communicating. Diagnosis Prior To Rupture Is Unusual Can Be Made By Usg Mri. Tsafrir Etal
Outlined Criteria For Diagnosis Of Ep In Rudimentary Horn.
1- Pseudo Pattern Of Asymmetrical Bicornuate Uterus.
2- Absent Visual Continuity Tissue Surrounding The Gestational Sac &The Uterine Cervix.
3- Presence Of Myometrial Tissue Surrounding The Gestational Sac.
Usual Outcome Is Rupture Occur In Second Trimester 90 % Cases.

Conclusion
ItS Recommended That Immediate Surgery Must Be Done Even Before Rupture.
There Is Need For Increased Awareness Of This Rare Condition & Have High Index Of Suspicion.

***************

A Case Of Eisenmengers Syndrome With Pregnancy

Author: Dr. Deepika Upadhyayula
Co Author:

Eisenmengers Syndrome Is A Large Communication Between Systemic And Pulmonary Circuits. Pregnancy In
Eisenmengers Carry 50%Mortality Risk And Hence Ideally Avoided.
Here Is Case Of 33Yrs Old G6A5 Presented At 12Weeks Gestation.Started On Sildenafil In View Of Severe Pah .Admitted
At 31Weeks Of Gestation With Iud
.Lscs Done Under Epidural Anaesthesia .Intraoperative Period Uneventful.2Hrs Post Operatively Patient Develeped Pph
Managed With Uterotonics Blood And Blood Products But Unsuccesful.Peripartum Hysterectomy Done . Patient
Developed Dic Which Was Irreversable She Succumbed With In 12Hrs Of Lscs.
Thus Eisenmengers Carries A High Perinatal An Maternal Mortality.
***************

Emergency Obstetric Care (Emoc): Complications Of Pregnancy And Labour At A Tertiary Care Centre
Author: Dr. Haritha Sagili
Co Author:

Emergency Obstetric Care (Emoc): Complications Of Pregnancy And Labour At A Tertiary Care Centre
Haritha Sagili & Papa Dasari
Dept Of Obgy, Jipmer, Puducherry. India.

Background: Complications Arising During Pregnancy And Child Birth Are The Main Causes Of Maternal Morbidity And
Mortality. It Is Estimated That Worldwide Twenty Three Million Pregnant Women Develop Complications And 6, 00,000
Women Die Due To Pregnancy Related Complications. When A Woman Is In Good Health During Antenatal Period, There
Is No Way To Know Whether She Develops Complications And Requires Emoc.

Aim& Objectives: To Find Out The Complications That Are Commonly Encountered In Pregnant Women Seeking Emoc At
A Tertiary Care Hospital.

Materials & Methods: This Study Was Carried Out In Jipmer, A Tertiary Care Centre In South India. Retrospective Analysis
Of Monthly Statistical Reports Of The Department For A Period Of One Year (June 2012 To May 2013) Was Carried Out.
The Proportion Of Patients With Medical Disorders And Obstetrical Complications Were Determined.

Results: The Total Number Of Deliveries Were 12,859. Of These, 54.5% Of Women Suffered From Medical Disorders And
27.6% Had Obstetrical Complications. The Life-Threatening Complications Contributed To 11.34%. The Emergency Cs Rate
Was 16.5% .The Maternal Mortality Rate Was 196/100,000 Live Births And The Pnmr Was 71/1000 Births.

Conclusion: More Than 50% Of The Pregnant Population Utilizing Emoc Services Of Jipmer Had Medical Complications,
One Quarter Had Obstetrical Complications And The Maternal Mortality Is Low When Compared To The National Average.
It Is Essential To Know The Complications That Arise In A Pregnant Population Seeking Emoc Services So As To Increase
The Efficiency Of Services By Targeting The Particular Complications.

***************

Fuel Mediated Teratogenicity-Pregestational Diabetes And Caudal Regression Syndrome

Author: Dr. Bhavya Yr
Co Author: Dr.Bhavya.Y.R1, Dr.Radhika2,

Fuel Mediated Teratogenicity - Pregestational Diabetes And Caudal Regression Syndrome

Back Ground:Caudal Regression Syndrome Is A Rare Sporadic Neural Tube Defect, Characterized By Incomplete
Development Of Terminal Spinal Segment. It Is Rare Congenital Anomaly With Incidence Of Approximately 1:60,000 Live
Births. It Is Classical Diabetic Embryopathy With Incidence Of 1.3 Per 1000 Diabetic Pregnancies. Hba1C >10% Experience
Rates Of Congenital Anomalies As High As 20%-25%.
Case: Mrs X G3P2L1 With 6 Months Of Amenorrhoea, Referred In View Of Anomalous Fetus. Obstetric History:Non
Consanguinous Marriage.
1St Pregnancy-Iud At 8Th Month, Vaginal Delivery.
2Nd Pregnancy-Emergency Lscs, Female Baby, 3.5 Kg, 5 Yrs Back Now Active And Healthy. Had Gestational Diabetes
Mellitus At 2Nd Month And Started On Insulin. Postpartum Diagnosed As Type 2Diabetes Mellitus And Put On Insulin,
She
Was
Not
On
Regular
Treatment
Because
Of
Financial
Constraints.
3Rd Pregnancy- Unbooked.
Bmi-30.5Kg/M2, Uterus 24 Weeks
Size.
Obstetric Ultrasound- Single Live Foetus Of 21-22 Weeks Gestation
With Absent Lumbar And Sacrococcygeal Vertebral Segments, Horse Shoe Kidney.
Fbs186Mg/Dl, Ppbs-275Mg/Dl, Hba1C-9.7
Managed With Injection Insulin 20-012, FoleyS With Misoprostol Induction Done.
Fetus Expelled Had Defect In Lower Half Of
Body, Sacral Agenesis With Imperforate Anus. Taking Into Consideration The Diabetic History Of Mother, Caudal
Regression Syndrome Was Suspected And Diagnosis Confirmed By Taking An X-Ray.
Conclusion:India Being worldS Diabetic Capital Has Shown Increasing Prevalence Of Diabetes Mellitus In
General And In Younger People In Particular And Has Lead To An Increasing Number Of High Risk Pregnancies With The
Complication Of Pregestational Diabetes.Periconceptional Counseling With Effective Contraception Should Be Offered
To Delay Conception Until Diabetic Control Is Optimized. Caudal Regression Syndrome Being One Of The Rare And
Classical Embryopathy Associated With Type 2 Diabetes Can Be Prevented By Control Of Blood Sugar Levels
Periconceptionally As It Always Goes prevention Is Better Than Cure.
***************

A Rarest, Lower Segment Deeply Invading Partial Mole Necessitating Hysterectomy

Author: Dr. Priyanka Singh
Co Author:

Gestational Trophoblastic DiseaseS Spectrum Varies From Benign To Malignant Disease. More Than 80% Of
Hydatidiform Moles Are Benign. In 10 To 15% Of Hydatidiform Moles May Develop Into Invasive Moles. Partial Moles Are
Less Virulent Form Of Molar Pregnancies, Having Malignant Sequelae Varing From 4% To 14.5% .We Report An
Extraordinarily Rare Case Of A Partial Molar Pregnancy In The Lower Uterine Segment, Attached To The Scar Of Lscs And
Invading Deeply Into It. During Standard Therapy Of Suction Evacuation Torrential Haemorrhage Ensued And Products
Remained Densely Adherent To Lower Segment. Life-Saving Obstetrical Hysterectomy Had To Be Done.
Case History: A 25 Year Old Lady, G4P1L1A2, Had One Living Issue Born By Lower Segment Caesarean, Presented With
2.5 Months Amenorrhea With Pain And Bleeding Per Vaginum. Ultrasound Scan Revealed A Partial Hydatidiform Mole Of
11Wks And She Was Posted For Suction And Evacuation. Suction Evacuation Resulted In Torrential Bleeding. Measures
To Achieve Hemostasis Such As Bi-Manual Compression And Uterotonics Were Aggressively Attempted, To No Avail. It
Was Felt That The Products Are Adherent To The Uterine Wall. A Decision For Emergency Exploratory Laparotomy Was
Taken. In Situ, A Mole In The Lower Segment, Attached To The Previous Scar And Deeply Invading The Myometrium Was
Seen. As There Was No Possibility Of Evacuating This Invading Monster, And The Patient Was Exsanguinating
Rapidly, A Life-Saving Obstetric Hysterectomy Had To Be Done After Obtaining Consent. Requisite Blood Was Replaced.
Histopathology Confirmed The Diagnosis Of A Deeply Invasive, Lower Segment Molar Pregnancy. Patient Is Following Up
Regularly. Beta-Hcg Levels Repeated Fortnightly Are Showing A Steady Decline. Patient Remains Symptomatically
Comfortable Except For Some Difficulty In Accepting The Loss Of Her Child Bearing Ability.
Keywords: Invasive Partial Mole, Lower Segment Scar

***************

Ruptured Heterotopic Pregnancy Occuring In Natural Cycle, With History Of Previous Ectopic Pregnancy.
Author: Dr. Anusha Shivanna
Co Author: Dr.R.C.Prameela1, Dr.Mamatha2,

Heterotopic Pregnancy (Hp) Is Defined As Simultaneous Development Of An Intra-Uterine Pregnancy And Ectopic
Pregnancy. It Was First Reported In 1761 After An Autopsy. Its Incidence Varies Between 1 For 10,000 And 1 For 30,000
Pregnancies Under Natural Circumstances. It Is A Very Rare Event In Natural Cycle. However There Is An Increase In The
Incidence Of Hp With The Increasing Popularity Of Ovulation Induction Performed During Assisted Reproductive
Techniques. Extensive Search Of Literature Revealed Very Few Cases Of Heterotopic Pregnancy Occuring In Natural Cycle
Presenting With Acute Abdominal Pain.
We Here Present A Case Of Heterotopic Pregnancy With Ruptured Ectopic In A Spontaneous Conception, In A 19 Year Old
Female, Gravida2, With History Of Previous Left Sided Tubal Ectopic Pregnancy Two Years Ago, For Which She Had
Underwent Laparotomy And Left Sided Salphingectomy. In The Present Pregnancy, She Had An Intrauterine Gestation Of
9 Weeks And Ruptured Ectopic Of The Left Tubal Stump. She Was Managed Surgically. She Then Continued With Her
Intrauterine Pregnancy And Delivered A Healthy Baby Vaginally.
Previous Tubal Damage, Ectopic Pregnancy, Sexually Transmitted Infection, Intrauterine Device, Smoking, Hormonal
Contraception, Pelvic Surgery And Assisted Reproduction Techniques Are The Risk Factors For Heterotopic Pregnancy.
Intrauterine Pregnancy With Hemorrhagic Corpus Luteum Can Simulate Heterotopic Pregnancy Or Ectopic Gestation Both
Clinically And On Sonography. Even Though It Is Rare, Its Diagnosis Should Be Considered In Appropriate Scenarios And
Timely Intervention Can Prevent Maternal Morbidity And Mortality And Lead To Successful Continuation Of Intrauterine
Gestation Leading To The Birth Of Live Healthy Baby.

***************

Hiv Health Education And Pptct

Author: Dr. Ramani Anishetty
Co Author: Dr.M.Anitha1,

Hiv Is A Pandemic Disease, Present Over A Large Area, Spreading. About 2.39(2012) Million People Living With Hiv In
India,With Adult Prevalence- 0.31% , Women- 39% , Children-4.4%.Women Tested Annually (Pptct) Increased From 0.8
Million To 8.83 Million.
Mother To Child Transmission Of Hiv- Major Route Of Infection In Children. Out Of 27 Million
Pregnancies A Year, 52.7% Attended Health Services.Of Which 8.56 Million Anw Received Hiv Councelling And Found
12,551 Of Them Positive. To Enhance The Programme ,Nacp And Nrhm Were Clubbed In July 2010.
The Risk Of Transmission Of Hiv From Mother To Baby Is 25-40% Without Any Intervention.
Use Of Art Can Reduce Transmission To 10 %.

Early Initiation Art Will Not Only Improve Survival Rate, But Also Helps In Reduction In Mother To Child
Transmission.

Women With Advanced Hiv Infection , Accounts For More Than 75% Of All Hiv Among Children.

Arv Prophylaxis In Early Pregnancy Reduces Hiv Transmission.

Extended Prophylaxis To Mothers And Infants During Breastfeeding Prevents Transmission.

Updated National Guideline Helps In Achieving Goal By Reducing Transmission From Mother To Child, New Pediatric Hiv
Infections, Hiv Free Child Survival Which Can Reduce Risk To Less Than 5% In Breast Feeding Population.
Overall Goals Of Pptct Programme- Who Standards-Prong 1- Primary Prevention Of Hiv- Women Of Child Bearing Age.
Prong 2- Preventing Unintended Pregnancies - Women Living With Hiv
Prong 3- Prevent Hiv Transmission From Mother To Child
Prong 4- Provide Care ,Support And Treatment To Women With Hiv, 6 Children And Family.
Public Health Approach Provides Services To Women And Children To Ensure Quality Pptct Services.
Goals In India1.Primary Prevention Of Hiv - Women In Child Bearing Age
2.Integration Of Pptct Interventions With Health Services.
3.Strengthening Of Postnatal Care.
4.Provide The Essential Package.

***************

Hyperemesis Gravidarum A New Nemesis Convulsing Pregnant Mothers?

Author: Dr. Nandini Nair
Co Author: Dr.Usha Rani .G1, Dr . Syamala .O2, Dr . Rukshana3, Dr Sangeetha4,

Hyperemesis Gravidarum Is The Most Severe Form Of Nausea And Vomiting In Pregnancy, Characterized By Persistent
Nausea And Vomiting Associated With Ketosis And Weight Loss (>5% Of Prepregnancy Weight). Severe Hyperemesis
Requiring Hospital Admission Occurs In 0.3-2% Of Pregnancies1. The Most Commonly Occurring Symptoms Of
Hyperemesis Gravidarum Are Gastrointestinal In Nature And Include Nausea And Vomiting. Other Common Symptoms
Include Ptyalism (Excessive Salivation), Fatigue, Weakness, And Dizziness. New-Onset Seizures During Pregnancy Can Be
Quite Baffling Especially In The First Trimester . The Structural Causes Include Intracranial Haemorrhage Of Multiple
Types, Cerebral Venous Sinus Thrombosis, And Ischemic Stroke. Metabolic Causes Include Acute Hepatitis (Due To Fatty
Liver Of Pregnancy Or Viral Hepatitis); Metabolic Diseases, Such As Acute Intermittent Porphyria; Infections, Such As
Malaria; And Eclampsia. One Of The Metabolic Causes May Also Be Hyperemesis Gravidarum, Although Theoretically
Possible, It Has Rarely Been Reported. We Report A Case Of A 22 Year Old Woman In Her 2Nd Trimester Who Had An
Epileptic Seizure For The First Time During Her Pregnancy At 16 Weeks Of Gestation . Baseline Investigations Done
Showed An Electrolyte Imbalance With Elevated Lft . Mri Brain Done Showed No Significant Abnormality . Patient Was
Started On Anti Convulsants And Electrolyte Correction . Investigations To Rule Out Underlying Viral Meningoencephalitis
, Leptospirosis And Malaria Were Sent And The Same Were Ruled Out . Following Two Days Of Correction Of Electroloyte
Imbalance , Patient Was Symptomatically Better And Had No Further Episodes Of Seizures .
This Case Has Been Presented For The Clinical Rarity In Which Hyperemesis Gravidarum Has Led To Convulsions.

***************

Boy , Girl & A Mole!

Author: Dr. Vijayalakshmi Visagamoorthy
Co Author: Dr.K.Priyadarshini Md(Assistant Professor) 1,

Introduction- To Present A Case Of Triplet Pregnancy One Of Which Is A Vesicular Mole.

Case- 35 Years Old Lady G4A3 Married Since 16 Years Conceived After Ivf Technique With Chronic Hypertension
&Hypothyroid Of 14 Weeks Gestation Triplets(Tcta) With One Vesicular Mole Admitted With C/O Bleeding P/V. Serial
Beta Hcg Taken & Managed Conservatively & Weekly Follow Up Done.Admitted With C/O Draining P/V At 30 Weeks
,Steroids Completed & By Labor Natural Boy (1.3Kg)& Girl(1.5 Kg ) Delivered. After Placenta 1&2 Third Placenta Delivered
With Molar Changes. Specimen Sent For Pathology. Babies Admitted In Preterm Unit & Check Scan &Beta Hcg Taken And
Reviewed With Medical Oncologist.
Conclusion- After One Month Mother Discharged With 2 Babies. Hpe- Complete Molar Changes.
***************

An Atypical Aggressive Presentation Of Endodermal Sinus Tumour In A Young Girl

Author: Dr. Sangeeta Rai
Co Author: Dr Shreya Thapa1, Dr Hs Shukla2,

Introduction : Malignant Ovarian Germ Cell Tumours (Ogct) Comprise Only 25% Of All Ovarian Cancers. Endodermal
Sinus Tumor (Yolk Sac Tumor) Is The Second Most Common Malignant Germ Cell Tumour Of The Ovary After
Dysgerminoma And Comprise Approximately 2025% Of Malignant Germ Cell Tumors And 5% Of All The Ovarian
Malignancies. Yst Is Almost Always Unilateral And Large.
Here, We Report A Case Of Endodermal Sinus Tumour Which Occurred In A 19 Year Old Girl With Lower Abdominal Pain
For One Month. A Pelvic Mass Was Found And Being Investigated But Emergency Laparotomy Was Performed For Severe
Acute Abdominal Pain. An Intraoperative Diagnosis Of Stage Iv B Ovarian Tumour With Bilaterality And Intraperitoneal
Rupture Was Made .She Required Extensive Debulking Surgery , Later Confirmed As Yolk Sac Tumour.
Conclusion : Yolk Sac Tumour Are Rare Ovarian Malignancies . Their Incidence Increases Sharply Around Puberty And
Decreases In Older Age Group. The Most Frequent Presentation Is That Of Abdominal Pain And Large Unilateral Pelvic
Mass. If Complications, Such As Hydronephrosis Or Ovarian Torsion Are Present, More Acute Symptoms Can Occur As
Seen In The Present Case. In Terms Of Management , There May Be Arguments For Conservative Surgery In Younger
Women If Tumours Are Diagnosed Early Or Unilateral. The Recommended Treatment Is Unilateral Salpino-Oophorectomy
Followed By Combination Chemotherapy. However, Preservation Of Fertility Is Difficult In Cases Of Bilateral Involvement.
It Has Also Been Well Established That Staging And Tumour Reductive Surgery Strongly Affects The Prognosis Of The
Disease And So Tumour Reductive Surgery Is Advisable When Ascites Is Minimal. If The Disease Is Extensive, Pelvic
Clearance Is Indicated.

Keywords : Endodermal Sinus Tumour, Torsion,

***************

Role Of Laparoscopy In Diagnosis Of Chronic Pelvic Pain & Its Management

Author: Dr. Lokesh Singhal
Co Author: Prof Dr Veena Acharya1, Dr Ashok Meena2,

Introduction : Chronic Pelvic Pain Is Non Specific Pain Of 6 Month Or More In Duration That Localize To Anatomical Pelvis
, Anterior Abdominal Wall At Or Below Umbilicus And Lumbosacral Back.
Aims & Objective : Comparative Study Of Clinical Examination, Transvaginal Sonography & Laproscopy In Chronic Pelvic
Pain.
Material & Method : 110 Women With Complain Of Lower Abdominal Pain Attending The Gynaecology Opd Of Mgmc
Jaipur . Clinical History Regarding Site , Duration, Severity, Nature , Radiation Of Pain To Other Site, Aggravating &
Reliving Factor ,Association With Menstrual Cyle , Dysparenuria & Associated Complain Was Noted . All Women
Underwent Clinical & Pervaginal Examination ,Transvaginal Sonography With Use Of Soft & Hard Tissue Marker &
Diagnostic Laproscopy As A Gold Standard.
Result : The Mean Age Of Patient Was 30.31 Years , Mean Duration Of Pain Was 2.61 Year . In Our Study Clinical
Examination Was Normal In 24.55% And Pelvic Pathology Was Detected In 75.455 .The Sensitivity Of Clinical Examination
Was 76.84% Positive Predictive Value & Negative Predictive Value Was 87.95 &18.51% As Compared To Laproscopy. Tvs
Based Hard Marker Was Abnormal In 56.675 And Normal In 43.33%. The Sensitivity & Specicity Was 61.05 & 73.33%
. Tvs Based Soft Marker Showed Sesitivity & Specificity 89.47% & 40% And Positive Predictive Value Of 90.43%.
Laparosopy Examination Was Normal In 13.64 % & 86.36 Showed Pelic Patology. Most Comman Pathology Was
Adhesions In 58.55% , Endometrosis In 22.45%
Conclusion: From The Comparitive Study It Has Been Derived That Tvs With Use Of Hard & Soft Tissue Marker Can
Be Used As Primary Screening For Diagnosis Of Chronic Pelvic Pain But Laparoscopy Is Gold Stnadard In Diagnosis &
Management Of Chronic Pelvic Pain.

***************

Case Of Huge Cervical Fibroid Producing Secondary Polycythemia

Author: Dr. Khan Saima
Co Author: Dr Khan Saima1, Dr Sneha Raj2,

Introduction : Leiomyomas Are Benign Smooth Muscle Neoplasms That Typically Originate From The Myometrium. Their
Incidence Among Women Is Generally Cited As 20-25% But Has Been Shown To Be As High As 70-80% In Studies Using
Histologic And Sonographic Examination. Only About 0.4% Of All Leiomyomas Develop In The Cervix. Rarely Women With
Leiomyomas May Develop "Myomatous Erythrocytosis Syndrome" With An Incidence Of 0.2-0.5%. This May Result From
Excessive Erythropoetin Production By The Kidneys Or By The Leiomyomas Themselves.This Case Is A Rare Scenario Of A
Huge Cervical Fibroid Leading To Secondary Polycythemia With Resolution Of The Polycythemia After Removal Of The
Fibroid.
Case Report: 45 Year Old Female Admitted To Jjmmc Hospital, Dvg With Complaints Of Mass Per Abdomen And Difficulty
In Initiating The Act Of Micturation Since 5 Months. Ultrasound Revealed A Cervical Fibroid Of 15 X 12Cm. Moderate
Hydroureteronephrosis Of Right Kidney Was Present. Liver And Spleen Were Normal.On Routine Pre Operative
Investigations Cbc Showed Hb- 17.7G/Dl With Hct- 59% And Rbc 6.00X10^6/l. Wbc And Platelets Were Within Normal
Limits.These Features Were Suggestive Of Isolated Polycythemia. Serum Erythropoetin Level Was 21Miu/Ml In The High
Normal Limits. Ecg, Echo, Chest X Ray Pa View Was Normal. Hysterectomy With Left Salpingo Oopherectomy Was Done
After Enucleating The Fibroid. 15 Days Later Her Repeat Cbc Showed Hb- 10.4G/Dl, Hct-31.8%, Rbc-3.49X10^6/l, Serum
Erythropoetin-5.2Miu/Ml. Resolution Of Polycythemia Had Occurred.
Conclusion : Uterine Myomas Are A Rare But Not Uncommon Cause Of Erythrocytosis And Should Be Considered In The
Differential Diagnosis Of Secondary Polycythemia. Diagnosis Of The Myomatous Erythrocytosis Syndrome Should Still Be
Considered With Normal Serum Erythropoietin Levels, Especially With Levels Closer To The High End Of The Normal
Values.

***************

Non Immune Hydrops - A Case Report

Author: Dr. Ravjyot Kaur
Co Author:

Introduction- The Incidence Of Non Immune Hydrops Has Been Estimated To Be Around 1 In 1500 To 1 In 3500 Live Born.
Nihf Is The Result Of A Heterogeneous Group Of Conditions.
Case Report- A Case Presented To Department Of Obg Saims Indore. She Was G3P2L2 With 6 Months Amenorrhoea With
Bleeding P/V With Previous 2 Normal Deliveries. Both The Babies Are Alive And Healthy. In History Of Present Pregnancy
She Had History Of Low Grade Fever Associated With Chills And Rash With Itching All Over The Body In First Trimester
For Which No Treatment Was Taken. Investigations She Was An Unbooked Case. All Routine Investigations Were
Done. Positive Findings Were -Scan Showed Single Fetus Of 22 Weeks 4 Days, Moderate Soft Tissue Oedema Of Head
And Abdomen With B/L Gross Pleural Effusion. Toxoplasma Igm Was Positive And Rest Other Investigations Were In
Normal Range.Treatment -Patient Went In Spontaneous Labor. She Delivered A Male Iud Fetus Of 755Gms.Placenta
350Gms.Autopsy Was Done.
Conclusion The Cause Of Non Immune Hydrops In This Case Was Toxoplasma Viral Infection.

***************

Fetal Fibular Hemimelia With Focal Femoral Deficiency: A Case Report

Author: Dr. P Pallavee
Co Author: Dr P.Pallavee1, Dr Seetesh Ghose2,

Introduction. Although Congenital Longitudinal Fibular Deficiency Is One Of The Most Common Long Bone Deficiencies,
There Are Very Few Published Cases Of Its Association With Misoprostol Use.
Case Report. A Focal Femoral Deficiency With Fibular Hemimelia Syndrome ( Type Ii/Iii) Of The Left Limb Associated With
An Ectopic Left Kidney, Diagnosed At 18 Weeks Gestation In A Second Gravid Woman With A Previous Cesarean Section
Who Had Taken Four Doses Of Misoprostol At 40 Days Of Amenorrhea For Attempted Termination Of Pregnancy Is
Described. She Presented With Inevitable Abortion And Underwent Hysterotomy Due To Failed Medical Abortion And
Her Postpartum Period Was Uneventful. Post Natal X Rays Of The Fetus Confirmed The Sonographic Findings.
Conclusion. Misoprostol Is An Abortifacient Drug. Continuation Of Pregnancy After Its Use For Attempted Abortion In
Early Gestation Can Cause Congenital Malformation In The Offspring. A Range Of Possible Malformations In The Skeletal
System Have Been Well Documented With The Use Of Misoprostol. Fibular Hemimelia With Focal Femoral Deficiency Has
Been Rarely Reported As A Teratogenic Effect Of Misoprostol In The World Literature. We Report This Case For Its Rarity.

***************

The Predictive Value Of Modified Biophysical Profile In Evaluating Neonatal Outcome

Author: Prof. Alka Satija
Co Author: Dr Alka Satija1, Dr Varun Satija2, Dr Aekta Gupta3, Dr Harmesh Singh Bains4,

Introduction: One Of The Major Goals Of Ante Partum Foetal Surveillance Is Timely Detection Of A Compromised Foetus.
Modified Biophysical Profile (Mbpp) Combines Non Stress Test (Nst) With Amniotic Fluid Index (Afi). This Study Was
Undertaken To Assess The Predictive Value Of Modified Biophysical Profile In Evaluating Neonatal Outcome.
Method: 75 Women With High Risk Pregnancy Receiving Antenatal Care In Dayanand Medical College And Hospital,
Ludhiana Were Monitored Using Modified Biophysical Profile I.E. Biweekly Non Stress Test And Weekly Amniotic Fluid
Index Estimation After 32 Weeks Of Gestation. The Neonatal Outcome Was Evaluated In Terms Of Mode Of Delivery,
Timing Of Delivery, Foetal Distress, Meconium Staining Of Amniotic Fluid, Apgar Score At 1 And 5 Minutes, Duration Of
Stay In Nursery, Early Neonatal Complications And Neonatal Mortality. Statistical Analysis Of The Results Was Done Using
T- Test, Z- Test And Chi- Square Test.
Results: Normal Modified Biophysical Profile Was Associated With An Increased Incidence Of Vaginal Delivery,
Continuation Of Pregnancy Beyond 37 Weeks, Lesser Incidence Of Foetal Distress And Shorter Stay In Nursery. However
No Significant Relation Was Observed Between Abnormal Mbpp And Neonatal Complications, Apgar Score At 1 And 5
Minutes Or Meconium Staining Of Amniotic Fluid.
Conclusions: Though Mbpp Is An Easy, Sensitive And Cost Effective Primary Method For Ante Partum Foetal Surveillance,
It Has Low Specificity. Therefore Abnormal Mbpp Requires Reconfirmation Of Poor Foetal Status With Other Available
Modalities Like Doppler Velocimetry. Abnormal Mbpp Should Not Be Used As The Only Criterion For Early Termination
Of Pregnancy.
Keywords: Antenatal Foetal Surveillance, Modified Biophysical Profile, Amniotic Fluid Index, Non Stress Test, Perinatal
Morbidity.

***************

Rare Case Of A Prolapsed Cervical Leiomyoma - A Case Report

Author: Dr. Pragna Reddy
Co Author: Dr. N. Mamatha Reddy1,

Introduction: Uterine Fibroids Are The Most Common Tumors Of Uterus Which Develop In 2040% Of Reproductive
Age Women, But Cervical Leiomyomas Are Less Than 5% Of All Leiomyomas.Pedunculated Uterine Myomas Or
Submucosal Cervical Myomas May Protrude Through The Cervical Canal And Into The Vagina And May Become Necrotic
And Occasionally Infected Due To Inadequate Blood Supply
Case Report: A 35 Yr Old Woman Who Had Three Term Vaginal Deliveries Presented With The Chief Complaint Of Sudden
Protrusion Of A Large Irreducible Mass Out Of The Introitus During Defecation And Bleeding Per Vaginum Associated
With Clots Since One Day. She Also Gave A History Of Constipation And Urinary Retention Since One Day. On General
Examination, She Was Pale, Ill Looking And The Lower Abdomen Was Soft On Palpation. On Gynecological Examination,
A Globular, Irreducible, Unhealthy Mass Of 20X10 Cm Protruding Out Of The Introitus, With Focal Necrotic And Sloughing
Surface, Associated With Foul Smelling Discharge Was Noted And Rim And Body Of The Cervix Could Not Be Visualized
Separately From The Mass. Rectum Was Fully Loaded On Per Rectal Examination. Mri Was Done It Was Suggestive Of
Benign Mesenchymal Vaginal Tumor Hysterectomy Was Done By Vaginal Route. Post-Operative Period Was Uneventful
And The Patient Was Discharged On Seventh Postoperative Day. Histo-Pathological Examination Of The Specimen
Confirmed The Diagnosis Of Submucosal Leiomyoma Arising From The Cervix Of The Uterus.

Conclusion: Vaginal Hysterectomy Is The Treatment Of Choice For A Necrotic Irreducible Prolapsed Cervical Leiomyoma.
The Associated Morbidity Is Minimal. In This Case Of Huge Prolapsed Leiomyoma It Is Imperative To Have A Thorough
Preoperative Evaluation

***************

Dysgerminoma With 46Xy Pure Gonadal Dysgenesis-A Rare Case Report

Author: Dr. Ashwini Konin
Co Author: Dr Shivmurthy H. M.1,

Introduction:
Dysgerminoma Is The Most Common Germ Cell Tumor, Accounting For 30-40% Of All Ovarian Cancers Of Germ
Cell Origin. They Are Derived From Primordial Germ Cells Of The Ovary . This Malignancy Can Be Associated With Pure
Gonadal Dysgenesis Or Swyer Syndrome.One Quarter Of These Patients Are Asymptomatic Or Early Symptoms Can Be
Missed And A Pelvic Mass Is Noted Unexpectedly During Physical Or Sonographic Examination.
This Case Is Presented Because Of Its Rarity And Clinical Importance Of Recognizing Such Cases Because Of Excellent
Prognosis.
Case Scenario:
A 17 Year Old Girl Came For Evaluation Of Primary Amenorrhoea . She Complained Of Dull-Aching Abdominal
Pain Since One Week. On Examination Breast Development Corresponded To Tanner Stage I And Pubic Hair Sparse ,
Axillary Hair Absent. On Abdominal Examination A Large Mass Arising From Pelvis Reaching Upto Umbilicus With
Bosselated Surface And Variable Consistency.
Ultrasound Suggested Features Of Ovarian Teratoma.Her Fsh And Lh Levels Were Elevated, Alphafetoprotein And Hcg
Were Within Normal Limits. The Karyotype Revealed Xy Chromosomes.
The Patient Underwent Laparotomy,On The Table She Had Enlarged Right Ovarian Tumor With Irregular Surface
With Intact Capsule .Ascitic Fluid Of About 100Ml Present. No Metastatic Deposits Left Ovary Being Streak And Uterus
Hypoplastic.
It Was Proceeded With Total Hysterectomy, Bilateral Salphingoophorectomy With Infracolic Omental Biopsy.
Histopathology Showed Dysgerminoma Of The Right Ovary And Right Granulomatous Salphingitis With Metastatic Tumor
Deposit.
Conclusion:
Approximately 5% Of Dysgerminoma Are Discovered In Phenotypic Women With Abnormal Gonads. In Patients
With Swyer Syndrome The Risk Of Dysgerminoma Is High And Gonadectomy Is Recommended.

***************

An Intresting Case Of Pregnancy With Large Ovarian Mucinous Cystadenoma.

Author: Dr. Radha Katta
Co Author: Dr.G.C Prabhakar1, Dr.Manjari2, Dr.Kavitha3, Dr.Usha Rani4,

Introduction:
The Incidence Of Ovarian Cysts During Pregnancy Is Less Than 5% And Most Of Them Are Benign In Nature. Gaint Ovarian
Cysts Are Found In Less Than 1% Of The Cases Of Ovarian Cysts With Pregnancy. Patients Having Ovarian Cysts During
Pregnancy May Come With Pain Abdomen Due To Torsion, Infection, Haemorrhage , Rupture Of The Cyst. It Can Also Be
Associated With Iugr And Preterm Labour . But Here , We Present An Intresting Case Of Large Ovarian Mucinous
Cystadenoma With Pregnancy Which Was Asymptomatic And Without Any Adverse Effects.
Case Report: A 28 Year Old Lady Who Is G3P1L1A1 With 38 Weeks +5 Days Of Gestational Age With History Of One
Previous Lscs And A Known Case Of Hypothyroidism On Treatment Was Referred In View Of Safe Institutional Delivery
Of Pregnancy With Large Ovarian Cyst. On Ultrasonography , There Was An Intra Uterine Single Live Fetus With
Gestational Age Of 37 Weeks With Large Left Unilocular Ovarian Cystic Lesion Of 2218 Cms Occupying The Abdomen
And The Pelvis On The Left Side. Intraoperatively, After The Delivery Of A Live Baby Of Weight 2.8 Kg, Left Salpingo
Oophorectomy Was Done For A Left Ovarian Mass Of 25X20 Cms Weighing 4.9 Kgs. Histopathological Examination
Showed Mucinous Cystadenoma Of Left Ovary.
Conclusion: In Spite Of The Huge Size Of The Mass, Patient Was Unaware Of Its Presence. Though Huge Ovarian Cysts
Can Lead To Serious Complications During Pregnancy, There Is Also A Possibility For The Cyst To Be Asymptomatic,
Without Altering The Course And Outcome Of The Pregnancy.

***************

Postdated Pregnancies: A Comparison Of Outcomes Between Spontaneous And Induced Labours Shobana
Mahadevan, Uma Ram, Mathangi
Author: Dr. Shobana Mahadevan
Co Author:

Introduction:

Postdated Pregnancies Are Common And Contribute To A Major Proportion Of Induced Labours. Induction Of Labour
Considerably Increases The Workload On The Staff And May Increase The Caesarean Section Rate. Induction Is
Recommended At 41 Weeks In Order To Reduce The Perinatal Morbidity And Mortality. According To Nice Guidelines,
Perinatal Mortality In The Asian Population Starts Rising Significantly From 40 Weeks. It Has Been Our Policy To Induce
At 40+5 Weeks.
.
Aim: To Evaluate The Outcome Of Postdated Pregnancies And To Compare The Mode Of Delivery And Reasons For
Cesarean Sections In Induced And Spontaneous Labours In Post Dated Pregnancies In Our Practice.

Method : Retrospective Analysis Of All Singleton Pregnancies For One Year From 1/1/2013 To 31/12/2013.

Results: Out Of The Total 789 Deliveries, 200 Pregnancies (25%) Were Post-Dated. Of These 200 Post-Dated Pregnancies,
43% Were Delivered By Cesarean Section.

97/200 (48%) Went Into Spontaneous Labour. Among The Remaining 103, 93 Were Induced And 10 Had Elective Sections
For Maternal Request Or Mobile Head At 40+5.

75% (73) Of Those Who Went Into Sponatenous Labour Delivered Vaginally As Opposed To 45% (42) Amongst Those
Induced (P<0.001). Emergency Sections Were Done In 25% Of Spontaneous Labour Group And 55% Of The Induction
Group ( P=0.007). Even Among Those Closer To 41Weeks ( > 40+5), Those Who Laboured Spontaneously Had A
Significantly Higher Rates Of Vaginal Delivery

Among The Indications For Emergency Cesarean Section, Foetal Distress Was Significantly More Among The Induced
Compared To Spontaneous Labour (P= 0.07).

The Total No Of Admissions To The Nicu For Asphyxia Was 1And There Was No Mortality.

Conclusion: 25% Of Patients Go Beyond The Due Date In Our Practice. Waiting For Spontaneous Labour Upto 41Weeks
Improves The Chances Of Vaginal Delivery And Reduces The Caesarean Sections Done For Fetal Distress.

***************

Large Intestinal Obstruction During Pregnancy Is Still Alive As Rare Surgical Emergency
Author: Dr. Mohana Roopa
Co Author: Dr. Ramesh.G1, Dr.Jayashree.A.K2, Dr.Umashankar3,

Introduction:
Intestinal Obstruction In Pregnancy Is Rare. Delay In Diagnosis Is Due To Nonspecific Symptoms And A Disinclination To
Carry Out Radiological Investigations In Pregnancy.
Case Report:
23 Year Old Gravid2, Abortion1 At 32 Weeks Gestation Came With History Of Pain In The Right Lower Abdomen With 20
Episodes Of Loose Stools. Inspite Of Conservative Treatment Patient Had Persistent Symptoms And Reevaluated By
General Surgeons. Usg Day 2 Revealed Dilated Loops Of Large Bowels Impression Of Acute Large Bowel. Patient Was
Continued With Antibiotics, Had Relief Of Symptoms For Few Hours Followed By Recurrence. Usg On Day3 Showed
Dilated Whole Of Right Colon Diagnosis Of Obstruction Of Transverse Colon Of Unknown Etiology Was Made .
Patient Was Posted For Exploratory Laparotomy : Abdomen Opened By Midline Vertical Incision, View Of Abdomen Was
Compromised By Gravid Uterus So Caeserean Section Was Undertaken , Abdomen Reevaluated And Dilated Caecum ,
Ascending Colon Noted .There Was Malpositioning Of Transverse Colon And Descending Colon. Right Hemicolectomy
With Iliotransvers Anastomosis Done And Abdomen Was Closed .
Postoperative Period Was Un Eventfull. Patient Discharged With Baby.

Conclusion:
The High Morbidity And Mortality Rates Meant That Radiological Investigations And Surgery Should Not Be Delayed.

***************

Case Report Of Ante Partum Cortical Venous Thrombosis

Author: Dr. Anjana Vaidyanathan
Co Author:

Introduction:
Pregnancy Increases The Risk Of Cortical Venous Thrombosis (Cvt) But Cases Which Are Diagnosed Antenatally Are
Uncommon. This Case Relates To The Successful Management Of Cvt In An Antenatal Primigravida Who Was Also Ana
Positive. The Thrombogenic State Proved To Be A Challenge Till Delivery
Case Description:
A 20 Year Old Primigravida At 22 Weeks Of Gestation, Was Referred ,As An Established Case Of Cvt For Further
Management. The Patient Presented With Seizures At 9 Wks 5 Days. The Mri Scan Confirmed The Diagnosis Of Cortical
Venous Thrombosis. Patient Was Detected As Anti Rho / Anti La Positive And Was Started On Inj Enoxaparin, T.Eptoin,
T.Hydroxychloroquine And T.Aspirin 75 Mg . At 17 Weeks, The Patient Was Readmitted With Status Epilepticus As She
Was Not Taking Phenytoin Regularly. Repeat Mri Showed Partial Recanalization Of The Transverse And Sigmoid Sinus. In
View Of Being A High Risk Pregnancy, She Was Referred To Higher Centre.
At 22 Weeks, The Patient Was Admitted And She Developed A Seizure Episode, Which Was Medically Managed. At 36
Weeks, The Patient Came To The Er With History Of 1 Episode Of Seizure Following Trauma And Was Started On Iv Fosulin
And Iv Levipil As Advised By Neurologist. Inj Heparin Was Stopped And Delivery Was Planned At 37 Weeks. The Patient
Went Into Spontaneous Labour At 37 Weeks And Delivered A Healthy Baby By Assisted Vaginal Delivery. Post Natally,
Patient Was Discharged With Oral Anti Epileptics And Advised To Continue Injection Heparin For 6 Weeks.
Discussion:
This Case Illustrates The Need To Consider Cvt As A Possible Diagnosis For An Ante Natal Woman Presenting With
Seizures. It Also Reveals That Even In The Presence Of Additional Thrombogenic Factors, The Patient Can Be Successfully
Managed, Without Compromising The Health Of The Mother And Fetus.

***************

Twin To Twin Transfusion Syndrome (Ttts) : A High Index Of Suspicion Is Mandatory

Author: Dr. Jyoti Kamda
Co Author: Dr Sujata Datti1,

Introduction:
Twin-To-Twin Transfusion Syndrome (Ttts) Is A Rare Complication Of Pregnancy That Develops In 10- 15% Of Twins When
The Babies Share The Same Placenta (Monochorionic). Ttts Occurs In 5-38% Of Mono-Chorionic Twins .
Case Report:
G4P1L1A2 Was Referred To Our Hospital At 8 Months Of Amenorrhoea With Scan Report Showing Mono Chorionic
Diamniotic Twin Gestation With Growth Discrepancy Between The Twins And Doppler Changes. Lmp 20/03/13, Edd27/12/13. There Was No History Of Twinning In The Family,P/A- Uterus Was Over Distended, Relaxed, Sfh 38Cms, Ag
102Cms, Multiple Fetal Parts Felt, Fhs Of One Fetus Heard Distinctly Which Was 132Bpm. P/V -Cervix Posterior,
Uneffaced, Os Closed . On Scanning In Our Hospital Mcda Twin Twin A (Donor Twin) (Stuck Twin) Cephalic
Presentation, Corresponding To 29Weeks, Small For Gestational Age With Anhydramnios , Reversal Of Flow In The
Umbilical Artery. Twin B (Recipient Twin) Breech Presentation, Corresponding To 34 Weeks, Polyhydramnios, And
Pulsatile Umbilical Vein Waveforms. Ttts Grade 3 With Stuck Donor Twin. Patient Was Taken Up For Emergency Lscs
1St Twin Delivered By Breech Extraction With Excess Liquor, 2Nd Twin With Membrane Tightly Wrapped Around The
Baby Was Cephalic Presentation. Baby Details- Recipient Twin - Female, 2.01Kg Good Apgar. Donor Twin - Female, 1.3Kg
Good Apgar. Placenta Single With Thin Intervening Membrane Suggestive Of Mcda Placenta. There Was Difference
Of> 5G Hb Between The Twins, Weight Difference Of 0.7Kg(40).
Conclusion:
Appropriately Timed Diagnosis Of Twin-Twin Transfu-Sion Syndrome Is Crucial Because A Delay In Diagnosis May Result
In A Delay In Treatment And Increased Perinatal Mortality And Morbidity. To Accomplish This We Have To Do 2Weekly
Monitoring By Ultrasound Complimented By Doppler Where Necessary Once Monochorionicdiamniotic Twin Is
Diagnosed .

***************

Common Tumour At A Rare Site

Author: Dr. Anuradha.M
Co Author: Dr.Anjalakshi Chandrasekar1, Dr.Karthiga Prabhu2, Dr Ramyasundaram3,

Leiomyoma Is The Most Common Gynaecological Tumour Which Commonly Arises From Uterus And Cervix.Extrauterine
Leiomyomas Are Rare And Are A Great Diagnostic Challenge.Here We Are Reporting A Case Of Leiomyoma At A Rare Site.
Case:
Mrs X ,A 51 Year Old Multiparous Lady Presented To Our Outpatient Clinic With Complaints Of Swelling In The External
Genitalia For 5 Years. On Examination,A Lobulated Firm Vulvovaginal Mass Measuring 6X7Cm,Occupying The Right
Posterolateral Part Of Labia Majora Extending Into The Lateral Vaginal Wall Was Seen.Enucleation Of The Mass Was
Done.This Macroscopic Appearance Which Was Suggestive Of Leiomyoma Was Confirmed By Histopathology.
Conclusion:
Leiomyoma Vagina Is A Very Rare Condition.Approximately 300 Cases Reported World Wide.Here We Are
Presenting This Case Because Of Its Rarity.
***************

Unusual Presentation Of Leiomyosarcoma In A Post Hysterectomy Patient

Author: Dr. Sambit Nanda
Co Author: Dr Sambit Nanda1, Dr G M Niyogi2, Dr Kirti Bendre3,

Leiomyosarcoma Is A Soft Tissue Tumour Comprising 5-10% Of Total Soft Tissue Tumours, Which It Itself Is Rare.Owing
To Its Chemoresistant Nature And Unpredictability Of Being Dormant F Or Long Periods And Recurrence; It Possesses A
Formidable Diagnostic Challenge
55 Yrs Amina Meman Was Operated For Total Abdominal Hysterectomy With Bilateral Salpingooophorectomy For
Menorrhagia. Histopath Revealed Mutliple Degenerative Leiomyomas. She Presented With Distension Of Abdomen And
Breathlessness And Required Intensive Care Management. She Is Known Case Of Post Tuberculosis Bronchiectasis. On
Examination A Pelvic Mass Approx. Corresponding To 26 Weeks Pregnancy.Was Noted Which Was Firm, Irregular And
Mobile. On Radiological Investigations( Ct Scan) A Probable Diagnosis Of Ovarian Mass Of 14X18 Cms Was Obtained Along
With Hydroureter And Hydronephrosis. An Exploratory Lapratomy Was Performed And A Huge 5 Kg Mass Was Removed
With Ureteric Stenting. Histopathological Examination Concluded It To Be Leiomyosarcoma. Post Operative Period Was
Uneventful.
Thus Concluding That Leiomyosarcoma Can Have An Unusual Presentation And A High Degree Of Suspicision Must Be
Kept As They Ahve A Tendency To Recur.
***************

Mrkh Syndrome(Type 1) With Two Uteri,One Being Rudimentary And Other Having Adenomyosis.
Author: Dr. Parimala Devi
Co Author: Dr.Sindhuja1, Dr.Shanmuga Vadivu2, Dr.Parimala Devi3,

Mrkh Syndrome Is A Disorder That Occurs 1 In 4500 Newborn Girls.It Is The Second Most Common Cause Of Primary
Amenorrhoea.It Is Characterized By Congenital Aplasia/Hypoplasia Of Uterus,Cervix And Upper 2/3Rd Of Vagina In A
Women With Normal Secondary Sexual Characteristics And A Normal 46Xx Karyotype.It May Be Isolated(Type1) Or
Associated With Renal,Cardiac,Skeletal Anomalies Or Auditory Defect(Type 2 Mrkh Syndrome Or Murcs Association).This
Case Report Is About A 37 Year Old Women,A Known Case Of Primary Amenorrhoea Presenting With Lower Abdominal
Pain.On Examination,She Had Normal External Genitalia With A Blind Vaginal Pouch.On Pr Examination There Was A Right
Adnexal Mass Of About 5*4 Cm.Mri Pelvis Showed Well Defined Hypointense Mass Of About 4.7*4.7Cm In Right Adnexa
And 1.8*1.8Cm In Left Adnexa.Patient Was Further Investigated And In View Of Intense Abdomen Pain ,She Was Taken
Up For Exploratory Laparotomy.Per Operatively,There Was 5-10 Ml Of Blood Tinged Peritoneal Fluid.On Right Side, Close
To Pelvic Wall There Was A Uterus(7*5Cm) And On Left Side There Was Another Atrophic Uterus(4*5Cm).Both Uteri Had
Normal Fallopian Tubes And Ovaries And Cervix Absent.Both Uteri Had An Intervening Long Band Of Tissue Connecting
Each Other.Bilateral Uterus,Tubes,Ovaries Were Removed.Hpe Showed Proliferative Endometrium In Both Uterus With
Adenomyosis In Right Uterus.Ovaries And Tubes Had Normal Histological Findings.Our Case Is A Varient Of Mrkh (Type
1) With 2 Uterus,One Being Rudimentary And Other With Adenomyosis.Mrkh Syndrome Is Rare And Associated
Adenomyosis Is Still Rare.Hence We Present This Case For Its Rarity.
***************

Rare Presentation Of Rare Case- Stertoli Leydig Cell Tumor Of Ovary

Author: Dr. Madhu Ranjini
Co Author:

Mrs Bindhu 27Yrs P2L2 Had C/O Hoarseness Of Voice Since 6Yrs, Oligomenorrhea Since 6Yrs ,Painless Lump In Anterior
Abdominal Wall Above Umbilicus For 2Months.
Past H/O - H/O Rt Ovariotomy Done During 2Rd Month Of 1St Pregnancy 7Yrs Back .Intra Op Finding- Right Ovarian Mass
Of 16*10*14Cm With Solid And Cystic Areas.Hpr Was Retiform Variant Of Sertoli Leydig Cell Tumor Of Ovary.No Further
Treatment Offered. 4Yrs Later She Had C/O Anterior Abdominal Wall Lump , Underwent Excision And Hpr Was Secondary
Deposits From Sex Cord Stromal Tumor Of Ovary. Following This, She Had 6 Cycles Of Chemotherapy- Bep Regime.
No Significant Family History.
O/E- Well Built And Nourished.No Hirsutism.Secondary Sexual Characters -Normal .Vitals- Stable. P/A Firm Mass Of
5*5Cm,Fixed To Anterior Abdominal Wall. P/V Uterus Retroverted, Normal Size, Mobile, Fornices Free ,Adnexa Free.
Investigations- Mri Showed Soft Tissue Mass In Subcutaneous Plane Abutting The Anterior Fascia Over Right Rectus
Muscle With Peri Lesional Prominent Vessels . Fnac From The Abdominal Lump Shows Sex Cord Stromal Tumor
Recurrence.
Procedure -Tah With Left Salpingo-Oopherectomy + Omentectomy And Abdominal Wall Lump Wide Excision Done.Hpr
Of Lump Consistent With Metastasis Of Sex Cord Stromal Tumor To Abdominal Wall.Ihc- Ck, Calretonin Strongly Positive
And Inhibin Partially Positive And Uterus And Left Ovary Free Of Neoplasm.

***************

Systematic Approach To Symptomatology Unveils Rare Disease- Hocm

Author: Dr. Haritha Chinthaparthy
Co Author: Dr.Haritha Chinthaparthy1, Dr.Nagasundari2, Dr.Nirmala3, Dr.B S V K Sai4,

Mrs. X Of 23 Yrs Primigravida At Five Months Of Amenorrhea Attended Antenatal Opd With Complaints Of Cold , Cough
Shortness Of Breath For 2 Days.H/O Paroxysmal Nocturnal Attacks Occasionally .H/O Sudden Cardiac Deaths Of Two Elder
Siblings At Early Age.Her Vital Parameters Were Normal. Apexbeat Shifted To 5 Th Intercostal Space With 3/6 Ejection
Systolic Murmur In 2Nd/3Rd Intercostal Space Increased With Valsalva Manouvere.Ecg And Holter Monitoring Showed
Left Ventricular Strain Pattern.Provisionally Diagnosed As Primigravida At 20 Weeks Gestational Age With Heart Disease
Complicating Pregnancy Not In Failure.Evaluated Further By Echocardiography Revealed Hocm With Left Ventricular
Outflow Tract Gradient 0F 40Mmhg.
Family Was Counselled Regarding Obstetric And Medical Problems Associated With Heart Disease.She Was Started On
Tab.Metoprolol 12.5 Mg Once Daily.Her Antenatal Period Was Uneventful .Elective Caesarean Section Performed In V/O
Fetal Disproportion After Taking Consent For High Risk Anaesthesia Operative Procedure.Delivered An Alive Female Baby
On 09.09.14 With Birthweight 2.65Kg With Apgar 8,9.Postpartum Period Uneventful.
Conclusion : This Woman Presented With Common Symptoms But With Thorough History Taking, Physical Examination
We Could Detect Heart Disease Thereby Preventing Considerable Maternal Morbidity And Mortality.
Her Antenatal Period Was Uneventful
***************

Ovarian Ectopic Pregnancy In Multigravida Women: A Case Report

Author: Dr. Rajalakshmi Saravanan
Co Author: Prof.Th Nonibala Devi1,

Ovarian Ectopic Pregnancy In Multigravida Women: A Case Report

Presenting AuthorS Name: Dr M.S.Rajalakshmi
Institute : Department Of Obstetrics And Gynaecology, Rims, Imphal.
Address: Ladies Pg Hostel No 1, Rims, Imphal.
Qualifications: Mbbs.
Year Of Passing Graduation: 2008
Date Of Birth: 17/08/1984
Mobile No: 08119950393
E-Mail Id: Rlashwini910@Gmail.Com
Co-AuthorS Name: Prof. Th Nonibala Devi
Type Of Presentation: Poster
Abstract:
Primary Ovarian Ectopic Pregnancy Is A Rare Entity, The Reported Incidence Being 1 In 25,000 Pregnancies, And 0.5-3%
Of Extrauterine Pregnancies. A Case Of Ruptured Ectopic Ovarian Pregnancy In 34 Year Old Gravida Four Para Three
Patient Presented With Complaint Of Bleeding Per Vagina, Difficulty In Respiration, Severe Pain Abdomen With Signs Of
Acute Abdomen And Severe Pallor In Shock Is Described. Urine Beta Hcg Pregnancy Test Was Positive, Ultrasonography
Was Not Done. Patient Underwent Emergency Laparotomy And Gestational Sac Found In Left Ovary With Patent Left
Fallopian Tube And Diagnosed As A Case Of Ruptured Left Ovarian Ectopic Pregnancy. Wedge Resection Of Left Ovary
Was Done. Around Three Litres Of Blood Drained From Peritoneal Cavity. Histopathological Report Confirmed The
Diagnosis With Features Of Ovarian Tissue With Corpus Luteum Displaying Extensive Areas Of Hemorrhage, Numerous
Chorionic Villi And Trophoblastic Tissue. A Literature Review Discloses Very Few Cases Of Ruptured Ovarian Pregnancy.
Early Detection And Prompt Treatment Can Preserve The Future Fertility Of The Woman.

Key Words- Ovarian Pregnancy, Emergency Laparotomy, Acute Abdomen.

Corresponding Author
Dr M.S.Rajalakshmi

Imphal, Manipur
Email:Rlashwini910@Gmail.Com

Postgraduate Student
Dept Of Obstetrics & Gynecology
Regional Institute Of Medical Sciences
795004

***************

Enigmatic Ovarian Pregnancy

Author: Dr. Pydimukkala Divya Daniel
Co Author: Dr.Kavitha1, Dr. G.C.Prabhakar2,

Ovarian Pregnancy Is A Rare Ectopic Variant Which Constitutes 1-3% Of Ectopic Pregnancies. An Accurate Preoperative
Diagnosis Of Ovarian Pregnancy Is Very Challenging. The Conditions Which Are Most Commonly Confused With An
Ovarian Pregnancy Are A Ruptured Corpus Luteal Cyst, A Haemorrhagic Corpus Luteum And A Ruptured Endometriotic
Cyst. The Correct Diagnosis Is Most Frequently Made At The Surgery And Requires Histopathological Confirmation. Here
We Present Three Intresting Cases, Which Were Diagnosed Preoperatively As Ruptured Ovarian Pregnancy But Two Cases
Turned Out To Be Ruptured Haemorrhagic Corpus Luteal Cyst On Histopathological Examination.
Case Report: Ruptured Ovarian Pregnancy Is An Obstetric Emergency. Three Cases With Preoperative Diagnosis Of
Ruptured Ovarian Ectopic Pregnancy With Haemorrhagic Shock Presented To Our Hospital. After Initial
Resustication,Emergency Laparotomy With Unilateral Oophorectomy Was Done For All The Cases And Haemostasis
Secured.On Histopathological Examination, One Case Was Confirmed To Be Ovarian Ectopic Pregnancy And The Others
As Haemorrhagic Corpus Luteal Cyst.
Conclusion:
Ovarian Pregnancy Still Remains As A Diagnostic Challenge. There Are Very Few Reports Of An Accurate Preoperative
Diagnosis, Utilizing Sonography.There Is A Chance Of Misdiagnosis Of Ruptured Corpus Luteal Cyst As Ruptured Ovarian
Pregnancy When They Present With The Same Clinical Scenario. In Case Of Unruptured Corpus Luteal Cyst,Which Can Be
Managed Conservatively,Over Diagnosis May Lead To An Unnecessary Intervention

***************

Placental Mesenchymal Dysplasia

Author: Dr. Anita Mohan
Co Author: Dr.Gayathri Kamath1,

Placental Mesenchymal Dysplasia( Pmd) Is A Rare Condition In Pregnancy With Placentomegaly But A Normal Fetus . In
Early Pregnancy, It Is Often Mistaken For Partial Hydatiform Molar Pregnancy. As The Outcomes Are Different In Both
These Conditions, Knowledge Of Pmd Is Essential.

Case
Mrs.V, A 30 Years Old Lady, Had A Spontaneous Conception And At 12 Weeks The Placenta Was Found To Be Large With
Many Vesicles. Nuchal Thickness Of Fetus Was Normal. Differential Diagnosis Of Placental Mesenchymal Dysplasia Or
Partial Hydatiform Molar Pregnancy Were Kept In Mind.
Amniocentesis Revealed Normal Fetal Karyotype.
She Progressed To 24 Weeks Pregnancy Where She Was Found To Have An Incompetent Cervix On Ultrasound Exam. The
Internal Os Was Open And Total Cervical Length Was 9 Mm.
She Was Given Conservative Treatment With Progesterone Suppository And Bed Rest. She Developed Gestational
Diabetes And Blood Sugars Were Controlled On Diet. She Received Injection Betamethasone At 28 Weeks And Went Into
Spontaneous Labour At 32 + Weeks Of Gestation.
She Delivered A Female Baby Weighing 1.7 Kg And The Placenta Weighed 1.04 Kg. Placenta Showed Large, Fluid Filled
Grape-Like Cysts. Large Coiled Vessels Were Noted On The Fetal Surface.
Histopathological Examination Proved Placental Mesenchymal Dysplasia.
The Baby Was Normal With No Evidence Of Beckwith-Wiedemann Syndrome. Baby Was Found To Have Anemia And
Thrombocytopenia.
Umbilical Cord Showed Normal 3 Vessels.

Clinical Relevance

Pmd Resembles Partial Hydatiform Molar Pregnancy. The Placenta Is Large In Both These Conditions, But The Fetus Is
Abnormal In Partial Molar Pregnancy.
Beckwith Wiedmann Syndrome Is Seen In 20 % Of These Pregnancies Which Involves Fetal Macrosomia, Macroglossia
And Omphalocele.
Incidence Of Intrauterine Growth Restriction( Iugr) , Fetal And Neonatal Death Are Commonly Seen With Pmd. Hence
Close Monitoring Of The Pregnancy Is Essential.

***************

Play Safe
Author: Dr. Soniya Rijhwani
Co Author: Dr. Soniya Rijhwani1, Dr. Sareena Gilvaz2,

Play Safe
Dr. Soniya Rijhwani (Dnb Resident)
Dr. Sareena Gilvaz (Hod Of Obgy)
Jubliee Mission Hospital, Thrissur.
Background: As Per Studies Conducted All Over World, Who Concluded That Surgery And Surgical Complications Form
The Major Part Of Medical Morbidity And Mortality. Moreover, Majority Of Them Are Preventable. Considering This, The
Problem Area Selected For The Second Global Patient Safety Challenge, In 20072008, Was The Safety Of Surgical Care
And Who Published Guidelines For The Same In 2009.
Case Studies: Case Studies Used Are The Same As Specified By Who. These Define Ten Objectives To Be Achieved For
Safety: Operate On Correct Patient At Correct Site, Prevent Methods That Cause Harm To Patient, Prepare For Risk Of
High Blood Loss, Recognize And Effectively Prepare For Life-Threatening Loss Of Airway Or Respiratory Function, Avoid
Inducing An Allergic Or Adverse Drug Reaction, Use Methods Known To Minimize The Risk For Surgical Site Infection,
Prevent Inadvertent Retention Of Instruments And Sponges In Surgical Wounds, Identify All Surgical Specimens,
Effectively Communicate And Exchange Critical Information And Routine Surveillance Of Surgical Capacity, Volume And
Results.
Conclusion: Most Of The Medical Mortality And Morbidity Can Be Prevented And The Rate Can Be Decreased Following
Simple Guidelines During Surgical Preparation, Surgery And Post Surgical Management. Adoption By Whole Of Medical
Fraternity Is Necessary For Its Success And Patient Safety.

***************

A Case Of Partial Mullerian Agenesis Presenting With Primary Amenorrhea And Transverse Vaginal Septum
Author: Dr. Shruthi G
Co Author: Dr Sarojamma1, Dr Nagarathnamma2,

Primary Amenorrhea Is Defined As Absence Of Menses By 14 Years Of Age When There Is No Visible Development Of
Secondary Sexual Characteristics Or By 16 Years In The Presence Of Normal Secondary Sexual Characteristics. The Second
Type Occurs If There Is Blockage Of The Outflow Tract, If The Outflow Tract Is Missing Or If There Is No Functioning Uterus.
Outflow Obstructions Include Imperforate Hymen, Transverse Vaginal Septum Or Absence Of Cervix Or Vagina. Most
Women With Mullerian Abnormalities Will Have Normal Ovarian Function And Thus Have Normal Sexual Secondary
Sexual Characteristic Development. The Blockage Of Blood Flow May Cause Hematometra, Hematocolpos Or
Hemoperitoneum And Endometriosis. Patients Are Adoloscents With Complains Of Cyclic Abdominal Pain Without
Menstrual Bleeding. Correction Of The Anatomical Defect And Drainage Of The Collected Blood Is The Surgical Treatment
Option. The Challenging Part Is The Reconstruction Of Vagina. We Report A Case Of 15 Year Old Patient With Partial
Mullerian Agenesis Presenting With Primary Amenorrhea With Hematocolpometra With Transverse Vaginal Septum.
***************

Primary Ovarian Pregnancy With Ipsilateral Benign Cystic Teratoma

Author: Dr. K Sharmila
Co Author: Dr.A.Kalichelvi Dgo Dnb Md1,

Primary Ovarian Pregnancy With Ipsilateral Benign Cystic Teratoma : A Case Report
Background
Ovarian Pregnancy Is A Rare Form Of Ectopic Pregnancy With Incidence Of 0.15-3%. Mature Cystic Teratoma Is The
Common Form Of Germ Cell Tumour And Usually Occurs In The Reproductive Age Group . The Concomitant Occurance
Of A Ovarian Pregnancy With Cystic Teratoma In The Same Ovary Is Exceeding Rare.
Case Report:
29Yrs Old Primi Presented In The Opd With 2Months Of Amenorrhoea With Out Any Pain Or Bleeding Per Vaginum. On
Examination She Was Not Anaemic, Systemic Examination Were Normal , Her Abdomen Was Soft No Tenderness, Per
Vaginal Examination Shows Normal Size Of Uterus , Movement Of Cervix Not Painful And Fullness In The Left Fornix..
Lab Investigation Hb 12.5Grams , Blood Group B Positive, Serum Beta Hcg 1500Iu/Ml. Urine Pregnancy Test Was Positive
, Ultra Sound Showed No Gestational Sac Inside The Uterus With Left Adnexal Mass Of 6*5Cm , No Free Fluid In Pouch
Of Dougles. Suspected A Case Of Tubal Pregnancy Emergency Laproscopy Was Done. Operative Findings Normal Size
Uterus , Both Tubes Normal, Right Ovary Appears Normal . Left Ovary Enlarged About 6*7 Cm And Cystic In Nature . Cyst
Couldnot Removed Separatelyhence Oophorectomy Was Done And Sent For Hpe. Post Operative Period Was Unevent
Ful.Histologic Examination Revealed Primary Intrafollicular Ovarian Pregnancy With Cystic Teratoma.
Conclusion
The Simuntaneous Occurance Of Ovarian Pregnancy With Ipsilateral Bening Teratoma Remains A Rare Entit The Diagnosis
Of Ovarian Pregnancy Can Be Made Out By Good Quality Ultrasound . Laprascopy Approach Would Be Idealof Managing
Both The Conditions.

***************

Role Of Mthfr Gene In Idiopathic Recurrent Miscarriages Among Lower

Author: Dr. Usha Rani V
Co Author:

Role Of Mthfr Gene In Idiopathic Recurrent Miscarriages Among Lower

Socioeconomic Women Of South India

Socioeconomic Women Of South India

V. Usha Rani1, Supriya K2, Parveen Jahan2

1
2Department Of Genetics, Osmania University, Hyderabad, 500007, Ap, India

Background: Recurrent Spontaneous Miscarriages (Rm) Is A Frequent Obstetric Complication Of Human Pregnancy And
Is One Of The Least Understood Pathological Processes With A Multifactorial Etiology. Reduced Activity Of Methylene
Tetrahydrofolate Reductase (Mthfr) With Low Serum Folate And Elevated Homocysteine Levels Is A Genetic Risk Factor
For Rm. The Objective Of The Present Study Is To Establish The Association Of Two Well Characterized Polymorphisms Of
Mthfr Gene (C677T And A1298C) In Idiopathic Rm Among Lower Socio- Economic Women Of South India.
Methods: A Total Of 190 Subjects Were Recruited For The Study Which Included 80 Rm Cases And 110 Healthy Parous
Controls From Government Maternity Hospital, Petlaburz, Hyderabad, India. Genotyping For Both The Snps Was Carried
Out By Pcr-Rflp.
Results: Mthfr C677T Snp Analysis Showed Complete Absence Of Tt Genotype In Patients And Controls. Cc Homozygotes
Were Higher In Frequency In Controls Than In Patients (P< 0.05, 2= 6.124). Data On A1298C Polymorphism Revealed An
Elevated Frequency Of Cc Genotype In Patients Compared To Controls, Giving An Or Value Of 2.99 Indicating A 3- Fold
Increased Risk Of This Genotype Over The Others Experiencing Rm (P= 0.0002). Further Analysis With Respect To
Genotypes And Number Of Abortions Showed The Involvement Of Genotypes With Mutant Allele In Higher Prevalence
Of Rm.
Conclusion: The Mthfr C677T And A1298C Snps Are Suggested To Be Involved In The Occurrence Of Rm In South Indian
Women With Low Socioeconomic Status. However, A Study With Large Sample Size Is Warranted For Better
Understanding Of This Polymorphism.

***************

Ruptured Noncommunicating Rudimentary Uterine Horn Ectopic Pregnancy: A Case Report

Author: Dr. Manuja Naik
Co Author: Dr.Manuja N1, Dr.K.Yadav2,

Ruptured Noncommunicating Rudimentary Uterine Horn Ectopic Pregnancy: A Case Report

Dr.Manuja.N. And Dr.K Yadav
Theme: Safe Surgery Saves Lives
Name Of Prize: Fogsi-Dr Jagadishwari Mishra
Abstract
Background: An Ectopic Pregnancy Is A Gestation That Implants Outside The Endometrial Cavity, It Represents A Serious
Hazard To WomanS Health And Her Reproductive Potential. Rudimentary Horn Is One Of The Rarest Congenital
Uterine Anomaly And Consists Of A Relatively Normal Appearing Uterus On One Side With A Rudimentary Horn On The
Other Side,With Majority Of Cases Being Non Communicating. Pregnancy In Rudimentary Horn Is Rare And Represents A
Form Of Ectopic Gestation. Incidence Of Rudimentary Horn Pregnancy Is 1 In 76,000 1,50,000 Pregnancies. In 90%
Rudimentary Horn Is Non-Communicating. Despite Recent Advances In Ultrasound, The Diagnosis Remains Elusive With
Confirmatory Diagnosis Being Made At Laparotomy, When Rupture Occurs, Manifesting Commonly As Acute Abdominal
Pain With High Risk Of Maternal Mortality.
Case: A 19 Years Old Primi, Presented With 3 Months Amenorrhoea,With Severe Abdominal Pain, Vomiting, For The Last
6 Hours, On Examination She Was In Shock, Features Of Acute Abdomen Present. Culdocentesis Was Positive. Urgent
Exploratory Laparotomy Revealed Ruptured Rudimentary Horn Of The Uterus With Haemoperitonium And Fetus In The
Abdominal Cavity With Intact Fallopian Tubes And Ovaries On Both Sides. Excision Of Non-Communicating Rudimentary
Horn And Right Side Fallopian Tube Was Done,Right Ovary Preserved. Post-Operative Recovery Was Uneventful.
Conclusion: So, A High Index Of Suspicion Is Required To Save This Catastrophic Event And Associated Maternal Morbidity
And Mortality. In Our Opinion, Routine Excision Of Rudimentary Horn Should Be Undertaken During Nonpregnant State
Laparoscopically. However, Those Women Who Refuse Should Be Adequately Counseled Regarding Potential
Complications And If Pregnancy Occurs In Rudimentary Horn, First Trimester Laparoscopic Excision Should Be Done.

***************

Scrub Typhus In Pregnancy: A Rare Case Report

Author: Dr. Priya Singh
Co Author:

Scrub Typhus In Pregnancy : A Rare Case Report

Scrub Typhus, A Rickettsial Disease Is Very Rare In Pregnancy, The Incidence Of Which Is Not Yet Reported.When It Occurs
During Pregnancy It Can Have Serious Repercussions For The Mother And The Developing Fetus.Since It Is Extremely
Uncommon, The Clinical Impact Of Scrub Typhus On Pregnancy Has Not Been Elucidated And An Effective And Safe
Regimen Has Not Been Validated.
I Report A Case Of 24 Year Old Female, Primigravida At 27 Weeks Of Gestation, Presented With High Fever,Vomitting And
Loose Stools For 4 Days.On Examination There Was A Eschar On Her Lower Abdomen And Weil Felix Test Was Reported
To Be Positive.She Was Successfully Treated With Azithromycin But Preterm Delivery Occurred.Her Infant Died Of
Respiratory Distess.Vertical Transmission Was Not Demonstrated In This Case.She Also Suffered From Sensorineural
Hearing Loss Which Recovered Slowly Follwing Discharge From Hospital.
Safe And Effective Drug Regimen For Treating Scrub Typhus In Pregnancy As Well As Prevention Of Fetal And Maternal
Complications Still Remains A Major Challenge.

***************

Spontaneous Endometriotic Cyst In Rectus Abdominous Muscle

Author: Dr. Niharika Munaganuru
Co Author: Dr.M Niharika1, Dr.Geeta Doppa2, Dr.Ravikanth G O3,

Spontaneous Endometriotic Cyst In Rectus Abdominous Muscle

Dr.M.Niharika1, Dr.Geeta Doppa2, Dr.Ravikanth G O3
Jr Resident1, Prof & Hod2, Asst Prof3
Background:
Extra Pelvic Endometriosis Is Defined As Endometriotic Lesions Found Elsewhere In The Body, Including The
Cervix,Vagina,Vulva,Intestinal Tract,Urinary Tract,Abdominal Wall,Thoracic Cage And Lungs, Extremities, Previous Scars
And Central Nervous System.Differential Diagnosis Includes Abscess, Lipoma, Hematoma,Sebaceous Cyst, Suture
Granuloma,Desmoid Tumor, Sarcoma, Lymphoma And Primary Or Metastatic Cancer. We Are Presenting A Case Report
Of Infraumbilical Endometrioma.

Case:
A 24Yr Old P1 L1 Presented With Continuous And Localized Pain Abdomen Three Cm Left And Below Umbilicus Since
Four Months Which Increases Three Days Before, During And Four Days After Menses. Pain Abdomen Was Progressive
And Spasmodic In Nature.Patient Was Given Oral Contraceptive Pills For 3 Cycles Elsewhere Which DidnT Reduce Her
Pain.Patient Complains Of Nausea But Not Associated With Vomiting. Ultrasound Showed Well Defined,
Heteroechoic,Vascular Mass Lesion In Rectus Muscle Infraumbilical Region.An Ultrasound Guided Fnac Showed Features
Of Endometriosis. At Surgery An Incision Of About 2Cms Was Taken Over The Lesion And Subcutaneous Fat Was
Separated After Which On Palpation There Was A Nodule Of About 1.31.5 Cm. On Opening The Rectus Sheath A Bluish
Bulging Membrane Of The Cyst Was Opened To See Dark Brown Fluid.The Cyst Was Excised With 4Mm Of Surrounding
Tissue. Histopathological Examination Of Specimen Showed Features Of Endometriosis.Post-Operative Period Was
Uneventful.

Conclusion:
Abdominal Wall Endometriosis Occurs Spontaneously In The Umbilicus And Inguinal Canal, Usually Without Any
Associated Intrapelvic Endometriosis. Extrapelvic Endometriosis Is Rare And May Result From Vascular Or Lymphatic
Dissemination Of Endometrial Cells As In Our Case. It Causes A Swelling Which Becomes Bigger And More Painful About
The Time Of Menstruation. It Appears Blue From An Underlying Blood Cyst And Sometimes Discharges Blood. The Cyst Is
Not Encapsulated And Surrounding Tissue Is Indurated.

***************

Triplets With Persistent Theca Lutein Cysts. A Rare Complication Of Ovulation Induction
Author: Dr. Ramya Priya Vankadara
Co Author: Dr. Nvr Murty1,

Title : Triplets With Persistent Theca Lutein Cysts. A Rare Complication Of Ovulation Induction
Background: Ovulation Induction Is The Most Commonly Used Treatment For Anovulatory Infertility. Clomiphene Citrate
Is The Most Commonly Used Drug. Incidence Of Twins With Clomiphene Is 5%. Triplets And Higher Order Births Is Rare
Around 1-2%.
Theca Lutein Cysts Are Commonly Seen With Molar Pregnancies And Multifetal Gestation, More So When
Human Chorionogonadotropin Is Used For Ovulation Induction.
Case: Mrs. X 25 Yrs Old Primigravida Married For 1 Year And Known Case Of Hypothyroidism And Pcos Presented To
Us At 10 Weeks Of Pregnancy After Conception With Clomiphene Citrate 50Mg And Hcg 5000Iu . Viability Scan Done
Outside Showed Triplet Pregnancy. Tiffa Done At 16 Wks Showed Normally Growing Fetuses Mcma And Mcda. It Also
Showed Bilateral Multi Loculated Thin Walled Cystic Lesions With Thick Septations Measuring 9.9X7.5 Cms In Left Ovary
& In Right Ovary 7.8 X6 Cms But No Solid Component,No Ascites.Doppler Was Normal. Ca125 And Hcg Were 24.10
U/Ml And 171304 M Iu/Ml Respectively. She Was Monitored As High Risk Pregnancy .Serial Scans Showed Appropriate
Growth Of Three Fetuses And Gradual Increase In Size Of Cysts. She Underwent Emergency Lscs At 33 Weeks. Aspiration
Of Cysts Done Fluid Sent For Ca 125 Analysis(145 U/Ml). After 6 Weeks Of Delivery Ca125 Is 12.19 U/Ml And Usg Showed
Decrease In The Size Of The Cysts Right Ovary 6X4 Cms And Left Ovary 5.4 X2.6 Cms. At Last Follow Up She Was
Asymptomatic.
Conclusion :
1.
This Is Presented For The Rarity Of Persistent Thecalutein Cysts Through Out Pregnancy Without Other Features
Of Ohss.
2.

Luprolide Is A Better Alternative To Hcg.

3.
Possibility Of Ovarian Tumor To Be Excluded Particularly When Isolated Ovarian Masses Without The Other
Features Of Ohss.

***************

Maternal And Fetal Outcome In Thalassemia Minor Complicating Pregnancy - A Retrospective Study
Author: Dr. Uma Shirpure
Co Author: Dr. Aparna, Mbbs,Md1, Dr.Nvr Murty, Mbbs,Md2,

Title:
Maternal And Fetal Outcome In Thalassemia Minor Complicating Pregnancy - A Retrospective Study.
Objective:
To Study Maternal And Fetal Outcome In Thalassemia Minor Complicating Pregnancy.
Material And Method:
It Is A Retrospective Analytical Study Of Pregnant Women With Thalassemia Minor At Our Institute From June 2012
To June 2014.
Outcomes Were Observed In Terms Of Gestational Age At Delivery, Mode Of Delivery, Antenatal, Intranatal And Postnatal
Complications And Need For Blood Transfusions. Birth Weight And Apgar Score At 1 And 5 Min Were Also Noted.
Results:
All 8 Patients Were In Their Twenties; 7 Out 8 Patients Were Detected To Have Thalassemia Minor First Time In This
Pregnancy. Four Out Of These 7 Patients Were Detected To Have Thalassemia Before 30 Weeks Of Gestation Due To
Workup Done For Resistant Anemia. Mean Antenatal Hemoglobin Was 8.2Gm%. The Associated Antenatal Complications
Were Preeclampsia In One Patient, Fgr In 3 Patients And Oligohyadromnios In 2 Patients. The Mode Of Delivery Was
Caesarean Section In 4 Patients For Obstetric Indication. Three Patients Required Antenatal Blood Transfusion, While 1
Patient Required Postnatal Blood Transfusion. Neonatal Outcome Was Good. Mean Birth Wt Of Newborns Was 2.468.
Mean 1 Min Apgar Was 8 And Mean 5 Min Apgar Was 9. Those Patients Who Were Detected To Have Thalassemia In
Late Trimester Were Associated With Blood Transfusions And Fgr.
Conclusion:
1)

Not Only Early Detection Of Anemia But Typing Of Anemia Is Also Important.

2)
Before Treating Anemia, Thalassemia Minor To Be Ruled Out To Avoid Inadvertent Use Of Intravenous Iron
To Avoid Iron Overload.
3)
Regular Follow Up And Early Detection Can Decrease Complications Associated With Thalassemia Minor In
Pregnancy.
4)

Screening Of Partner And Genetic Counselling Should Be Done.

***************

Swyer Syndrome
Author: Dr. Banupriya.M Banupriya.M
Co Author: Dr.Sindhuja1,

Title; Dysgerminoma In Swyers Syndrome-A Rare Case Report

Introduction
Swyer Syndrome Is Characterized By Female Phenotype Unambiguous Female Genital Appearance And 46Xy First
Described By Swyer 1955. Risk Of Gonadal Neoplasia Reported In Swyer Syndrome Is 20-30% Commonest B/L
Gonadoblastoma.The Condition Usually Presents As Primary Amenorrhea Since Streak Gonads Have No Hormonal Or
Reproductive Potential
Case Report:
35Yrs - Primary Amenorrhea , Progressive Pain Lower Abdomen- 2Months ,Urinary Retention- 2Days .
O/E , Short Statured , Kyphoscoliosis,Breast -Tanner Stage0,No Axillary Hair , Sparse Pubic Hair,Normal Female External
Genitalia.P/A - Hard Mass Of 15X10Cm Occupying Hypogastrium & Left Iliac Fossa. P/V-Vagina Admitted One Finger
,Cervix Hypoplastic, Same Mass Felt Through Anterior , Left Fornix, Which Not Separate From The Uterus. P/R -Revealed
Same Mass.
Usg Abdomen - 10.7X8.5 Cm Hypoechoeic Mass Posterior To Bladder,Uterus And Cervix Not Visualized Separately ,Left
Moderate Hun.Ct Abdomen -Mixed Density Mass In Pelvis , Left Hun.Preop Tumour Markers Not Done.
On Laparotomy Irregular Firm To Hard Mass Bosselated Surface Left Adnexa Adherent To Uterus , Posterior To
Rectosigmoid. Fallopian Tube& Ovary On Right Side Rudimentary, Uterus Atrophic.Left Pelvic Node Conglomerate 5X
4Cm.Saline Wash Of Abdomino Peritoneal Cavity Sent For Cytological Analysis.After Adhesiolysis Total Hysterectomy
With Complete Excision Of Mass Done.Pelvic Lymphadenectomy &Infracolic Omentectomy Done.
Hpe - Dysgerminoma L Ovary With External Rim Of Uterine Myometrium & Opposite Side Broad Ligament -With
Tumour.Right Ovary & Tube Atrophic. Uterus - Atrophic Endometrium.Pelvic Nodes-Tumour Deposits.Omentum , Saline
Wash - No Tumour Cell.Surgicopathological Stage Iia.
Postoperative Tumour Markers- Mild Elevation Of S.Ldh-278 U/L. S.B Hcg 9.1 Miu/Ml, S.Afp- 8.38Ng/Ml In Normal
Range.Chromosomal Analysis - 46 Xy- Y Chromosome Conformed By Quinacrine Fluorescence.The Derivative Of Y
Consists Additional Material Of Unknown Origin At Terminal Region Of Q Arm.Post Operative Period Uneventful &
Referred For Adjuvant Chemotherapy After 3 Weeks.

***************

Pregnancy With Post Thyroidectomy Hypoparathyroidism

Author: Dr. K.Pushpa Latha Latha
Co Author:

Title-Pregnancy With Post-Thyroidectomy Hypoparathyroidism

K.Pushpa Latha, Shashikala Bhat, Krupa Shah, Seema Shetty, Shashikiran Umakanth
Background: Hypoparathyroidism In Pregnancy Is Rare. Incidence At Endocrine Surgical Centers Reported As 0.9 To 1.6
%. It Occurs As A Result Of Inadvertent Removal Or Damage To The Glands, Usually To Their Blood Supply, During Neck
Surgeries . Clinical Features Include Tetany, Paraesthesias , Muscle Cramps, Seizures And Rarely Frank Psychosis. It Is
Important To Monitor Serum Calcium During Pregnancy Periodically To Detect Hypo/ Hypercalcemia. Treatment Is
Calcium And Active Vitamin D Supplementation. Acute Symptomatic Hypocalcemia Is A Medical Emergency And
Warrants Immediate Management. Perinatal Presentation Is Variable Ranging From Asymptomatic To Fetal Bone
Demineralization, Growth Restriction And Rarely Death.
Case Presentation: A 30-Year-Lady, Second Gravida, With History Of Hypoparathyroidism Following Total Thyroidectomy
4 Years Ago, Presented In Early Pregnancy. Anticipating Complications Related To Hypocalcemia In Pregnancy, Her
Calcium Replacement Was Optimized And She Was Followed Up Regularly With Frequent Estimation Of Serum Tsh And
Calcium. She Was Asymptomatic And Calcium Levels Were Always Above 7.5 Meq/L Until 36-Weeks Gestation, When She
Presented With Features Of Respiratory Infection And Severe Acute Hypocalcemic Crisis. She Had Low Serum Total
Calcium (6.6Mg/Dl), Ionized Calcium (2.20Mg/Dl), Magnesium (1.7Mg/Dl) Along With Respiratory Alkalosis (Ph-7.50 And
Pco2 -25.6Mm/Hg). Tachypnea Due To Respiratory Infection Was Hypothesized As The Cause For Respiratory Alkalosis
That Precipitated The Acute Hypocalcemia.
She Was Actively Managed With Intravenous Calcium Gluconate And Magnesium, Treatment Of The Respiratory Infection
And Optimization Of The Oral Supplementation. She Responded Well To The Treatment And Delivered A Healthy Neonate
Normally After An Induced Labour At 38 Weeks Of Gestation. Postnatal Period Was Uneventful.
Conclusion: Post-Thyroidectomy Hypoparathyroidism With Hypocalcemia Can Complicate Pregnancy. Key To Successful
Outcome Is Serial Calcium Monitoring And Appropriate Management Of Acute Hypocalcemic Episodes.

***************

Use Of Peripheral Dexa Scan For Osteoporosis In Semiurban Population

Author: Dr. Kavya Vazrala
Co Author: Dr.Radha Bai Prabhu1,

Use Of A Peripheral Dexa Scan For Osteoporosis Screening In Semiurban Population

Introduction &Aim
Studies Have Shown That Prevalence Of Osteopenia And Osteoporosis Is High Among Perimenopaual Women Belonging
To Urban Population.This Study Was Undertaken To Study The Prevalence Of Osteoporosis Among Perimenopausal
Women, Belonging To Semiurban Area And To Study The Various Risk Factors That Can Lead To Osteoporosis.

Methodology
This Was A Prospective Analytical Study Conducted In The Obg Department Of Meeenakshi Medical College And
Research Institute, Kanchipuram. 100 Perimenopausal Women Were Chosen At Random From The Clinics And In These
Women, Detailed History Was Taken For The Known Risk Factors. Women Were Subjected To Peripheral Dexa Scan Of
The Calcaneal Bone.
Result
Women, 32 Were Having Osteopeania And 13 Were Suffering From Osteoporosis .

Out Of 100

For Both Osteopenia And Osteoporosis , Identified Risk Factors Were Non Exposure To Sunlight , Dietary Habits, And
Comorbidities Like Type 2 Diabetes & Hypertension. Women Were Given Advise On Sun Light Exposure,Diet ,Medication
And Treatment For Osteoporosis.
Conclusion
P-Dexa Heel Bmd Has Utility For Non Invasive Office Screening Of Patients Who Are At Risk For Osteoporosis And Helps
In Early Intervention Of Osteoporosis, And Thereby Reduces Morbidity And Mortality.

***************

Vagaries Of Ovarian Torsion

Author: Dr. Jayalakshmi Muthusamy
Co Author: Prof. Dr. Radhabhai1, Dr. Vaelayudham2,

Vagaries Of Ovarian Torsion

Abstract:
Background:
Adnexal Torsion Accounts For 3% Of Gynecological Emergencies. It Is Most Common During The Reproductive Years. Here
We Report Cases Of Ovarian Torsion Occurring In Different Age Group And Their Treatment Modalities Are Discussed.
Case Report:
Case: 1
13 Year Old Girl Presented With Acute Abdominal Pain, Diagnosed As Left Ovarian Cyst With Torsion. At Laparotomy, Due
To Gangrenous Nature Of Ovarian Cyst, Left Oopherectomy Was Done.
Case: 2
19 Year Old Primi Diagnosed With Vesicular Mole With Bilateral Theca Lutein Cyst. Two Days After Evacuation, Patient
Developed Acute Abdominal Pain And Usg Guided Aspiration Was Done To Relieve The Tension Within The Cyst. Pain
Recurred After One Week And Laparotomy Showed Torsion Of Right Ovary With Viable Ovarian Tissue. Torsion Was
Undone And The Cysts Were Reaspirated Again.
Case: 3
55 Year Old Postmenopausal Woman Presented With Acute Abdominal Pain, Vomiting And Fever And Was Diagnosed As
Right Ovarian Cyst Torsion, Ca- 125 Normal. At Laparotomy Cyst Had Undergone Torsion 5 Times And Bilateral
Salpingo-Oopherectomy Was Done.
Conclusion:
This Case Series Has Shown That Torsion Can Occur At Extremes Of Age And Conservative Management Is Possible If
Diagnosed Early.

***************

Pregnancy Outcome In A Patient With Moyamoya Disease

Author: Dr. Maya Menon
Co Author: Maya Menon1, Sridevi T.A2,

Back Ground :
Uterocutaneous Fistula, Although Not Exceptional, Is A Very Rare Clinical Entity. Approximately 120 Cases Of
Uterocutaneous Fistula Have Been Reported In The World Literature In Its Entirety Over The Past 200Years With Not
More Than 3Cases From India In The Past 50Years. It Occurs Most Often After Uterine Or Pelvic Surgery .Surgical
Treatment With Hysterectomy And Excision Of The Fistulous Tract Has Been Successful.
Case :
A 24 Year Old P2L2 Came To Casualty With Complaints Of Pain And Swelling On Left Lateral Edge Of Pfannensteil Scar
Since 4Days. She Underwent Two Lscs, 2Nd Lscs Was Done 3 Years Prior To Presentation. Patient Had Similar Complaints
On Right Lateral Edge Of Pfannensteil Incision 2 Years Back And Underwent Surgery As Said In Patients Words For
Drainage Of Abscess / Suture Granuloma In An Outside Hospital For Which Documented Details Were Not Available. Usg
Showed Echogenic Collection Measuring 1.8Cm In Endometrial Cavity Leaking Through Anterior Myometrial Wall Into
Intramuscular Planes From There To Subcutaneous Planes Causing Localized Collections. Mri Pelvis Showed
Uteroperitoneal Fistula Between Uterus And Intramuscular And Subcutaneous Planes. Patient Underwent Surgical
Exploration And
Fistulous Tract Was Excised And Given Danazol For 6 Months For Suppression Of Menstruation But Symptoms Recurred
After 6 Months. Relaparotomy Was Performed Where Total Abdominal Hysterectomy Was Done For Recurrence.
Histopathology Revealed
Chronic Cervicitis , Proliferative Endometrium, Fistulous Tract - Chronic Nonspecific
Inflammation, Foreign Body Giant Cell Reaction. Post Operative Period Was Uneventful .

Conclusion :

The Case Highlights This Rare Complication Of Caesarean Section. Although Medical And Surgical Treatment Is Mostly
Successful, The Best Treatment Of Uterocutaneous Fistula Remains Prevention Based On Better Uterine Surgery
Technique, Prevention Of Postoperative Infection.

***************

Obstetrical & Perinatal Outcome In Newborns With Nuchal Cord A Descriptive Study
Author: Dr. Sangeetha Karunanithi
Co Author: Dr.Seetesh Ghose1, Dr.P.Soundararajan2,

Aim: To Compare The Obstetrical And Perinatal Outcome Between The Newborns With & Without Nuchal Cord At The
Time Of Delivery. To Find Out The Proportion Of Pregnant Women Undergoing Operative Interference With Nuchal Cord.
Method: The Present Study Was Conducted To Find Out The Requirement Of Labour Induction, Requirement Of
Augmentation, Duration Of Labour, Mode Of Delivery (Obstetrical Parameters) And Gestational Age, Amniotic Fluid Index,
Foetal Heart Rate Irregularities, Birth Weight, Number Of Nuchal Cords, Meconium Stained Liquor, Apgar Score, Cord
Blood Gas Analysis (Neonatal Parameters) In Newborns With Nuchal Cord. For That Purpose The Newborns Born In The
Time Period Of August 2013 To May 2014, Who Fulfill The Inclusion And Exclusion Criteria Were Taken Into Account. All
The Pregnant Women Were Allowed To Have The Normal Course Of Labour.At The Time Of Delivery All Neonates Born
With Nuchal Cord Will Be Taken As The Study Group. Subsequent Delivery On The Same Day Without Nuchal Cord Will
Be Included In The Control Group. If The Nuchal Cord Is Loose, It Will Be Unwrapped From The Foetal Neck And The Baby
Will Be Delivered. Tight Nuchal Cord Will Be Clamped With A Set Of Clamps, Cut In Between And Baby Will Be
Delivered.Cord Blood Gas Analysis Will Be Done Using Blood Gas Analyser For Neonates With Intranatal Evidence Of
Foetal Distress.
Results: Newborns With Nuchal Cord Was Associated With Increased Foetal Heart Rate Irregularities (20.9% Vs 11.5 %)
And 1St Minute Apgar Score <7 When Compared To Control Group (13.2% Vs 7.2%, P=0.033). There Was No Statistically
Significant Difference Between The Two Groups In Relation To Other Variables. Thus Nuchal Cord Does Not Adversely
Affect The Obstetrical And Perinatal Outcome.
***************

A Study On Safety And Efficacy Of Ormeloxifene In Management Of Dysfunctional Uterine Bleeding.

Author: Dr. Sameena Sultana
Co Author: Nandagopal Km1,

A Study Of Efficacy And Safety Of Ormeloxifene In Management Of Dysfunctional Uterine Bleeding .

Sameena S1 , Nandagopal Km2.
1-Post Graduate, Department Of Obg, Ssmc, Tumkur, 2-Professor & Hod, Department Of Obg, Ssmc, Tumkur.

Aim: To Study The Effectiveness And Safety Of Ormeloxifene In Management Of Dysfunctional Uterine Bleeding .

Objectives:
1.

To Evaluate The Effectiveness Of Ormeloxifene In Treating Menorrhagia In Dub.

2.

To Study Effects Of Ormeloxifene On Endometrial Thickness.

3.

To Study Side Effects If Any And Watch For Patient Compliance.

4.
Materials And Methods:
A Longitudinal Study Was Carried Out On Patients With Menorrhagia In The Age Group Of 35 50 Yrs As Per
The Inclusion And Exclusion Criteria For A Period Of 18 Months. (October 2012 April 2014).Exclusion Criteria Were
Presence Of Pelvic Pathology-Uterine Fibroid, Pid, Adenomyosis, Endometriosis, Malignancies Of Uterus / Cervix /Ovary
/ Vagina / Complex Endometrial Hyperplasia With Atypia ,Systemic Diseases-Platelet Disorders, Coagulopathy, Previous
History Of Thrombosis ,Pregnancy And Lactation, Pcos, Chronic Cervicitis, Jaundice, Hepatic Dysfunction, Tb, Renal
Impairment, Hypersensitivity To Drug.

The Drug Was Administered Orally In Form Of Tablet (60Mg) Twice A Week , Every Sunday And Wednesday For First
12 Weeks And Then Once A Week For Another 12 Weeks. Blood Haemoglobin Levels And Endometrial Thickness (Trans
Abdominal Scan / Trans Vaginal Sonography) Were Measured Initially, At Three Months And At The End Of The Study (6
Months).

The Main Outcome Measures Were

1.
Pre Treatment And Post Treatment Assessment Of Menstrual Blood Loss Objectively By Pictorial Blood Loss
Assessment Chart (Pbac) Scores And Subjectively By Visual Analog Scale.
2.

Blood Haemoglobin Levels.

3.

Endometrial Thickness (Trans Abdominal/ Trans Vaginal Scan).

Results:
Out Of 70 Patients 6 Patients Lost To Follow Up And 59 Patients Attained Amenorrhea After 6 Months Of Treatment With
Ormeloxifene And 5 Patients Underwent Abdominal Hysterectomy. Ormeloxifene Was Effective In 84% Patients Of Dub
Causing Amenorrhea. Haemoglobin Percentage Before Treatment Was 6-11.2G%, After 3 Months It Ranged From 6.811.6G% And 7.2-11.6G% After 6 Months Of Treatment. Haemoglobin Was Increased After Treatment With Ormeloxifene.
P Value Is Statistically Significant After 3 And 6 Months Of Treatment With Ormeloxifene. Endometrial Thickness Ranges
From 4-28Mm Before Treatment, 3.5-14Mm After 3 Months Of Treatment And 3-16Mm After 6 Months Of Treatment.
Endometrial Thickness Is Reduced After 3 Months And 6 Months Of Treatment With Omeloxifene. P Value Is Statistically
Significant After 3 Months And 6 Months Of Treatment With Ormeloxifene. Pbac Scores Before Treatment, 3 Months,
And 6 Months. The Pbac Scores Ranges From A Minimum To Maximum 21-903 Before Treatment, 0-48 After 3 Months
Of Treatment With Ormeloxifene And 0-75 After 6 Months Of Treatment With Ormeloxifene. There Is Significant
Reduction In Pbac Score After Taking Ormeloxifene. P Value Is Statistically Significant After 3 Months And 6 Months Of
Treatment With Ormeloxifene.

Conclusion: Ormeloxifene Was Found To Be Effective In Management Of Dub. There Was A Significant Reduction In The
Endometrial Thickness, Pbac Score Significant Increase In Hemoglobin And Significant Reduction In Passage Of Clots With
Ormeloxifene Use.

***************

Engaging Private Sector For Increasing Access To Long Acting Contraceptive Method -Ppiud An Advantage For
Mother And Newborn
Author: Dr. Shikha Srivastava
Co Author: Dr. Shubhra Phillips1, Dr. Nayanjeet Chaudhary2,

Aim & Objectives:

Access To Safe And Effective Contraceptive During Immediate Post Partum Period Is Of Utmost Importance For
Addressing The High Unmet Need I.E. 65%, Preventing Untimely And Unwanted Pregnancy. Insertion Of An Iud
Immediately After Delivery Is Safe, Cost Effective And Has A Direct Effect On The Health Of The Mother And Newborn.
Expanding The Role Of Private Sector In Improving Ppfp Services Is One Of The Strategic Approaches.
Methods:
PsiS WomenS Health Program With Quality Assurance As A Key Component Is Working For Promoting Iud/Ppiud
Through 1100 Private Doctors Network In 30 Districts Across 3 States Of India. Providers With Heavy Delivery Load
(10- 15 Deliveries/ Month) And Who Are Willing For Inserting Ppiud Were Identified And Trained. Psi Partnered With
Government Approved Ppiud Training Centers For Training. Different Strategies Such As Training Of Trainers, Capacity
Building, Workshops And National Level Conferences Were Used To Update/Motivate These Private Providers.
Paramedics And Counselors Have Been Trained In Ppfp Counseling. Quarterly Supportive Supervision Visits Ensure Quality
Insertions And Documentation.
Psi Also Partnered With Fogsi, Has Done A Study On Safety And Efficacy Of Ppiud Which Shows Only 3 % Expulsion Rates
After 6 Weeks. Psi India Has Developed A Campaign For Goi To Support Their Strategy To Promote Ppiud And Increase
Its Awareness Among The Women Of Reproductive Age.
Results
The Outcome Suggests That During The Period Of Jan, 12 To Aug, 14- 183 Private Doctors Have Been Trained, 6739 Ppiud
Insertions Have Been Done, 20 Ppfp Counselors And 117 Paramedics Have Been Trained In Ppfp Counseling. The FollowUp Data Shows Only 7% Of Expulsion Rates.
Conclusion
Private Providers Can Play Supportive Role In Increasing Ppiud Insertions. Training Of Ppfp Counselors Has Been Effective.
Advocacy Efforts Have Contributed Generating The Interest Of Private Providers For Inserting Ppiuds.

***************

Ruptured Tubal Ectopic Pregnancy After Four Years Of Obstetrical Subtotal Hysterectomy: A Case Report
Author: Dr. Delphine Rose
Co Author:

Author Dr. T. Delphine Rose, Assistant Professor In Og, Thanjavur Medical College.

Abstract

Background: The Incidence Of Ectopic Pregnancy After Hysterectomy Is Much Less With Only 67 Cases Reported So Far
In Medical Literature. It Can Present Soon After Hysterectomy Or Several Years Later. If Not Considered As A Differential
Diagnosis Of Acute Abdomen In A Reproductive Age Post- Hysterectomy Patient, The Diagnosis May Be Delayed, Leading
To Very High Morbidity And Mortality.

Case: A 25 Year-Old Woman Admitted To Our Casualty In A State Of Shock With History Of Severe Lower Abdominal Pain,
Giddiness And Vomiting For Four Days. She Had Undergone Postpartum Subtotal Hysterectomy For Atonic Pph Four Years
Back. Examination Showed A Tense And Tender Lower Abdomen With Fullness In The Vaginal Vault. Tvs Showed A
Complex Heterogeneous Mass In The Pelvis With Free Fluid. After Resuscitative Measures An Emergency Exploratory
Laparotomy Was Performed And The Pelvic Mass Removed. The Pathology Report Indicated Tubal Ectopic Gestation.

Conclusion: Ectopic Pregnancy That Occurs Several Years After Hysterectomy Is A Rare Phenomenon That Appears To Be
Due To Migration Of Sperms From Vaginal Vault Into The Peritoneal Cavity Through A Fistulous Connection. Hence
Absence Of Uterus Does Not Rule Out An Ectopic Gestation. So Urine Pregnancy Test Should Be A Part Of The Diagnostic
Tests Of These Patients. Prompt Diagnosis And Early Treatment Might Save Lives.

***************

Mifepristone-Misoprostol Combination Versus Only Misoprostol In The Management Of Intrauterine Fetal Death- A
Randomised Comparative Study
Author: Dr. Sindhuri Ramaswamy
Co Author: Dr.Sunita Samal1, Dr.Swetha2, Dr.Seetesh Ghose3,

Background:
The Most Undesirable Consequence Of Pregnancy Is Intrauterine Fetal Death, That Occurs In 1% Of All
Pregnancies. Retention Of Dead Fetusin Utero Has Its Impact On Physical, Psychological And Social Aspects. Various
Pharmacological Agents Have Been Tried In The Management Of Intrauterine Death. The Present Study Was Performed
To Find Out The Efficacy And Safety Of Mifepristone- Misoprostol Combination With Misoprostol Alone In The
Management Of Iufd After 24Wks Of Gestation.
Materials And Methods:
This Randomized Comparative Study Was Conducted Over 56 Women With Iufd After 24 Weeks Of Gestation.
Patients Were Divided Into Two Groups. Patients In Group A, With Gestational Age Of 24-34 Weeks And More Than 34
Weeks Had Received 200 gm And100 gm Of Vaginal Misoprostol Respectively . Dose Was Repeated Every 4Hours
Upto A Maximum Of 4 Doses. Patients In Group B, Had Received 200 Mgm Of Oral Mifepristone As Outpatient Medication,
Irrespective Of Gestational Age. After 24 Hours Same Dose Of Misoprostol Was Followed As Per Group A.
Result:
The Age , Bmi, Parity And Gestational Age In The Two Groups Were Found To Be Similar. The Mean Induction
To Delivery Interval Was 5.090.95Hours In Group B As Compared To 13.143.75 Hours In Group A Which Was
Significantly Less (P<0.001**). Requirement Of Misoprostol Doses Was Also Less( Group B-1.110.32, Group A2.931.25) In Mifepristone Pretreated Group. Parity (Group A P=0.1406, Group B P=0.1999) And Bishop Score(Group AP Value=0.90, Group B- P=0.28) Did Not Affect Idi In Both Groups. But In Group A Idi Was Less With Increasing Gestational
Age (P=0.03+) Where As In Group B Gestational Age Did Not Modify The Idi (P=0.8715). Incidence Of Gastrointestinal
Side Effects Along With Fever And Chills Were Significantly More Associated With Group A (P=0.093+).
Conclusion:
In Management Of Intrauterine Fetal Death, Combination Therapy Of Mifepristone And Misoprostol Is More
Effective Than The Misoprostol Alone For Induction Of Labour Which Is Easily Tolerable And Safe.

***************

Prelabour Silent Rupture Of An Unscarred Uterus At 32 Weeks Gestation

Author: Dr. Arumuga Selvi
Co Author: Dr. S.Ramalakshmi1,

Background:
Spontaneous Rupture Of An Unscarred Uterus Prior To Onset Of Labour In Early Third Trimester Is Extremely Rare
And Very Few Cases Have Been Reported So Far.
Case Presentation:
A 38Years Old G2P1L1 With Previous Vaginal Delivery With 32 Weeks Gestation Presented With Abdominal
Pain.She Was Haemodynamically Stable With Prelabour Rupture Of Uterus With Extrusion Of Intact Amniotic Sac From
Uterine Fundus Through The Rent.
Conclusion:
Uterine Fundal Rupture Is A Relatively Unknown Phenomenon And The Clinical Presentation Might Be
Confusing.It Should Be Kept In Differential Diagnosis Of Pregnancy With Abdominal Pain Of Any Degree With Fetal
Demise.

***************

An Acute And Atypical Presentation Of Partial Molar Pregnancy...A Case Study.

Author: Dr. Papiya Biswas
Co Author:

Background:
Partial Molar Pregnancy Is A Variation Of A Molar Pregnancy In Which An Embryo Either Develops Incompletely, Or Not
At All. In A Partial Molar Pregnancy, An Incomplete Embryo And Placenta Develop Side By Side.
Case:
A Twenty Years Old Third Gravida Lady With Previous History Of Caesarian Section Presented With Twentyfour Weeks Of
Gestation And With Complaints Of Excessive Vomiting,And Bleeding. Her Urine For Pregnancy Test Was Positive And She
Was Under Regular Ante Check Up.On Examination, Patient Was Found To Be Hypertensive . Her Fundal Height (32
Weeks) Was Found To Be More Than Period Of Amenorrhoea. On Auscultation, Fetal Heart Sound Was Audible.
Ultrasonography Showed Single Live Foetas With Enlarged Heterogenous Echotexture Situated At Anterior Wall Of Uterus
Away From Internal Os . There Was Mild Pericardiac Effusion With Cerebral Ventricles Were Found Dilated With
Nonvisualisation Of Cerebellum And Pons. Termination Of Pregnancy Was Planned Due To Uncontrolled Bp And The
Fetus Having Suspected Multiple Congenital Anomalies. Pretermination B-Hcg Level Was 64.4Miu/Ml. Induction Was
Done By Dinoprostone Gel But Failed. Fundal Height Gradually Increased In Size And With Suspicion Of Concealed
Haemorrhage Patient Was Taken Up For Surgical Intervention. Hysterotomy Was Done And Gush Of Blood And Blood
Clots Mixed With Grape Like Tissue Expelled Out. Subsequently A Dead Fetus And Placenta Were Delivered. The Diagnosis
Was Consistent With Partial Molar Pregnancy. Postoperative Period Was Uneventful. On Follow Up PatientS Fundal
Height Decreased To 16 Weeks And Blood For B-Hcg Was 12Miu/Ml On Second Post Operative Day And 6Miu/Ml On
Tenth Post Operative Day.Initial Post Operative Bp Was High (150/90 Mm Of Hg) Which Was Normalized Subsequently
With The Use Of Amlodipine. Patient Was Discharged From Hospital In A Stable Condition.
Conclusion
A Partial Molar Pregnancy Occurs Rarely And Can Be Considered A Genetic Accident. Bleeding In Early Pregnancy Along
Severe Nausea, Vomiting, And Hypertension Should Prompt For Immediate Ultrasonography. If Diagnosed, Partial Molar
Pregnancy Should Be Terminated Early By Removing The Embryo And Placenta From The Uterus.
.
.

***************

Assessment Of Risk Factors In Antenatal Patients Registered In First Trimester In Bharati Hospital And Their Post
Natal Outcome
Author: Dr. Nayanika Gaur
Co Author: Dr. Girija Wagh1,

Objective:
To Observe The Assessment Of Risk Factors In The Antenatal Patients Who Have Sought Care From The First Trimester Of
Pregnancy At Bharati Hospital And Their Post Natal Outcomes.
Study Design: A Detailed Study Of Patients Registered Antenatally In The First Trimester In Bharti Hospital Was Done And
The Risks Were Assessed By Means Of History Taking, Defined Set Of Investigations And Relevant Counseling. Outcome
Variables Studied Were Mode Of Delivery , Weight Of The Baby And The Need Of Nicu Post Delivery.
Result:
In All 50 Cases Were Studied. Benign Abnormalities Could Be Detected In 8 % Of The Patients In The Anomaly Scan In 2Nd
Trimester.The Incidence Of Anaemia And Urinary Infections Was 4 % Each Detected With In The 2Nd Trimester. With
Proper Follow Up And Treatment The Investigations Were Repeated In The 3Rd Trimester. 4% Were Detected To Have
Iugr And Polyhydramnios Each In The 3Rd Trimester Scan. 50 % Of Them Had A Vaginal Delivery And 50 % Underwent
Cesarean Section Out Of Which 32% Were Emergency Cesarean Section And Rest Were Elective. 80% Of The Study Group
Were Within The Age Group Of 20 To 30 Years. 8 % Were Above The Age Of 30Years.. Post Natally 42% Of The Total
Outcome Were Under 2.5Kg Weight And 16 % Of Them Required Nicu Admission.
Conclusion:
With The Regular Antenatal Visits During The Course Of Pregnancy Risk Assessment Can Be Done And Proper Measures
Can Be Taken To Prevent Complications And Improve The Perinatal And Post Natal Outcome. Even Then We Hold 10 %
Risk Of Foetal Distress Intrapartum Contributing To Increased Caesarean Section Rate. Inspite Of An Early Onset Optimum
Antenatal Care Perinatal Outcomes Continue To Be Suboptimal.However Major Complications Of Pregnancy Can
Definitely Be Avoided .

***************

An Innovative Technique Of Perineorraphy

Author: Dr. Krishna Lingegowda
Co Author: Krishna Lingegowda1, Shailaja Nageshu2, Kirtan Krishna3,

Objectives: To Study The Beneficial Effects Of New Technique Of Perineorraphy Like Reduced Operative Time, Blood Loss
And Post Operative Pain.
Methodology : Studied 50 Patients With Deficient Perineum Over A Period Of One Year At Pesimsr,Kuppam From 1St
January 2013 To 31St Dec 2013.
An Incision Was Made At Mucocutaneous Junction Of The Perineum. Bulbospongiosus And Transverse Perineal Muscles
Were Taken With The Help Of Needle Without Dissecting The Facia Covering The Perineal Body. The Stitches Were Tied
Using Enough Tension Just To Achieve The Approximation Of The Muscles. Later The Vaginal Mucosa Was Sutured Using
Continuous Suture Without Locking. The Perineal Skin Was Closed Using Subcuticular Stitch. The Blood Loss And Time
Taken For The Procedure Were Noted. The Length Of The Perineum Was Measured Before And After The Procedure.
Post Operative Perineal Pain Was Assessed On Post Operative Day 1 Using Visual Analogue Scale.
Results: Mean Time Taken For The Procedure Was 5.120.72 Min. Blood Loss During The Procedure Was 8.702.00
Ml. Mean Length Of The Perineal Body Achieved Was 4.010.31 Cm. Post Operative Pain On The Visual Analogue Scale
Was <2.

Conclusion : With This Innovative Technique We Could Achieve Desired Perineal Body Length With The Advantages Of
Reduced Blood Loss, Operative Time & Post Operative Pain . We Would Like To Do A Comparison Study Between
Conventional Method & Innovative Method Before Recommending It For Clinical Practice.

***************

Myomas And Moms What Myomas Do To Moms And What We Did To Myomas Bothering Our Moms.
Author: Dr. Miriam Fenn
Co Author:

Presenting Fibroids Complicating Pregnancies , The Effect Of Fibroids On Pregnancy And Vice Versa What The
Literature Says .
Then Presenting Our Figures From A Medical College In Kerala Of All Our Cases Of Fibroids With Pregnancy Over
The Last Decade And Their Outcomes. How We Have Evolved From Do Not Touch A Fibroid In Pregnancy To Fairly Routine
Caesarean Myomectomies. 24 Cases Of Caesarean Myomectomy Were Done Over The Last 4 Years With Only 2 Requiring
Blood Transfusion. We Present A Short Video On Caesarean Myomectomy And How It Is Done.
Presenting An Interesting Case Of Postpartum Collapse, Of A Patient With Sub Serous Fibroid Complicating Pregnancy.
And Another Case Of A Patient With Torsion Fibroid Requiring Ante Partum Myomectomy.

I, Dr Miriam George Fenn Aged 43 Years , Associate Professor , M O S C Medical College, Kolenchery Am Hoping For A
Slot For 20 Minute Presentation On The Above Topic. I Have Finished Obg Training Fom C M C Vellore.
My Colleagues And I Feel That This Will Make A Very Interesting And Relevant Presentation For All Practising ObstetricianGynaecologists. This Presentation Can Come Either In The Category Of high Risk Pregnancy , Or, safe Surgery
Saves Lives Category. I Belong To The Cochin Society Of Obstetrics & Gynaecology, And The Society Has Registered
My Talk With The Committee Earlier. My Fogsi Membership No. Is Coc 0553.

Waiting For Your Positive Reply,

Dr Miriam George Fenn Md,Dgo,Dnb.

***************

Author: Dr. Debabrat Sahoo

Co Author: Dr. C. Mohanta1, Dr. P. Khuntia2,

Title - Maternal Mortality Magnitude Of The Problem And Its Prevention At Vss Mch, Burla A Rural Based Tertiary
Care Centre
Authors - Dr. Debabrat Sahoo 1 , Dr.N.R. Bhoi 2, Dr. Chintamani Mohanta 3& Dr. Puspanjali Khuntia 4 , Vss Mch ,Burla,
Sambalpur, Odisha .

Aim: 1.To Estimate The Number Of Maternal Death And Identify Its Cause
Interventions And Solutions To Prevent Maternal Death

2.

Materials & Methods: A Study Was Conducted In The Department Of Obstetrics And Gynaecology Vss Medical College
Hospital, Burla From September 2012 To August 2014. All Maternal Deaths Were Studied In Detail With Respect To
Maternal Age, Parity, Booking Status, Residence, Referral, Socio-Economic Class, Admission- Death Interval, The Cause
Of Death And Preventable Factors.
Result: Maternal Mortality Ratio Was 1258.45/1,00,000 Live Births In This Study.
The Causes Of Death Were
Hypertensive Disorders (40.3%), Unsafe Abortion (13.6%), Puerperal Sepsis (12.8%), Hemorrhage (11.7%), Embolism (3%)
And Other Indirect Causes (18.6%). Maximum Number Of Deaths (78.3%) Occurred In Women Between 20-29 Years Of
Age. 52% Of Deaths In The Postpartum Period, 88% Were Unbooked Cases, 75.6% Belonged To Low Socio-Economic
Status And 80% Were Referred Cases.
Conclusion: In The Present Study Such A High Mmr Is Because Our Institution Is The Only Tertiary Health Center In
Western Odisha And Majority Of The Cases Were Referred And Critically Ill Cases. Majority Of The Cases Had No Anc.
Poverty, Illiteracy, Lack Of FamilyS Awareness, Deliveries And Abortions Conducted At Home By Untrained Persons,
Delayed Referral And Lack Of Transport Facilities Are Contributed To Increased Maternal Deaths. Had Measures Been
Taken Many Death Could Have Been Prevented.
Authors: 1. Post Graduate Trainee 2. Senior Resident 3. Assistant Professor 4. Associate Professor.

***************

Malignant Brenner Tumour -Case Report

Author: Dr. Vijayalakshmi Gnanasekaran
Co Author: C. Santhanalakshmi1, A.R.Chakravarthy2,

Introduction

Brenner Tumour Is A Relatively Uncommon Neoplasm Mostly Occurring Among Postmenopausal Women. It Is An
Epithelial Tumour Of The Ovary, Contributing To 1.4- 2.5% Of All Ovarian Neoplasms. Most Are Benign And Only 2-5% Are
Malignant.

Case Report

Our Case Was A 65 Year Old Postmenopausal Lady Who Presented With Gradual Abdominal Distension Over A Period
Of 1 To 2 Years, And Pain Abdomen For 1 Month Duration. Examination Revealed A Mass Of About 32Week Size. Imaging
Revealed A Huge Mass Of About 251923Cm. With Fluid Of About 5 Lit Showing Mutiple Mural Nodules And
Vascularity. Tumour Markers Ca125 And Cea Were Elevated. She Underwent Staging Laparotomy And Proceeded With
Tah And Right Ovariectomy And Left Oopherectomy With Infra Colic Omentectomy. The Histopathology Revealed The
Mass To Be Proliferating Brenner Tumour.

Conclusion

Malignant Brenner Tumours Are Rare And Were First Decscribed In 1945. There Is Confusion Surrounding The
Histogenesis, Hormonal Capabilities And Malignant Potential. The Above Case Is Presented For Its Rarity.

***************

Mixed Germ Cell Tumour- Case Report

Author: Dr. Ganitha G
Co Author: Vijayalakshmi Gnanasekaran1, C. Santhanalakshmi2, Subashree3,

Introduction

Mixed Germ Cell Tumours Are Relatively Uncommon Neoplasm Mostly Occurring Among Young Girls And Women.
They Contribute To 10% -20% Of Ovarian Neoplasms.Th Incidence Of Malignant Ovarian Germ Cell Tumours Ranges
Between 1% - 6% In The West And Is Higher About 8% - 19% In Asia. The Prognosis Depends Mainly On The Histological
Composition Of The Tumour.

Case Report

A 25 Year Old, P2L2 Presented With Pain Abdomen For 1 Month Duration. Examination Revealed A Mass Of About 18
Week Size. Imaging Confirmed A Huge Right Ovarian Mass Of About 17.3 13.2 12.3 C.M. With Both Cystic And
Solid Component With Increased Vascularity And Mimimal Free Fluid. She Underwent Staging Laparotomy And
Proceeded With Tah And Right Ovariectomy And Left Oopherectomy With Infra Colic Omentectomy. Intraop The Mass
Was About 20 15 Cm., Adherent Posteriorly, Surface Intact.

The Histopathology Revealed Sheets Of Cuboidal Epithelium With Glandular Pattern Mixed With Immature
Mesenchymal Tissue Comprising Of Immature Cartilage, Smooth Muscle, Ectodermal Squamous Epithelium, Endodermal
Derivatives Like Respiratory Epithelium, Colonic Mucosal Glands And Areas Of Necrosis. It Had 70% Features Of Immature
Teratoma And 30% Of Yolk Sac Tumour.

Conclusion

The Most Important Prognostic Factors For Stage I Disease Depended On The Composition And Size Of The Tumour. If
The Tumour Had More Than 1/3 Of Components As Endodermal Sinus Tumour , Choriocarcinoma Or Grade 3 Teratoma,
And A Size > 10C.M The Prognosis Was Poor. The Above Case Is Presented For Its Rarity And High Malignant Potential.

***************

A Study Of Trail Of Labour In Post Cesarean Pregnancy

Author: Dr. Shalini Kumari
Co Author: Dr(Prof) Chandra Kiran1, Dr K.Manju2, Dr Abha Rani Sinha3,

Aims & Objective- To Study The Incidence Of Vaginal Delivery Following Trial Of Labour In Women Of Previous Lscs, Its
Role In Reducing The Incidence Of Repeat Lscs And And To Study The Maternal Fetal Outcome In Post-Lscs Women After
Trial Of Labour.
Material & Methods- A Prospective Study Was Done At Antenatal Clinic And Labor Room Emergency Pmch, Patna, Bihar
From August 2013 To August 2014. A Total Of 120 Pregnant Women Were Selected Using Strict Inclusion And Exclusion
Criteria Who Underwent Trial Of Labour. All Stages Of Labour Were Vigilently Monitored.
Results- Out Of 120 Selected Pregnant Women 48 Didnot Give Consent .72 Underwent Trial Of Labour. 46
Women(63.88%) Had Spontaneous Vaginal Delivery Without Augmentation Of Labour, 6 Women(8.33%) Were
Augmented Under Strict Monitoring. Remaining 20(27.77%) Had Emergency Lscs. There Was No Maternal And Fetal
Mortality In This Study.
Conclusion- Trial Of Labour After Lscs Has Good Success Rate In Properly Selected Cases With Good Cervical Score. It
Should Always Be Tried In Tertiary Care Centre Where There Are Facilities For Continous Maternal And Fetal Monitoring,
Emergency Ot With Trained Staff And Functional Blood Bank.

***************

A Case Report Of Post Operative Watery Discharge Through The Vault Secondary To Liver Dysfunction.
Author: Prof. Premalatha Ramachandran
Co Author: Dr.Geethanjali.E.1,

A Case Report Of Post Operative Watery Discharge Through The Vault Secondary To Liver Dysfunction.
Background :
Profuse Watery Discharge Through The Vault After Tah Due To Vesical & Ureteric Fistulas Are Reported To Be 0.5 2%
& 0.05% Respectively.Liver Dysfunction As A Cause For Watery Vaginal Discharge Is Very Rare.
Profuse Watery Discharge Pv On 6Th Pod After Tah Is Reported With A Diagnostic Dilemma Of The Cause , Peritoneal
Fluid Or Urine.

Case :
48 Yrs,Mrs.S,P3L3, H/O Menorrhagia On Medical Treatment 2Yrs With Anaemia, Tah With Bso Done For Dub.She
Presented On 6Th Pod,With C/O Profuse Watery Discharge P/V Since 1 Hr,More On Standing .She Was Able To Pass Urine
Adequately With Good Continence. G/E Gc Fair,Vitals Stable.P/A Wound Induration With Mild Serous
Discharge.S/E Vault Healthy & Dry.On Standing,Profuse Watery Discharge From Vagina. Usg Abdomen & Pelvis
Normal Except For Mild Bilateral Hydronephrosis.All Basic Investigations - Normal. Vaginal Fluid Urea & Creatinine Values
Were Identical To That Of Plasma Values And Hence Urinary Leak Ruled Out.Lft - Raised Liver Enzymes.Ct Abdomen
Kidneys Normal.Hepatic Cirrhosis,Portal Hypertension,Splenomegaly & Ascites.Patient Developed Icterus On 8Th Pod &
Treated With Albumin Infusion & Hepatoprotectives.Vaginal Discharge & Wound Leak Decreased. Retrograde Analysis Of
All PatientS Reports Revealed That She Was Evaluated For Nausea 2 Months Back & Lft Showed Raised Liver
Enzymes.The Preoperative Usg Abdomen Was Also Normal.
Conclusion:
This Is A Rare Case Report Of Profuse Watery Discharge Through The Vault Due To Liver Dysfunction &
Ascites.Probably,The Surgery Has Unmasked Liver Dysfunction.Now,The Question Arises Whether Lft Is Mandatory As A
Pre Operative Investigation In All Patients For Safe Surgical Practice.

***************

The Study Of Hcg Level Along With General Biochemical Profile In Pre-Eclampsia
Author: Dr. Sumitra Yadav
Co Author: Dr.Sumitra Yadav1, Dr.Namrata Shrivastava2, Dr.Aruna Kumar3, Dr.Preeti Pawar4, Dr. Sangeeta Paneri5

Abstract
Objective-Preeclampsia Is One Of The Leading Cause Of Maternal Mortality And Morbidity Worldwide. The Purpose Of
This Study Was To Determine The Level Of Hcg And Other Biochemical Markers In Preeclampsia And In Normotensive
Patients .
Material And Method This Was A Prospective Study Conducted On 50 Preeclamptic (Case) And 50 Normotensive
Pregnant Women (Control) In Obstetrics And Gynaecology Department Of M.Y. Hospital From Oct2013 To April2014. All
Subjects Belonged To Age Group 18-40, And Have Gestational Age Between 28-40 Weeks. Blood Sample Was Collected
From All Subjects And Analyzed For Hcg. Level Of Hcg And Other Biochemical Markers (Serum Triglyceride, Total
Cholesterol, Platelets Count, And Serum Creatinine) Between Case And Control Was Compared With Chi-Square Test. PValue <0.05 Was Considered Significant.
Result- In Our Study 26% Of Normotensive Women Have Hcg Level<10,000Miu/L While None Of Preeclamptic Women
Have Hcg Level Below10,000 Miu/L. 44% Of Preclamptic Women Have Hcg Level > 20,000 Compared To1 % Of
Normotensive Women. In Our Study Mean Hcg Level In Preeclamptic Women ( 27,802.51 Miu/L ) Was Higher Than
Normotensive Pregnant Women (12, 551.08Miu/L) With P-Value<.05. Level Of Other Biochemical Markers Triglycerides,
Total Cholesterol Were Also Higher In Preeclamptic Women Compared To Normotensive Pregnant Women With PValue <0.05.
Conclusion- The Result Of This Study Show That, Level Of Hcg Is Significantly Higher In Preeclampsia Then In
Normotensive Pregnant Women. Level Of Triglyceride And Total Cholesterol Also Has Significant Difference In Both
Groups With Higher Level In Preeclampsia.

***************

A Comparative Observational Study Between Postpartum Iucd And Interval Iucd In Terms Of Acceptance, SideEffects, Complications And Removal Rate
Author: Dr. Sneha Tyagi
Co Author: Reena Srivastava1, Vani Aditya2,

Abstract

Objective: A Comparative Evaluation Of Ppiucd And Interval Iucd In Terms Of Acceptance, Side Effects, Complications And
Rate Of Removal.

Methods: A Total Of 100 Women Were Inserted Ppiucd With Informed Consent. Chorioamnionitis, Prom >18Hrs,
Unresolved Pph And Puerperal Sepsis Were Excluded. Another 100 Eligible Women Were Inserted Interval Iucd. All
Women Were Followed Up For 6 Months.

Results: The Rate Of Acceptance Of Ppiucd Was 30.41% And 18% For Interval Iucd (P Value 0.0001). Continuation Of Iucd
Use At 6 Months Was 79% In Ppiucd Group And 76 % In Interval Group. Expulsion Occurred In 6% In Ppiucd And 2% In
Interval Group (P Value= 0.2790). The Chief Cause Of Iucd Removal Was Bleeding Per Vaginum In Interval Group (37.5%)
And Pain Lower Abdomen In Ppiucd Group (38.4%).

Conclusions: Postpartum Insertion Of Iucd Is Safe Effective, Feasible And Reversible Method Of Contraception.

***************

Anti-Mullarian Hormone, An Early Diagnostic Marker For Premature Ovarian Failure

Author: Dr. Usha Suresh Mudragada
Co Author:

Abstract

Premature Ovarian Failure (Pof) Is One Of The Infertility Associated Endocrine Disorders Characterised By Loss Of
Functional Ovarian Follicles During The Reproductive Age That Affects 0.9-2% Of Females Prior To 40 Years. Till Date, The
Cause For Pof Is Largely Unexplained. Clinically, Pof Is Recognized As Secondary Amenorrhoea Lasting For At Least 4-6
Months With Low Concentrations Of Oestrogen, Anti-MLlerian Hormone (Amh) And Raised Concentrations Of Follicle
Stimulating Hormone (Fsh), Luteinising Hormone. Fsh And Amh Are The Two Prime Hormones Secreted At Two Different
Stages Of Follicular Maturation With Varying Functions And Play Crucial Role In The Regulation Of Menstrual Cycle And
In Assessing The Functional Ovarian Reserve (Or). For The First Time From South India We Conducted A Case-Control
Study To Investigate Whether Amh Could Be Considered As A Prognostic Biomarker Of Functional Or In Pof Patients.
A Total Of 140 Subjects Were Recruited For The Present Study Which Comprised Of 65 Pof Patients And 75 Normal
Women. Serum Was Separated From 3 Ml Of Venous Blood, Stored At 200C And Estimated The Fsh And Amh Levels
Using Elisa. Patients Showed Significantly High Fsh And Low Amh Levels Than Controls (P<0.001). The Outcome Of Our
Preliminary Study Certainly Suggested That Amh Could Be Considered As A Better Future Marker By The Clinicians To
Assess Or In The Fertility Treatment Options.

***************

Association Of Weight Gain During Pregnancy And Birth Weight Of The Baby
Author: Dr. Rohini Sehgal
Co Author: Prof Alka Kriplani1, Dr Neeta Kumar2, Dr Nomita Chandhiok3, Dr P Vanamail4, Prof Suneeta Mittal5

Aim & Objectives :

A) To Investigate The Association
Between Total Maternal Weight Gain (Mwg) During Pregnancy
And
Birth Weight(Bw) Of
Baby
B) To Find Out The Relation Between Maternal Bmi At Start Of Pregnancy, Gestational Age At Delivery And Bw Of The
Baby
Materials & Methods:
This Prospective Hospital Based, Descriptive, Longitudinal Study Was Conducted In The Department Of Obstetrics And
Gynaecology, All India Institute Of Medical Sciences, New Delhi, From February 2007 To September 2013. Primigravidas
Aged Between 20 And 30 Years ,In First Trimester With Live Singleton Pregnancy On Ultrasound Were Recruited After
Taking Informed Consent. Inclusion Criteria Included Healthy Primigravidas With Or Without Mild To Moderate Anaemia
And No Other Medical Illness. The Maternal Bmi At The Time Of First Visit Was Recorded Besides Routine Anc. Total Mwg
In Pregnancy, Gestational Age At Delivery And The Bw Weight Of The Baby Was Recorded. The Data Was Analyzed Using
Spss Ibm Version 19.0.
Results:
A Total Of 328 Primigravidas That
Included 179 Non Anaemic Healthy Primigravidas (56%) And 149 (44%) Mild To Moderately Anaemic Primigravidas Were
Recruited For The Analysis. The Mean (Sd) Bw Of Male (156) And Female Babies (172) Was 2776.5+447.2 And
2718.37+396.2 Respectively(P=0.2).The Mean Mwg During Pregnancy For All Women Was 8.6+2.6 Kgms And Women
With Bmi<18.5, 18.5-24.9 And >25 Was 8.9+2.4, 8.6+2.6 And 8.5+2.9 Kgms Respectively (P=0.651) .The Mwg Was Less
With Increasing Bmi (P<0.05) ;Bw Was Significantly (P<0.05) More With Increasing Bmi And Increasing Mwg Though With
Poor Correlation (<0.5) In Both The Cases.Bw Did Not Differ Significantly Between Sex Of The Babies. It Was Observed
That Both Mwg And Bw Showed A Significant (P=0.006) Positive Correlation With Gestational Age At Delivery.
Conclusion
Evidence To Support Associations Of Birth Weight With Gestational Age At Delivery, Maternal Weight Gain And Maternal
Bmi

***************

Variations In Fetal Heart Rate During First Trimester

Author: Dr. Hethyshi Ranganna
Co Author:

Aim To Determine The Fetal Heart Rate Variations That Occur In Early Pregnancy From 6 Weeks To 13 Weeks Of
Gestation. Also To Construct A Prototype Graph Of The Fetal Heart Rate During First Trimester For The Local Population..
Materials And Method - The Study Was Conducted In The Department Of Obstetrics In A Tertiary Care Set Up Attached
To A Medical College. 51 Pregnant Women Who Had An Early Trimester Scan For Confirmation Of Viability Between 6
To 13Weeks Of Gestation Were Included In The Study And The Fetal Heart Rate Was Noted At The Time Of Scan And
Was Plotted Against The Period Of Gestation. Results After Plotting On The Graph It Was Noted That The Fetal Heart
Was In The Range Of 100 -110 Bpm At 6 Weeks Which Gradually Increased With Increasing Gestation To Reach 170
180Bpm By 13 Weeks Of Gestation.. Conclusion Fetal Heart Rate Of 110-160 Bpm Is The Conventional Normal Range
Of Fetal Heart During Pregnancy. During Early Gestation Fetal Heart Rate Can Be Less Than 100Bpm And Also More Than
160Bpm Which Should Not Be Considered As Ominous By The Treating Obstetrician Since Itcould Still Be Within The
Normal Trend Of Variation Of Heart Rate During The Early Trimester. Awareness About The Early Pregnancy Fetal Heart
Variations Can Help Alleviate The Fears Of Poor Prognosis Of Pregnancy Associated With Bradycardia Or Tachycardia
During Early Pregnancy.

***************

The Outcome And Related Maternal Mortality For Very Sick Pregnant Mother In Tertiary Care Centre In West
Bengal .
Author: Dr. Jheelam Mukhopadhyay
Co Author: . . . . .

Aim And Objective:

The Outcome And Related Maternal Mortality For Very Sick Pregnant Mother In Tertiary Care Centre In West Bengal .
Material And Method:
Over A Period Of One Year (September 2012 To September 2014) I Admitted 20 Pregnant Mother Near Term At Two
Different Multispecialty Hospital. The Inclusion Criteria Of Patient Was :1) Gestational Age More Than 28 Weeks
2)Haemodyanamically Unstable 3) Admitted Directly To Intensive Care Unit 4) They Needed Multidisciplinary Approach
5) Pregnancy Was Uneventful Till 2Nd Trimester .
All Cases Were Analyzed Individually With Basic Parameters Like PatientS Age, Address In Terms Of Distance From
Health Centre, Economic Condition, Previous Antenatal Check Up With Type Of Health Personal, Past Medical And
Surgical History, Presenting Complains.
Each Patients Hospital Course ,Duration Of Ventilator Support, Type Of Antibiotic Used, Investigation Reports,
Arterial Blood Gas Status Were Noted.
Maternal Mortality Calculated. Also Short Term And Long Term Maternal Morbidity Analyzed.
Early Intervension In Terms Of Hysterotomy, Relaparotomy ,Perimortum Cs Were Done To Save Mothers Lives.
Multiple Blood Transfusion Given. Higher Antibiotic Support, Multidisciplinary Approach Given.
Result:
Out Of 20 Patient 11 Patients (55%)Died. The Diagnosis At Admission Was Pre-Eclampsia 4 Patients(20%),Primary
Haemorrhage Following Cs And Haemoperitoneum 3 Patient(15%),Jaundice 4 Patients(20%) With One Hepatic
Encephalopathy (5%),Pulmonary Embolism One Patient(5%) And One Patient With Probable Diagnosis Of Amniotic Fluid
Embolism.
Associated Factors Were Found To Be Intrauterine Death, Uterine Rupture, Dic , Aph And Mods.
Short Term Morbidity Was Wound Infection In Two Patients(10%).
Long Term Morbidity Noted Till Date As Hypertension One Patient(5%).
Conclusion:
Early Intervention, Mdt, Institutional Support Can Save Mothers Lives. But Due To Preexisting Physiological Changes
, Mothers Condition Detoriates Very Fast And So The Window Period For Gynecologist And Team To Act, Is Very
Small To Win The Challenge.

***************

Can Vaginal Birth At Any Cost (Vbaac) Be Given Even At Periphery In Hiv Positive Cases On Antiretroviral Therapy
(Haart) ? - Yes.
Author: Dr. Nagalakshmi Muddu
Co Author:

Aim:
To Show Vaginal Birth And If Necessary Caesarean Section For Obstetric Indications Only, Can Be Conducted At Any
Level In Hiv Positive Women Who Are On Haart As Per The Government Protocols.
Materials And Methods:
From January 2014 Till Date We Found 106 Hiv Positive Cases Delivered At Mgmh (Tertiary Care Hospital) Hyderbad.
Sixteen Cases Were Booked And Ninety Were Un-Booked Referred From Different Areas In And Around Hyderbad. Out
Of 106 88 Cases Received Haart As Per The Government Protocol And Cd4 Count Done In All Cases .Rest Of The 18
Cases Who DidnT Receive Haart -8 Cases Had Spontaneous Abortion, 2 Had Ruptured Ectopic Pregnancy And 8 Cases
Received Intrapartum Protocol. All The Babies Were Given Nevirapine Drops.
Results:

Among The Referred Cases 22% Were From Hyderabad District.

28% Rangareddy.

29% Mahaboobnagar.

04% Bidar(Karnataka).

01% Each From Nizamabad And Adilabad.

Out Of 106 Cases 70% Spontaneous Vaginal Deliveries, Of Them

Deliveries.

03% Preterm

Presentation.

20% Caesarean Section- 3 Cases Were Brought In Obstructed Labour With Neglected Shoulder

02% Laparotomy- Ruptured Ectopic Pregnancy.

08% Miscarriages.

15% Were Still Births Brought Late In Labour.

3% Had Maternal Morbidity In The Form Of Sepsis And Burst Abdomen

One Had Maternal Mortality- G2P1L1 With 34 Weeks Gestation With Severe Preeclampsia And Acute Pulmonary
Edema.

Conclusion: Hiv Positive Pregnant Women Who Are On Haart As Per The Government Protocol Can Be Given Vbaac /
Caesarean Section For Obstetric Indications Even At The Periphery Without Effecting Maternal And Perinatal Morbidity
& Mortality.

***************

Complications Observed During Follow Up Of Ppiucd Insertions

Author: Dr. Kumudini Jha
Co Author: Dr. Shashi Prabha1,

Aim:- India Is Facing A Population Explosion. A Feasible Method Of Contraception Is Needed To Curtail It.
This Study Has Been Done To Explore The Cause Of Failure Of Post Partum Iucd Insertions By Observing The Complications
After The First Four Weeks Of Insertion.
Material Method:- This Study Was Conducted At Darbhanga Medical College Hospital Between February 2013 And April
2014. A Total Of 8Oo Cases Accepted Ppiucd Insertion 92% Had Undergone Lscs And 8% Vaginal Delivery.
Cu 380 A (Govt. Supply) Was Used. Manual Application Was Done In Cases Of Cs While KellyS Forceps Were Used In
Cases Of Vaginal Delivery. Application Was Done Within 10Mins Of Expulsion Of Placenta So That It Could Be Placed High
In The Funds And Reduce Chances Of Expulsion.
The Strings Were Directed Towards The Os But Not Pulled Down.
All Aseptic Precautions Were Observed.
Contraindications Were Obstructed Labour, A.P.H., Uterine Malformations Handled Cases & Cases Of Pph.
Result:- A Total Of 1000 Cases Were Councelled 800 Cases Accepted Pp Iucd Insertion. Of Them 500 Cases (62.5%) Came
For Follow Up, At 4 Wks Of Which 240 Patients (48%) Had No Complaints, 260 Patients Had Complications Of Which 40
Cases (8%) Requested Removal. Coiling Of Strings Was Seen In 22.7%, Excessive Vaginal Bleed In 13.6% Excessive Vaginal
Discharge In 16.8% Chronic Pain In 36.4%, Missing Strings In 10.5%, Perforation In 0.2%, Pregnancy I.E. Failure In 0.7%.
92% Cases Continued To Use Iucd.
Conclusion:- Ppiucd Is A Viable Method Of Contraception. It Should Be Used In All Indicated Cases, After Proper Prenatal
Counseling. Follow Up & Assurance For Complications Like, Mennorhagia, Pain And Vaginal Discharge, Will Increase
Acceptance. Post Partum Phc Staff Involvement Is Of Utmost Importance In The Success Of Ppiucd

***************

Comparative Evaluation Of Pelvic Ultrasound And Hystero Laparoscopy In Female Subfertility Workup
Author: Prof. Karuna Jha
Co Author: Dr Anil Kumar1,

Aims And ObjectivesThis Study Is Focused On The Evaluation Of Efficacy And Reliability Of Ultrasonography Tvs, 3D, Color Doppler In Female
Subfertility Workup By Direct Visualization Of Pelvic Pathology By Hysteroscopy And Laparoscopy.
Uterine Factors
Shape, Size Of Uterus And Uterine Cavity, As In Mullerian Anomalies And Uterine And Cervical Fibroids, Polyps And Ut
Synaechea.
Echo Texture And Vascularity Of Myometrium And Endometrium As In Pathologies Like Adenomyosis, Fibroids And
Endometrial Response To Menstrual Phases.
Tubal Factors
To Masses, Calcified Hyper Echoic Spots In Fallopian Tubes In Tubal Blockage. Water Fall Sign Indicating Tubal Patency.
Ovarian Factors
Size, Shape And Ovarian Echo Texture, No Of Follicles, Evaluation Of Spontaneous Or Stimulated Ovarian Cycles,
Folliculometry, Ovulation, Corpus Luteum, Luf, Lfd And Intra Ovarian Vascularity.
Ovarian Volume -Smaller In Pof, And Larger In Pcod, Ov. Masses, Chocolate Cyst, To Mass, And Ovarian Echo Texture,
No Of Follicles.
Peritoneal Factors-----Aadhesions, Retention Cysts, Collection Of Free Fluid In Pod, Around Uterus And Appendages Can Be Visualized.
Materials And Methods---3000 Women With Complaints Of Primary, Secondary Subfertility And Recurrent Pregnancy Losses Were Included In
This Study, Over A Period Of 10 Years, From 2004 To 2014.
Detailed History Taking, Thorough Clinical Examination, And Routine Labs Workup With Serum Lh, Fsh, Tsh Levels
Evaluated. Pelvic Usg Was Done In All The Cases Utilizing Ge Volusion I With Tvs, 3D And Color Doppler.
Hydrosonosalpingography Done As Well.
Results--Utero-Tubal, Ovarian And Peritoneal Factors Noted On Usg Were Verified By Hysteron--Laparoscopy In All The Cases. In
2,529 Patients (84.3%) The Usg Findings Were In Conforming To Subsequent Hysteroscopy -Laparoscopy Findings.
Conclusion---Usg Is A Simple, Low Cost, Safe And Non-Invasive Tool To Detect Several Causative Factors For Female Infertility, Helping
In Total Workup.

***************

Study Of Effects Of Drain Vs No Drain In Vault On Postoperative Morbidity After Vaginal Hysterectomy In Benign
Gynaecological Diseases
Author: Dr. Ananya Agrawal
Co Author: Chinmayee Kar1, Babita Ramani2, Sharmila Pradhan3, Ojaswini Patel4, Santosh Kumar Behera5

Aims And Objectives:

The Aim Of Our Study Was To Evaluate The Efficacy Of Vault Drainage In Reducing The Risk Of Early Postoperative
Morbidity Following Vh For Benign Gynaecological Conditions.
Materials And Methods:
Place Of Study

Pg Department Of Obstetrics And Gynecology,

V.S.S. Medical College And Hospital, Burla

Duration Of Study : September 2012 To September 2014
Inclusion Criteria: Cases Undergoing Vh For Benign Gynaecological Disease.
Exclusion Criteria: Cases In Whom Hysterectomy To Be Performed For Malignant Disease And The Insertion Of A Surgical
Drain To The Vault Would Be Clinically Indicated.
Plan Of Study:
Primary Outcome Measures: Postoperative Febrile Morbidity.
Secondary Outcome Measures: Hospital Readmission Rate, Return To Theatre, Blood Transfusion, Change In
Postoperative Hemoglobin And Length Of Hospital Stay.
Result:
In All Of 112 Cases, 55 Women Were Randomized To Have A Drain And 57 To 'No Drain'. No Differences Were Found In
The Incidence Of Febrile Morbidity, Length Of Stay, Change In Haemoglobin Or Need For Postoperative Blood Transfusion
Between The Two Groups.
Conclusion:
The Routine Use Of Vault Drain At Vaginal Hysterectomy For Benign Disorders Has No Significant Effect On Postoperative
Morbidity. The Use Of Vault Drain In This Context Is Not Recommended.

***************

A Rare Case Report Of Uterocutaneous Fistula

Author: Dr. Sailaja Kanakamedala
Co Author: Dr. Venkata Sujatha Vellanki1, Dr. Sajana Gogineni2, Dr.Jahnavi3,

Back Ground :
Uterocutaneous Fistula, Although Not Exceptional, Is A Very Rare Clinical Entity. Approximately 120 Cases Of
Uterocutaneous Fistula Have Been Reported In The World Literature In Its Entirety Over The Past 200Years With Not
More Than 3Cases From India In The Past 50Years. It Occurs Most Often After Uterine Or Pelvic Surgery But Also Can
Complicate The Postpartum Period. Surgical Treatment With Hysterectomy And Excision Of The Fistulous Tract Has Been
Successful.
Case :
A 24 Yr Old P2L2 Came To Casualty With Complaints Of Pain And Swelling On Left Lateral Edge Of Pfannensteil Scar Since
4Days. She Underwent Two Lscs, 2Nd Lscs Was Done 3 Years Prior To Presentation. Patient Had Similar Complaints On
Right Lateral Edge Of Pfannensteil Incision 2 Years Back And Underwent Surgery As Said In Patients Words For Drainage
Of Abscess / Suture Granuloma In An Outside Hospital For Which Documented Details Were Not Available. Usg Showed
Echogenic Collection Measuring 1.8Cm In Endometrial Cavity Leaking Through Anterior Myometrial Wall Into
Intramuscular Planes From There To Subcutaneous Planes Causing Localized Collections. Mri Pelvis Showed
Uteroperitoneal Fistula Between Uterus And Intramuscular And Subcutaneous Planes. Patient Underwent Surgical
Exploration And Fistulous Tract Was Excised And Given Danazol For 6 Months For Suppression Of Menstruation But
Symptoms Recurred After 6 Months. Relaparotomy Was Performed Where Total Abdominal Hysterectomy Was Done
For Recurrence. Histopathology Revealed Chronic Cervicitis , Proliferative Endometrium, Fistulous Tract - Chronic
Nonspecific Inflammation,Foreign Body Giant Cell Reaction. Post Operative Period Was Uneventful .

Conclusion :

The Case Highlights This Rare Complication Of Caesarean Section. Although Medical And Surgical Treatment Is Mostly
Successful, The Best Treatment Of Uterocutaneous Fistula Remains Prevention Based On Better Uterine Surgery
Technique, Prevention Of Postoperative Infection.

***************

A Case Of Conjoined Twin

Author: Dr. Dipak Nayak
Co Author: Dr.Om Avishek Das1, Dr.Sanghamitra Dash2,

Background
Conjoined Twinning Occurs In 1 In 100 Sets Of Monozygotic Twins, 1 In 50,000 Gestations Or 1 In 250,000 Live Births.
There Is A Greater Incidence (70%) Of Female Conjoined Twin .

Case Report
A 25 Yr Old, G2P1 Presented Through Lr With Premature Labour Pain At 33Wks Of Gestation. She Was Referred From A
District Hospital As A Suspected Case Of Conjoined Twin Pregnancy .She Delivered A Term Female Child Vaginally 1 Yr
Back, No H/O Intake Of Any Ovulation Induction Drugs Nor Any Art. P/A :- Uterus Overdistended, Fundal Height 36 Wks,
Multiple Fetal Parts Felt, Uterus Relaxed, Fhr(1) -146/Min, P/V :- Cx Short Soft, Os 2Cm Dilated, Presenting Part High Up.
On Ultrasound Intrauterine Live Conjoined Twin With Cephalic Presentation With Two Heads, Single Thorax And
Abdomen, Four Lower Limbs With Two Pelves And A Single Heart With Cardiac Activity Fhr 144/Min, Aga 29Wks And
30Wks With Efw 2410 Gms And Afi 12. Placenta Single Anterior Not Low-Lying, Gr Ii Maturity. Lscs Was Done With
Delivery Of First Twin By Cephalic And Second Twin By Breech Extraction, Both Were Preterm Male Babies Joined
Anteriorly Starting From Thorax To Umbilicus (Thoracopagus) Weighing 3 Kg With Four Arms And Four Legs, Babies Did
Not Cry After Birth ,Declared Clinically Dead In Few Minutes By Neonatologist. Placenta Monoamniotic Monochorionic
, No Pph, Uterine Shape Normal, Tubes Ovary Healthy.. Post Operative Period Was Uneventful.
Conclusion
The Birth Of Two Connected Babies Can Be Extremely Traumatic And Approximately 4060 % Of These Babies Are
Delivered Stillborn With 35 % Surviving Just 1 Day & Overall Survival Rate Of Conjoined Twin Is Between 5 And 25 %.

***************

A Rare Case Of Mullarian Adenosarcoma In A Reproductive Age Group.

Author: Dr. Sheetal B
Co Author: Dr.Vijaya Harsoor1, Dr.Chandrashekar T2,

Background: Mullarian Adenosarcoma , A Variant Of Mullarian Mixed Mesodermal Tumor Of The Uterus Accounts For
Only About 8% Of All Uterine Sarcomas. Its Usually Seen In Age Group Of 60Yrs. It Originates In The Endometrium And
Grows As A Polypoidal Mass Within The Cavity. It Is Typically Composed Of Benign But Sometimes Mildly Atypical
Glandular Epithelial Elements Admixed With Malignant Sarcomatous Stroma. Common Presentation Would Be
Abnormal Vaginal Bleeding And A Polypoidal Mass Protruding Through A Dilated Cervical Canal.

Case: A Newly Married 20 Yr Old Nulligravida Presented To Us With Abnormal Vaginal Bleeding Since 3 Months ,Post
Coital Bleeding Since 1 Month .On Examination Uterus Was 24 Weeks Size , A Huge Polypoidal Mass Was Protruding
Through External Os Which Was Bleeding On Touch , Usg Abdomen And Pelvis Was Suggestive Of Linear Mixed Echoic
Mass Extending From The Fundus To Cervical Canal. Mri Was Suggestive Of Large Polypoidal Endometrial Vascular Cystic
And Solid Lesion With Extension Into Vagina And Infiltration Into Myometrium . Hpe Report Was Malignant Mixed
Mullerian Tumor .Ihc Was Positive For Er, Pr And Cd10. She Was Given Progesterone Oral Tablets And Being Followed
Up.

Conclusion : Adenosarcoma Is A Rare Biphasic Tumor Of The Uterus And Usually Seen In Post Menopausal Women And
Present As Polypoidal Mass In The Endometrial Cavity .When They Arise From Cervix They Can Be Confused With Benign
Cervical Polyp .Microscopic Differentiation Is Crucial For Further Treatment . Surgery With Postoperative Radiotherapy
With Adjuvant Chemotherapy Is The Ideal Treatment Of Choice.
***************

A Rare Case Of Spontaneous Uterine Rupture Of An Unscarred Uterus

Author: Dr. G Shalini
Co Author: Dr.Madhushree Vijayakumar1,

Background: Spontaneous Uterine Rupture Is Rare.This Is A Case Of Uterine Rupture In A Patient With Previous Normal
Delivery And With Out Uterine Contractions And Without Uterine Scar.
Case:Mrs X G4P1L1A2 With Previous Full Term Vaginal Delivery.She Had Atonic Pph In Her Previous Pregnancy And
Underwent Uterine Artery Embolization .In The Present Pregnancy Presented At 34 Weeks Ga With Pain Abdomen
.Patient Was Diagnosed To Have Uterine Rupture And Placenta Increta Intraoperatively. Underwent Peripartum
Hysterectomy . Postoperatively Managed In Icu With Blood Products And Got Discharged In A Stable Condition .
Conclusion: Uterine Rupture Can Happen Even After Normal Delivery.Uterine Artery Embolization Is A Risk Factor For
Abnormal Placentation And Uterine Rupture In Subsequent Pregnancies.Its Life Threatening For The Women If Not
Operated Immediately.

***************

A Study Of Waist Hip Ratio And Lipid Profile Among The Antenatal Women In First Trimester
Author: Dr. Divya Khare
Co Author: Dr.Mudita Jain1, Dr.Jyoti N Modi2, Dr.Mita Mazumdar3,

Background: Abnormal Lipid Profile Has Been Reported To Be Associated With Pregnancy

Complications Such As Gestational Hypertension. The Waist Hip Ratio (Whr) Represents Body Fat

Distribution And May Be Considered A Clinical Indicator Of Dyslipidemia.

Aim & Objectives: To Study The Correlation Between Waist Hip Ratio And Serum Lipid Profile

Among Pregnant Women In The First Trimester. To Find Out The Component Of Lipid Profile That Best

Correlates With Increased Whr.

Materials And Methods: As A Part Of A Larger Long-Term Study, This Interim Cross Sectional Data

Analysis Was Carried Out For The First 43 Antenatal Women Recruited In The First Trimester Of

Pregnancy. The Variables Studied Were Whr, Serum Lipid Profile And The Lipid Risk Ratios.

Results: The Mean Age Of The 43 Antenatal Women Included In The Study Was 24.7 Years [Sd3.7]

And The Mean Gestational Age At The Time Of Sampling Was 10.2Weeks [Sd2.9]. Eleven (25.6%)

Out Of 43 Women Had Whr>=0.85. Among The Lipid Profile Components, The Serum Trigylceride

Levels Showed The Highest Positive Correlation With Rising Whr (Correlation Coefficient 0.21).

The Hdl Levels Were Negatively Correlated (Correlation Coefficient -0.12) With The Whr. Among

The Lipid Ratios, Tg/Ldl Ratio Correlated Better With Whr Than Cholesterol/Hdl Ratio

Conclusion: The Waist Hip Ratio In The 1St Trimester Of Pregnancy Can Be Explored As A Marker Of

Deranged Lipid Profile (Elevated Triglycerides) And Therefore As A Possible Predictor Of Pregnancy

Complications Especially In Resource Limited Settings.

***************

"Primary Hydatid Cyst Of Broad Ligament: A Case Report"

Author: Prof. Valsa G
Co Author: Dr Valsa Diana G1, Dr Vinod Pandurang Kamble2,

Background: Cystic Lesions Of The Female Pelvis Are Common. Mostly Been Benign Originating From Ovaries, Rarely
Originating From Fallopian Tubes, Broad Ligaments Etc. Hydatid Disease Is Caused By The Tapeworm Echinococcus
Involving Commonly Liver And Lung. Female Reproductive System Is Rarely Involved Mostly Secondarily. Primary Broad
Ligament Hydatid Cyst Is Extremely Rare. Hereby Presenting Case Of Primary Broad Ligament Hydatid Cyst.
Case: A 50 Years Perimenopausal Lady Came With Complaints Of Mass Per Abdomen And Lower Abdominal Pain Since 2
Years. No History Of Contact With Dog Or Other Pet Animals. General Examination Was Normal. On Abdominal
Examination A Softlobulated Irregular Mass Of 20 Weeks Arising From The Pelvis And Occupying Hypogastrium. Bimanual
Examination Located The Mass In Left Fornix. Routine Investigations And Tumour Markers Were Within The Normal
Limits. Usg Abdomen, Suggested A Complex Multicystic Lesion With Multiple Septation Measuring 15.2X11.7Cm, More
On Left Side With Small Speck Of Calcification And No Solid Component. Ct Abdomen Showed Hypodense Cystic Lesion
Measuring 14.1X10.2Cm In The Middle Of Pelvis Extending Upto Infraumbilical Region With Multiple Septations And
Calcifications In The Wall. Laparotomy Performed Suspecting Malignant Ovarian Cyst. Intra Operatively Right Broad
Ligament Cyst Of Size 15X10Cm Was Present. Uterus, Tubes And Ovaries Were Normal. Peroperatively Cyst Ruptured
Releasing Multiple Hydatid Cyst. Cyst Excised And Tah +Bso Done. Resected Specimen Sent For Histopathology.
Microscopically Cyst Wall Composed Of Lamellated Ectocyst With Chronic Inflammatory Cell In Pericyst, Consistent With
Diagnosis Of Hydatid Cyst Of Broad Ligament.
Conclusion: Hydatid Cyst Of Female Pelvis Is Rare With Primary Pelvic Hydatid Disease Been Rarest. A High Degree Of
Clinical Suspicion Is Essential In Differential Diagnosis Of Pelvic Cystic Diseases To Identify Such A Rare Entity Especially In
Endemic Areas. In Present Case Diagnosis Was Incidental Hence Surgery Followed By Chemotherapy With Albendazole
Was Given.

***************

Extrauterine Leiomyomas- The Management Dilemmas

Author: Prof. Nirmala Duhan
Co Author: Meenu Gill1,

Background: Leiomyomas Are The Commonest Benign Tumors Of The Uterus. Rarely, They May Arise From Several
Extrauterine Sites Within The Peritoneal Cavity Like The Broad Ligament Or The Round Or Uterosacral Ligaments. We
Present A Very Rare Case Of A Large Extraperitoneal Leiomyoma In A Hysterectomized Woman Mimicking An Ovarian
Tumor.
Case: A 60 Years Old Woman Who Had Undergone A Vaginal Hysterectomy 25 Years Ago For Genital Prolapse Presented
With A Large, Firm, Mobile Mass Extending From The Pelvis To Above The Umbilicus. The Previous Surgery Had Also
Resulted In Passage Of Fecal Matter Through The Vagina. Vaginal Examination Revealed A 1 Cm Wide Rectovaginal Fistula
Near The Normally Located Vault. Ultrasonography Of The Abdomen Suggested A Heteroechoic, Irregular, Multiloculated
Mass In The Pelvis And Abdomen. Serum Ca-125, Afp, Hcg And Ldh Levels Were Normal. She Underwent A Laparotomy.
However, The Peritoneum Could Not Be Reached As A Highly Vascular, Greyish White, Multiloculated Mass Filled The
Retropubic Space As Well As The Extraperitoneal Area Beneath The Recti. The Mass Was Removed After Ligating The
Large Vascular Channels Entering The Mass From All Sides. Now The Peritoneal Cavity Was Opened And The Rvf Was
Repaired By The General Surgeons. Atrophic Ovaries Were Present On Both Sides In The Pelvis. Histology Revealed The
Mass To Be A Leiomyoma.
Conclusion: Extraperitoneal Masses May Mimic Ovarian Masses And Should Be Kept As A Possibility Specially In
Hysterectomized Women Reporting With Abdominal Masses. Absence Of Ascites And The Mobility Of Such Masses May
Hint Towards A Benign Origin. Nevertheless, The Role Of Biochemical Tumor Markers And Of Ct Scan And Mri Cannot Be
Understated In These Cases.

***************

A Rare Case Of Double Yolk Sac In Early Miscarriage

Author: Dr. Ramesh P
Co Author: Dr Parvathy Ganesan1, Dr Ramesh Gaikwad2, Dr Soumya Nair3, Dr Fessy Louis T4, Dr Kk Gopinathan5

Background:

First Embryological Structure Seen In A Gestational Sac Is A Yolk Sac. It May Be Visible As Early As 5Th Gestational
Week. Early Embryo Develops Along The Outer Margin Of The Yolk Sac. By The End Of First Trimester, Yolk Sac Is No
Longer Seen And It Gets Absorbed Into The Umbilical Cord. Recently Much Debate Has Occurred Regarding Abnormalities
Of Yolk Sac Like Abnormal Size And Shape, Calcification, Echogenic Yolk Sac Etc. Calcified Yolk Sac Is Seen In Dead Embryo.
Echogenic Yolk Sac Is Associated With Poor Prognosis. Abnormally Large Yolk Sac Is Associated With Trisomy 21, Partial
Mole, Omphalocele Etc.

Case:
Mrs Pk, 30Years Of Age Who Had Undergone 8 Iuis Outside Came To Our Opd. HusbandS Semen Analysis Revealed
Severe Oligo Astheno Teratozoospermia With >85% Dead Sperms. She Was Planned For Icsi With Standard Down
Regulation Protocol Using Leuprolide Acetate. She Was Stimulated Using Human Menopausal Gonadotropin 150Iu Per
Daily For 9Days. She Got 11 Good Quality Oocytes. Icsi Was Done And She Got Only 3 Grade I Embryos Which Were
Transferred. Her Beta Hcg Was 156 After 15 Days Of Et. First Trimester Ultrasound After 2 Weeks (6Weeks Ga) Revealed
A Single Gestational Sac With Fetalpole And Absent Cardiac Activity. There Were 2 Yolksacs (Double Yolk Sac) And These
Findings Were Confirmed In A Scan After One Week.

Clinical Relevance:
Abnormalities Of Yolk Sac Are Seen Associated With Miscarriages. Here We Are Reporting A Very Rare Case Of Double
Yolk Sac And Its Clinical Relevance And Pathogenesis Is Yet To Be Elucidated. Pubmed Search DidnT Reveal Any
Reported Case Of Double Yolk Sac. Hence It Is Prudent To Identify And Document Details (Diameter, Morphology And
Other Features If Any) Of Gestational Sac And Yolk Sac In All Early Pregnancy Scans.

***************

A Rare Case Of Struma Ovarii In Pregnancy

Author: Dr. Vandana Veerendra
Co Author: Dr.Usharani N1,

Background:
Struma Ovarii Is A Specialized Monodermal Teratoma, Constituting 1-4% Of Benign Ovarian Teratoma. Composed
Predominantly Of Mature Thyroid Tissue Of More Than 50%.Based On Histological Features It Can Be Classified In To
Benign And Malignant. The Overall Incidence Of Dermoid Cyst Is 20-25%.

Case:
A 28 Year Old Multipara (G3P2L2) Reported To Vims Labor Room Complex In Active Phase Of Labor At Term Gestation
With Hand Prolapse With Previous History Of Full Term Normal Deliveries.

Conclusion:
Struma Ovarii Is A Rare Tumor Of Ovary. Diagnosis Is Made By Histopathological Findings.The Optimal Treatment For
Benign Tumor Is Surgical Resection I.E Either Simple Cystectomy Or Unilateral Oophorectomy.Malignant Cases Need
Adjuvant Treatment. Recurrence Is Uncommon .

***************

Analysis Of Pelvic Lymph Nodal Metastasis In Operable Cases Of Cancer Cervix -1Year Study Ahregional Cancer
Centre ,Cuttack.
Author: Dr. Abarajda V
Co Author: Prof.S.K.Giri1, Dr.Ashok Kumar Padhy2, Dr.Sagarika Samantaray3,

Dr.Abarajda.V,Prof.S.K.Giri,Dr.Padhy Ashok Kumar ,Dr. Samantaray Sagarika.

Dept Of O&G,Scb Med College,Dept Of Gynec Oncology And Oncopathology,Ahregional Cancer Centre,Cuttack.
Abstract:
Aims&Objective:
To Analyze The Incidence Of Nodal Metastasis In Early Stage Operable Cancer Cervix(Clinically Evaluated Stage
Ia,Ib,Iia).Nodal Metastasis Was Correlated With Different Parameters Like Stage,Degree Of Differentiation
,Lymphovascular Invasion(Lvi)And Stromal Invasion.

Materials&Methods:
This Is An Observational Study Conducted In Dept Of Gynec Oncology,Ahregional Cancer Centre,Cuttack.The Study Period
Was From September 2013 To August 2014.Lymph Node Positivity,Lesion Size,Stromal Invasion,Lvsi Were Analyzed In 80
Patients Who Underwent Wertheim Hysterectomy For Early Stage Cancer Cervix.

Results:
The Mean Age Of Patients Was 52.5Years.The Most Common Symptom Was Post Menopausal Bleeding(47.5%).Various
Stages Of The Disease Were Analysed,Stage Ia In 2(2.5%),Stage Ib In46(57.5%),Stage Iia In 32(40%)Were Noted
Respectively .Histopathologically Majority Were Squamous Cell Carcinoma 68(85%).Pelvic Lymph Nodal Metastasis Was
Identified In 14(17.5%) Most Of Which Had Bulky Lesions With Size More Than 4 Cm..Lvi Was Noted In 12 Patients And
Stromal Invasion Was Noted In 16 Patients. Patients With Lymphnode Positivity And Parametrial Positivity,Positive
Vaginal Margin (1 Out Of 3High Risk Factors) Received Chemoradiation Under High Risk Category. Patients With Lesion
Size More Than4 Cm, Lvsi,Deep Stromal Invasion(2 Out Of 3 Intermediate Risk Factors) Received Radiation Only.All Other
Patients Were Advised For Regular Follow Up.

Conclusion:
The Incidence Of Lymph Node Metastasis In Cancer Cervix Patients Is Quiet Significant Mostly Found In Stage Ib,Iia.With
The Limited Follow Up Available We Are Of Opinion That,WertheimS Hysterectomy And Bilateral Pelvic
Lymphadenectomy Is An Effective Mode Of Treatment In Patient With Early Stage Cancer Cervix Which Is Required For
Risk Stratification As Per Post Operative Histopathological Analsis To Decide Adjuvant Therapy For The Better Survival
Rate Of Patients.

***************

Abdominal Wall Endometrioma- A Case Report And Review Of Literature.

Author: Dr Poonam
Co Author:

Endometriosis Is The Presence Of Endometrial Glands And Stroma At Extrauterine Sites. These Ectopic Endometrial
Implants Are Known As Endometrioma When They Present In Form Of A Discrete Lump. Endometriosis Involving The
Abdominal Wall Is An Unusual Phenomenon Which Should Be Considered In The Differential Diagnosis Of Abdominal Wall
Masses In Women.
This Case Report Is About A Twenty Six Years Old Lady ,Para Three, Abortion Two, Who Presented To Gynaecology
Outpatient Department With Complaints Of Continuous Pain Abdomen Since Eight Months On The Right Side Of The
Midline Infraumbilical Scar.Abdominal Examination Revealed A Tender Small Lump Around 4X3 Cm In The Infraumbilical
Region About 1.5-2 Cm Lateral To The Midline.She Gave A History Of Only Tubal Ligation And Like Us She Too Was
Unaware Of Her Hysterotomy Scar Which Accidentally Came To Our Notice During Laparotomy.The Initial Ultrasound
Gave A Normal Report. A Repeat Scan Detected The Mass With A Differential Diagnosis Of Desmoid Tumor And Nodular
Fascitis.Fnac Strongly Suspected Edometriosis. Surgical Resection With Disease Free Margin Was Done. Histopathology
Confirmed Ectopic Endometrium.
To Diagnose Endometriosis One Has To Have A Strong Suspicion In Mind Especially When The Picture Is Not Classic Like
In Our Case With No Relation To Menses. Tissue Handling Should Be Kept To Minimum In Any Gynaecological And
Obstetric Surgeries To Prevent Such Non Serious But Annoying Post Operative Complication.

***************

Rytrytr
Author: Mr. Raghvendra
Co Author:

Jhurrytryt Rytry Ytrytryt Rytr Ytry Trty Ryt Ryt Ry Rytr Y R

***************

Misoprostol-In Gynaec Procedure

Author: Dr. Satish Doshi
Co Author: Dr.Sunetra S.Doshi1,

Misoprostol Has Been Extensively Researched For Its Use In Obst.And Has Provided To Be Very Effective Cervical Softening
Agent Before Termination Of Pregnancy.The Beneficial Effects On Cervicalripening Make Misoprostol A Desirable Agent
For Helping Cervical Dilation On Non Pregnant Women Also.The Objective Is To Study The Efficacy Of Misoprostol As
Cervical Priming Agent Before Gynaecological Procedure On Non Pregnant Women Such As-Dilation & Curettage In
Primary Sterility, Endometrial Thermal Ablation By Balloontherapy, Polypectomy, Pyometra,Dub (Not Responding To
Hormone Therapy),Iucd Insertion.
Misoprostol Has Been Found To Be A Useful Drug With Range Of Application In Gynaecology.Because Of It'S
Effectiveness, Low Cost, Stability In Light & Hot Climate Condition And Ease To Administration.It Has Been Show That
Misoprostol Increases Myometrial Contractions As Well As Decreases Cervical Resistance.
This Study Was Conducted In Private Hospital At Akluj (Maharashtra). 100 Cases Were Selected Form 1Sr.Jan.2013
To 30Th.Jun.2014.Tab Misoprostol 400Mcg.Orally And 400Mcg Vaginally Kept 4 Hours Prior To Procedure.55% Cases Of
Primary Sterility, 20% Cases Of Balloon Therapy And 12% Cases Of Dub And Remaining Cases Are Of Polyp,Pyometra &
Iucd Insertion.
70% Cases Does Not Felt Resistance While Dilating Cervix, While In 30%Cases Mild To Moderate Resistance Felt During
Dilation.
70% Cases Does Not Have Any Side Effects While Only 30% Shows Minor Side Effects Such As Chills, Nausea,Vomitting
And Abdominal Cramps.
There Was Not A Single Case Of Uterine Perforation, Cervical Trauma And Bleeding. Thus Misoprostol Acts As A
Cervical Priming Agent In Gynaec.Procedure For Cervical Dilation.Thus Misoprostol Is Such A Good Drug In Preventing
Dreaded Complication Such As Uterine Perforation, Cervical Injury And Bleeding In Gynaec.Procedure.
This Is A Small Study, Its Requires Larger Study To Confiem Above Findings.
***************

Sexual Dysfunction In Women An Overview Of Risk Factors And Prevalence In Indian Women
Author: Prof. Vineet Mishra
Co Author: Vineet Mishra1, Rohina Agrrawal2, Sumesh Choudhary3, Nisarg Dharaiya4,

Objective- To Detect The Prevalence Of Sexual Dysfunction And Also To Investigate Possible Risk Factors That May Cause
Sexual Dysfunction In The Indian Women.
Material And Methods -The Study Consisted Of 500 Women Between Ages 18-66 Years From Different Sociocultural
Areas. The Women Were Divided Into 5 Groups According To Their Ages < 24Yrs (N=129), 24 - 30 Yrs (N=182), 31-37 Yrs
(N=125), 38-42 Yrs (N=22) , >42 Yrs (N=42). Female Sexual Function Was Assessed With A Detailed 19-Item Fsfi
Questionnaire To Evaluate Five Domains Of Sexual Dysfunction I.E Desire, Arousal, Lubrication, Orgasm And Pain. The
Prevalence Of Sexual Dysfunction Was Calculated For Each Domain And Compared Among The Groups. In Addition
Demographic Characteristics And Medical Risk Factors Were Evaluated And Findings Were Compared Between The
Women With And Without Sexual Dysfunction.
Results- Based On Total Sexual Function Score 278 (55.6%) Of Total 500 Patients Had Sexual Dysfunction. Thet
Commonest Dysfunction Was Orgasm (91.7%) Followed By Lubrication (89.2%). Out Of 278 Patients, 53 Patients (19%)
Were In The Age Of More Than 38 Years In The Fsd Group. Female Sexual Dysfunction Was More Prevalent In Illiterate
Women ,7.19% Patients Were Illiterate In The Fsd Group As Compared To 3.15% Patients In The Women With No Fsd (
P=0.04).It Shows Fsd Was Significantly Higher In The Older Age Group And In Illiterate Patients.
Conclusion- The Prevalence Of Female Sexual Dysfunction Including Desire, Arousal, Lubrication, Orgasm And Pain Rises
With Age. In Addition, The Presence Of A Lower Education Level, Chronic Disease And Menopausal Status Are Important
Risk Factors.

***************

Management Of Major Degree Placenta Previa During Lscs Operation A New Surgical Technique (DuttaS)
Author: Dr. Indranil Dutta
Co Author: Dr Dilip Kumar Dutta1,

Objectives
Evaluation Of A New Surgical Technique (DuttaS) To Prevent Postpartum Hemorrhage Due To Major Degree Placenta
Previa During Cesarean Section.
Methods
This Study Was Conducted At Tertiary Care Hospital At Kalyani, Nadia, West Bengal, India From The Period January 2004
To December 2009.Ninty Four (94) Cases Diagnosed To Be Having Major Degree Placenta Previa, Undergoing Lscs
Operation, Were Selected For This Study. New Surgical Technique(DuttaS) Was Adopted In A Stepwise Manner =
Delivery Of Baby > Bilateral Uterine Artery Ligation By Chromic Catgut No-1 Suture >Injection Tranexamic Acid (1000Mg)
Im > Injection Oxytocin In Intravenous Infusion(10 Units 30 Drop /Min In 500 Ml Of 5% Dextrose)>Delivery Of Placenta
And Membranes> Checked Properly If Any Tear Or Laceration In Placental Site > Closure Of Uterine Wound Was Done
After Securing Bleeding From Placental Bed >Closure Of Abdomen In Layers By Polyglycolic Acid No 1 Suture.
Results
It Was Observed From This Study That Good Effectiveness To Control Bleeding And Intra Operative Blood Loss Less Than
300Cc Were Seen In 89(94.68%) Cases Respectively. Six (6.3%) Cases Required Underlying Interrupted Suture For Bleeding
From Placental Bed. Subtotal Cesarean Hysterectomy Was Advocated In 3(3.28%) Cases Due To Failure To Control Uterine
Atony. Immediate Post Operative Bleeding Less Than 200C.C Was Found In 81 (86.16%) Cases. Maternal Mortality Was
Found To Be Absent. Maternal Morbidity Was Seen In 12(12.76%) Cases. Subsequent Menstrual Cycles Were Found To
Be Normal In 80(87.91%) Cases And Repeated Pregnancy Was Observed In 26(28.57%) Cases Indicating Non Effect On
Gonadal Function.
Conclusion
DuttaS New Surgical Technique During Lscs For Major Degree Placenta Previa Was Found To Be Simple, Safe And
Quick Procedure. It Reduces Perfusion Pressure, Permits Time For Further Steps, Thereby Avoiding Unnecessary Ligation
Of Bilateral Internal Iliac Arteries And Cesarean Hysterectomy.

***************

A Diagnostic Challenge: Case Series Of Peripartum Cardiomyopathy

Author: Dr. Aishwarya B
Co Author: Dr.Nagarathnamma R1,

Peripartum Cardiomyopathy Is A Relatively Rare But Life-Threatening Condition Associated With Pregnancy In A
Previously Healthy Woman. It Is A Type Of Dilated Cardiomyopathy Defined As The Onset Of Acute Heart Failure In The
Last Month Of Pregnancy Or Within 5 Months Of Delivery. It Has A Worldwide Incidence Of 0.1 % Of Pregnancies And A
High Morbidity And Mortality Rate Of 5 % To 32 %. Some Women Have A Very Good Prognosis But Few Cases Rapidly
Deteriorate Leading To Cardiac Failure And Death. The Onset Of Ppcm Can Easily Be Masked And Missed Because The
Manifestations Mimic Those Within The Normal Spectrum Of Pregnancy And Postpartum Period. Thus This Case Series
Stresses Upon The Diagnostic Challenge Of Ppcm And Its Associated High Morbidity And Mortality Rate Despite The
Diagnosis And Treatment.

We Report 4 Cases Encountered In Our Hospital That Presented At Various Stages Of Peripartum Period With
Signs Suggestive Of Cardiomyopathy. The 4 Cases Were In The Late 20S, 2 Primigravida & 2 Multigravida, With No
Associated Co-Morbid Conditions. Of The 4 Cases, 1 Presented As An Iud And The Other 3 Cases Underwent Caesarean
Section For Maternal Reasons With Good Perinatal Outcome. In Postpartum Period They Commonly Presented With
Dyspnea, Orthopnea, Tachycardia &Unexplained Changes In Ecg & Echo Such As Sinus Tachycardia, Global Lv Hypokinesia,
Lv Dilatation And Reduced Ef, Which Confirmed The Diagnosis Of Ppcm.

The Cases Were Managed Conservatively In The Icu With A Multi-Disciplinary Approach. Of The 4 Cases, 1 Was Referred
To Higher Centre For Further Treatment. With Improvement In The Cardiac Parameters On Echo; The Other 3 Were
Discharged On Diuretics, B Blockers, And Anti-Coagulants And Were Followed Up With Echo, Which Showed Good
Recovery.

Key Words: Peripartum Cardiomyopathy, Ppcm

***************

Comparison Between Aggressive And Expectant Line Of Management Of Premature Rupture Of Membranes And
There Outcome.
Author: Dr. Nuthakki Spandana
Co Author: Ass.Prof. Sapna I.S1, Dr. Bhavya Jha2,

Premature Rupture Of Membranes (Prom) Is A Significant Obstetric Problem And Is Important Cause Of Maternal And
Neonatal Morbidity.

The Most Significant Maternal Risk Of Prom Is Intrauterine Infection Which Increases With The Duration Of Membrane
Rupture. Fetal Risks Include Birth Asphyxia, Sepsis, Ascending Infections.
.
When Prom Occurs At Term, Labor Typically Ensues Spontaneously Or Is Induced Within 12 To 24 Hours.
.
Aims:
The Main Aim Of Present Study Is To Calculate The Incidence Of Prom , Compare The Expectant And Aggressive
Management And Its Neonatal And Maternal Outcomes.

Materials And Methods:

This Is A Prospective Study Carried Out In The Obstetric And Gynecology Department Of J.J.M Medical College, Davangere,
Karnataka.
There Were 7025 Deliveries During The Study Period (Jan 2013-Dec 2013).

Results:

There Were 573 Cases Of Prom Giving Incidence Of 8.15%. The Incidence Was Found To Be Higher In Case Of
Rural, Young, Primigravida.

Out Of 573 Prom Cases 467(81.5%) Were Managed Aggressively, And Out Of Which 391 (83.7) Delivered
Vaginally And 27 (5.7%) Delivered By Lscs, Perinatal Mortality Was 6 (1.28%) ,Morbidity Was 21(4.49%), Maternal
Morbidity Was 5(1.07%)And Mortality Was Zero.

Out Of 573 Prom Cases 106 (18.4) Were Expectantly Managed Out Of Which 75(70.75) Delivered Vaginally And
31 (29.2) By Lscs, Perinatal Mortality Was 8( 7.54%) ,Morbidity Was 20(18.86%), Maternal Morbidity Was 6(5.66%) And
Mortality Was 1(0.94%).

Conclusion:
Aggressive Management By Induction Of Labor Within 12 Hours In A Case Of Prom Reduced The Time Of Delivery And
The Rates Of Chorioamnionitis, Endometritis, And Admission To The Neonatal Intensive Care Unit.

A Proposed Plan Of "Aggressive Management" Is The Final Answer To Decrease Maternal And Neonatal Morbidity And
Mortality.
Keywords
Incidence, Maternal And Neonatal Morbidity And Mortality, Obstetric Outcome, Premature Rupture Of Membranes,
Aggressive Management.

***************

An Unusual Case Of Acute Postpartum Massive Broad Ligament Hematoma Following Vaginal Delivery
Author: Dr. Priyadharshini Durairaju
Co Author: Priyadharshini1, Soki Da Emi Sumer2, Victor Khuman3, Rameshwor Singh4,

Background:Broad Ligament Hematoma Following Vaginal Delivery Is A Rare Complication.It Has A Incidence Of 1:20000
In Literature.It Can Be Life Threatening If Not Recongnised And Managed Quickly As The Patient Can Loose Large Amount
Of Blood In A Short Time.We Report An Unusual Case Of Acute Postpartum Massive Broad Ligament Hematoma After
Assisted Vaginal Breech Delivery Necessiating Laparotomy And Managed Sucessfully.
Case: A 27 Yr Old G3 P1+0+1+1 With Term Pregnancy With Breech Presentation In Active Labour Was Admitted In The
Labour Room For Safe Delivery.She Delivered An Alive Female Baby By Assisted Vaginal Breech Delivery With Right
Mediolateral Episiotomy.Right Sided Cervical Tear Was Noted And Repaired. Minimal Fresh Bleeding Was Noted From
Uterus.High Intracervical Packing Was Done After Repairing Episiotomy As Uterus Was Well Contracted. Immediate Post
Delivery Check Up After 30 Minutes Showed 100Ml Of Clots. Uterus And Vaginal Cavity Was Explored Under General
Anesthesia. No Findings Suggestive Of Retained Placental Bits Or Traumatic Bleeding. No Fresh Bleeding ,Hence Tight
Sterile Vaginal Packing Was Done And Patient Was Kept Under Observation.
Patient General Condition Detoriated With Progressive Pallor,Hypotension, Tachycardia And Droping Saturation.P/A
A Large Mass Of Size 20*15Cm In Right Illiac And Lumbar Region Pushing The Uterus To Contralateral Side Was Noted,P/V
Vaginal Pack Was Soaked And Right Side Fornix Fullness Noted. Internal Bleed Was Suspected And Laparotomy Was Done
. Intraoperatively Massive Right Sided Broad Ligament Hematoma With Right Lateral Wall Uterine Rupture Was Present.
Subtotal Abdominal Hysterectomy With Right Salphingo Oophorectomy Done. 4 Pint Packed Red Blood Cells Transfused.
Vitals Stabilised And Postoperative Period Was Uneventful.
Conclusion: Postpartum Collapse Is An Frightening Obstetric Complication. This Literature Aims To Remind Readers To
Keep In Mind Broad Ligament Hematoma As An Important Possible Cause Of Unexplained Postpartum Collapse Without
Obvious Vaginal Bleeding And The Significance Of Quick Resuscitation.Volume Replacement And Surgical Explorations In
Its Management To Avoid Maternal Mortality.
***************

Hysteroscopic Removal Of Iucd

Author: Dr. Niharika Goel
Co Author: Mohsin Zehra1, Baghel Kalpana2, Fatima Zebi3, Singh Priyanka4,

Patient Was A 28 Years Female Who Came To The Uhi Clinic For Multiload Removal Which Was Inserted 1 Year Back.
Threads Of Multiload Were Not Visible And Its Removal Was Tried But Failed. So Patient Was Referred To J.N.Medical
College Hospital ,Aligarh.
Multiload Removal Was Tried In The Ot Under I.V. Sedation But Only Pieces Of Multiload Could Be Removed.
Hysteroscopy Was Done And The Curved Limb Of Multiload Was Found Embedded In The Fundus And Successfully
Removed.

***************

A Study Of Clinical Characteristics, Predictability & Fetomaternal Outcome Of Obstetric Patients In Intensive Care
And High Dependency Unit.
Author: Dr. Samarina Kamal
Co Author:

Aim And Objective : To Assess The Reasons For The Admission Of Obstetric Patients To The Icu (Intensive Care Unit) And
High Dependency Unit (Hdu), Interventions Required, Their Clinical Outcomes, To Compare The Roles Of The Current
Scoring System In Predicting The Prognosis Of The Critically Ill Obstetric Patients.

Materials And Methods

A Prospective Study Was Conducted In Intensive Care Unit At Alam Hospital & Research Centre Over A Period Of 5 Years
From October 2009 To October 2014. All Obstetric Admissions To The Intensive Care Unit Upto 42 Days Postpartum Were
Included. The Data Collected Were Of Three Categories - Demographic, Obstetric And Icu Related.

Results : A Total Of 50 Obstetric Patients Required Icu And Hdu Admissions. Forty Two Percent Of The Patients Were
Admitted Due To Hypertensive Disorders Of Pregnancy. Sixteen Percent Patients Were Of Obstetric Haemorrhage. Sepsis
And Heart Disease Topped The List With Sixteen Percent And Ten Percent In The Non Obstetric Group.
Risk Factors For Admission Included Lesser Gestation Age, Caesarean Section, Blood Loss And Co-Morbid Conditions Of
The Patent. Inotropic Support Was Received By Twenty Percent, Cvp Monitoring Was Done In Twelve Percent And
Ventilator Support Was Needed In Twelve Percent. There Was Six Percent Of Mortality.

Conclusion
Pregnancy Reduced Hypertensive Disorders And Haemaorrhage Appear As The Major Risk Factors Influencing Maternal
Outcome In Obstetric Patients. Invasive Haemodynamic Monitoring And Ventilatory Support Were The Two Main
Interventions. Scoring Systems Help To Determine The Probability Of Mortality In Obstetrical Patients.
Keywords: Obstetric Icu, Maternal Mortality, Apache-2, Saps-2, Sofa

***************

A Study Of Thyroid Dysfunction In Women With Abnormal Menstruation

Author: Dr. Pranay Phukan
Co Author: Dr. Jikmik R Onak1,

Aims And Objectives: To Find Out The Prevalence Of Thyroid Dysfunction In Women With Abnormal Menstrual Pattern,
To Know The Pattern Of Menstruation In Thyroid Dysfunction And To Study The Response To Treatment .
Materials And Method : The Study Was Undertaken On 200 Women With Aub From Puberty To Premenopausal Age,
Attending Gopd, Assam Medical College And Hospital From 1St July 2012 To 30Th June, 2013. The Women Using Ocp,
Iucd, Diagnosed Already With Thyroid Dysfunction ,Using Drugs Like Steroids, Androgens, Etc , With Genital Or Thyroid
Malignancy, Coagulation Disorders Were Excluded .Pattern Of Menstrual Bleeding Was Noted. And Patients Were
Subjected To Routine Blood Investigations And Serum T3, T4 And Tsh Estimation.
Results Maximum Number Of Cases Belong To 31-40 Years Age Group With Para 2 (24%) Commonest Bleeding Pattern
Was Menorrhagia (47.5%) Followed By Oligomenorrhea (31%). The Most Common Thyroid Dysfunction Was
Hypothyroidism Which Was 18.5% Compared To Mere 3% Of Hyperthyroidism. Hypothyroidism Was Noted In Cases Of
Menorrhagia(34.7%), Polymenorrhea(20%) And Oligomenorrhea(12.9%). Out Of 6 Cases Of Hyperthyroidism 4 Was
Having Oligomenorrhea As The Presenting Symptom(66.7%). Tsh Has The Maximum Sensitivity Compared To T3 And T4
In Detecting Thyroid Dysfunction Which Is Also Significant Statistically. 96.7% Hypothyroid Patients Showed Good
Response With Treatment While 80% Hyperthyroid Patients Showed Good Response. Primary Infertility Was Seen In 5.4%
Women While Miscarriage Was Seen In 51.3% Women, Which Is Significant. 16.2% Of Hypothyroidwomen Were
Suffering From Type 2 Diabetes Mellitus And 18.9% Were Found To Be Obese
Conclusion: From The Study It Is Concluded That Thyroid Dysfunction Is A Significant Cause Of Menstrual Disturbances In
Women Of All Age Group. Correction Of Thyroid Dysfunction Helps These Women To Avoid Unnecessary Interventions
Like Hormonal Treatment, Invasive Procedures And Hysterectomies.

***************

An Interesting Case Of Secondary Live Abdominal Ectopic Pregnancy

Author: Dr. Soumen Daspoddar
Co Author:

35 Yrs Old G7P4L4A2 Lady Presents With Lower Abdominal Pain With Irregular Bleeding P/V Since Last 02 Months. On
Clinical Exam & Usg It Was Diagnosed As A Case Of Live Secondary Ectopic Pregnancy On Rt Side With Mild Collection In
Pod. On Laparotomy A Live Ectopic Preg Seen On Rt Tube, Amnion Was Intact, Fetus Of 14 Wks Size Was Moving Inside
The Sac, Placenta Was Attached To The Surrounding Structure, Placental
***************

Dangerous Dermoid!!
Author: Dr. Padma Ravindranathan
Co Author:

A 53 Year Old Lady P2L2, Presented With Complaints Of Severe Lower Abdominal Pain Of Increasing Intensity Since Last
3 Years. She Gives History Of Irregular Bleeding P/V For 3 Years.
Her Usg Shows A Bulky Uterus With Thickened Endometrium And A 5/5Cm Left Ovarian Dermoid Cyst.She Presented In
Our Op For Surgery.
Her Bowel And Bladder Habits Were Normal.
No Past H/O Abdominal Surgeries.
Her Blood Parameters, Ecg And X-Ray Were Normal.
Total Laparoscopic Hysterectomy Planned And Proceeded.
Intra-Operatively, A Dermoid Cyst Of 5/5 Cm Seen On The Left Adnexa Densely Adherent To The Rectum. Fearing Rectal
Damage, A Portion Of The Cyst Was Left Behind And The Remaining Was Shaved Off And Hysterectomy Proceeded With
Ease.
Soon, There Was A Drop In Oxygen Saturation With Hypotension And Tachycardia. An Immediate Laparotomy Done, That
Revealed A Small 1Cm Defect In The Anterior Wall Of The Rectum, Hard And Fibrosed, On The Left Behind Shaven Area
Of The Dermoid, Showing A Clear Communication Between The Rectum And The Dermoid, Through Which Fecal Matter
Was Leaking Causing Fecal Peritonitis. It Was Not A Damaged Or Injured Rectal Wall Though!
The Dermoid Seemed To Have Deeply Infiltrated The Rectum.
Same Area Excised And Sent For Hpe.
Primary Closure Of Rectum Was Done Along With Diversion Colostomy.
Hpe Reports Confirmed That The Dermoid Indeed Had Infiltrated The Rectum.
Colostomy Closed 2 Months Later With Complete Recovery.
Think TankThe Fistula Can Occur As A Consequence Of Cyst Leakage And The Subsequent Development Of Dense Adhesions Between
The Cyst And The Bowel Leading To Wall Necrosis, Inflammatory Change, Perforation Of The Wall And Consequent Fistula
Formation.
Do We Need An Mri Scan For All Long Standing Dermoids??
Dr.R.Padma

***************

A Hospital Based Study Of Prevalence Of Gestational Diabetes Mellitus

Author: Dr. Atish Singla
Co Author: Dr Parneet Kaur1, Dr Khushpreet Kaur2, Dr Arvinder Kaur3, Dr Preet Kanwak Sibia4,

A Hospital Based Study Of Prevalence Of Gestational Diabetes Mellitus

Atish Singla, Parneet Kaur, Khushpreet Kaur, Arvinder Kaur, Preet Kanwal Sibia
Dept Of Obst&Gynae, Government Medical College &Rajindra Hospital, Patiala 147001

Introduction: The Prevalence Of Diabetes Is Increasing Globally And These Numbers Include Women With Gestational
Diabetes Mellitis (Gdm).Women With Gdm Are At Increased Risk Of Diabetes In Future As Are Their Children.Thus,
Diagnosis Of Gdm Is An Important Public Health Issue.
Aims & Objectives: The Study Was Done To Find The Prevalence Of Gdm Among Indian Pregnant Women And The
Association Of Various Risk Factors With Gestational Diabetes Mellitus.
Materials & Methods: The Study Was Performed On 200 Pregnant Women Attending The Antenatal Clinic At Our Hospital
Between 24-28 Weeks Of Gestation. Women Who Were Known To Have Diabetes Prior To Index Pregnancy Were
Excluded From The Study. The Oral Glucose Tolerance Test (Ogtt) Was Done By Givingthem 75G Of Anhydrous Glucose
In 300 Ml Of Waterirrespective Of Her Fasting Status. After 2 Hours, A Venous Blood Sample Was Taken.Diagnosis Of
Gdm Was Made If 2Hr Plasma Glucose Values Were 140Mg/ Dl.
Results: The Prevalence Of Gestational Diabetes Mellitus Came Out To Be 20% In Our Hospital. The Average Age Of The
Screened Population Was 25.705Yrs. The Mean Bmi Of The Population Was 24.615 With 57.5% Of The Positive Cases
Having Bmi Below 25. Among The Positive Cases 14 (35%) Were Such Who Had No Associated Risk Factor.
Conclusion: We Concluded That There Is High Prevalence Of Gdm In The Study Population, Irrespective Of Presence Of
Any Associated Risk Factors, Thus Necessitating The Need Of Universal Screening.

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Seroma-A Rare Case Report

Author: Dr. Swamigari Pallavi
Co Author: Dr.Kaliki Hyamavathi Reddy1,

A Seroma Is Defined As Sterile Accumulation Of Serum In A Circumscribed Location In The Tissue .Seromas Can Occur
After Surgeries ,Especially Those That Are Extensive Or Involve Significant Tissue Disruption Viz. Hernia Repairs , Plastic
Surgeries Such As Breast Augmentation Or Reconstruction, Abdominoplasties ( Tummy Tucks ) And Removal Of Large
Intra Abdominal Space Occupying Lesions Like Huge Fibroids/Ovarian Masses. The Literature Citing The Exact Incidence
Of Seromas Following Removal Of Large Intra Abdominal Masses Is Scant . Seroma At Times Become Severely
Symptomatic . The Best Way To Prevent A Seroma Is Not To Give It Any Place To Form . ItS Easier Said Than Done .
Here Is An Interesting Case Report Of Postoperative Seroma Following Removal Of A Large Broad Ligament Fibroid.

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Ectopic Pregnancy : Incidence,Clinical Presentation And Surgical Management

Author: Dr. Megha Gupta
Co Author: Dr Usha Rawat1, Dr Geeta Jain2, Dr Purnima Upreti3,

Abstract
Objectives: The Aim Of This Study Was To Determine And Evaluate The Incidence, Clinical Presenta-Tion, Site And
Management Of Ectopic Pregnancy And To Assess Clinical And Laboratory Findings, Operative Finding And Operative
Procedures In Women Who Have Undergone Laparoscopy Or Laparotomy For Ectopic Pregnancy.
Methods: This Was A Cross-Sectional Study Of Ectopic Pregnancies Managed In Dr Susheela Tiwari Government Hospital
Haldwani During The Study Period From 1St September 2013 To 31St August 2014 And 56 Women Were Enrolled. A
Structured Questionnaire Was Used To Collect Information. Clinical Symptoms And Signs, Laboratory Findings (Including
Hb And Serum -Hcg Levels), Size Of Ectopic Mass And Its Location, Type Of Surgery And Operative Notes Were Recorded.
Results: Total No. Of Deliveries During The Study Period Were 2251. There Were 56 Cases Of Ectopic Pregnancy And
Incidence Was 2.4%. The Commonest Clinical Presentation Was Abdominal Pain. No Mortality Recorded. 43 Of 56 (77%)
Had Ruptured Ectopic Pregnancies,10 Of 56 (18%) Had Tubal Abortion And The Remaining Three (5%) Were Unruptured.
39 Had Undergone Laparotomy And 17 Had Undergone Laproscopy.
Ectopic Mass Size, And Bhcg Level Before Surgery Were Significantly Higher In
Women Who Had Undergone
Laparotomy. Laparoscopy Was Commonly Performed For Tubal Abortions. Right Tubes Followed By Left Tubes Were The
Most Affected Sites. Unstable Vital Sign Was Recorded In The Laparotomy Group More Than The Laparoscopy Group.
Conclusion: : Results Of The Current Study Showed That Women Who Had Undergone Laparotomy Had Significantly
Higher Mass Size, And B-Hcg Level And Were More Unstable Than The Laparoscopic Group.
Key Words: Ectopic Pregnancy, Laparoscopy,Laparotomy

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Etiology And Maternal Consequenses Of Pph

Author: Dr. Neetu Singh
Co Author: Dr.Kiran Pandey1, Dr.Neena Gupta2,

Abstract: To Study The,Etiology And Maternal Consequences In Reffered Cases Of Pph

Dr.Neetu Singh, Dr.Kiran Pandey,Dr Neena Gupta
Aims And Objective: To Study The Sociodemographic Profile,Etiology And Maternal Consequences In Reffered Cases Of
Pph At Our Tertiary Care Centre.
Material An d Methods:This Was A
Retrospective Study Conducted At Deptt Of Obstetrics And Gynaecology Gsvm Medical College, Kanpur From Feb2011
To July2013(29 Months). Only Reffered Cases Of Pph Were Included. Records Were Analysed With Respect To
Demographic Profile, Etiologic Factors ,Maternal Morbidity And Mortality.

Observation: Among All The Reffered Cases At Our Centre,63.1% Of Cases Were Due To Pph .Majority Of The Reffered
Cases Of Pph Were Belong To Lower Socioeconomic Status And Were From Rural Area.62.8% Patients Were Multipara
And 37.2% Patints Were Primaepara. Most Common Cause Was Atonic(53.5%) Followed By Traumatic(23.5%). The Most
Common Complication Was Shock(28.8%). Maternal Mortality At Our Centre Due To Pph Was(24.9%)
Conclusion : By Promoting Institutional Delivery Of Nearly All Antenatal Patients By Skilled Personale And Timely
Referral,We Can Decrease Incidence Of Reffered Cases Of Pph And Therefore Maternal Morbidity And Mortality.

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3D Omni View In Managent Of Uterine Anomalies.

Author: Dr. Andru Narasimha Reddy
Co Author: Dr.Ashwani1,

Aim

Role Of 3D Ultrasound In Contemporary Gyn Practice.

Material Methods: Incidence Of Uterine Anomalies Were Analised And Diagnostic Comparisons Were Made Between
2D/Hsg 3D And 3D With Omniview..Intraoperative Use Of 3D Ultrasound Is Analised.
Results. ; It Has Been Observed That 3D With Omniview Is Scoring An Edge Over Coventional Hsg And Mr In Majority Of
Cases..
Conclusion: It Has Ben Concluded That 3D With Omniview Is Less Invasive More Informative And User Friendly Approch
To The Management Of Congenital Uterine Anomalies.

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Operative Laparoscopy A Safe Procedure In Early Pregnancy - A Five Year Review And Presentation Of Ovarian
Abscess In Pregnancy
Author: Dr. Jayanthi Reddy
Co Author: Dr. Rukmini Ramamohan.T1, Dr. Anuradha - Anu Test Tube2, Dr. Lokeshwari - Anu Test Tube3,

Aim & Objective:

To Show That Minimal Access Surgery Can Be A Safe And Effective Procedure In Early Pregnancy With Good Outcome.
Material & Methods:
Over A 5Yr Period At Jj Hospital Operative Laparoscopy In Early Pregnancy Was Performed In The Following Cases With
Good Outcome:

3 Heterotrophic Pregnancies

4 Cases Of Torsion Of Ovaries Cyst In Early Pregnancy

2 Cases Of Torsion Of Ovary & Tube Due To Ohss

2 Cases Of Ruptured Corpus Luteal Cyst

2 Cases Of Ruptured Hemorrhagic Cyst

1 Case Of Ruptured Ovarian Abscess

A Ruptured Ovarian Abscess Is An Uncommon Surgical Emergency Often Requiring Laparotomy & Oophorectomy

Early Recognition And Prompt Surgical Intervention Can Help Salvage The Ovary

The Patient Underwent Ivf & Was Referred To Jj Hospital With Early Intrauterine Pregnancy & Fever With Severe Lower
Abdominal Pain.

Ultrasound Showed A Viable Intrauterine 6 Week Pregnancy With A Right Adnexal Mass.

Surgical Profile Was Done, Patient Stabilized And Taken Up For Laparoscopy

Findings: There Was A Ruptured Right Ovarian Abscess Draining Pus Into Peritoneal Cavity. Abscess Was Incised And
Drained Completely & Cavity Scraped.
Antibiotics & Support Treatment Of Pregnancy Was Continued For One Week And Patient Discharged

Result : Follow Up In Opd Showed A Resolved Abscess Of Viable Intrauterine Pregnancy. Patient Went To Term &
Delivered A Healthy Baby By C-Section, Ovary Was Un -Remarkable At Laparotomy

In This Rare Case, Laparoscopy Proved To Be A Safe Surgical Procedure For Salvaging The Ovary With Good Fetal Outcome

Conclusion:
In All The Cases We Performed At Jj Hospital, Laparoscopy Proved To Be Safe, Effective In Early Pregnancy And Had Good
Pregnancy Outcome.

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Interpretating The Role Of Ultrasound In Detecting Perimenopausal Urinary Incontinence

Author: Dr. Nirza Saikia
Co Author: Dr Nirza Saikia1,

Aim : To Co-Relate Assessment Of The Urethra & Post Void Residual Urine Volume In Detecting Incontinence By Tvs.
Materials & Methods
Prospective Randomized Clinical Study.

The Study Was Carried Out At O&G Dept, Amch From 1St May 2013 To 30Th April 2014. 400 Perimenopausal Women
Were Included In This One Year Analysis, 200 Women Who Presented With Symptoms Of Incontinence Were Compared
With 200 Symptomless Women By Transvaginal Scanning [Tvs] Using 5-7.5 Mhz To Visualise The Position, Shape Of The
Urethra & Urethrovesical Angle And Post Void Residual Urine (Pvru).
Results
Internal Urethral Sphincter (Ius), Being A Cylinder, The Level & Extent Of Rupture Along The Cylinder Will Determine The
Type & Degree Of Incontinence. If The Rupture Affects The Upper Part Of Ius, It Will Lead To Detrusor Overactivity,
Revealed As Funneling Of The Bladder Neck, Loss Of Urethro-Vesical Angle And Apparent Descent Of The Bladder Neck.
If The Rupture Affects The Lower Part Of The Ius, It Will Lead To Stress Incontinence Seen As Flask Shaped Appearance
Of The Bladder Neck. If The Rupture Affects The Whole Of The Ius, It Will Lead To Mixed Type Of Incontinence Being Seen
As Irregular Walls & Short Urethra. Based On This Data, 45% Women Had Stress Incontinence, 25% Had Urge Incontinence
While 14% Had Mixed Incontinence. Interestingly Of The Asymptomatic Group 36% Had Findings Suggestive Of Stress
Incontinence While 11% Had Urge Incontinence.
23 % Of Patients With Incontinence Had Pvru More Than 200Ml While 49% Had Residual Urine Less Than 50 Ml.
Conclusion
Tvs Can Be Advocated As A Routine Procedure In Detection And Differentiation Of The Type Of Incontinence Which Will
Help Clinicians In Determining The Treatment Protocol. It Can Also Detect Patients Who Are At Risk Of Developing
Incontinence.

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Perineal Tear Repair:Delayed Vs Early Repair In Neglected Cases Of Third And Fourth Degree Tear
Author: Prof. Seema Hakim
Co Author: Dr Farah Ziauddin1, Dr Nada Mushtaq2,

Aim And Objective(S):To Evaluate The Effect Of Repair Of Perineal Tear(Third And Fourth Degree) In Delayed
Presentation(More Than 12 Hours)Of Neglected Cases At The Time Of Presentation With That Of Recommended Repair
After An Interval.
Material And Method(S):Patients Presenting To The Opd Or Emergency Labour Ward In Jawaherlal Nehru Medical
College,Amu, Aligarh With Features Of Anal Incontinence Following A Third/Fourth Degree Perineal Tear Sustained
During Childbirth Were Selected.The Tears Were Missed At The Setup And Patients Presented After 12 Hours Of
Childbirth.Duration Of Study Was Of Two Years.Patients Were Selected During 2012-2014.
Result:There Was Significant Patient Satisfaction And Improvement In The Anal Continence After The Anal Sphincters
Were Repaired Immediately Irrespective Of The Time The Patient Presented And Wound Being Healthy Or Infected.
Conclusion: Repair Of Anal Sphincter In Third/Fourth Degree Perineal Tear Is Not Necessarily To Be Performed After An
Interval,Primary Repair Has Beneficial Results. Conversion Of Third/Fourth Degree To First/Second Degree Has Good
Results In Relation To Patient Satisfaction And Anal Continence.

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A Study Of Thrombocytopenia In Hypertensive Disorder Of Pregnancy

Author: Dr. Neha Singh
Co Author:

Aim- To Study Incidence Of Thrombocytopenia In Hypertensive Disorder Of Pregnancy And Its Fetomaternal Outcome.
Material And Method- It Is An Observational Study. The Study Was Conducted In The Deptt Of Obstetritrics And
Gynaecology Pmch Patna Over A Period Of Six Months From January 2014 To
June 2014 The Number Of Patients Studied Were 100 Attending The Labour Room Emergency
And Rch Opd.Of Pmch Patna.All Patients With Hypertension During Pregnancy Were Included
In The Study.

Results-Main Cause Of Thrombocytopenia Were Gestational Thrombocytopenia

Itp,Preeclampsia,Hellp Syndrome.
Thrombocytopenia In Hypertensive Disorders Of Pregnancy Leads To
Induction Of Labour,And Preterm Deliveries.
Thrombocytopenia Occurs More Commonly In Patients With Eclampsia(30%) And Preeclampsia.(15% -18%)
Conclusion-Moderate And Severe Thrombocytopenia Leads To Increase Maternal Morbidity
And Perinatal Complications. There Is Association Between Thrombocytopenia And Hypertensive
Disorders Of Pregnancy. Proper Antenatal Care Can Decrease The Morbid Outcome In Pregnancy
And Fetal.

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Management Of Thrombocytopenia In Pregnancy With Varied Etiology

Author: Dr. P Vandana
Co Author: Dr.M.Usha Suresh1, Dr.V.Usha Rani2,

Aim:
To Study Aetiology,Management And Outcome Of 66 Cases Of Thrombocytopenia In Pregnancy In Mgmh,Petlaburz.

Material And Methods:

Prospective Study Of 66 Cases Of Thrombocytopenia In Pregnancy Who Delivered Between Jan 2014-September 2014
At Mgmh.

To Follow All Thrombocytopenic Cases Throughout Pregnancy Till Delivery And Post Partum.
Followup Of Babies Of All Cases Of Thrombocytopenia

Results:
Incidence Of Thrombocytopenia In Pregnancy Is 0.84%.Severe Pre Eclampsia Is The Most Common Cause(31.8%), Next
Common Being Hellp And Partial Hellp(24.2%) And Gestational Thrombocytopenia(12.1%). Highest Incidence Is In The
Age Group Of 23-27Yrs(42.4%) With 68% Cases With Gestational Age Above 32 Yrs With Perinatal Mortality Of 46.9% And
Maternal Mortality Of 6%

Conclusion:
When Platelet Count Below 1 Lakh/Mm3 Is Identified In Pregnancy Important Clinical Differences And Therapeutic
Implications Exists When Compared To Non Pregnant Patients.
Management Of Thrombocytopenia In Pregnancy Should Be Multi Disciplinary At A Tertiary Care Centre.Each Case
Of Thrombocytopenia Has To Be Individualized And Managed For Better Pregnancy Outcome.Appropriate Investigations
And Management For Mother And Fetal Follow Up Will Help In A Long Way For Good Maternal And Fetal Outcome.
Adverse Pregnancy Outcome Is Specifically Attributed To Dic,Hellp And Severe Pre Eclampsia.

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Study Of Impact Of Maternal Overweight And Obesity On Pregnancy Outcome.

Author: Dr. Lata Dwivedy
Co Author: Dr. Kanchan Mala1,

Aims & Objective:Obesity And Overweight Is A Major Public Health Issue Of Our Time. It Is Considered The Fifth Leading Risk For Global
Health. Who Has Defined The Criteria Of Overweight As Bmi >25 And That Of Obesity As Bmi >30. Several Studies Have
Shown That Obesity In Pregnancy Puts The Mother And Fetus At Risk Of Several Complications.
This Study Is To Find Out The Incidence Of Pregnancy Complications And To Assess The Obstetrical And Perinatal Outcome
In Overweight And Obesity In Pregnancy.
Material And Methods:This Study Has Been Conducted In The Dept Of Obst & Gynae Of Patna Medical College & Hospital From Sept 2013 To
Aug. 2014. 25 Obese & Overweight Pregnant Women Attending Antenatal Clinic And Labour Room Were Selected For
The Study And Compared With 25 Control Group Of Pregnant Women.
Inclusion Criteria Were Primi And Multigravida With Singleton Pregnancies & Bmi >25Kg/M2. Women Who Are Already
Obese With Medical Complications Were Not Included In The Study.
Results:Out Of 25 Study Group 16 Patients Had Pregnancy Induced Hypertension, 2 Developed Gestational Diabetes Mellitus And
2 Had Spontaneous Abortion. 15 Pts Had Lscs For Different Indications. Regarding Perinatal Outcome 4 Were Premature
Out Of Which 2 Developed Rds. 2 Had Iugr, 2 Were Big In Size And 1 Baby Was Born With Congenital Malformation. One
Iud Occurred At 34 Weeks Gestation. Control Group Developed Very Few Complications.
Conclusion :Thus This Study Confirms The Previous Studies Regarding Adverse Maternal And Perinatal Outcome Related To
Overweight & Obesity & Thus It Highlights The Importance Of Preconceptional Counseling Regarding Obesity And Related
Issues.

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Title: Low Grade Inflammation And Oxidative Stress Are Positively Correlated With Incidence Of Polycystic Ovary
Syndrome (Pcos) In Patients Of Menstrual Abnormalities
Author: Dr. Uma Pandey
Co Author: Vivek Pandey1, Prof Y B Tripathy2,

Aims & Objectives: The Aim Of The Present Study Was To Correlate The Degree Of Low Grade Inflammation, Oxidative
Stress And Prevalence Of Pcos In Patients Of Menstrual Dysfunction In Eastern Up Region. Materials & Methods: We
Prospectively Studied 19 Women Aged 18 To 32 Years, Who Attended The Opd Of Gynaecology In Sir Sunderlal Hospital,
Bhu For Common Complaint Of Menstrual Dysfunction. All Women Who Consented For The Study, Were Asked To Fill Up
A Short Pcos Symptoms Questionnaire On The Pattern Of Menstrual Cycle, Hirsutism, Acne And Information About Past
Diagnosis Or Any Other Illnesses. Out Of 19 Patient 7 Patients Were Consented For Collecting Their Blood Sample For
Further Studies In Which Pcos Was Diagnosed In 3 Patients By Rotterdam Criteria. Their Blood Samples Were Further
Subjected For Assessment Of Activity Of Catalase And Superoxide Dismutase (Sod) In Rbc Hemolysate And Degree Of
Lipid Peroxidation (Lpo) In Serum As Parameter Of Oxidative Stress; Level Of Hscrp As Inflammatory Marker. Results: Out
Of 19 Women, 42% Had Irregular Menses, 37% Had Oligomenorrhea, 16% Had Amenorrhea And 5% Had Hypomenorrhea.
3 Women Out Of 19 Satisfied Rotterdam Criteria. Patients Of Pcos Showed Elevated Level Of Hscrp (10402.67
1615.62Ng/Ml) Compared To 4 Non-Pcos Patients (4724.992250.9Ng/Ml). Pcos Patients Also Had Increased Level Of
Oxidative Stress As Degree Of Lpo Was Higher (0.7150.130 Vs 0.410.049 Nmol/Mg Protein) And Activity Of Sod
(6.250.70 Vs 7.70.49 U/Mg Protein) And Catalase Enzyme (1.60.11Vs 1.750.042 U/Mg Protein) Was Lower.
These 3 Pcos Patients Did Not Show Significant Higher Bmi Than Non Pcos Bearing Patients.Conclusion: The Patients Who
Attended The Opd For Problem Related To Infertility And Menstrual Irregularity Showed Confirmation Of Pcos Only In
15%.
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Comparative Study Of Squatting Position Vs. Supine Position In Second Stage Of Labor
Author: Dr. Alka Dani
Co Author:

Aims & Objectives: To Assess The Risks And Benefits Of Squatting Position During Second Stage Of Labour And Its
Comparison With The Supine Position.
Introduction: Before 17Th Century, The Upright Position Was Common For Birthing. There Is A Need To Revisit The Age
Old Practice Of Labour As For The Patients In Squatting Position:

Pelvic Outlet Widens 30% More

Straightens The Birth Canal

Makes Use Of Gravity

Expected To Quicken The Second Stage Of Labour

Method: The Study Has Been Conducted At The Department Of Obs & Gynae, D.Y.Patil School Of Medicine. A Total Of
200 Patients, 100 Patients For Case Study Group (Squatting Position)) And Another 100 Patients For Control Group
(Supine Position) Depending On The Inclusion And Exclusion Criteria Were Randomly Selected. Patients Of Both The
Groups Were Comparable I.E. Age, Parity, Socio-Economic Status And Other Parameters. Antenatal Registered Patients
With Full Term Without High-Risk Pregnancy Were Selected.
Results:
The Age Of Patients In Both Groups Varied Between 18 37 Years. There Were 30% Primi-Gravida And 70%
Multigravida In Both Groups. It Is Found That Duration Of 2Nd Stage Was Decreased By An Average Of 8 Minutes In Both
PrimiS And MultiS, Which Is Significant. The Vaginal Instrumental Delivery And Lscs Rates Are Non-Significant.
The Maternal And Fetal Morbidity Due To Episiotomy Given Or Perineal Tear And Resuscitation Of New Born Respectively
Are Non-Significant Statistically. Need For Oxytocin And Its Dosage Required Was Significantly Less, While And Maternal
Satisfaction On Vas Is Significantly High In Study Group
Conclusions:
Squatting Position For 2Nd Stage Of Labour Is Much Convenient For Mothers In Terms Of Duration Of 2Nd Stage,
Need And Oxytocin Quantity Required For The Subjects, Extension Of Episiotomy And Maternal Satisfaction On Vas. No
Significant Variation Is Found In Incidences Of Maternal And Fetal Complications, Need For Instrumental Delivery And
Lscs.

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Various Outcomes Of Ppiucd Insertion In Women Who Delivered At Diphu Civil Hospital In The District Of Karbi
Anglong
Author: Dr. Ram Rongphar
Co Author:

Aims & Objectives: To Assess The Various Outcomes Of Ppiucd Insertion Among Women Who Delivered At Diphu Civil
Hospital In The District Of Karbi Anglong, Assam.
Materials & Methods: A Hospital Based Prospective Study Was Done. All Women Who Came To Deliver At Diphu Civil
Hospital From April 2013 To September 2014 (18 Months) Were Informed About Ppiucd. Those Women Who Agreed And
Had Given Consent, Ppiucd Insertion Was Done. These Women Were Then Followed Within The First 6 Weeks Following
Delivery And Then Every 6 Months Thereafter.
Results: Out Of The 227 Women Who Received Ppiucd, 50(22%) Were Given Post-Placental (Within 10 Minutes), 9(3.96%)
Post-Partum(Within 48 Hours) And 168(74%) Intracaeserean. Again Out Of The 227 Women, 212(93.39%) Came For
Follow-Up.The Number Of Clients Coming For Follow-Up Within 6 Weeks After Delivery Were 65(30.66%) And
147(69.33%) Came After 6Weeks Of Delivery. During The Follow-Up Period 208(98.11%) Had No Complaints, 61(28.77%)
Reported Of Missing Strings, 4(1.88%) Had Other Complaints And 2(0.94%) Reported Of Self Removal. Spontaneous
Expulsion And Infection Were Not Reported During Follow-Up.
Conclusion: Women Who Received Ppiucd Showed A High Level Of Satisfaction With This Choice Of Contraception And
No Major Untoward Outcomes Following Ppiucd Insertion Were Reported.

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Evaluation Of Pelvic Masses By Tas Vs Tvs & Its Operative Correlation

Author: Dr. Arati Behera
Co Author: Dr Arati Behera1, Dr Prosun Bera2, Dr Puspanjali Khuntia3, Dr Subrat Behera4, Dr Deepika Dash5

Aims & Objectives:

1.To Determine Accuracy Of Transabdominal Vs Transvaginal Sonography In Diagnosis Of Different Pelvic Masses.
2.Correlation Of Clinical,Transabdominal,Transvaginal Sonography With Intraoperative Findings As Well As
Histopathological Findings.
Materials & Methods:
It Is A Cross Sectional Study Conducted In Dept Of O & G,Vssmch,Burla From A Period Of Oct 2012-Sep 2014.Total Of 100
Patients With Clinical Suspicion Of Pelvic Masses Were Included In The Study.Detailed History & Clinical Examination
Done Followed By Trandsabdominal & Transvaginal Scanning.
Results: Clinically All I.E. 32 Cases Of Fibroid Were Detected Correctly.But There Was Misdiagnosis In 4 Cases.2 Cases
Adenomyosis & 1 Case Of Fibrosarcoma Were Diagnosed As Fibroid.Tas & Tvs Detected 2 Cases Of Adenomyosis Correctly
But Unable To Diagnose 1 Case Of Fibrosarcoma.Clinically All Ovarian Tumours Were Detected But 3 Cases Were
Misdiagnosed I.E. 2 Cases Of Pcod & 1 Case Of Endometriosis Of Ovary.Tas & Tvs Were Able To Diagnose Correctly Except
2 Cases Of Chylolymphatic Cyst.1 Case Of Didelphus Uterus Was Diagnosed As Ectopic Pregnancy Clinically But Tvs
Diagnosed It Correctly Unlike Tas.Dermoid Cysts , Hematocolpos & Hematometra Were Correctly Diagnosed In All Cases.
Conclusion:Usg Is A Valuable Aid In Assessing Pelvic Masses,Being Nonivasive , Free From Radiation Hazard , Cheap &
Time Saving.Tvs Though Has High Accuracy , Tas & Tvs Are Complimentary Technique Which Should Be Used Together
For Evaluation Of Pelvic Masses.

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Accuracy Of Clinical Evaluation Of Patients With Site Specific Vaginal Wall Prolapse Ant Its Correlation To Surgical
Diagnosis
Author: Dr. Garima Sharma
Co Author: Dr Shashank Parulekar1,

Aims & Objectives:

To Clinically Evaluate The Patients Of Uterovaginal Prolapse For Site Specific Defects And Levels Of Damage

To Correlate The Clinical Evaluation With Evaluation During Surgery

To Perform The Site Specific Repair Of The Defects

Material & Method: A Prospective Observational Study Was Conducted On 45 Women With Pelvic Organ Prolapse
Admitted In Kem Hospital, Seth G.S. Medical College, Mumbai. After Taking History And Gpe, Thorough Local Examination
Of Vaginal Compartments Was Done For Site Specific Defects. Degree And Extent Of Uterine Descent Was Also Noted.
These Were Reiterated At The Time Of Surgery Followed By Site Specific Surgery.
Results: Clinical Diagnosis Of Central Transverse Defects Of Anterior Compartment Had Accuracy Of 90.5% With Error Of
9.5%, Sensitivity 100%, Specificity 12.8%, Ppv 90.48%, Npv100% And Positive Likelihood Ratio Ratio 1.75. Kappa Value
Was 0.559. Accuracy Of Clinical Diagnosis For Right & Left Paravaginal Defects Was 50% And 83.3% Respectively. Thus
Clinical Diagnosis Of Unilateral Defects Showed Sensitivity 63.64%, Specificity 91.18%, Ppv 70%, Npv 88.57%, Positive
Likelihood Ratio 7.21 And Negative Likelihood Ratio 0.40. Kappa Value Was 0.595. Bilateral Paravaginal Defects Were
Diagnosed Correctly On Clinical Examination In 100% Cases. However, Diagnosis Of Absence Of Defects Was Accurate In
90.2% With Error Of 9.8%. The Clinical Diagnosis Had Sensitivity 50%, Specificity 100%, Ppv100%, Npv 90.24% And
Negative Likelihood Ratio Of 0.50. Kappa Value Was 0.622. Posterior Compartment Defects-Clinical Diagnosis For
Transverse Defect Was Accurate In 88.2% With Error Of 11.8%. Clinical Diagnosis For Mere Presence Of Posterior
Compartment Defects Had Sensitivity 100%, Specificity 81.82%, Ppv 94.44%, Npv 100%
Conclusion: The Intraoperative Diagnosis Of Site Specific Defects Remains The Gold Standard For Detection Of These
Defects.

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Effect Of Single Loading Dose Of Mgso4 In Severe Pih

Author: Dr. Jyoti Mokharia
Co Author:

Aims And Objective- To Evaluate The Effect Of Single Loading Dose Of Mgso4 In Severe Preeclampsia.
To Evaluate The Foeto Maternal Outcome In Patients With Severe Preeclampsia.
Material And Methods-The Study Will Be Conducted At The Department Of Obstetrics And Gynaecology, Pannadhay
Rajkiya Mahila Chikitsalaya, Rnt Medical College, Udaipur.
One Group Of 50 Women Received A Single Loading Dose Of 4Gm Of Mgso4 Was Given I.V. After Diluting It In 20Ccof
5%Dextrose Over 10-15Min And Simultaneously 10Gm Of Undiluted 50%Mgso4 Was Administrated I.M.
Another Group Of 50Women Were Given Complete Standard Regime According To The Pritchard Regime I.E. 14Gm
Loading Dose Followed By 5Gm I.M. Every 4Hrs For 24Hrs.
Number Of Fits Was Observed After Mgso4 Given. Side Effect Due To Drug Like Vomiting, Headache, Pain Or Abscess At
Site Of Injection Was Observed.
Serious Side Effects Including Respiratory Distress, Renal Failure, Cardiac Arrest And Immediate Neonatal Outcome Was
Also Observed.
Results-There Were Total Of 100Patients Of Severe Pih In Study Were Randomized To Receive Either Standard Pritchard
Regime Or Loading Dose Only.The Profile Of Patients Between Case And Control Were Comparable. The Mean Age Of
The Patients Were 22.38And 22.12Years Respectively. There Were No Significant Differences In Parity And Gestational
Age Of The Patients In Between Two Groups.
The Number Of Convulsion Were 5In Case And 4 In Control Group Not Significantly Different. Pvalue-0.727
The Disease Severity Indicators Serum Uric Acid And Lft Between Two Groups Were Also Comparable.
The Rate Of Caesarean Delivery Was 46.0%In Case And 26.0%In Control Group.
There Were Also No Significant Difference In Foetal Outcome.
Conclusion-The Study Suggested That Only Loading Dose Of Mgso4 Is As Effective As Standard Regime In Controlling
Convulsion In Severe Pih. The Number Of Fits Was Comparable In Both Groups. It Reduces Painful I.M.Injections And
Definitely Reduces The Sideeffects.

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A Study Of Perinatal Mortality

Author: Dr. Sesha Lakshmi Prasanna Nainala
Co Author:

Aims And Objectives:

1)

Estimation Of Perinatal Mortality In Correlation With Clinical Findings And Autopsy Findings.

2)

To Analyze Various Preventable Etiological Factors .

Materials And Methods

This Is A Study Of Perinatal Mortality And Analysis Of Causes Of Still Births And Early Neonatal Deaths
Occurring Among Women Who Delivered In The Department Of Obg, Ggh , Kakinada Andhra Pradesh, Over A Period Of
2 Years. All Women Who Are Attending Labor Ward During Study Period Were The Study Group. Late Fetal Deaths & Early
Neonatal Deaths Were Included In The Study. Babies Weighing < 1000 Grams And < 28 Weeks Of Gestation Were Excluded
. During The Study Period, There Were 21,864 Deliveries And 419 Were Still Births And 268 Neonatal Deaths. Fetal
Autopsies Were Done In 80 Cases In The Department Of Pathology .
Results:
The Still Birth Rate Was 19.1 Per 1000 Births And The Neonatal Death Rate Was 12.4 Per 1000 Live Births. The Perinatal
Mortality Rate Was 31.7 / 1000 Births. Prematurity Stands As A Major Etiological Factor. 37.2% & 62.7% Of Still Births
And Neonatal Deaths Occurred Due To Maternal Medical & Obstetric Complications. Out Of 80 Autopsies, 40% Had Anoxic
Changes, 27.5% Pulmonary Lesions, 7.5% Birth Trauma, 11%Congenital Malformations,10% Miscellaneous Features And
10% Cases Had No Obvious Pathology . Among 268 Early Neonatal Deaths, Rds Due To Prematurity Is The Most Common
Cause.
Conclusion:
Most Of The Perinatal Deaths Are Due To Preventable Causes . Maintenance Of The Correct Vital Statistics And
Continuous Autopsy Study Is Essential. Fetal And Neonatal Deaths Only Brings The Tip Of Iceberg In Terms Of Perinatal
Problems. So, The Obstetrician Has An Important Role To Play Not Only In Survival Of The Infant But Also In Determining
Its Quality Of Life Subsequently.
***************

Maternal Morbidity In Emergency Laparotomy For Ectopic Pregnancy

Author: Dr. Muthamizh Kannadasan
Co Author: Dr. Mini.C.H1,

Aims And Objectives:

To Determine The Risk Factors For Ectopic Pregnancy.
To Assess The Severity Of Haemorrhagic Shock And Its Relation To Gestational Age And Site Of Ectopic.
To Assess The Postoperative Period And Hospital Stay.
Materials And Methods:
Retrospective Descriptive Study Done In Govt. Medical College, Calicut During January To September 2014. All Patients
Admitted To Emergency Department With A Diagnosis Of Suspected Ruptured Ectopic And Laparotomy Done. All Patients
Were Given General Anaesthesia And Intraoperative Findings Recorded. Blood Transfusion Given Noted. Anaesthesia
Complications Noted. Postoperative Period Monitored Till Discharge.
Results:
Out Of Total 75 Patients, 70(93.3%) Had Ruptured Ectopic And 5(6.7%) Unruptured. Most Common In Age Group 25-35
Years(58.6%). Commonest Site Is Ampulla(72%) And On Right Side(60%). 58 Patients (77.3%) Had Ruptured Ectopic
During 6-8 Weeks Gestation. Risk Factors Identified Were Sterilisation Failure 14(18.6%), Previous Abortion 16(21.3%),
Previous Ectopic 2(2.6%), 1 Case Each Of Tubal Recanalization And Iucd. Hemorrhagic Shock Severity Assessed By Blood
In Peritoneal Cavity And Amount Of Blood Transfusion Required Showed 40% Patients Had 500-1000Ml And 19% Had
More Than 1 Litre Blood In Peritoneal Cavity. 66% Received 1 Unit Prbc And 20% Received More Than 1Unit Prbc.
Majority(48%) Underwent Near Total Salpingectomy.1 Had Ovarian Ectopic. No Anaesthesia Complications. There Were
No Complications Related To Blood Transfusion. Postoperative Period Uneventful In All Patients And Were Discharged
On Day 5 To Day 7.

Conclusion:
Early Prompt Diagnosis Of Rupture Of Ectopic And Immediate Emergency Laparotomy With Adequate Blood Transfusion
Facilities And Availability Of Good Anaesthetic Care Has Contributed To Reduced Maternal Morbidity In This Series.

***************

Comparative Study Between Intracervical Foleys Catheter Insertion And Stripping Of Membranes For Cervical
Ripening In Previous Caesarean Section
Author: Dr. Digvijay Kadam
Co Author: Dr Digvijay Kadam1, Dr N S Kshirsagar2,

Authors
Dr Digvijay Kadam, Postgraduate Student, Kims Karad
Dr. N.S.Kshirsagar, Professor , Kims Karad
Abstract
Aims And Objectives :
To Compare The Efficacy Of Intra Cervical Foleys Catheter With Stripping Of Membranes In Cervical Ripening For The
Successful Induction Of Labor In Previous Caesarean Section Patients.
Material And Methods :
In This Study 80 Women At Term Were Admitted In Kims, Karad From 1St April 2013 To 31St May 2014 With A Bishop'S
Score <3 With Various Indications For Induction With Previous One Caeserian Section Were Randomly Allocated To
Receive (40Pts) Intra-Cervical Foleys Catheter And Stripping Of Membranes(40 Pts) For Induction Of Labour. After 12 Hrs
Post Induction, Bishop'S Score Was Evaluated And Labor Was Augmented If It Was Required. Statistical Analysis Was
Done.

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Just Pack And Go Back(Pelvic Pressure Packing For Intractable Obstetrical And Gynaecologic Haemorrhage
Author: Dr. Neha Kamath
Co Author: Dr Archana Bhosale1, Dr R V Mayekar2, Dr Y S Nandanwar3,

Authors: Dr Neha Kamath, Co Author 1 Dr Archana Bhosale,Co Author 2: Dr R V Mayekar,

Co Author 3 :Dr Y S Nandanwar.
Aims: 1.To Achieve Hemostasis With The Help Of Pressure Pack In Gynaecological And Obstetric Surgeries Where
Standard Methods Failed.
2.To Evaluate Efficacy Of Simple And Modified Technique Of Pack Preparation.
Materials And Methods: Haemorrhage Continues To Be A Serious Complication Of Both Obstetrical And Gynaecological
Surgeries.This Is An Observational Study Of 11 Cases Conducted Over A Period Of 2 Years 1St August To 31St August.
This Study Reports On Modification Of Standard Packing Techniques That Prevents Some Of The Limitations Of Traditional
Packing.Here The Pack Was Used In Different Cases Of Gynaecology And Obstetrics Both Where Intractable Haemorrhage
Was The Major Problem And Std Methods To Control Haemorrhage Had Failed.Here A Very Simple,Readily Available
Materials Like Condom Catheter And Normal Saline Were Used To Prepare A Pack And Kept Over Bleeding Surface.This
Specific Pack Will Adopt The Shape Of The Body By Which Required Pressure Is Achieved And Remains For Long Time.Pack
Was Removed After 24 Hours Of Insertion. Postoperative Control Of Bleeding,Patients Stability And Morbidity Were
Studied.
Results: The Pelvic Pressure Pack Successfully Controlled Bleeding In 100 % Cases.There Were No Complications Or
Deaths.
Conclusion:In The Contemporary Management Of Post Hysterectomy Or Adhesiolysis Induced Uncontrollable Pelvic
Bleeding And Venous Oozes, The Pelvic Pressure Pack Appears To Be A Valuable And Effective Option Affording Correction
Of Coagulopathy And Further Stabilization. We Believe All Obstritian And Gynaecologist Should Be Familiar With This
Simple, Safe And Cheap Potentially Life Saving Technique.
***************

Maternity Care Monitoring In A Tertiary Care Hospital

Author: Dr. C.V. Lakshmi Rao
Co Author:

Authors: Dr Venkata Lakshmi Rao, Associate Professor, Dr.A.Shilpa, Dr.Reshma Bhanu

Aim: To Evaluate Trends In Change In Management And Referrals To A Tertiary Care Centre.
Methodology: A Detailed Prospective Analysis Of All Patients Delivered During A Period From Jan 2013 To Dec 2013 At A
Tertiary Care Hospital In South India Was Performed.
Results: Total Deliveries Were More Than Total Admissions (135%).
Rate Of Caesarean Section Has Increased Six Fold (60%) Than Elective Sections (10%). Gynaec Surgeries Have Reduced To
Half Of The Emergency Caesarean Sections.
Conclusion: Tertiary Care Centre Should Be The Key Monitor Of All Hospitals Conducting Maternal And Child Health
Programme. Eg: Primary Care Centre And Secondary Care Centre And Doctors At Periphery Should Inculcate Obstetric
Skills And Commitment To Give Maternity Care At Their Areas, At This Point Telemedicine Can Be Put To Use Efficiently.
***************

Spontaneous Rupture Of Pyometra With Pneumoperitoneum

Author: Dr. Dilpreet Pandher
Co Author: Dr Anju Huria1,

Background - Pyometra Is A Rare Condition In Which Pus Collects Inside The Uterine Cavity. Spontaneous Perforation Of
Uterus Is A Rare Complication Of Pyometra, ItS Incidence Being 0.01- 0.5% In Gynae Patients. However It Is More
Common In Postmenopausal Females And The Incidence Is 13.6%.
Case - I Report A Rare Case Of A 70 Year Female Who Was Referred To Surgical Casuality With Diagnosis Of Peritonitis
For Five Days, Now In Shock, Renal Failure And Respiratory Distress. She Was Shifted To Icu On Full Ventilatory Support
And Ionotropes.
At Laparotomy, About 1.5 Litre Of Pus With Thick Flakes And Multiple Small Bowel Adhesions Were Found In Peritoneal
Cavity, Whole Of The Bowel Was Intact, A Rent Of 2Cm Was There At Uterine Fundus With Pus Oozing From It. The Uterus
Was Small Size And Bilateral Tubes And Ovaries Were Atrophied. She Was Obese And Tissues Very Friable And
Oedematous, Hysterectomy Seemed To Be Difficult In Such Obese And Moribund Patient.
Uterine Curettage Was Done Through Rent, No Curettings Obtained And Biopsy Was Taken From The Margins Of Rent.
In Lithotomy Position Cervix Was Inspected, Atrophied, Small Polyp ( 5 Mm) At Os Was Removed And Cervical Biopsy
Also Taken, Both Sent For Histopathological Examination.
Cervix Was Stenosed On Sounding. Serial Dilatation Upto HegarS No 6 Was Done. So Thorough Peritoneal Lavage
Using Normal Saline Was Done And Uterine Rent Was Repaired.
Patient Gradually Recovered, She Remained In Icu For Six Weeks. Histopathological Examination Revealed Benign Cells.
Before Discharge, Ultrasonography Was Normal.
Conclusion - Although Spontaneous Rupture Of Pyometra Is Rare, It Should Be Kept In Mind As A
Differential Diagnosis In Postmenopausal Women Presenting With Acute Abdomen, Because Correct
Diagnosis, Early Intervention Can Reduce Morbidity And Mortality.

***************

Prevalence Of Gdm In Urban And Rural Areas Of South Karnataka

Author: Dr. Ambarisha Bhandiwad
Co Author: Dr Abhishek Bhandiwad1,

Background & Objectives:

Prevalence Of Gestational Diabetes Mellitus (Gdm) Is Known To Vary Widely Depending On The Region Of The Country,
Dietary Habits, And Socio-Economic Status. This Study Was Undertaken To Determine The Prevalence Of Gdm In Women
Attending An Antenatal Care (Anc) Clinic At Mysore ( Urban) And Chc Santemaralli (Rural) Chamarajanagara District In
Southern Karnataka.
Methods:
This Study Enrolled Women Attending Antenatal Care (Anc) Clinic At J S S Hospital In Mysore City And At Chc Santemaralli
In Chamarajanagara District. After Informing, Women Who Consented To Participate Were Given A Dipsi Test. A Proforma
Containing General Information On Demographic Characteristics, Socio-Economic Status, Education Level, Parity, Family
History Of Diabetes And/Or Hypertension And Past History Of Gdm Was Filled Up. Dipsi Criteria For 75 G 2-H Ogct Was
Used For Diagnosing Gdm.
Results:
A Total Of 813 Women Participated In The Study And Gdm Was Diagnosed In 72 (8.85%) Women. Risk Factors Found To
Be Significantly Associated With Gdm Were Age, Educational Level, Socio-Economic Status.
Interpretation & Conclusions:
The Prevalence Of Gdm Was Found To Be 9.49 Per Cent In Urban And 7.45 Percent In Rural Southern Karnataka.
Appropriate Interventions Are Required For Control And Risk Factor Modifications.
Keywords: Blood Glucose, Gdm, Ogct, Prevalence

***************

A Case Of An Intrapartum Pulmonary Embolism With A Good Maternal And Fetal Outcome
Author: Dr. Rajani C
Co Author: Prof.Jikki Kalaiselvi1,

Background : Intrapartum Pulmonary Embolism Is A Relatively Rare Complication Of Pregnancy. Maternal Mortality Is
Increased As Pulmonary Embolism Is One Of The Leading Causes Of Maternal Deaths. To Prepare The Mother For The
Blood Losses Associated With Delivery, A State Of Hypercoagulability Develops During Pregnancy.
This Hypercoagulability, Combined With Other Pregnancy-Associated Physiologic Changes, May Lead To The
Development Of Pulmonary Embolism, Especially In The Presence Of Additional Risk Factors. Given The Higher Risk Of
Pulmonary Embolism And The Significant Mortality In Pregnancy, A Timely And Accurate Diagnosis Of Pulmonary
Embolism (Pe) Along With Early Institution Of Appropriate Therapy Are Crucial In The Management Of These Patients.
Case Scenario : This Case Was A Similar Condition Of One Of The Rare Forms Of Intrapartum Pulmonary Embolism Where
This Patient Who Had A Very Uneventful Antenatal Period Suddenly Went In To An Acute Pulmonary Embolism
Intrapartum And Suffered 3 Consecutive Episodes Of Hypoxia,Went In For Cardiac Arrest And Was Revived. Based On The
Clinical Findings Alone,An Early Diagnosis Was Made And She Was Managed Appropriately. The End Result Was That The
Patient Went Home Healthy With A Healthy Baby.
Conclusion : Pulmonary Embolism Is A Highly Fatal Disorder Which Is A Clinically Diagnosed Condition.Early And Timely
Intervention Is The Need Of The Hour.If Diagnosed Early And Managed Appropriately,The Life Of Both ,The Mother And
The Baby Can Be Saved.

***************

Psi India Technical Assistance For Improved And Accessible Safe Abortion Services And Implementation Of Medical
Termination Of Pregnancy (Mtp) Act
Author: Dr. Sharad Singh
Co Author:

BackgroundIn India Mtp Act Is An Enabling Act Which Aims To Improve The Maternal Health Scenario By Preventing Large Number
Of Unsafe Abortions And Consequent High Incidence Of Maternal Mortality & Morbidity. The Conditions In Which
Pregnancy Can Be Terminated Are: When If Continuation Of Pregnancy; Causes Injury To Mental/Physical Health Of
Woman, Rape, Contraceptive Failure Among Married Women And Birth Of Child With Congenital Anomaly. In Such Cases
Mtp Can Be Done At A, Hospital Established Or Maintained By Government Or A Place Approved For The Purpose By
District Level Committee (Dlc).

Case
Psi India Is Working In Up, Delhi And Rajasthan Under The Pehel Project On Family Planning/Welfare & Safe Abortion
Services By Providing Whole Range Of Technical Assistance For The Same Along With Ta To Mohfw And Counterparts In
The States. We Found That Around 50% Sites Of Qualified Obgyn In The Implemented Towns Of Whp Intervention Were
Not Registered Under The Mtp Act For Safe Abortion Services Resulting Into A Big Missed Opportunity To Both
Government And Private Providers And Off Course Clients Were Not Able To Access The Safe Abortion Services.
Psi Has Organised Consultations In Collaboration With State Governments, Goi And Fogsi In Up & Rajasthan To Bring The
Greater Attention Towards This. Fogsi Is Our Long Term Knowledge Partners And Training Their Rank And File To Ensure
Good Quality Safe Abortion Services. Both Meeting Were Chaired By Md-Nrhm.
Psi Further Extended Its Support To The Districts And Worked For Improved Access For Safe Abortion. Psi Has Been
Working With Local Health Officials And Advocating More And Better Service Provision. One Of The Highlights Of Support
Is Activating District Level Committees (Dlcs) In All Districts Of Up And Most Of The Districts Of Rajasthan. Dlcs Are Very
Crucial For Ensuring Quality Of Safe Abortion Services And They Are Mandated To Accredit Private Service Provider For
Safe Abortion Services. Further Support Is Also Provided On Medical Method Of Abortion And Advocated For Availability
Of Medical Abortion (Ma) Drugs Across The Delivery Points. Ma Drug Has Been Enlisted In The Essential Commodity For
Rmnch+A. Ma Drugs Are Now Available In Considerable Districts Of Up And Procurement Of The Same Has Been
Strengthened.

Conclusion/ Clinical Relevance

In Many Districts, The District Level Committee Have Been Activated With Psi/IS Efforts

After The Dlc Meetings With These Consistent And Focused Efforts, Psi Has Been Successful To Get Around Two
Hundred Facilities Registered At Up & Rajsthan.

Now Availability Of Ma Drugs At Government Health Facilities Has Been Started As Mentioned In 5X5 Matrix.

***************

Gynaecological Pathologies Presenting With Pure Urological Symptoms How To Approach.

Author: Dr. Amita Jain
Co Author: Dr Gagan Gautam1, Dr Rajesh Ahlawat2,

Background:
Female Voiding Disabilities Are Usually Considered Under Domain Of Urology. We Encountered Eight Cases With Severe
Refractory Voiding Dysfunctions, Where Further Evaluation Revealed Unexpected Gynaecological Pathologies As Etiology.

Cases:
The First One Complained Of Recurrent Retention Of Urine, Requiring Frequent Catheterisation With Normal Flow In
Interval Period. Second Case A Morbidly Obese Lady With Past Abdominoplasty And Third Case An Elderly Nulliparous
Lady; Both Had Overactive Bladder Symptoms, Which Were Not Relieved Even On Highest Doses Of Anticholinergics.
Fourth Case A Young Unmarried Lady Complained Of Intermittent Leakage Of Urine With Feeling Of Incomplete Voiding
And Underwent Bladder Neck Incision For This, But Not Relieved. Fifth Case A Postmenopausal Lady, Despite Of Several
Urethral Dilatations For Obstructive Uropathy In Past, Presented With Chronic Renal Failure. The Sixth Case Admitted In
Emergency With Progressively Increasing Lower Abdominal Pain And Difficulty In Passing Urine With Recent Haematuria
And Last Two Cases Presented With Severe Discomfort And Pain During Micturition.
On Detailed Investigations, We Found That The First Case Had Recurrent Retention Of Urine, Due To Intermittent
Compression Of Bladder Neck By A Large Subserosal Cervical Fibroid. Next Three Cases Had Huge Subserosal Anterior
Fibroids Pressing Over The Bladder From Above. Pelvic Examination Of Fifth Case Showed A Large Cystocoele Causing
Urethral Kinking. Radiological Imaging Of Sixth Case Detected A Large Ovarian Cystadenoma, Compressing Bladder And
Both Ureters And On Cystoscopy Bladder Cavity Was Found Completely Obliterated. The Last Two Cases With Past History
Of Lower Segment Caesarean Sections Were Found To Have Scar Endometriosis Invading Into The Bladder.
Removal Of Causative Pathology Resulted In Relief In Each Case.

Conclusion:
Gynaecological Causes Should Always Be Considered In Differential Diagnosis For Refractory Voiding Dysfunctions, Even
In Absence Of Gynaecological Symptoms.

***************

Recurrent Adnexal Torsion

Author: Dr. Nagashree Undinti
Co Author: Dr.Sumana Manohar1,

Background:
Adnexal Torsion Is A Gynaecologic Emergency Caused By Partial Or Complete Twisting Of The Mesoovarium; Accounting
For 3% Of All Gynaecological Surgeries. We Report A Rare Presentation Of Bilateral Adnexal Torsion Within A Period
Of 4 Months In Normal Appearing Ovaries.
Case: A 35 Year Old Parous Lady Underwent Total Laparoscopic Hysterectomy For Third Degree Uterine Prolapse
Presented With Left Adnexal Torsion Within 45 Days Post-Surgery And Later Right Adnexal Torsion Within A Span
Of 2 Months. She Underwent Laparoscopic Left Salpingo Oophorectomy And Laparoscopic Right Oophoropexy Later.
Conclusion: Predisposing Factors For Adnexal Torsion Is Not Known And Its Recurrence Is Definitely A Concern. The
Importance Of Early Diagnosis And Surgical Intervention In Adnexal Torsion Is Highlighted In A Report Showing Delay Of
Intervention For 36 Hours Resulting In Significant Congestion And Necrosis.

***************

A Rare Case Of Post Partum Presacral Hematoma

Author: Dr. Prashanthi Vemulapalli
Co Author: Dr Venkata Sujatha Vellanki1, Dr Prashanthi2, Dr Dharmaja3,

Background:
Incidence Of Puerperal Hematomas Is 1 In 309 To 1 In 1500 Deliveries, With Large Hematomas Complicating
Approximately 1 In 4000 Vaginal Deliveries.
Puerperal Hematomas, Classified As Vulvar (Anterior Triangle Or Posterior Triangle), Vulvovaginal, Vaginal Or Sub
Peritoneal Might Represent A Significant Hemorrhage And Should Be Considered Obstetric Emergencies. The Extent Of
Pelvic Vascular Injury During Vaginal Delivery Corresponds To The Degree Of Progression Of Parturition And The Volume
Of Blood Accumulated. Puerperal Hematomas Generally Involve Branches Of The Hypogastric Artery And Are Often
Disregarded As Benign Vulvovaginal Hematomas In Situ Until Hypovolemic Shock Occurs. Most Such Hematomas Present
With In 24 Hours Of Delivery. External Ureteral Obstruction Caused By A Concealed Retroperitoneal Hematoma Is Rare,
But Embolization Or Ligation Of The Involved Artery Are Effective Treatment.

Case Report:
A Case Of G2P1L1, Who Had Uneventful Vaginal Delivery, Complained Of Tenesmus And Severe Pain 1 Hour After The
Delivery. On Examination, A Boggy Mass Was Felt In The Posterior Vaginal Wall. Episiotomy Wound Was Explored. Clots
Were Removed From The Posterior Vaginal Wall. She Was Posted Foe Exploratory Laparotomy. A Localized 10X 10 Cm
Retroperitoneal Hematoma Extending Upto The Sternum Was Observed. Conservative Management With Crystalloids
And Blood Products Was Done.Step Wise Devascularization Was Done, But The Pre Sacral Hematoma Was Found To Be
Increasing In Size. Peripartum Hysterectomy Was Done To Control Bleeding.

Conclusion:
Presacral Hematomas Are Rare And Vigilant Monitoring Of The Patient In The Post Partum Period Is Necessary As
Uneventful Vaginal Delivery Can Also Go For Pre Sacral Hematoma
***************

A Case Of Concealed Abruptio Placentae With Iufd Causing Dic And Pph Leading To Maternal Death
Author: Dr. Shanti Snehlata
Co Author:

Background-Concealed Abruptio Placentae With Fetal Demise Is A Potentially Life Threatening Complication Of
Pregnancy With Significant Perinatal(25-50%) And Maternal(2-6%) Mortality.Abruptio Placentae Is Separation Of The
Placenta From Its Implantation Site Before The Birth Of Fetus. Fetal Demise In Abruptio Is An Index Of Severity Of The
Disease .

A 26 Years Old Primigravita Admitted With Ftp & Pain Abdomen On 11-01-2013 At 11.30Pm With History Of Exteme
Weakness,,Nausea & Vomiting Since Morning. Anc Done By Local Practitioner Showed Normal Usg And Hb Report. .On
Examination Patient Was Pale And Ill Looking. .Bp-100/90 Mm Of Hg, Pulse-98/Min, Regular,Pallor++( Out Of Proportion
To Hb% ),P/A-Uterus Term Size,Contraction+,Fhs Could Not Be Located.P/V-Cx 6- 8 Cm Dilated,Membrane+,Show Was
Bloody .She Delivered A Dead Female Foetus Of Term Size On 12-01-2013 At 01:45Am Immediately Followed By Expulsion
Of Placenta Along With Passage Of Dark Coloured Big,Old Clots(Estimated Loss 2-3 Litres).Clots Were Followed By Fresh
Bleeding P/V.Soon She Had Coffee Coloured Vomiting .Bp-70Mm Of Hg(Systolic),Pulse-110/Min,Feeble
Volume,Sweating++On The Forehead With Cold Extremeties. Patient Was In Haemorrhagic Shock.
With Wide Bore Cannula Crystalloid Iv Fluid Started.Oxytocics Given. Tranexamic Acid Given. Bimanual Uterine
Compression & Indwelling Catheterisation Done. Paramedical Persons ,Senior Consultants Called For Help.
Dexamithasone ,Hydrocortisone Given. Blood Transfusion Started.Uterine Packing Done .Every Possible Effort Made To
Control Pph And To Combat Shock But She Could Not Be Saved.
Discussion--Concealed Abruptio Placentae Is Difficult To Diagnose. Due To Intense Reactionary Vasoconstriction Mostly
Haemoglobin,Haematocrit & Bp Are Falsely Raised Causing Delayed Diagnosis.In Spite Of Advances In Usg & Mri The
Diagnosis Of Abruptio Is Essentially Clinical.So Every Practising Obstetrician Should Have Its Knowledge.
History Of Abruption,Increased Bp Should Alert The Treating Obstetrician To Take Preventive Measures..
Early Diagnosis,Availability Of Fresh Blood,Platelet Concentrate,Clotting Factor,Good Team For Emergency Obstetric
Management Are Essential For Better Foetal And Maternal Outcome.

***************

Case Report- Ovarian Ectopic Pregnancy

Author: Dr. Jyoti Puhan
Co Author: Dr Sujata Singh1,

Background-The Incidence Of Ectopic Pregnancy Is Increasing Day By Day.Although Most Ectopics Are Of Tubal Variety,
0.5-1% Of Them Also Occur In Ovary.Now A Days Due To Increased Use Of Iucd ,The Incidence Of Ovarian Ectopics Are
Increasing.

Case-A 27 Year G4P2A1 H/F Presented To Scbmch Lr On 10/9/14 With Ga Of 7 Weeks 2 Days With Complain Of Pain
Abdomen & Realing Of Head For 1 Day With H/O Of Previous Right Partial Salpingectomy Done For Ampullary Pregnancy
With Usg Revealing Ruptured Right Ectopic Pregnancy.Upt & Paracentesis Became Positive.On Laparotomy There Was 11.5 L Of Fress Blood Suctioned Out & There Was Ruptured Right Ovarian Pregnancy For Which Right SalpingeOophorectomy Was Done.Prophylactically Left Salpingectony Was Also Done.Rest Of Abdomen Closed In Layers After
Maintaining Proper Haemostasis.Post-Op Events Were Uneventful.Hp Study Shows Ovarian Ectopic Pregnancy.

Conclusion-The Treatment Of Choice For Ovarian Ectopic Pregnancy Is Oophorectomy. But If Same Side Tube Is Also
Involved Then Partial Or Total Salpinge-Oophorectomy Can Be Done.

***************

Cord Entanglement In Monochorionic Monoamniotic Twins: A Case Report

Author: Dr. Kiran Naik
Co Author:

Cord Entanglement In Monochorionic Monoamniotic Twins: A Case Report

1Kiran Naik, 2B.K.Devi
1Post Graduate Trainee, 2Professor, Dept Of Obstetrics And Gynaecology, Regional Institute Of Medical Sciences, Imphal,
Manipur, India
Abstract:
Monochorionic Monoamniotic Twin Gestations Have Been Associated With Perinatal Mortality Rates As High As 28 %
To 47 %. Umbilical Cord Entanglements And Knots, Twin-To-Twin Transfusion Syndrome, Congenital Anomalies,
Prematurity And Intertwin Locking During Labor Are Responsible For Their High Perinatal Morbidity And Mortality.
We Report Here One Case Of Cord Entanglements In Which Twin Dead Babies Were Delivered Vaginally But With
Multiple True Knots In Between Two Cords.
There Is Still No Consensus In Literature For The Management And The Mode Of Delivery Of These Rarely Encountered
Cases.

Key Words: Monochorionic Monoamniotic Twin Gestation, Umbilical Cord Entanglement.

***************

Laparoscopic Evaluation Of Infertility

Author: Dr. Gurpinder Kaur
Co Author: Dr. Parmjit Kaur1, Dr. Ruby Bhatia2, Dr. Aman Dev3, Dr. K.D. Singh4, Dr. S.K. Bhatia5

Dept. Of Obstetrics & Gynaecology, Govt. Medical College, Patiala

Diagnostic Laparoscopy Remains An Excellent Tool In Evaluation And Workup Of Infertility Patients, After Baseline NonInvasive Investigations. The Diagnosis And Often Treatment And Operative Procedure Can Be Accomplished In One Sitting
Only.
Aims And Objectives
(1) To Evaluate Causes Of Infertility And Their Frequency In Primary And Secondary Infertility. (2) To Visualize Tubal
Morphology And Patency By Chromopertubation. (3) To Visualize The Pelvic Organs And Identify Pathology, If Any. (4) To
Do Operative Procedures As Indicated.
Material And Methods : The Present Study Was Carried Out On 100 Patients Of Infertility (Primary As Well As Secondary)
In Department Of Obstetrics And Gynaecology At Rajindra Hospital, Patiala. A Detailed Work Up Of Infertility Was
Performed. Laparoscopic Evaluation Was Done Under Ga After Informed Consent.

Results :The Prevalence Of Primary Infertility Was 64% And Secondary Infertility Was 36%. The Mean Age Of Patients
With Primary Infertility Was 27.874.57 And That Of Patients With Secondary Infertility Was 30.225.32. On Diagnostic
Laparoscopy 83% Patients Had Abnormal Finding. Majority Of Patients Had Endometriosis (21%), Pelvic Inflammatory
Disease (19%), Tubal Blockage (10%), Pcod (8%), Adhesions (6%), Hydrosalpinx (5%), (4%) Each Of Pelvic Tb, Fibroids And
Mullerian Anomalies. On Chromopertubation, Out Of 100 Patients, 59% Patients Had Bilateral Spill While Bilateral Spill
Was Absent In 17% Cases. Unilateral Spill Was Seen In 14 Patients, While Bilateral Delayed Spill Was Seen In 10% Cases.
Extravasation Of Dye Was Seen In 8 (8%) Patients.

Conclusion : The Laparoscopy With Chromo-Pertubation Remain The Gold Standard Procedures For Evaluation Of
Patients Of Infertility And Before Planning Further Management Or Opting For Artificial Reproductive Techniques.
***************

Correlation Of Maternal And Fetal Vitamin D Deficiency With Fetal Growth Restriction In Early Onset Severe
Preeclampsia
Author: Dr. Sujitha G
Co Author:

Dr.Sujitha.G1,Prof.G.S.Kamilya2, Dr.A.Rakshit3
Post Graduate Trainee1, Professor2, Assistant Professor3, Department Of Obstetrics & Gynaecology, Ipgme&R, Kolkata20.

Aims And Objective:

The Purpose Of This Study Was To Study The Relation Between Maternal And Fetal Vitamin D Levels And To Examine The
Association Between Vitamin D Levels And Fetal Growth Restriction In Patients With Early Onset Severe Preeclampsia.
Materials And Methods:
Patients With Early Onset Severe Preeclampsia Were Recruited And Demographics, Outcomes, And Plasma And Cord
Blood Were Collected. 25-Hydroxy-Vitamin D (25-Oh-D) Was Assessed By Elisa And Reported In Ng/Ml. Results Were
Analyzed By Regression Analysis, Mann Whitney U Test, Spearman Correlation And Reported As Median (Q1Q3).
Results
In Patients With Eospe (N=56), 25-Oh-D Was Lower In Patients With Fgr (13 Ng/
Ml) Verses Normal Fetal Growth (24.60 Ng/Ml) (P=0.02). 25-Oh-D Was Significantly Correlated With Percentile Growth
At Delivery ( P=<0.0001).Regression Equation Of Fetal Vit D=44.1262+1.0535X Vit D Of Mother Obtained.
Conclusions:
Fetal Vitamin D Levels Are Determined By Maternal Levels. Vitamin D Is Lower Among Patients With Fetal Growth
Restriction In Early Onset Severe Preeclampsia Than Those Without Growth Retardation.

***************

Factors In Post Operative Wound Infection

Author: Dr. Vrinda Loyalka
Co Author: Dr.Padma Shukla1,

Factors In Post Operative Wound Infection

Dr.Vrinda Loyalka , Dr.Padma Shukla
Aim: To Determine The Prevalence Of Wound Infection In Post Operative Patients In Department Of Obstetrics
/Gynaecology ,Gmh ,Rewa.
Method: Retrospective Study Of Available Data.
Results : Wound Infection Was Significantly Higher In Patients With Poor Personal Hygiene Or Patients Taken As
Emergency Surgery. Patients With Hb<= 8G% Had Increased Incidence Of Wound Infection. Decreased Duration Of
Hospital Stay Was Associated With Decreased Rate Of Wound Infection.
Conclusion: PatientS Pre Operative Condition If Improved Along With Good Personal Hygiene Can Lead To Decreased
Hospital Stay Along With Decreased Post Operative Wound Infection.

***************

A Case Of Uterine Prolapse In Late Pregnancy

Author: Dr. Askar Nisha
Co Author: Dr. Vidya A. Thobbi1, Dr. Ambika S. Patil2,

Https://Www.Polarisoffice.Com/A/Dkzm0Cj
***************

A Rare Mullerian Anomaly With Severe Dysmenorrhea

Author: Dr. Anju Rani
Co Author: Dr Deepa Kapoor1, Dr Anand Prakash2,

Introduction
Unicornuate Uterus With A Noncommunicating Functional Rudimentary Horn Is A Rare Type Of MLlerian Anomaly That
Results In Obstruction To Menstrual Blood Flow, Leading To Endometriosis And Dysmenorrheal. It May Be Asymptomatic
Or Can Give Rise To Many Gynaecological And Obstetrical Complications Throughout A WomenS Reproductive Life..
Though The Majority Of Cases Of Dysmenorrhea In Adolescents Require Only Reassurance And Symptomatic
Management, It Is Important To Be Aware Of Rare Causes Such As MLlerian Anomalies So That These Cases Can Be
Managed Properly.

Case

A 25 Years Old Nulligravida Women Presented With A History Of Dysmenorrhea Since Menarche. The Severity Increased
With The Time And Had Minimal Response With Routine Medications. Clinical Examination Was Normal.
Hysterosalpingography Showed Right Unicornuate Uterus With Normal Fallopian Tube Spill. Magnetic Resonance
Imaging Suggestive Of Noncommunicating Rudimentary Horn With Haematometra. Diagnostic Laparoscopy Showed
Right Hemiuterus With Normal Fallopian Tube & Ovary. There Was A Separate Round Structure Of 4 Centimeter Diameter
(Left Rudimentary Horn) In Close Proximity To The Left Pelvic Wall With Hypoplastic Left Fallopian Tube And Apparently
Normal Ovary. There Was No Anatomical Connection Between The Two Mullerian Ducts, Rather They Were Wide Apart
Without Any Signs Of Endometriosis. After Proper Counseling, Left Rudimentary Horn Was Resected Leaving Behind Left
Fallopian Tube And Ovary .Resected Specimen Showed All Three Layers Of Uterine Wall With Haematometra .
Histopathology Confirmed Functional Uterine Horn.
Conclusion
Uterine Anomaly Should Be Suspected In Patients Of Reproductive Age Group Who Presents With Dysmenorrhea Since
Menarche , Adenexal Mass And Infertility. A Correct Diagnosis Of This Malformation May Be Difficult When The
Rudimentary Uterine Horn Is Displaced Laterally. Early Diagnosis Is Essential To Prevent Complications. Surgical Removal
Of The Rudimentary Horn Is The Main Stay Of Management With The Basic Objective Of Pain Relief And Maintenance Of
Reproductive Capacity.

***************

Audit Of Caeserian Section For Non Progress Of Labour

Author: Dr. Tripti Singh
Co Author: Dr.Rekha Sapkal(Prof.)1,

Introduction: All Obstetricians Dread Emergency Lscs For Its Potential Maternal And Fetal

Complications . The Predominant Problems Are Because Of Non Progress Of Labor. Predicting The Reasons

For Complications Will Help For Preventive Measures In Future .With This Aim Study Was Conducted At

Pcms And Rc Bhopal During Period Of One Year From June 2013 June 2014 .

Objective:

To Predict The Reasons For Non Progress Of Labour Who Land Up Into Lscs .

To Study The Status Of Newborn Born After That.

Methodology : Retrospective Analysis Of 42 Emergency Cases In Labor Who Landed Up Into Caeserean

Section For Nonprogress Of Labor Was Done .Demographic Variables Like Age ,Gravida And Parity Was

Studied . The Indication For Lscs .Duration Of Labor ,Type Of Abnormal Labor Was Assessed In All Cases

.Coexistent Conditions Were Judged. Neonatal Condition At Birth Was Analyzed. Status Of New Born At

Birth With Apgar Score And Need For Nicu Admission Was Calculated. Distribution Parameters Are

Expressed In Terms Of Their Mean Value And Standard Deviation .

Results :Majority 35(83%) Patients Were Nullipara ,Primipara 10% , In 7% Cases Parity Was More Than

Two. 31% Delivered After Midnight . Mean Age Was 25 Years(Sd 2.26)Mode & Median Value 26 Years .

Maximum Cases (21%) Were Of Gestational Age 38 Weeks (Sd 2.29). Maximum Patients Had Moderate

Anemia 10 (24%) Prom, Oligohydramnios And Iugr 9(21%) , Gdm, Post Datism =5 (12%).Others Like

Post Maturity ,Pih ,Hypothyroidism Uti,Rh Iso-Immunization Were 8%. Female New Born Were 55%

.Average Baby Weight Was 2689Gramms (Sd-Gms 446.60). Median Range Of Birth Weight Was 2800 Grams

Conclusion Moderate Anaemia, Oligohydramnios, Prom, Iugr Was Commonly Associated

(24-21%) Conditions Observed Along With Non Progress Of Labour .Prolong Labor Was Observed In

Primi Gravida And With Increasing Gestational Age After 38 Weeks .

***************

Intestinal Obstruction Complicating Pregnancy

Author: Dr. Priyanka Upmanyu
Co Author: Dr. Anjali Kanhere1,

Introduction: Intestinal Obstruction And Related Complications Are Rare But Severe Conditions Which Increase The
Morbidity And Mortality Rates Of Mother And Fetus. As Some Early Non-Specific Signs And Symptoms Of Intestinal
Obstruction Are Commonly Present In Pregnancy A High Degree Of Suspicion Is Needed For Their Early Diagnosis And
Management.
Case Reports: A 30 Year Third Gravida At 27 Weeks Presented With Pain In Abdomen And Constipation Since 4 Days.
There Was Mild Tenderness In Right Hypochondrium, Uterus 28 Weeks With Fetal Heart Regular. Sonography Showed
Anencephaly With Bilateral Multicystic Dysplastic Fetal Kidney With Fetal Ascites. Loops Of Intestines Were Seem
Adherent To Old Rent Of Uterus. Surgeons Were Consulted And Conservative Management Was Advised. She Was
Induced. Her Condition Deteriorated After 12 Hrs. With Sever Tenderness Over Abdomen And Guarding With Rigidity And
Absent Bowel Sounds. Laparotomy Was Performed, Multiple Jejunal Perforations Were Present Resection Anastomosis
Was Done. Post Operatively Peritonitis Leading Into Septic Shock Resulted In Her Death.
A 35 Year Old Fourth Gravida At 26 Weeks With Severe Pain Abdomen And Vomiting Since 3 Days Was Admitted In
Emergency With Soft Distention Of Abdomen, Tenderness In Flanks, Sluggish Bowel Sounds Relaxed Uterus And Regular
Fetal Heart Rate. Laparotomy Was Done For Perforation Peritonitis Followed By Resection Anastomosis. Premature
Labour After 24 Hrs Lead To The Delivery Of Still Birth Baby. Patient Died On Post-Operative Day 7.
Conclusion: Displacement Of Abdominal Contents By The Gravid Uterus May Predispose Pregnant Patients To Intestinal
Obstruction In Presence Of An Underlying Bowel Abnormality. Prompt Diagnosis And Appropriate Management Are
Needed To Avoid Fatal Or A Severely Morbid Outcome.
***************

A Rare Case Of Placenta Percreta With Rupture Uterus And Haemorrhagic Shock
Author: Dr. Shaik Beejan
Co Author: Dr.G.C.Prabhakar1, Dr.Usha Rani2,

Introduction-Placenta Percreta Is A Rare Life Threatening Obstetric Condition Characterised By Abnormal Invasion Of
Placental Trophoblasts Into The Myometrium ,Uterine Serosa And Even To The Bladder.It Can Lead To Major Obstetric
Haemorrhage Due To Incomplete Placental Seperation And May Neccessiate For Peri Partum Hysterectomy.Here We
Present A Interesting Case Of Placenta Percreta With Uterine Rupture Leading To Irreversible Haemorrhagic Shock And
Maternal Death.
Case Report-A 20 Years Old Gravida2 Para1Live1 With 29Weeks Of Gestational Age With One Previous Caessaren Was
Reffered To Our Hospital In View Of Severe Anemia And Ascitis With Complaints Of Pain Abdomen,Abdominal Distention
For Three Days.On Ultrasonography Findings Were Haemoperitoneum With Central Placente Previa With Intra Uterine
Single Live Foetus,For Which Simultaneously Resuscitation Emergency Laparotomy Was Done. Intra Operatively There
Was Massive Haemoperitoneum With Rupture Of Lower Uterine Segment,Anterior Uterine Wall Was Thinned
Out,Placenta Percreta Invading The Bladder Was Identified.A Live Female Baby Was Delivered And Emergency
Hysterectomy Was Done. Patient Expired Three Hours After Surgery Due To Cardia Arrest Secondary To Haemorrhagic
Shock,Misdiagnosis And Delayed Referral Aggravated The Condition.Unfortunately We Could Not Save The Patient Inspite
Of Emergency Resuscitation And Intervention.
Conclusion-Placenta Percreta Though A Rare Cause Of Meternal Mortality Is On Its Rise Due To Increased Incidence Of
Caesarren Rates Over Past Few Decades.High Index Of Suspicion Is Especially Neccessary In Cases Of Placenta Previa With
Previous Caessarren.Early Diagnosis And Prompt Refferal Of Such Cases To Teritary Centers Where Rearly Effective
Intervention Can Save Life
***************

Hypersensitivity To Misoprostol-Our Experience

Author: Dr. Gayathri Kamath
Co Author:

Misoprostol Is Used Extensively In The Management Of Postpartum Haemorrhage. Considering Its Cost, Shelf Life And
Easy Storage, In A Country Like Ours It Has A Potential To Be One Of The First Line Drugs In The Therapeutic
Armamentarium Of Postpartum Haemorrhage. It Is Essential For Us To Ensure That The Usage Of This Drug In The
Prophylaxis And Treatment Of Postpartum Haemorrhage Should Be Extremely Safe When Used In A Primary Health Care
Like Setting. Our Experience With Two Cases Of Misoprostol Hypersensitivity Is To Highlight The Need For Constant
Monitoring Of Vital Parameters In Women With Postpartum Haemorrhage For Whom Misoprostol Has Been
Administered.
Mrs A. A 25 Year Old Primigravida Had A Precipitate Labour. In View Of Her Atonic Uterus, Prophylactically, Misoprostol
600 Micrograms Was Administered Rectally . She Developed A Shock-Like Picture With Altered Sensorium, Cold Clammy
Skin And Feeble Peripheral Pulses. She Was Shifted To The Icu Where Investigations Revealed Metabolic Acidosis. Her
Acidosis Was Corrected And She Recovered Completely.
Mrs S A Dichorionic Diamniotic Twin Pregnant Primigravida Underwent An Elective Caesarean Section At The 40Th Week
.She Developed Atonic Postpartum Haemorrhage Which Did Not Respond To Carboprost. The Bleeding Stopped After The
Placement Of The B-Lynch Brace. To Keep The Uterus Contracted In The Post Operative Period, Misoprostol 600
Micrograms Was Inserted Rectally. Within A Span Of 50 Minutes, She Became Restless, Disoriented, And Developed A
Shock Like Picture With Peripheries Getting Cold And Clammy And Was Shifted To The Icu. Blood Investigations Revealed
Metabolic Acidosis Which Was Eventually Corrected.
Thus, Misoprostol Is A Powerful Uterine Stimulant But One Needs To Administer Caution While Using This Drug As There
Have Been Reports Of Some Women Being Hypersensitive To The Vasoconstrictive Effects Of The Drug In The Peripheral
Vasculature Causing Shock-Like Syndrome And Metabolic Acidosis.

***************

Effect Of Myoinisitol Supplementation In Reducing Hyperandrogenism In Polycystic Ovarian Syndrome

Author: Dr. Anjana Sinha
Co Author:

Objective- To Provide An Overview On Some Of The Studies Conducted To Evaluate The Effects Of Administration Of
Myoinositol On Hyperandrogenism In
Patients With Pcos

Polycystic Ovarian Syndrome Affects 5-10% Of Women In Reproductive Age And Features Of Hyperandrogenism Has
Been Seen In About 50-90% Of The Patients. Several Studies Have Reported That Insulin Resistance Is Common In Pcos
Women And Plays A Prominent Role In Causing Hyperandrogenism In These Patients.Insulin Sensitizing Compounds Have
Been Proposed As Putative Treatments To Solve Hyperinsulinemia Induced Hyperandrogenism.
Myoinositol Is An Insulin Sensitizing Compound.Previous Studies Have Demonstrated That Myoinositol Is Capable Of
Reducing Androgen Levels By Positively Affecting Hyperinsulinemia In Pcos Patients.

Conclusion- With The Present Review We Aim To Provide An Overview On How Myoinositol Supplementation Causes
Marked Reduction In Hyperinsulinemia Induced Hyperandrogenism In Pcos

***************

Intravaginal Misoprostol Versus Carboprost For Cervical Priming Prior To First Trimester Surgical Termination Of
Pregnancy Krithika K. A. Revathy C. K.
Author: Dr. Krithika K.A.
Co Author: Dr.C.K.Revathy1,

Objective To Compare The Efficacy And Tolerability Of Intravaginal Misoprostol With Intramuscular Carboprost For
Cervical Dilatation Prior To First Trimester Termination Of Pregnancy.
Material And Methods A Prospective Study Was Conducted In The Government Maternity Hospital, Puducherry Which
Included 100 Patients Visiting The Antenatal Opd With Gestational Age <12 Weeks Seeking For Termination Of Pregnancy
As Per Mtp Act From October 2006-October 2007
They Were Randomly Divided Into Two Groups By Block Randomization Method.
Group 1-Vaginal Misoprostol 400 Microgram Was Used 3 Hours Prior To Surgical Termination(N=54)
Group 2-Intramuscular Injection Of 250Microgram Of Carboprost(N=46) Was Used 2 Hours Prior To The Procedure.
Observation The Quantitative Variables Between Drug 1 And Drug 2 Were Compared Using Parametric T-Independent
Test. The Qualitative Variables Compared Using PearsonS Chi Square Test Or Fishers Exact Test And Anova Test
Whichever Appropriate Was Used.
Results Dilatation Was Easy In Majority Of Carboprost (82.6%) Than Misoprostol(61.1%) Group.
Acceptability Rates Were High For The Misoprostol Group(96.3%) Group.56.5% Of Carboprost Group Felt It Is
Unacceptable Because Of Increased Intensity Of Abdominal Pain, Diarrhea, Preoperative Vaginal Bleeding.
Conclusion Intravaginal Misoprostol Appears To Be An Effective And Acceptable Alternative To Intramuscular Carboprost
For Cervical Dilatation Prior To First Trimester Surgical Termination Of Pregnancy.
***************

Microsurgical Tubal Recanalisation-A New Hope.

Author: Sushma Singh
Co Author:

Objectives
To Study The Various Factors Affecting Pregnancy Rate After Microsurgical Tubal Recanalisation, To Evaluate The
Standard Guidelines For Sterilisation And The Reasons For The Failure Of The Procedures.
Methods
The Present Study Was Conducted On 30 Patients Who Came For Reversal Of Sterilisation During 2012-2013 At Pmch.
They Underwent Microsurgical Tubal Recanalisation. Principles Of Microsurgery Were Followed Throughout The
Procedure Meticulously.
Results
With Microsurgery.60% Of Pregnancy Rates Was Achieved. In These Patients, Pregnancy Outcome Was In Form Of
Intrauterine Pregnancy(96.66%), Ectopic Pregnancy (3.33%), Term Viable Pregnancy (96.55%) And Spontaneous Abortion
(3.45%).
Conclusion
The Important Factors For Determining The Success Of Operation Were Age Of Patient, Time Interval Between
Sterilization And Reversal, Site Of Ligation, Method Used For Previous Ligation And Remaining Length Of Tube After
Recanalisation.

***************

Study Of Thrombocytopenia In Pregnancy

Author: Dr. Vaishali Paliwal
Co Author: Dr Latika Sahu1, Dr Ashmita Rathore2,

Study Of Thrombocytopenia In Pregnancy

Paliwal V, Sahu L, Rathore A
Objective: To Study The Causes & Pregnancy Outcomes In Women With Thrombocytopenia Associated With Pregnancy.
Methods: In This Study, Pregnant Patients Admitted With Thrombocytopenia Were Enrolled Over A Period Of Nine
Months. They Were Divided Into 3 Groups According To The Cause: Gestational Thrombocytopenia, Hypertensive
Disorders & Others. Also The Cases Were Categorised According To The Severity Of Thrombocytopenia (Platelet Count)
Into Mild (1-1.5Lac), Moderate (50000-1Lac) & Severe (<50000) The Maternal & Neonatal Outcomes In All The Groups
Were Compared.
Results: Most Of The Cases Are Gestational Thrombocytopenia (80%), Hypertensive Disorders (15%) & Others (5%).
Majority Cases Are Of Moderate Thrombocytopenia. Average Number Of Platelet Transfusions Are 1 Unit Per Patient And
Is Related To The Severity Of Thrombocytopenia & The Mode Of Delivery. Maternal And Perinatal Outcome Is Good With
Gestational Thrombocytopenia However Thrombocytopenia With Hellp Or Medical Disorder Had Comparatively Poor
Outcomes.
Conclusion: Gestational Thrombocytopenia Is The Commonest Cause Of Thrombocytopenia In Pregnancy Followed By
Hypertensive Disorders. Maternal Complications Include Postpartum Haemorrhage Mostly. Intracerebral Bleed Was
Documented In One Case. Perinatal Complications Include Premature Delivery & Intracranial Haemorrhage.

***************

Late Postpartum Eclampsia With Aphasia

Author: Dr. Reshma Kamate
Co Author: Dr. R.R.Godbole1,

Background:
Incidence Of Eclampsia Is 1 In 2000 To 3250 Deliveries In Developed Countries And 0.9 To 1.8% In India. Eclamptic Seizures
Can Occur Antepartum, Intrapartum Or Postpartum. Postpartum Eclampsia Can Be Subdivided Into Early Postpartum
Eclampsia Occurring Within 48 Hours And Late Postpartum Eclampsia Occurring After 48 Hours Of Delivery. Late
Postpartum Eclampsia Can Present With A Variety Of Clinical Features. Here We Present A Case Of Late Postpartum
Eclampsia Along With Aphasia Presenting On The 7Th Postnatal Day.
Case Report:
A Patient By Name Xyz Was Admitted With Generalized Tonic Clonic Seizures And Inability To Speak On 7Th Day Of Full
Term Vaginal Delivery. In The Antenatal Period She Was Diagnosed As A Case Of Preeclampsia In The Last Month Of
Pregnancy And Was Started On Antihypertensive Treatment. On 7Th Postnatal Day She Had Headache Followed By
Seizures And Aphasia. At Admission Her Bp Was 16090 And Urine Albumin 2+. She Was Stabilized And Started On Inj
Magnesium Sulphate According To The Pritchard Regimen And Inj Mannitol And Tab Atenolol 50 Mg O.D. Her C.T Scan
Of The Brain Showed A Sub-Acute Infarct With Hemorrhagic Transformation In The Left Frontal Region. She Convulsed
Again On Day 13 And Subsequent Mri Showed Superior Sagittal Sinus Thrombosis. She Was Started On Anticoagulants.
Clinical Relevance:
Late Postpartum Eclampsia May Occur After A Prodorme With Symptoms Like Headache, Nausea, Vomiting, Generalized
Or Focal Neurological Deficits And Visual Disturbances Or It May Just Begin Abruptly. Preeclamptic Patients Being
Discharged After Delivery Must Be Advised To Watch Out For Symptoms Of Late Postpartum Eclampsia Prodorme In The
Postpartum Period. If Any Such Symptoms Arise Within One Month Of Delivery It Should Be Promptly Evaluated And
Treated With The Aim Of Preventing Late Postpartum Eclampsia.

***************

"Scrub" In Pregnancy - A Case Series

Author: Dr. Shweta Suryaraj
Co Author: Prof. M.G. Dhanalakshmi1,

Dr. Shwetasuryaraj; Pg Ms.Obg; Prof. M.G.Dhanalakshmi,

Sri Ramachandra Medical College
Abstract
Scrub Typhus Is A Mite-Borne Infectious Disease Caused By Orientia Tsutsugamushi. It Is Distributed Throughout The Asia
Pacific Rim. The Disease Is Endemic In India. Scrub Typhus Is Manifested Clinically By High Fever, Intense Generalized
Headache, Diffuse Myalgias, And, In Many Patients, Rash And An Eschar At The Site Of The Chigger (Larval) Bite. The
Clinical Manifestations Of The Disease Vary In Severity From Mild And Self-Limited To Fatal, And The Case-Fatality Rate
Can Be As High As 30% If Untreated.Although Scrub Typhus Is Rare During Pregnancy And The Impact Of Scrub Typhus
On Pregnancy Is Unclear, Some Data Report That Scrub Typhus May Be Associated With Increased Fetal Loss. Diagnosis
Can Be Made From Clinical History And Serological Tests. Treatment Of Choice Has Been Azithromycin In Pregnancy As
Doxycycline Is Contraindicated. We Have Studied 7 Cases Of Scrub Typhus In Pregnancy From October 2013 To October
2014 At Our Institution. The Clinical Features, Diagnostic Techniques, Treatment Given And Outcome Of The Cases Will
Be Depicted.

***************

To Study The Accuracy Of Endometrial Assessment By Transvaginalultrasound Along With Saline Infusion So No
Graphy In Case Of Abnormal Uterine Bleeding
Author: Dr. Meenal Jain
Co Author: Dr Saroj Singh1, Dr Sadhna2, Dr Shikha Singh3,

.With Saline Infusion Sonography In Case Of Abnormal Uterine Bleeding

Authors: Dr Meenal Jain, Dr. Saroj Singh, Dr. Shikha Singh, Dr. Sadhana

Department Of Obst. & Gynaecology, S.N. Medical College, Agra

Aims And Objectives:

To Study And Compare The Sensitivity And Specificity Of Endometrial Assessment By Tvs Alone And With Addition Of
Saline Infusion Sonography In Cases Of Abnormal Uterine Bleeding (Aub).

Material And Methods:

60 Patients In Age Group 20-50 Years Presenting With Abnormal Uterine Bleeding Were Selected For The Study From
Gynae Opd, S.N.M.C. Agra.

Patients Excluded Were - With Clinically Demonstrable Organic Cause, Pregnant Females, Postmenopausal, Patients With
Stenosed Cervix, Patient With Any Evidence Of Active Infection Of Genital Tract.

All Patient In Study Group Were Subjected To Tvs And Sis In The Same Sitting. Histopathology Sample Either As
Endometrial Biopsy Or From Hysterectomy Sample (If Done) Were Taken Within 14 Days Of The Procedure.

Results:

Amongst The Study Group 32.14% Cases Presented With Menorrhagia And Majority Of Patients Had Uterine Volume
Between 151-200 Cc, Tvs Found Endometrial Polyp In 10% Cases, Endometrial Hyperplasia In 23.33% Cases And
Submucous Myoma In 15% Cases. On Tvs 61.67% Cases Endometrial Thickness Was 6-7 Mm Thick, 11-15 Mm In 18.33%
Cases And 16Mm Found In 8.33%. Sis Found Endometrial Polyp In 16.67%, Endometrial Hyperplasia In 11.67% And
Submucous Myoma In 21.67%. Histopathology Showed Endometrial Polyp In 71.67%, Endometrial Hyperplasia In 15%
And Submucous Myoma In 78.33%. Thus Results Of Sis Were More In Agreement With Histopathology Than Tvs.

Conclusion:

Sis Has Higher Sensitivity And Specificity When Compared With Tvs. Nevertheless, Tvs Is A Simple, Minimally Invasive Low
Cost Technique And It Should Be The First Diagnostic Method Of Choice In Evaluation Of Aub, Sis Should Be Second Line
Diagnostic Procedure In Evaluation Of Aub If Tvs Findings Are Inconclusive.

***************

Clinic Pathological Study On Hysterectomy Specimens

Author: Dr. Sireesha T V
Co Author: Dr.Radhika .Y1,

Abstract:

Objective: To Study The Most Common Pathologies Identified In Hysterectomy Specimens And To Correlate With Pre
Operative Diagnosis

Material And Methods: A Retrospective Study Of Total Of 110 Hysterectomy Specimens Was Carried Between August
2013 And August 2014 In The Department Of Obstetrics And Gynaecology, Yashoda Hospital, Somajiguda, Hyderabad.
Histopathological Diagnosis Of The Hysterectomy Specimens Were Compared With Their Clinical Indications.

Results: Commonest Indication For Hysterectomy Was Leiomyomata In 40% Cases Followed By Adenomyosis 22.7%
Cases, Simple Hyperplasia With Focal Complex Hyperplasia With Atypia 9.09%,Complex Hyperplasia With Atypia
9.09%,Simple Hyperplasia Without Atypia 6.36%,Adenocarcinoma 4.5%,Benign Endometrial Polyp 2.7%,Cystic Atrophy
1.8% ,Unremarkable Hpe13.6%.

Conclusion: The Commonest Indication And Histological Finding In Our Setting Was Leiomyoma. Histopathological
Findings In Present Study Corroborates Well With The Preoperative Clinical Diagnoses And Or Indications Of The
Hysterectomy Procedure.

***************

Urogynaecological Symptoms And The Co-Relation With Urodynamic Findings.

Author: Dr. Jaishree Gajaraj
Co Author: Dr A Tamilselvi1,

Aim And Background: The bladder Is Said To Be An Unreliable Witness As Far As History Is Concerned. The
Subjective Symptoms And Objective Findings Have Known To Vary In The Urogynaecological Population. The Aim Of Our
Study Was To Analyse The Symptom Profile Of Patients Referred For Urodynamics And To Co-Relate Their Presenting
Symptoms With The Urodynamic Findings.

Method: Retrospective Analysis Of Patients Records Who Underwent Urodynamic Evaluation Over A 12 Month Period.
The Setting Was A Diagnostic Centre With Urodynamic Services Over Last Six Years. Indications For The Urodynamic
Testing, Patient Symptom Profile And The Filling And Voiding Cystometry Findings Were Obtained From The
Computerised Datasheet.

Results: The Predominant Referral Indication Was For Mixed Incontinence, Prior To Surgery For Sui And Pelvic Organ
Prolapse. In 33% Of Patients With Sui The Cystometry Was Normal, Detruor Over Activity Was Not Demonstrable In 21%
Of Patients With Overactive Bladder Symptoms And In 90% Of Patients With Voiding Symptoms, The Cystometry Finding
Was Detrusor Over Activity.

Conclusion: There Appears To Be A Definitive Role For Urodynamic Evaluation In Patients Not Responding To
Conventional Conservative Management Options. In Cases Of Patients With Voiding Symptoms, Urodynamic Study
Should Form Part Of The Initial Assessment

***************

Comparison Of Fetal Weight Estimation By Various Methods Like JohnsonS , InslerS And HadlockS
Formula.
Author: Dr. Babita Ramani
Co Author: Prof. S K Behera1, Dr. Benudhar Pande2, Dr. Prasun Bera3,

Aims And Objectives- To Know The Accuracy Of Clinical Method And Hadlocks Formula. Method And Materials- All
Singleton Pregnant Women Of Gestational Age 37-42 Weeks Without Any Complication, Having Usg Report Of Atleast
Within 3 Daysprior To Delivery Were Included In The Study. Abdominal Girth And Symphysiofundal Height Were
Measured By A Measuring Tape, Then Estimation Of Birth Weight Was Done By JohnsonS And InslerS (Agxsfh)
Formula And Compared With Hadlock'S Formula And Original Birth Weight. Results- Most Of The Babies Were In Between
2.5-4Kg Weight. Hadlocks Formula Was Consistent With Overestimation Of Birth Weight In Lower Birth Weight Groups.
The Accuracy Of Clinical Methods Was Comparable With HadlockS Formula. Conclusion- Clinical Methods Are Equally
Reliable, Cheap And Easier To Teach And Can Go A Long Way In Aiding Decision-Making Process In Resource Poor
Developing Nations Without Compromising On The Results In Terms Of Fetal And Maternal Well Being.
***************

A Case Of Interloking Twins During Labour In Diamniotic Gestation

Author: Dr. Shreelatha Bhat
Co Author: Shankar J1, Chandrashekhar T2, Shaila C3,

Back Ground - Interlocking Of Twins Is A Rare Complication Where The Chin Of The First Twin In Breech Presentation
Locks Behind The Chin Of The Second Twin Which Is In Cephalic Presentation In Birth Canal Preventing Vaginal Delivery.It
Is Mostly Seen In Monoamniotic Twins With Incidence Of 1 In 1000 Twin Pregnancies.If This Condition Is Diagnosed Early
Both Fetuses Can Be Delivered By Cesarean Section.Fetal Mortality Rate Is As High As 50%.
Case Report - A Twenty Year Old Primigravida With 32 Weeks Of Diamniotic Twin Gestation With First Twin In Breech
Presentation Referred To Vims Hospital Due To Arrest Of Labour In Second Stage.On Examination First Twin With Breech
Presentation Was Delivered Upto Head And Head Of The Second Twin Was Felt Through Vaginal Examination After
Giving Episiotomy. Attempt To Disimpact Fetuses Through Vaginal Manipulation Was Unsuccessful.During Cesarean The
First Twin With Breech Presentation Was Delivered First By Breech And Then The Second Twin Was Extracted.
Conclusion - Even Though Interlocking Of Twins Is Rare, It Can Still Happen In Case Of Preterm Labour Or In Diamniotic
Twin Gestation With Rupture Of Membranes Of Both Sacs During Labour.

***************

Laparoscopic Conservative Surgery In Adnexal Torsion

Author: Dr. Mini C H
Co Author:

BackgroundAdnexal Torsion Is A Gynaecological Emergency Warranting Surgical Treatment. Earlier Only Clinical
Diagnosis Was Possible And Surgery Necessitated Laparotomy And Adnexectomy. With New Imaging Modalities Accurate
Diagnosis Is Possible Early, And Laparoscopic Approach Confirms The Diagnosis, Helps More In Conservative Treatment
With Minimal Morbidity.
Objectives
To Study The Outcome After Laparoscopic Detorsion And Conservative Management.
Methods - Case Series . Number Of Patients 3. Period - Oct 2013 To Sept 2014. Setting- Tertiary Care Centre. All Patients
Were Admitted To The Casualty With Severe Abdominal Pain And Vomiting With A Palpable Mass Per Abdomen.
Clinically Diagnosed As Twisted Ovarian Tumour, Confirmed With Usg And Doppler . Laparoscopic Detorsion Done In All
Cases
Results
All Patients( Age : 16-18 Yrs ) Presented With Pain In The Iliac Fossa. Vitals Were Stable. Laparoscopy Confirmed Torsion
In All Cases.
1. One Patient Was Operated > 5 Days After The Onset Of Symptoms. Showed An Ovarian Cyst Of 15X10 Cm, Undergone
2 Twists , Oedematous,Bluish Black. Fallopian Tube Was Stretched Over The Cyst. Detorsion Done And Vascularity
Appeared. Decided For Expectant Management.
2.Second Patient Was Operated 3 Days After The Onset. Left Ovary Had A Cyst Of 10X10Cm , Twisted Once , Yellowish.
Detorsion Was Done.
3.Third Case Operated 3 Days After The Onset. Left Ovary Had A Cyst Of 14X12 Cm ,Twisted On Its Pedicle. Tube Was
Stretched Over The Cyst , Bluish Black In Colour. Fallopian Tube Was Reperfused Within Mts. Cyst Was Identified And
Cystectomy Was Done.

All Patients Were Followed Up. The Ovary Which Was Gangrenous Showed A Normal Appearance After 6 Months.
Conclusion
1.Detorsion Of A Twisted Ovarian Tumour May Be Best Done By Laparoscopy.
2.Gross Appearance Of The Ovary Does Not Correlate With The Outcome.
3.Cystectomy Can Be Done When Feasible Since Fenestration Leads To Recurrence.

***************

Egg Donation Programme And Surrogacy In Unusual Infertility Scenarios Dr.Madhupriya, Dr.Thankam Varma And
Team Institute Of Reproductive Medicine,Mmm Hospital,Chennai
Author: Dr. Madhupriya Ananthakrishnan
Co Author:

Background
Infertility Is One Of The Most Emotionally Detrimental Aspects Of Women With Uterine Or Ovarian Dysgenesis.Use
Of Artificial Reproductive Techniques Like Egg Donation / Surrogacy Programme Gives Them A Chance Of Producing Their
Offsprings.Concerns About Transmission Of Same Congenital Problem To The Offspring Needs To Be Addressed.
Case
Our Reproductive Medicine Case Scenarios Brings Forth The Utility Of Egg Donation Protocol And Surrogate Protocol
In Helping Women With Uncommon Conditions Turner Syndrome , Mrkh Syndrome.
Case 1 Mrs.L, 25Yrs, Married For 1 Year, Known To Have Turner Syndrome Since 16 Yrs Of Age When She Was
Investigated For Primary Amenorrhea, Karyotype 45X0,Infantile Uterus And Streak Ovaries On Evaluation.Cardiology
Evaluation Showed Congenital Bicuspid Valve With Mild Aortic Stenosis.After Thorough Genetic And Fertility Counseling
Sessions And After Cardiology Clearance Icsi With Egg Donation Programme Was Done. Conceived 2013,Multidisciplinary Followup During Antenatal Period, Delivered In 2014.
Case 2- Mrs. As, 30 Yrs, Married For 2 Yrs, Known To Have Mrkh Syndrome Since 14 + Yrs Of Age When She Was Evaluated
For Primary Amenoorhoea, Karyotype 46Xx, Absent Uterus , Both Ovaries Present On Evaluation.After Thorough Genetic
And Pre Ivf Counseling Sessions She Had Ivf Programming Stimulation Done With Gnrh Antagonist Protocol
Egg Collection Done In 2 Cycles Embryos Cryopreserved. Surrogate Transfer Of The Embryos Done . Programmed In
2014.

Clinical Relevance
In The Presenting Case Scenarios , We Are Sharing Our Experience ( Stimulation Protocols, Ethical Issues Faced,Pre Ivf
Checks,Counselling Issues, Multidisciplinary Team Work) In Dealing With Egg Donation / Surrogacy Program In Turner /
Mrkh Females.

***************

Conception Following Vaginal Septal Resection

Author: Dr. Gunamanam D
Co Author:

Background

23 Year Old Mrs.X Married For Two Years Was Seen On 19-04-14.She Was Being Evaluated For Primary Infertility
Elsewhere For The Past Six Months. Previous H/O Failure To Perform Hysterosalpingogram Due To Difficulty In Locating
The Cervix.

Case

Clinical Examination Now Revealed A Thick Transverse Vaginal Septum 5 Cm From The Vaginal Introitus With A Dimple In
The Middle.After Counseling, Septal Resection Was Done.Patient Conceived Spontaneously Three Months After Surgery
With Ongoing Pregnancy Now.

Conclusion

Unbiased, Methodical And Complete Clinical Examination Is The First And Most Important Step In Patient
Approach.

Safe And Simple Surgery Like Resection Of Vaginal Septum Could Save Time, Avoid Unnecessary Investigations
And Added Stress On The Infertile Patient.

***************

Multiple Pregnancy In Ivf - Is It A Boon Or Burden?

Author: Dr. Thasneem Arif
Co Author: Dr.Thasneem Mohamed Arif1, Dr.Radhika2, Prof.Jamilahameed3, Dr.Narmada4, Dr.Haseena5

Background
In Vitro Fertilization A Method Of Assisted Reproductive Technology (Art) Is The Need For Most Infertile Couples Today.
An Important Issue Is The Rising Rates Of Multiple Births Due To Art Is Associated With Neonatal And Maternal Risks,
Along With Financial Burden For The Patients. On Average, 1 In 5 Ivf Are Multiple Compared To 1 In 80 Spontaneous
Pregnancies.
Case
A 34-Year-Old Female With Regular Cycles With Active Married Life For 14 Yrs Was Anxious To Conceive. Her General And
Systemic Examinations Were Clinically Normal. Investigations Including Hormonal Evaluation (Fsh, Lh, E2) , Ultrasound
Abdomen & Pelvis, Diagnostic Hysterolaparoscopy Revealed Normal Parameters. Her Husband, 38 Yrs Old Has
Unremarkable Medical And Genitourinary History With Normal Semen Analysis.
She Had Undergone 6 Cycles Iui, 2 Ivf Day 3 Transfer & Frozen Embryo Transfer (Et) Resulted Negative. 1 Year Later,
Through Intracytoplasmic Sperm Injection (Ivf-Icsi) With Long Gnrh Agonist Protocol, 11 Oocytes Were Retrieved On
Day11 Out Of Which 9 Fertilized, Rest Arrested. On Day 3, Out Of 9 Fertilised, 8 Were Grade A(Istanbul Guidelines). On
Day 5, Out Of 4 Blastocysts Formed, 3 Were Grade 4 (Istanbul Guidelines) Used For Et. On Day 14Th Of Et, Hcg Was
764Miu/Ml. On 6Th Week, Ultrasound Showed Triplet Gestation For Which The Couple Underwent Fetal Reduction On
11 Th Week. Currently The Patient Is At 18Weeks Of Ongoing Twin Pregnancy.
Conclusion:

Even Though Most Couples Choose Multiple Pregnancies To Complete Their Family In One Treatment Cycle; In View Of
Risk Factors Like Demographic Features, Hospitalization Stay Cost, Nicu Admissions, Maternal And Fetal Morbidity
Mortality And Congenital Malformation, Multiple Pregnancy Is A Burden In All Aspects.

***************

A Rare Case Of Complete Androgen Insensitivity Syndrome

Author: Dr. Padmapriya G. V.
Co Author: Dr Sudha R1, Dr Bhavani S Y2,

Background: Complete Androgen Insensitivity Syndrome Or Testicular Feminisation Syndrome Is Defined As Female
Phenotype In A 46 Xy Male With Normal Testes And Normal Testosterone Production And Metabolism. It Is An X-Linked
Recessive Disorder With An Incidence Of 1:20,000- 64,000 Male Births
Case: A 26Yr Old Unmarried Lady Presented With Primary Amenorrheoa, Examination: Secondary Sexual Characteristics
With Breast Development Tanner Stage Iv And Normal External Genitalia With Sparse Axillary And Pubic Hair And A Blind
Ending Vaginal Pouch, Per Rectal Examination Uterus Could Not Be Palpated. Investigations: Serum Testosterone:
152.21Ng/Ml, Fsh: 20.29Miu/L, Lh: 31.05Miu/L. , Ultrasound Examinaton Showed Absent Uterus And Ovaries, Bilateral
Hypoechoic Oval Structures In Both Inguinal Canals Suggestive Of Testes, Buccal Smear : Negative For Barr Body,
Chromosomal Analysis: Karyotype 46Xy. Patient Counselled Regarding Need For Gonadectomy And The Option Of
Vaginoplasty. Bilateral High Inguinal Orchidectomy Performed, Sent For Histopathological Examination. Post Operative
Period Uneventful.
Conclusion: Complete Androgen Insensitivity Syndrome Was Initially Described By J.M. Morris, An American
Gynaecologist In 1953. The Most Common Causes Of Ais Are The Point Mutations In The Androgen Receptor Gene
Resulting In A Defective Receptor Protein Which Is Unable To Bind Hormone Or Bind To Dna. This Alteration In The Gene
Blocks The BodyS Response To Masculinising Hormones (Androgen) During Fetal Development And After Birth. The
Body Can Respond To Feminizing Hormones (Estrogen), But Not Androgen. Successful Management Of Patients With This
Condition Requires Counseling, Gonadectomy, Vaginal Enlargement And Estrogen Replacement. Gonadectomy Is Best
Delayed Until After Puberty Is Completed As Pubertal Development Generally Proceeds More Smoothly In Response
To Endogenous Hormonal Production . The Overall Risk Of Gonadal Tumour Development Is 3.6% And 33% At The Age Of
25 Years And 50 Years Respectively. Once The Testes Have Been Removed, Estrogen Needs To Be Taken In Order To
Maintain Feminity.

***************

Pentology Of Cantrell - A Rare Multiple Congenital Malformation Syndrome

Author: Dr. Balwinder Kaur
Co Author: Dr Khushpreet Kaur1, Dr Parneet Kaur2, Dr Rama Garg3, Dr Princy Mittal4,

Background: Pentology Of Cantrell Is A Rare Multiple Congenital Malformation Syndrome Characterized By Combination
Of 5 Features: Abdominal Wall Defect, Defect Of Lower Sternum, Defect Of Diaphragmatic Pericardium, Defect Of
Anterior Diaphragm And Congenital Cardiac Anomalies. These Defects Can Be Diagnosed As Early As 1St Trimester Of
Pregnancy. The Complexity Of These Anomalies, In Particular The Presence Of Cardiac Defects, Determines The
Management As Well As Prognosis.
Case Report: A 30 Year Old Unbooked Female Gravida 4, Para 1, Abortion 2 With A Previous History Of Normal Delivery
Was Admitted At 31 Weeks Of Gestation With Usg Showing Multiple Congenital Anomalies. An Unusual Finding Was
Noted In Thoracoabdominal Region Of Fetus. There Was Defect In Anterior Abdominal Wall And Chest Wall. Abdominal
Organs And Heart Were Lying In Amniotic Cavity. Patient Went Into Spontaneous Labor And A Single Alive Male Baby
(Birth Weight 1500Gm) Was Delivered Who Died Immediately After Birth. On Examination Of Baby, Anterior Abdominal
Wall Defect Was Present And Intestinal Loops, Stomach, Spleen, Liver And Heart Were Protruding Out Of The Defect.Our
Anatomical And Ultrasonographic Findings Correlated. The Baby After Examination Was Diagnosed As A Case Of
Incomplete Expression Of Pentology Of Cantrell, Which Is A Rare Case With Prevalence Of 1 Per 65000 To 5.5 In A Million
Live Births
Conclusion
Prenatal Routine Sonography In 2Nd Trimester May Screen Pentology Of Cantrell. So Emphasis Must Be Given To 2Nd
Trimester Ultrasound And Offered To Each And Every Patient.

***************

Birth Defects
Author: Dr. Barkha Gurjar
Co Author: R.P.Rawat1, Himanshu2,

Birth Defects Observed At J.K.Lon Mother & Child Hospital , Kota

Birth Defects Are Defined As Abnormalities Of Structure, Function Or Body Metabolism That Are Present At Birth.The
American College Of Obstetricians & Gynaecologists Says That 3 Out Of Every 1000 Babies Born In Us Have Major Defects.
Some Of The Birth Defect At J.K.Lon Hospital Are
Anencephaly
Cephalic Disorder That Occurs When Rostral End Of Neural Tube Fails To Close B/W 23Rd& 26Th Days Of Conception.
Associated With Deficiencies Of Transcription Factor Tead 2, Folic Acid Deficiency, High Exposure To Lead,Chromium,
Mercury, & Nickel.

Congenital Hydrocephalus
Build Up Of Excess Csf In Brain At Birth.
Most Common Cause Is Obstruction Of Cerebral Aqueduct, Others Are Bleeding In Fetus Before Birth, Maternal Infections,
Birth Defects, Genetic Defects.

Spina Bifida
Developmental Disorder Caused By Incomplete Closing Of Embryonic Neural Tube. 3 Categories Are1)Spina Bifida Occulta
2)Spina Bifida Cystica With Meningocele
3)Spina Bifida Cystica With Myelomeningocele
Most Commonly In Lumbar & Sacral Region.

Cleft Lip & Cleft Palate

Approximately 1 In 700 Babies Have Cleft Lip Or Cleft Palate.
Associated With Smoking, Diabetes Mellitus, Drugs(Topiramate, Valproic Acid)

Hydrops Fetalis

Condition In Fetus Characterised By An Accumulation Of Fluid/Edema In Atleast 2 Fetal Compartments.Locations Can

Include- Subcutaneous Tissue/Scalp, Pleura,Pericardium, Peritoneal Cavity.Causes Include- Non Immune & Immune
Anaemia.

Cystic HygromaCongenital Multiloculated Lymphatic Lesion That Can Arise Anywhere But Is Classically Found In Left Posterior Triangle
Of Neck & Armpits.

Omphalocoele
Midline Abdominal Wall Defect In Which The Intestines,Liver& Other Organs Remain Outside Of Abdomen In A Sac,
Occurs In 2.5/10,000 Birth.

Ectopia Vesicae
Congenital Protrusion Of Urinary Bladder Through Abdominal Wall Defect,Occur In 1/10000 To 1/50000.

Dysmelia
Reduction Deformity On One Or Several Limbs,Occur In 0.69/1000
Dandy Walker Syndrome
Brain Malformation With Enlargement Of The Fourth Ventricle,Complete Abscence Of The Cerebellar Vermis,Occur In
1/30,Ooo Live Births

***************

Nobody Wants A Girl Child But Everybody Wants Afemale In Bed

Author: Dr. Renu Tandon
Co Author:

Every Female Is Indispensible.----------------------------No Child Can Thrive Without A Mother.

Every Mother Wants A Wife For Her Son.
Every Man Wants A Woman In Bed.
All Families Need A Woman To Carry On The Lineage.
All Beauty In This World Is Due To Females ,Be It Looks ,Dance, Songs ,
Still We Want To Terminate The Better Half Of Nature Whenever It Suits Us!
Man Kills The Male Child Of Cow When Its Presence Does Not Suit Him.
They Need To Sell Cows Milk And That Stupid Male Child Drinks Too Much Of That Valuable Milk----So----- They Kill Him.
Hence Its Not Actually The Gender ItS The Selfishness Of Humans That Makes Him Do That..!

***************

Umbilical Cord Coiling Index And Perinatal Outcome

Author: Prof. Shailesh Kore
Co Author: Dr.Y.S.Nandanwar1,

Introduction:
The Umbilicus, Navel, Actually A Scar, Is The Only Visible Memento Of The Close Connection With Our Mother Before
Birth.
The Umbilical Coiling Index (Uci ) Is Determined As The Number Of Complete Coils Divided By The Length Of Cord In
Centimetres. (Strong Et Al)
Aim:
The Primary Aim Of The Study Was To Find Out Correlation Of The Abnormal Postnatal Umbilical Coiling Index (Puci) And
Adverse Perinatal Outcome In Terms Of : Incidence Of Pih, Iugr, Meconium Staining Of Amniotic Fluid At The Time Of
Labour, Presence Of Non Assuring Fetal Status In Labour, Mode Of Delivery, Apgar Score At 5 Minutes, Low Birth
Weight, Ponderal Score.
Materials And Methods:
300 Consecutive Deliveries After 28 Weeks,
Uci Calculated After Deliveries
Uci= Number Of Coils / Total Length Of The Cord (Centimetres).
Results:
10Th , 50Th And 90Th Percentile Values Of Coiling Index Were 0.12, 0.20, 0.28
Normocoiled: Coiling Index Between 0.12 To 0.28 (N=250)
Hypocoiled: Coiling Index < 0.12 (N=29)
Hypercoiled: Coiling Index >0.28 (N=21)
Conclusion: Abnormal Uci Was Associated With Adverse Perinatal Outcome.

***************

Persistent Labial Adhesion In Adolescence Or In Adults

Author: Dr. Kamala R
Co Author: Dr Ramesh Sonowal1, Dr Ajay T Naik2, Dr Mohini Sinha3,

Labial Fusion Is The Condition Where The Labia Minora Become Fused Together By Fibrin. It Is Rare At Birth. It Generally
Occurs In Paediatric Population, And Resolves Spontaneously At The Onset Of Puberty, Again Making It Rare During
Adolescence. Low Maternal Estrogens Were Taken As An Etiological Factor. However, Recent Studies Have Not Supported
This View. Other Possible Causes Are Vaginal Inflammation Including Dermatitis, Or Tissue Trauma, Including Childhood
Sexual Abuse, . Post-Partum Adhesions May Occur Due To Perineal Trauma During Un-Supervised (Non-Institutional)
Childbirth.
If Treatment Is Necessitated By Symptoms Or Blockage Of Most Of The Vaginal Opening, Topical Oestrogen Cream May
Be Tried. If Medical Care Does Not Result In Separation Of The Labia Minora, Manual Or Surgical Separation May Be
Considered. Other Reasons To Consider Intervention Include Severe Fibrous Dense Adhesions Or Rare Cases With Urinary
Retention.
Here We Report A Case Of Adolescent Labial Fusion, Which Is A Rare Finding.
If The Presentation Is At A Pre-Pubertal Age, A Wait And Watch Policy Is Advocated. During Puberty, The Treatment Is
Often Topical Estrogen Creams With Or Without Topical Steroids7. The Best Option At This Stage Is Still Debateable8.As
Our Patient Had A Complete Closure Of The Introitus And Difficulty In Micturition Leading To Retention Of Urine, We
Opted For A Surgical Intervention After Informed Consent. The Procedure Was Successful, Indicating It May A Good First
Line Therapy In Patients With Sexual Maturity As Delay Of Treatment At This Stage May Deteriorate The Condition Of
The Patient.

***************

The Effect Of Location Of Placenta On Uteroplacental Blood Flow And Development Of Preeclampsia And Iugr.
Author: Dr. Nidhi Kalkal
Co Author: Dr. Arun H Nayak1, Dr.Meenal Sarmalkar2, Dr.Madhuri Mehendale3,

The Effect Of Location Of Placenta On Uteroplacental Blood Flow And Development Of Preeclampsia And Iugr.
Authors:
Dr.Nidhi Kalkal
Dr.Arun H.Nayak
Dr.Meenal Sarmalkar
Dr. Madhuri Mehendale
In Most Pregnancies Each Uterine Artery Contributes Equally To Placental Blood Flow.Even When The Placenta Is Located
Laterally,Contralateral Uterine Artery Has A Significant Contribution.However, In Some Cases There Is Significant
Difference Between The S/D Ratios Of Right And Left Uterine Arteries.This Usually Occurs When Placenta Has A Lateral
Implantation.Resistance In Iplsilateral Artery Is Less Than That Of Contralateral Side.This May Be The Indication That
Ipsilateral Uterine Artery Is More Important In Determining Placental Blood Flow In Lateral Placentas.Incidence Of
Preeclampsia And Iugr Is More With Lateral Placentas And With Increased S/D Ratio Or Diastolic Notching In Ipsilateral
Uterine Artery Than In Contralateral One.We Conducted A Retrospective Case Control Study In Ltmgh(Sion
Hospital).Study Comprises Of 120 Cases Of 24-28 Week Singleton Pregnancies.60 Were Cases Of Preeclampsia And
Iugr.60 Were Without Any Comorbidity. Results : The Incidence Of Lateral Placenta In Cases Against Control Was
Significantly More.[ Confidence Interval 99 % ].The Incidence Of Raised Uterine Artery Resistance In Lateral Placenta As
Compared To The Central Placenta Was Quite Significantly More. [ Confidence Interval 95 % ] .Laterally Located Placenta
Are Associated With Raised Uterine Artery Resistance More On Contralateral Side Compared To Ipsilateral Side. Thus,
Lateral Placenta Can Be Used As A Predictor Marker For Preeclampsia.

***************

"Integrated Care- A New Model To Achieve Vision 2022 & Healthy Generation
Author: Dr. Shikha Seth
Co Author: Dr Priya1,

Title: -integrated Care- A New Model To Achieve Vision 2022 & Healthy Generation.
Dr. Shikha Seth, Dr. Priya Sharma
U.P. Rural Institute Of Medical Sciences & Research Saifai, Etawah.
Abstract:
1.
Introduction: Vision 2022 Is The FogsiS Plan To Tackle The Major Issues Related With WomenS Health
As A: Anaemia Eradication Among Adolescents And Pregnant, B: Beat Female Foeticide & Saving The Girl Child, C:
Contraceptive Choices & Cervical Cancer Awareness, D: Diabetes And Other Non-Commnicable Disease Burden In
Pregnancy, E:Education And Empowerment. Aim: Aim Is To Innovate, Educate And Advocate The New integrated
Model For Preparing The TomorrowS Physicians Who Not Only Will Treat The Diseased But Also Depart Health
Education For Empowering Their Future, Family And Community. Methods: 1.Gynaecologists Have Easy Opportunity As
All The Females At One And Other Time As Puberty, Pregnancy, Abortion, Delivery Or Menstrual Abnormalities, Approach
Them And Mostly Eager To Learn About Changes In Their Body Through Reproductive Years. 2.The Lives Of Women Can
Improve With A Holistic Approach Including Medicinal Part Along With Educating And Counselling About The Risk Factors,
Complications And Most Importantly Measures To Avert Them. 3. Curriculum Should Incorporate Sex And Gender
Medicine Beyond Reproductive Medicine, Blending Biomedical, Psychosocial, And Public Health Aspect Of Health And
Disease Both. Result: Instead Of Developing Multifocal Activities & Clinics, This New Integrated Care Model Can Ensure
Overall Wellbeing Of Women. Conclusion: We Promote The Conversion Of Medical College Educational Model Into An
integrated WomenS Health Model For Buiding A Healthy Generation.

***************

A Case Of Pregnancy Following Fertility Sparing Surgery For Dysgerminoma

Author: Dr. Saranya Elancheran
Co Author:

Introduction
Dysgerminoma Is The Most Common Malignant Germ Cell Tumour(30-40%) Occuring In Young Woman And To
Have Bilateral Presentation. Most Common Ovarian Malignancy Asociated With Pregnancy.Irrespective Of Any
Stage/Subtype, Conservative Surgery Should Become Standard Approach To Treating Most Patient With Malignant Germ
Cell Tumour As Fertility Seems To Be Only Marginally Affected As It Responds Well To Chemo &Radiotherapy.
Case:
22Yrs Primi With H/O 8 Months Amenorrhoea With Lmp:25.02.2014,Edd:04.12.2014 Is A Case Of Pregnancy Following
Dysgerminoma. She Has Been Evaluated 1 1/2 Yrs Back For Complaints Of Abdominal Pain. Mri Abdomen With Pelvis
Showed Features Of Left Ovarian Malignancy Of Size 18*18*13 Cm With Solid And Irregular Cystic Necrotic Areas With
Minimal Ascites And Omental Thickening.Right Ovary-Normal.Whole Body Colour Doppler Showed Features Suggestive
Of Dysgerminoma With Ascites.Ct Thorax-Normal Study. Fnac Was Suggestive Of Dysgerminoma.Tumour Markers Such
As Ldh,-Hcg Were Increased.Afp-Within Normal Range. She Was Treated With 3 Cycles Of Adjuvant Chemotherapy(Bep
Regime). Post Chemotherapy Ct Abdomen With Pelvis Showed Residual Left Ovarian Mass Of Size 5*5*6 Cm With No
Evidence Of Secondaries/Ascites/Para-Aortic/Retroperitoneal Lymphadenopathy.She Was Proceeded With Conservative
Surgery In Form Of Left Oophorectomy.She Conceived 5 Months After Surgery. Tumour Markers Are Within Normal
Range.At Present She Is A Case Of Primi With 32 Weeks Of Gestation With No Obvious Foetal Anamoly.
Conclusion
Most Patient Even With Metastatic Dysgerminoma Can Expect Cure With Maintanence Of Normal Reproductive Function
When Treated With Conservative Surgery And Chemotherapy

***************

Prediction Of Preeclampsia By Serum Beta Hcg Levels In Second Trimester Of Pregnancy

Author: Dr. Dr Preetha Govindarajan
Co Author:

Prediction Of Preeclampsia By Serum Beta Hcg Levels In Second Trimester Of Pregnancy

Dr.Preetha M.S (O&G)Post Graduate
Professor Dr. Usharani Md, Dgo, Dnb (O&G)
Aim And Objective
1)To Predict Preeclampsia By Elevated Beta Hcg Levels In The Second Trimester Of Pregnancy.2)To Assess The Severity
Of Preeclampsia Correlated With The Elevated Levels Of Beta Hcg Levels

Materials And Methods

It Was Randomized Controlled Study At The Institute Of Obstetrics And Gynecology The Tertiary Referral Center In South
India With About 10,000 -12,000 Deliveries Per Annum. Women Who Presented To Our Antenatal Clinics With Singleton
Pregnancies,In The Second Trimester Of Pregnancy
Duration Of The Study January 2014 October 2014.

All Normotensive Nonproteinuric Pregnant Women Selected Randomly Between Gestational Age 13 To 20
Weeks Attending An Clinics Irrespective Of Parity,Gestational Age Calculated From Reliable Menstrual History Dates And
Early Ultrasonographic Measurement Of Fetal Crown Rump Length.

Serum Beta Hcg Levels Estimation Done By Chemiluminscent Method

Follow Up Of An Mothers Done Till Third Trimester By Monitoring Blood Pressure And Proteinuria,Prediction Of
Preeclampsias Done According To The Elevated Serum Beta Hcg Levels,Severity Of The Preeclampsia Classified According
To The Elevated Beta Hcg Levels.
Inclusion Criteria:
All Normotensive Nonproteinuric Pregnant Women Selected Randomly Between Gestational Age 13 To 20 Weeks
Attending An Clinics Irrespective Of Parity
Exclusion Criteria
Women With Multiple Pregnancy ,Essential Hypertension ,Diabetes Mellitus

,Molar Pregnancy

Outcome Of The Study

Elevated Serum Beta Hcg Levels Are In Second Trimester Are Associated
Elevated Beta Hcg Levels Are Associated With Severity Of Preeclampsia
Better Maternal And Perinatal Outcome In Patients With Preeclampsia.

With Preeclampsia

***************

Interesting Case Report- Aggressive Angiomyxoma Vulva

Author: Dr. Mohana Sundari
Co Author: Mohana Sundari.K.P.1, Anandhi2, E.Sukanya3,

Presenting Author:

Dr.K.P.Mohanasundari M.D O.G.,

Senior Assistant Professor

Co Author:

Dr.Anandhi M.D O.G., Professor

Dr.E.Sukanya Md O.G.,
Senior Assistant Professor
Department Of Og
Govt Mohankumaramangalam
Medical College Hospital,
Salem Medical College, Salem.

Background:

Aggressive Angiomyxoma Is A Rare, Locally Invasive, Slow Growing Mesenchymal Tumour Occurring Usually In Women
Of Reproductive Age.It Was First Described By Steeper And Rosai In 1983.

Case Report:

We Describe A 30 Year Old Woman Who Presented With Complaints Of A Huge Mass Hanging From Vulva For Past 10
Years.On Examination There Was A Pedunculated Mass With Superficial Erosion Of Size 10*10 Cm Arising From Right Side
Labia Majora. The Pedicle Length Was 10 Cm. Provisional Diagnosis Of Pedunculated Papilloma Was Made.She Was
Admitted, Evaluated And Excision Of The Mass Done.Histopathology Reported As Aggressive Angiomyxoma Of Vulva.

Conclusion:

Aggressive Angiomyxoma Has A High Risk For Local Recurrence.Hence We Need To Differentiate It From Other Tumours
Of Vulva.Appropriate Management And Long Term Follow Up Is Necessary.

***************

Empowerment Of Women By Medical Awareness

Author: Dr. Monika Sharma
Co Author:

Empowerment Of Women By Medical Awareness

To Change A Person And Achieve Their Potential, They Need To Be Empowered, By Information.. If We Empower WomenWe Empower India.Pledge For Excellence.
How Can Be Empower India
-By Reaching Out To Adolescents
To Young Adults
To Women In Reproductive Age Group.
Women Above 40 Yrs
Senior Citizens.
Empower India By Reaching Out To Young

Sexual Matuity Comes With Some Potential But Easily Avoidable Problem I.E Infection Of The Genital Tract . Unsafe
Sexual Behavior May Lead To (1) Unwanted Pregnancies (2) Unsafe Abortion (3) Stds, Hiv, Aids(4) Pelvic Pain , Infertility,
Cancer Of Cervix.
Knowledge Of Proper Nutrition .
Exercise .
Youths Should Be Offered Vaccines Against Rubella & Cervical Cancer.
Empower India By Educating Women In Reproductive Age Group.
Millenium Development Goals By 2015 Is To Achive Women Empowerment By Reducing Child Mortality Rate, To
Improve Maternal Mortality Rate, To Combat Hiv, Aids, Stds.
Implementation Of Pcpndt Act To Ensure That No Female Has To Go For Sex Selection And Sex Selection Foeticide.
Women Should Be Taught About Sexual Hygeine, Safe Sexual Practices, Annual Check Up With Gynaec For Pap Smear,
Breast Examination, Mammography.
Empower India By Reaching Out To Menopausal Women.
In Menopausal Women, Awareness About Cancers, Osteoporosis, Hormonal Changes Is Very Important.
By Life Style Changes, Obesity Can Be Reduced, Thus Reducing Coronary Artery Disease And Few Cancers, Osteoarthritis.
Empower Fogsians.
By Attending Focused Workshops For Training And Capacity Building Maternity Care , Eg

Post Partum Haemorrhage- Predict ,Prevent And Handle.

Recent Advances In Management Of Hypertensive Disorders.
Management Of Fetal Growth Restriction.
Current Trends In Management Of Preterm Labour.
Neonatal Resuscitation.
Caesarian Skills
Communication Skills

.If Women Empower Themselves By Medical Awareness, Productivity Of Whole Family Increases Thus Leading To
National And Global Wellbeing.

***************

Report On Case Of Successfull Quintuplet Pregnancy

Author: Dr. Khyamanidhi Sethy
Co Author:

Report On A Successful Quintuplet Pregnancy

[Type The Document Subtitle]

User

Dr Khyamanidhi Sethy,Dr R. N. Satpathy,Scb Mch Cuttack Orissa

[Type The Abstract Of The Document Here. The Abstract Is Typically A Short Summary Of The Contents Of The Document.
Type The Abstract Of The Document Here. The Abstract Is Typically A Short Summary Of The Contents Of The Document.]

Aim And ObjectiveTo Report A Case Of A Successful Quintuplet Pregnancy At 35 Weeks Of Gestation With Delivery Of 4 Babies-One Female,3
Male And One Fetus Papyraceous.
MethodsWe Reported A Case Of Of 24 Years Old G2P1L0 With Quintuplet Pregnancy At 34 Weeks 5 Days With History Of Ovulation
Induction With Cervical Encirclage In Situ.Hospitalisation,Intensive Care Of Pregnancy And Ceaserian Section Done.

ResultsSuccessful Pregnancy With Delivery Of 4 Babies-One Female,3 Male And The 5Th One Was Fetus Papyraceous.

Conclusion-

Frequency Of Multiple Pregnancies With More Than Two Fetus Has Increased Considerably Since The Introduction Of
Methods Of Ovulation Induction,In-Vitro-Fertilisation And Embryo Transfer.

***************

A Rare Case Of Delayed Retained Adherant Placenta

Author: Dr. Sandhya Jilhekar
Co Author:

Critical Case Transferred From Cama Hospital As 25Yr Old P3L2Iufd With? Incomplete Abortion 3 Months Post Delivery In
Haemorrhagic Shock And In Semi-Concious State On Oxygen Complaining Of Excessive Bleeding Pv Since Morning.
Pt Was Admitted In Assam Govt. Hospital For 15 Days For Heavy Blpv 1 Month After Delivery.4 Bt Given.Papers Na.
Pt Had No Bleeding For 2 Months.
O/EGc Poor.Pt Semiconscious Responding To Painful Stimulus.
Pallor +++
P-130/Min Bp-80/50Mmhg
P/A-Ut 14-16Wks
P/S-Min Bleed+,Os Closed
P/V-Ut 16Wks,A/V,Osclosed,Soft
Imp- ?Gestational Trophoblastic Disease ?Rpocs With Blpv With Severe Anaemia With Dic With Convulsion With Hb 3.7
2Pcvs, 6 Platelets,5 Ffps Given.
29/05/14 Usg(A+P)-Ut 12X8.8X5.9Cm With Edematous Endometrium. A 5.6X3.5X3Cm Endometrial Collection See. No
Vascularity/Ff Seen.
30/05/14-B Hcg-1918
Pt Taken For Emergency Hysterectomy Under Ga.
Intraop-2 Wb,4 Ffps,4 Platelets Give.Emergency Hysterectomy Done.
Insitu-Ut 16 Wks. Cut Section-12X10X6Cm Fleshy Growth Seen In Cavity Adherent To Fundus ?Adherant Placenta ? Pstt
Pt Shifted To Ccu For Monitoring. Pt Stable.
13/06/14-Hpr S/O Retained Placenta.

***************

A Rare Case Of Non Immune Hydrops

Author: Dr. Swati Mahale
Co Author:

A Rare Case Of Non Immune Hydrops And Fetal Anaemia As A Cause And Its Treatment And Outcome
***************

Study Of Pancreatitis In Pregnancy In A Tertiary Centre , Kims Hospital And Research Centre ,Bangalore.
Author: Dr. Ramya Madireddy
Co Author:

Abstract
Aims And Objectives Pancreatitis In Pregnancy Is A Rare Event And Has A Varied Course Ranging From Chronic
Pancreatitis With No Effect On Pregnancy To An Acute Or A Fulminant One Necessitating Termination . The Aim Of Our
Study Is To Study The Incidence , Etiology And Complications And Course Of Disease In The Cases Of Pancreatitis In
Pregnant Patients In Our Hospital.
Materials And Methods This Is A Retrospective Study For A Period Of 1 Year (October 2013- October 2014) In
Department Of Obg , Kims Hospital , Bangalore.
Results The Incidence Of Pancreatitis Was Less Than 1% (5 Cases In Total )
2 Of Which Were Chronic Pancreatitis Without Any Effect On Pregnany And Its Course, 2 Of Which Were Newly Diagnosed
Acute Pancreatitis Cases, 1 Was Recurrent Pancreatitis Which Necessitated Termination. The Cause For 2 Chronic Cases
Was Gall Stones And The Rest 3 Cause Not Identified. One Case Had Co-Existing Pre-Eclampsia. No Mortality Noted.
Conclusion - Though Often Come-Across As Mild Attacks, Pregnancy-Associated Pancreatitis May Be Severe, Morbidity
And Mortality Can Be Significant. Mechanisms Behind Less Common Contributing Factors Should Become Prime Focus
Of Further Research And Investigation In This Line, Which Would Further Guide Us Towards Discovering Therapies And
Preventing The Potential Sequelae.

***************

Autoimmune Thyroid Disorders On Pregnancy Outcome

Author: Dr. Jigyasa Singh
Co Author:

Abstract-Aims: To Universally Screen The Pregnant Population For Thyroid Disorders.To Study The Effect Of Autoimmune
Thyroid Disorders On Pregnancy Outcome-To Know If They Are Significantly Associated With Gestational Diabetes
Mellitus, Hypertensive Disorders Of Pregnancy, Miscarriage, Infertility And Adverse Neonatal Outcomes.
To Timely Diagnose And Treat The Thyroid Disorders In Pregnancy For Better Fetomaternal Outcome.
Materials And Methods: The Study Cohort Comprised Of 100 Pregnant Women Attending The Antenatal Clinic Of Ssh,
Bhu From 1St July 2012 To 30Th June 2014.
Thyroid Hormone Level And Thyroid Peroxidase Antibody Were Estimated. Patient With Thyroid Dysfunction Were
Assessed Periodically Or Treated Depending On The Severity. Subjects Were Followed Until Delivery.
Results: Hypothyroid And Tai Were Associated With Miscarriage. Total 100 Patients Were Included With Age Range 2036 Years. Out Of 100 Subjects, 32 Were Primigravidae, In Which 13 Were In Case Group And 19 In Control Group.
Seventeen (15 In Case Group And 2 In Control Group), 6, 6, 10, 9 Subjects Had History Of Spontaneous Abortion(P=0.02),
Still Birth, Gdm(P=0.209), Infertility Treatment(P=0.092) And Pregnancy Induced Hypertention(P=0.249) In Previous
Pregnancy Respectively.
Eleven, 7, 6, 9, 18 Subjects Had Pre-Eclampsia(P=0.201), Gdm(P=0.038), Spontaneous Abortion(P=0.204), Preterm
Delivery(P=0.003), Lbw(P=0.008) In Present Pregnancy Respectively. In Neonatal Outcome One, 3, 1 Babies Had
Congenital Anomaly(P=1.00), Neonatal Hypothyroidism(P=0.106) And Neurological Deficit(P=0.966) Respectively. Three
Mothers Had Subsequent Thyroid Disease In Post Partum.
Conclusions: Autoimmune Thyroditis Is Associated With Reduced Fertility And Higher Incidence Of Fetal Loss. The AntiTpo Antibody May Affect Post Implantation Embryo Development, Leading To Fetal Loss.
Collaboration With Endocrinologist, Obstetrician And Neonatologist Would Be Necessary For A Correct Approach Of
Women Affected By Hypothyroidism During Pregnancy And For Management Of The Neonates During The First Month
Of Life.

***************

Study To Assess Psychological Disturbance & Quality Of Life Among Transgenders Attending The Special Clinic At Sree
Balaji Medical College
Author: Dr. N Nikath Nasreen
Co Author: Dr.N.Nikath Nasreen Ii Yr Pg M.S. (Og) Sree Balaji Med Coll Chrompet 1, , Prof.K.Saraswathy Md (Og) Dgo
Hod Dept Of Obg Sree Balaji Med Coll Chrompet2, Drmaihtrey Pg Md Psychiatry Sree Balaji Med Coll Chrompet3,
Dr.S.Nirupa Md Dgo Asst Prof Of Og Sree Balaji Med Coll Chrompet 4,

Aim & Objective:

The Aim Of The Study Is To Assess The Emotional Problems And Quality Of Life Among Transgenders.
Materials And Method:
It Is A Descriptive Study Of 20 Outpatients Attending The Transgender Special Clinic At Og Department In Sree Balaji
Medical College And Hospital, Chennai. Informed Consent Obtained. The Socio Demographic Details And The Details
About The Emotional Problems Were Collected Using Semi Structured Proforma Developed Especially For The Study.
Initial Screening To Recognize Any Psychological Problems Was Assessed By General Health Questionnaire (Ghq) And
Were Further Assessed By Hospital Anxiety And Depression Rating Scale (To Assess Anxiety And Depression) And Whoqol
Scale (To Assess Quality Of Life).
Result:
All The Attendees Had Depression And Poor Quality Of Life.
Conclusion:
As Per Latest Data Available It Is Reported That There Are Nearly 4,90,000, Transgenders In India. The Actual Number
May Be More Than This. Majority Of Them Had Traumatic Experience In Their Childhood And Had Confused Orientation
Regarding Their Gender Identity.
Recently The Government Of India Also Recognized Transgender As The Third Gender After Male And Female. This
Forward Step Of Our Government, Motivated Many Of These People To Come To Surface And Want To Rectify There
Problem. Even Though Some Of Them Come From Good Family Background, After They Become Transgender There Is A
Gradual Deterioration Of Their Medical, Psychological, Social, Financial And Legal Complications.

***************

Twins With Fetal Growth Restriction : Antenatal Growth Pattern & Pregnancy Outcome
Author: Dr. Lakshmi Sundaram
Co Author:

Aim & Objectives: Antenatal Growth Trend Of Ultrasound Parameters Helps With Timely Safe Delivery In Fgr Twins. The
Study Aim Is Fgr Detection To Delivery Interval, Neonatal Outcomes, Neuro-Developmental Outcome.
Material & Methods: 67 Multiple Pregnancies With Birth Weight < 5% For Gestation Delivered At Irm From 2010-2013.
Data Collected Retrospectively From Clinical Records.
Results
43 Women Had Fgr, In 22 Women Both Foetuses Fgr
Birth Weight Range: 645G - 2.38 Kg
< 1.5 Kg = 26/67
Discordance: 24 Sets Had >20% (Includes 3 Twins > 40%)
Antenatal Risk Factors: 34% Started As Higher Order Multiple, 16% High Uterine Artery Resistance, 16% Obese, 11% PreEclampsia, And 9% Diabetes.
Onset Of Fgr
First Scan Abnormality Noted <30 Wk = 25 (Includes Progression To Abnormal Doppler = 12 ), 30W-34W = 8 Twins
(Abnormal Doppler = 6 ), Beyond 34W = 7 ( None Doppler Abnormality)
Delivery Gestation: 62% Had Fgr <30 Wks Only One Needed Delivery <30 Wks. 20 % Delivered At 30-34 Wk, 60% Delivered
At 34-37 Wks, 18% At 37-38 Wks.
Newborn Outcome: Two Of The Nnd At 30 Weeks
Neuro-Developmental Follow-Up: Available For 24 Infants. 3 Moderate To Severe Developmental Delay, 7 Had Mild Delay
That Includes 4 That Had Normal Antenatal Dopplers.
Conclusion:
1.
In 58% Fgr Seen Before 30 Wks But Only 22% Required Delivery By 34 Wks. Hence Gestation Prolongation
Possible With Careful Monitoring.
2.

Developmental Follow-Up Is Vital.

***************

Fetal Cerebral Parenchymal Bleed: A Multi-Disciplinary Approach

Author: Dr. Shivani Gopal
Co Author:

Background- Fetal Neonatal Alloimmune Thrombocytopenia Is Caused By Maternal Sensitization To Paternally-Derived

Antigens On Fetal Platelets, Most Commonly Hpa-1A. It Occurs In Approximately 1 In 1000 Live Births And Is The
Commonest Cause Of Severe Fetal And Neonatal Thrombocytopenia, And Of Intracranial Hemorrhage In Neonates Born
At Term. Since There Is Currently No Routine Screening, First-Time Cases Of Fetal Alloimmune Thrombocytopenia Are
Generally Identified Following The Birth Of A Markedly Thrombocytopenic Neonate. Antenatal Management Is Thus Only
Possible In Subsequent Pregnancies
Case- A 30 Year Old Female, Non-Consanguinous Couple, G2A1 At 36 Weeks Pregnancy, Underwent Growth Scan Which
Revealed Intracerebral Hyperechogenicity Without Vascularization, Suspicious Of Haemorrhage. Targeted Scan At 20
Weeks Was Normal. Mri Confirmed Grade 4 Cerebral Hemorrhage. The Newborn Was Thrombocytopenic And
Succumbed At 72 Hours Of Life. Fetal/Neonatal Alloimmune Thrombocytopenia (Fnait) Was Diagnosed By The Presence
Of Hpa 2A/2B In The Newborn Serum, Similar To The Paternal Antigens. In Fnait, Fetal Platelets Express Paternal Platelet
Antigens. Antibodies Produced Against These By The Mother, Cross The Placenta Causing Thrombocytopenia In The Fetus.
Thrombocytopenia Causes Intracranial Bleeding Leading To Death Or Neurological Sequelae. Fnait Index Cases Are
Detected Only At Birth, Since Antenatal Screening Programs Are Unavailable. Immunized Pregnancies Require
Immunoglobin Treatment If Chorionic Villus Sampling, Showing Hpa 2A/2A For The Mother And The Fetus. The Platelet
Antigen Incompatibility Has Therefore Not Recurred. Targeted Scan Was Normal In This Ongoing Pregnancy.
Conclusion- This Case Reveals How Detailed Examination At Growth Scan Reveals Evolving Fetal Complications. Prenatal
Diagnosis Confirms That Intracranial Haemorrhage Is Not Due To Obstetric Causes. It Aids Prenatal Diagnosis In
Subsequent Pregnancies For Therapeutic Interventions To Optimize Outcome.

***************

Uterine Torsion With Successful Pregnancy Outcome

Author: Dr. Dimple Kriplani
Co Author:

Background
Torsion Of The Uterus Is A Rare Condition In Which The Uterus Rotates On Its Own Axis By More Than 45 Degrees And
Can Go Upto 180 Degrees. The Exact Mechanism By Which It Occurs Is Not Known But There Are Various Associated
Factors With It Such As Uterine Neoplasms, Uterine Anomalies, Pelvic Masses, Pendulous Abdomen, Previous Pelvic
Operations, Spinal Deformities , Malpresentations , Trauma, Etc.
Case
A 37 Year Old Morbidly Obese Patient Weighing 106 Kg, G2P1L1, With 39 Weeks Gestation,With Previous Cesarean With
Preeclampsia Was Admitted In Obstetric Care At Jj Hospital. Patient Was Already Started On Tablet Alphamethyldopa
And Nifedepine For Raised Blood Pressure From Her Private Practitioner Where She Was Registered Earlier.
On Examination, Her Blood Pressure Was 120/80Mmhg, Edema Feet And Abdominal Wall Edema Was Present. On
Abdominal Examination, Uterus Was Full Term With Breech Presentation With Regular Fhs And Relaxed. Obesity Was
Present With Pendulous Abdomen.Her Routine Investigations Were Normal And Her Obstetric Ultrasonography Was
Suggestive Of Single Live Intrauterine Gestation Of 36 Wk With Breech Presentation With No Other Abnormality.
She Was Taken For Emergency Cesarean Section For Previous Cesarean With Breech Presentation In Labour.
In Situ Findings- Gravid Uterus Was Rotated To Right By Around 120 Degrees With Left Cornual Structures Facing
Anteriorly And To Right, With Ovarian Ligament Being The Anterior Most While The Round Ligament Being The Posterior
Most, Thus Confirming The Diagnosis Of Uterine Torsion To Right Side.
A 3.6 Kg Female Child Was Delivered By Posterior Hysterotomy With Transverse Incision On Lower Uterine Segment. After
Suturing, Uterus Was Reposited Back In Anatomical Position. No Maternal Abdominopelvic Pathology Was Seen.
Postoperatively Baby Was With Mother. Both Went Home Healthy On 9Th Postoperative Day.
Conclusion- Deliberate Posterior Cesarean Hysterotomy Is An Option For Fetal Delivery With Irreducible Torsion.

***************

A Case Of Primi With Discordant Twin Gestation

Author: Dr. Leelamadhuri Veeranki
Co Author: Dr.Padmaleela1,

Background: The Incidence Of Multiple Pregnancy Is On The Rise Worldwide Due To Increasing Use Of Art And Increasing
Maternal Age At Childbearing. When More Than One Fetus Develops In The Uterus It Is Called Multiple Pregnancy.
Simultaneous Development Of Two Fetuses Is Called Twin Gestation. It Is The Most Common Variety Of Multiple
Pregnancy. Multifetal Gestations Are At Higher Risk Of Prematurity, Prom, Fetal Growth Restriction And Fetal
Malformations.
Case: A 23Yr Old Primi With 8Months Of Amenorrhea Belonging To Low Socioeconomic Strata Admitted In V/O Of Twin
Gestation For Safe Institutional Delivery. Being Her Menstrual Cycles Regular, Period Of Gestation Was 33Wks6D. She
Conceived Spontaneously After 9 Months Of Marital Life . She Had Non Consanguineous Marriage. No Relevant Past
/Personal/ Family History. On U/S Scan At 5Th Month She Found To Be Monochorionic And Diamniotic Twin Gestation
With Bilateral Single Umbilical Arteries. Obstetric Scan At 34Wks Revealed Discordant Twin Gestation With 73%Growth
Discordancy. Then She Was Serially Followed Up After Hospitalization By Daily Nst And Biwkly Afi. At 35Wks4Days Patient
C/O Decreased Fetal Movements And U/S Revealed Intrauterine Demise Of Discordant Twin. Then Labour Was Induced
By Dinoprost Gel And Patient Delivered One Alive Male Child Of Birth Weight 2.3Kg With Apgar-10 And Another Dead
Male Child Of Birth Weight 1.2Kg With Apgar-0.
Conclusion: Multiple Gestations Are Associated With An Increment In All Complications Of Pregnancy. Monochorionic
Twins Are At Increased Risk Of Complications. Discordant Twin Growth Is One Of The Common Problems Affecting 15%29% In Which There Is High Risk For Perinatal Complications Like Rds, Neonatal Seizures, Intra Ventricular Hemorrhage
And Sepsis. Once The Diagnosis Of Twin Gestation And The Type Of Placentation Are Made, The Efforts Must Be Directed
Towards Prevention Of Perinatal Mortality And Morbidity.

***************

Pyrexia In Pregnancy:A Prospective Study.

Author: Dr. Sudipta Banerjee
Co Author:

Background:Any Acute Or Chronic Infectious Disease May Be Contracted During The Course Of Pregnancy, And
Conception And They May Occur In Women Already Susceptible To Infection.The Effects Of Pyrexia On Pregnancy Depend
On The Extent Of Temperature Elevation, Its Duration, And The Stage Of Fetal Development When It Occurs.It Can Lead
To Poor Fetal Development And Even Fetal Death In Utero.A Prospective Study Was Conducted Over A Period Of One
Year Of The Cases Of Pyrexia In Pregnancy To Identify The Presenting Features,The Clinical Diagnosis,Investigations To Be
Done,The Management And The Outcome Of The Pregnancy.Materials And Methods:All Consecutive Pregnancies
Presenting With Pyrexia Were Enrolled In The Study After Their Consent.The Clinical Presentation Were Noted, A Fixed
Protocol Of Investigations,The Diagnosis Were Studied. The Cases Were Reviewed In Consultation With The Physician
Incharge.The Pregnancies Were Treated According To The Cause And Were Followed Up Till Delivery To Know The
Outcome Of The Same.Results:Total 73 Women Presenting With Fever Were Enrolled.51,Were Primigravidas,22
Multigravidae,Age Group In The Range Of19-37Yrs.Underlying Predisposing Conditions Were Found To Be
Anemia,Hypoproteinemia,Preterm Premature Rupture Of Membranes.The Study Found The Most Common Etiologies To
Be Viral Fever,Upper Respiratory Tract Infections,Malarial Fever,Chorioamnionitis And Typhoid Fever.Outcome Of
Majority Of The Pregnancies Were Good With 7 Pregnancies Having Babies With Birth Weight <2.5Kg.The Average Birth
Weight Were Between 2.7-3.5Kg.There Were No Abortions,Stillbirths Or Abnormalities In The Babies.Conclusion:Fever In
Pregnancy Can Lead To Maternal And Fetal Morbidity And Even Mortality.Early Recognition,Correct Diagnosis And
Prompt Treatment Helps To Have A Favourable Outcome.
***************

Evaluation Of Follow - Up System Among Hiv Seropositive Antenatal Women

Author: Dr. Richa Kaushik
Co Author:

Objective: Study Of Hiv Seropositive Antenatal Women Over A Period Of 6 Years To Evaluate The Cd4 Counts, Hiv Status
Of Their Husband And Baby, Occurrence Of High Risk Groups Among Them And Their Spouses And An Evaluation Of
Follow Up System In Our Hospital.
Material And Method: A Retrospective Study Was Done In Which Follow Up Of All Women, Who Reported In Antenatal
Clinic In Our Hospital During Period Of 6 Years (July 2008 - July 2014) And Found Hiv Seropositive Was Evaluated.
Results: Majority Of Women Were From Urban Area (75.7 %), Primigravida (31.7 %) And Illiterate (26.1%). 47.6 5%
Women Had Cd4 Count In Stage 2 (According To Cdc Classification). Hiv Status Of Husband Was Known In 89.7 % Cases
And Hiv Status Baby Was Not Known In 71 % Cases. No Women Were In High Risk Group And 25 % Husbands Were In
High Risk Group.
Conclusion(S): Follow Up Of Hiv Seropositive Antenatal Women Is A Challenging Task In Terms Of Hiv Status Of Their
Spouse And Baby Due To Lags In Contact Tracing. Better Follow Up Can Lead To A Halt In Hiv Transmission At The
Very Beginning.

***************

Ovarian Conservation In Twisted Adnexa

Author: Dr. Ravindra Shelmohakar
Co Author:

Ovarian Conservation In Twisted Adnexa

Background: Torsion Of The Adnexa Is An Acute Emergency And Grievous Problem In Females. The Tissues Start
Becoming Congested And Necrotic Rapidly. The Problem Becomes More Serious When It Happens In Young Girls Where
Preservation Of Ovarian Function Is Crucial From Future Reproductive Life. This Case Study Is About Successful Ovarian
Preservation In An Young Unmarried Girl With Twisted Necrotic Adnexa.
Case : A 23 Year Old Unmarried Girl Admitted Under Physician Care For C/O Vomiting, Pain In Abdomen And Urinary
Symptoms. She Was Treated With Analgesics, Antibiotics And Iv Fluids. Usg Done Revealed An Ovarian Cyst Of 9*7 Cm
Without Torsion. On Examination There Was A Palpable Pelvic Lump With Tenderness. The Patient And Relatives Were
Reluctant For Surgery As The Symptoms Were Reduced. The Pain Reappeared In Spite Of Analgesics And Decision For
Laparoscopy Taken. On Laparoscopy The Right Adnexa Was Twisted With Congestion And Necrosis. Untwisting Of Adnexa
Done And Then Ovarian Cystectomy Done. Right Ovarian Fixation Done To Lateral Pelvic Wall. Good Suction-Irrigation
Performed.
Patient Given Good Antibiotic Cover Postoperatively. Review Usg After 72 Hours Revealed Blood Supply In Part Of The
Ovary. Iv Antibiotics Given For Five Days & Then Orally For Seven Days. Postoperative Period Was Uneventful. Review
Usg After 45 Days Revealed Normal Right Ovary.
Conclusion: Ovarian Conservation Can Be Done Effectively In Cases Of Twisted Adnexa In Young Girls With Good
Intraoperative Precautions And Vigilant Postoperative Management.

***************

A Rare Case Of Solid Pseudopapillary Epithelial Neoplasm Of Pancreas (Spen) In Pregnancy

Author: Dr. Muskaan Chhabra
Co Author:

Spen-Solid Pseudupapillary Tumor Of Pancreas Is A Rare But Characteristic Neoplasm, Afflicts Young Women .The
Presenting Features Are Usually Vague And Include Abdominal Pain, Fullness, Nausea And Vomiting. These Tumors Are
Of Low Malignant Potential And Long Term Cure Is Achieved In More Than 95 % Cases.
22Yrs, Primi With Full Term Gestation With A Retroperitoneal Mass ?Malignancy Of Pancreas Referred From Gmc Akola
For Further Management. Pt Was Diagnosed With A Mass 19.1X 8.8 Cm In The Left Renal Fossa At 12 Weeks Gestation
At Akola Maternity Hospital . Pt Counselled For Mtp But Pt Not Willing As It Was Infertility Conception (Ovulation
Induction).
Pt Had Chronic Vague Abdominal Pain Since 1Yr.Pt Had Regular Anc Visits At Akola.
27/03/14-Ct Scan Was S/O A Distal Pancreatic Mass 17X14X12Cm ?Neoplasm ?Nhl.Usg Guided Fnac Was Inconclusive
And Tumor Markers Were Negative. No E/O Any Mets.
Pt Referred From Gmc Akola To Jjh On 01/09/14. Pt Delivered Male Baby 2Kg On 1/9/14 .
Post Delivery Ct Scan At Jjh S/O Heterogenous Large Lobulated Mass In Left Pararenal Space With Areas Of Necrosis And
Haemorrhage. Possibility Of A Primary Retroperitoneal Sarcoma More Likely Than Pancreatic Neoplasm. Usg Guided
Biopsy S/O Spen Of Pancreas Which Was Confirmed At Tata Memorial Hospital. Tumor Markers Wnl. Onco Reference
Done. Advised Surgery With Splenectomy Sos Nephrectomy After 15 Days Of Pneumo And Meningococcal Vaccine. Pt Is
Awaiting Surgery.
Differential Diagnosis Of Spen Is Wide And So The Problems With Its Diagnosis, However, Once Diagnosed It Has Excellent
Prognosis Because Of Its Low Malignant Potential . Surgical Resection Is The Standard Of Care There Is No Role Of
Chemoradiotherapy.

***************

Giant Chorioangioma Of Placenta:An Infrequent Placental Cause For Adverse Fetomaternal Outcome
Author: Dr. Neha Bansal
Co Author:

Title- Giant Chorioangioma Of Placenta: An Infrequent Placental Cause For Adverse Feto-Maternal Outcome
Presenting Author-Neha Bansal
Co-Authors- Sheeba Marwah, Harsha Gaikwad, Manjula Sharma, Pratima Mittal
Background-Chorioangioma Is A Relatively Rare Benign Angioma Of Placenta Arising From Chorionic Tissue. Large And
Vascular Chorioangiomas Render A Challenge To Obstetricians With Their Potential Critical Complications Adversely
Altering Feto-Maternal Outcome. Diagnosis Is Suspected Antenatally By Ultrasound And Doppler Studies, And Is
Inveterated By Histopathology Post-Delivery.
Case- Here We Report A Pregnancy Complicated By A Giant Placental Chorioangioma (Transverse Diameter 15.5 Cm) In
A Young Mother, Prenatally Diagnosed At 28 Weeks With Polyhydraminos, And Deranged Liver Function Tests,
Culminating With Preterm Delivery Of A Plethoric Stillborn Fetus, And Intractable Postpartum Hemorrhage In Mother.
Conclusion-Vascularization Of The Tumor Is A Pivotal Determining Factor Of Pregnancy Outcome. High Fetal Death In A
Case Of Giant Chorioangioma Warrants Close Antenatal Surveillance And Institutional Delivery.
***************

Evaluation Of Pelvic Masses By Tas Vs Tvs & Its Operative Correlation

Author: Dr. Mamata Samal
Co Author:

Authors:Dr Arati Behera1,Dr Prosun Bera2,Dr P.Khuntia3

Pgt1,Pgt2,Asso Prof3
Ph No.8895813490
Email-Aratibehera001@Gmail.Com

Aims & Objectives:

1.To Determine Accuracy Of Transabdominal Vs Transvaginal Sonography In Diagnosis Of Different Pelvic Masses.
2.Correlation Of Clinical,Transabdominal,Transvaginal Sonography With Intraoperative Findings As Well As
Histopathological Findings.
Materials & Methods:
It Is A Cross Sectional Study Conducted In Dept Of O & G,Vssmch,Burla From A Period Of Oct 2012-Sep 2014.Total Of 100
Patients With Clinical Suspicion Of Pelvic Masses Were Included In The Study.Detailed History & Clinical Examination
Done Followed By Trandsabdominal & Transvaginal Scanning.
Results: Clinically All I.E. 32 Cases Of Fibroid Were Detected Correctly.But There Was Misdiagnosis In 4 Cases.2 Cases
Adenomyosis & 1 Case Of Fibrosarcoma Were Diagnosed As Fibroid.Tas & Tvs Detected 2 Cases Of Adenomyosis Correctly
But Unable To Diagnose 1 Case Of Fibrosarcoma.Clinically All Ovarian Tumours Were Detected But 3 Cases Were
Misdiagnosed I.E. 2 Cases Of Pcod & 1 Case Of Endometriosis Of Ovary.Tas & Tvs Were Able To Diagnose Correctly Except
2 Cases Of Chylolymphatic Cyst.1 Case Of Didelphus Uterus Was Diagnosed As Ectopic Pregnancy Clinically But Tvs
Diagnosed It Correctly Unlike Tas.Dermoid Cysts , Hematocolpos & Hematometra Were Correctly Diagnosed In All Cases.
Conclusion:Usg Is A Valuable Aid In Assessing Pelvic Masses,Being Nonivasive , Free From Radiation Hazard , Cheap &
Time Saving.Tvs Though Has High Accuracy , Tas & Tvs Are Complimentary Technique Which Should Be Used Together
For Evaluation Of Pelvic Masses.

***************

A Rare Case Of Conjoined Twins With A Single Heart

Author: Dr. Samyukta Gudena
Co Author:

Background: Conjoined Twinning Is One Of The Most Fascinating Human Malformations With An Incidence Of 1 In 49,000
To 1 In 1,89,000 Births. More Cases Are Reported Now Due To The Routine Use Of Fetal Ultrasonography. Still Birth Rate
Among Conjoined Twins Is 40-60%. Considerably, More Males Conjoin In The Womb Than Females; However Females
Are Three Times As Likely As Males To Be Born Alive (3:1). Still Born Conjoined Twins Are Predominantly Males. Conjoined
Twins Show Characteristic Points Of Attachment. Accordingly, 74% Of Conjoined Twins Are Thoracoomphalopagus(34%
Are Omphalopagus And 40% Are Thoracopagus); 18% Are Pygopagus; 6% Are Ischiopagus And 2% Are Craniopagus.
Treating Conjoined Twins Can Be A Daunting Challenge For The Surgeon. Furthermore These Cases Often Raise Religious,
Moral, Ethical And Legal Issues.
Case: A 22Yr Old G3P2L1D1 With Two Previous Caesarean Sections, Presented To Our Opd On 25-03-2013 With 7Months
Of Amenorrhea. She Did Not Remember Her Last Menstrual Period. A Urine Pregnancy Test Confirmed Pregnancy.
Ultrasound Revealed Conjoined Twins With A Single Heart. Mri Confirmed The Diagnosis Of Thoracopagus Conjoined
Twins With A Single Heart.
Conclusion: Separation Surgeries For Conjoined Twins Range From Simple To Complex Depending Upon The Site Of
Attachment. A Conjoined Heart Is A Contraindication Because The Heart Complex Is Usually Inseparable And The Divided
Heart Often Goes Into Congestive Cardiac Failure. Often One Twin May Have To Be Sacrificed To Save The Other; Thereby
Raising Ethical Questions. Parental Counselling Thus Becomes Vital In Further Management.

***************

Intra Hepatic Cholestasis Of Pregnancy With Post Partum Haemorrhage Two Case Reports
Author: Dr. Dheepa Vinayagam
Co Author:

Background
Intrahepatic Cholestasis Of Pregnancy (Icp), Also Known As Obstetric Cholestasis, Is The Most Common Liver
Disease In Pregnancy And Accounts For 0.5% To 1.5% In South Asian Women. Most Commonly It Presents In Third
Trimester With Generalized Pruritus. It Is Associated With Adverse Pregnancy Outcome Intrauterine Fetal Death,
Fetal Distress And Postpartum Hemorrhage. Hereby Presenting Two Cases Of Icp With Postpartum Hemorrhage (Pph).
Case 1
A 24 Years Primigravida With Gestational Diabetes Mellitus Controlled On Diet Presented With Pruritus And
Severely Elevated Liver Enzymes At 35 Weeks Of Gestation. She Was Induced With One Dose Of Dinoprostone And
Delivered Vaginally A Pre Term Male Baby Of 2.336 Kg. Intra Partum Patient Developed Atonic Pph And Was Managed
With Uterotonics. Immediate Postpartum, Packed Red Blood Cells And Fresh Frozen Plasma Concentrates Were
Transfused For Acute Blood Loss And Deranged Coagulation Profile.
Case 2
A 23 Years G2A1 Was Diagnosed With Icp At 37 Weeks Of Gestation And Was Induced With Three Dose Of
Dinoprostone And Taken Up For Lscs. She Delivered A Healthy Term Male Baby Of 3.25 Kg. Intra Operatively Patient Had
Atonic Pph For Which She Required Uterotonic Drugs & B- Lynch Sutures. She Was Transfused With Packed Red Blood
Cells And Fresh Frozen Plasma Concentrates.
Conclusion
Intrahepatic Cholestasis Of Pregnancy Also Known As Pruritus Gravidarum Has Maternal And Fetal
Complications.The Adverse Fetal Outcomes Tend To Be The Primary Concern Influencing Management Of Women With
Icp. In Both Our Cases Though The Fetal Outcome Was Good Because Of Extensive Monitoring, Both Patients Had
Postpartum Hemorrhage. Our Case Reports Thus Enforce Diligent Monitoring Of The Fetus And Optimum But Aggressive
Treatment Could Reduce The Mortality Rates In This Appalling Disorder.

***************

Ruptured Noncommunicating Rudimentary Horn Pregnancy At 18 Weeks With Previous Cesarean Delivery: A Case
Report
Author: Dr. Leela Regalla
Co Author:

Background:
Rudimentary Horn Is One Of The Rarest Congenital Uterine Anomalies And Consists Of Relatively Normal Appearing
Uterus On One Side And Rudimentary Horn On Other. Pregnancy In Non Communicating Rudimentary Horn Of
Unicornuate Uterus Is Very Rare With An Incidence Of 1 In 76000150000. It Occurs Following Transperitoneal
Migration Of Sperm/Zygote. Uterine Rupture Usually Occurs In 70-80% Of Cases In Second Trimester By 20 Weeks.
Prerupture Diagnosis Of Pregnancy In Rudimentary Horn With Ultrasonography Is Technically Difficult. We Report A Case
Of Ruptured Non-Communicating Rudimentary Horn At 18 Weeks In A Woman With Previous Lscs.
Case Report:

A 28 Year Old, G2P1L1 With 18 Wks Ga With One Previous Lscs Referred From Pvt Hospital In V/O Pregnancy In NonCommunicating Rudimentary Horn With ? Rupture. Patient Was Admitted In A State Of Shock. Abdomen Was Nearly 2022 Weeks. Cervix And Vagina Were Healthy With No Bleeding Through Os. Size Of Uterus Could Not Be Assessed Due To
Intense Guarding.PatientS General Condition Was First Stabilized. On Emergency Ultrasound, Dead Fetus Floating In
Abdominal Cavity With Gross Free Fluid Was Found. An Unicornuate Uterus With Ruptured Non-Communicating
Rudimentary Horn Was Noted. Emergency Laparotomy Decision Was Taken. Intraoperatively, Gross Hemoperitoneum,
Of Nearly 1.5 Lit Was Drained. A Unicornuate Uterus With Rupture Of Noncommunicating Rudimentary Horn With Dead
Fetus Was Found. There Was No Endometrial Cavity In Non-Communicating Horn. Both Ovaries And Tubes Were Normal.
Excision Of Rudimentary Horn With Ipsilateral Salpingectomy, And Peritoneal Toileting Done. Patient Received Five Units
Blood. She Had Uneventful Recovery With Discharge On 7Th Pod.
Conclusion
Pregnancy In Non Communicating Rudimentary Horn Is Rare And Carries Grave Consequences For The Mother And Fetus.
Therefore, High Index Of Suspicion Is Warranted To Detect This Rare And Important Complication Of Pregnancy Before
Uterine Rupture.

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Author: Dr. Maansi Jain

Co Author:

Tittle: A Rare Case Of Uterine Malignancy Of Mullerian Origin - Case Report & Review
Dr Maansi Jain, Prof Nutan Chandwaskar Assoc. Prof Neta Natu : Shri Aurobindo Institute Of Medical Sciences And Pg
Institute Indore
Background
Mixed Malignant Mullerian Tumor (Carcinosarcoma) Is A Biphasi Tumor Composed Of Epithelial And Mesenchymal
Tissue. It Is Rare, (<5% Of Uterine Tumors) But Is Responsible For 16.4% Of All Deaths Caused By Uterine Malignancies
Because Of Its Aggressive Nature. Presentation Is Always Short With A Fulminant Course In Post Menopausal Age Group
With A Typical Triad Of Pain Bleeding P/V And Passage Of Necrotic Tissue P/V.
Case Study:
Our Case Had A Atypical Presentation - Abdominal Lump (22 Wks Uterine Mass) , Urinary Retention With No
Postmenopausal Bleeding. Usg, Ct Revealed A Complex Cystic Uterine Mass, Normal Adnexa, No Lymphadenopathy,
Ascites Or Infiltration. Eb Was Negative For Malignancy But Because Of Its Fulminant And Short History In
Postmenopausal Age Group A Presumptive Diagnosis Of Carcinosarcoma Was Made.Tah Was Done .Macroscopic
And Microscopic Examination Confirmed The Diagnosis Mixed Malinant Mullerian Tumor - Homologous Type
With Focal Infiltration Of Myometrium And Serosa And Tumor Was Staged T1Cnxmx.
Disscussion:
Review Articles By Various Societies Have No Consensus Or Guidelines Regarding Treatment Planning Of
Carcinosarcoma. Treatment Options Include Surgery Alone, Surgery With Adjuvant Chemotherapy Or Surgery With
Adjuvant Radiotherapy. Aim Of This Case Presentation Is To Report This Rare Tumor With Atypical Clinical Features
, Negative Eb But A
Characteristic Short And Fulminant Presentation In Postmenopausal Age Group And Its
Management And Followup With A View To Help Formulate Treatment Guidelines.

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