Background: Bacterial Vaginosis is one of the most common causes of abnormal vaginal discharge in women of reproductive age, which can have a major impact on quality of life. Although the treatment course of oral metronidazole for 7 days results in curative rate of 70%–80% at four weeks of treatment, but is associated with high rates of recurrence occurred within twelve months, reaching up to 40%–50%. Methods: A Randomized Prospective Interventional Study was done on 1000 reproductive age group females (pregnant or non-pregnant) diagnosed with bacterial vaginosis from November 2020 to October 2022 at department of Obstetrics & Gynaecology, Kanpur. The study group were divided into two subgroups - Group 1 were given metronidazole 500 mg for 7 days and probiotics for 14 days and group 2 were given metronidazole 500 mg for 7 days and placebo for 14 days. The patients were followed after 3 months to know the recurrence. Results: Majority of patients belonged to rural background (63.1%) with lower socioeconomic (46.6%) and belong to age group 20-35 years. It was observed that there was significant change in Amsel’s criteria and Nugent’s scoring in Group 1 as compared to Group 2. The rate of recurrence at the end of the treatment for Amsel’s criteria in group 1 were 1.03 as compared to group 2 was 1.68 and for Nugent’s scoring, the rate of recurrence at the end of treatment in group 1 was 3.17 as compared to group 2 was 4.78. Conclusion: Probiotics can be considered as one the adjuvant therapy for treating bacterial vaginosis and re-establishing equilibrium in the vaginal microflora thus, preventing the recurrences.
Introduction: Severe Acute Maternal Morbidity (SAMM) is a tool which is more advantageous compared to maternal mortality as an indicator of obstetric care. The global MMR shows a reduction from 342 to 211 death per 1 lakh live birth from 2007 to 2017 with a 38% over 10 years. Under Millennium development goals (MDG)-5, goal was to reduce maternal mortality by 75% between 1990-2015. By the end of year 2020 MMR in India was 97 per lakh. Now the Sustainable development goal (SDG) is to reach MMR below 70 by 2030. Aims and Objectives: * To as certain the incidence of maternal near-miss indices * To as certain the reasons behind maternal mortality * To as certain the occurrences of near-miss instance Materials and Methods: A retrospective study was conducted at Cheluvamba hospital, Mysore, Karnataka, India during January 2022 to December 2022. Maternal fatalities and near miss incidents are included in the study population. Case definitions were made using the 2009 WHO criteria. Diagnoses of life-threatening illnesses were made, and cases that satisfied WHO 2009 criteria were chosen. Analyses of maternal mortality from the same time frame were also conducted. Anemia and other medical conditions were viewed as secondary causes leading to the mother's near-miss and death, while hemorrhage, hypertension, sepsis, and other conditions were classified as primary causes for patients based on their final diagnosis. Results: In our Institute, 8632 deliveries took place. In this study, the MMR was 251/100,000 live births, while the MNMIR (Maternal Near Miss Incidence Ratio) was 14/1000 live births. The ratio of MNM to MM was 5.7:1. The MI (total mortality) was 14.8%. The ratio of severe maternal outcomes to live births, or SMOR, was 16.8/1000. Hypertensive disorder (42.85%) was the leading cause of maternal mortality, with antepartum eclampsia being the main leading cause in our setup, followed by hemorrhage (19.04%). Among the near miss events, hypertensive disorder was the leading cause with 49.16%, followed by hemorrhage (31.66%), severe anemia, and abortion, which account for approximately 7.5%. Conclusion: Maternal morbidity and mortality can be decreased by recognizing the risk factors, identifying high-risk cases, promptly referring them, and stabilizing the referral system.
Background: Hypertension in pregnancy, called a disease of degree is more of a sign than a disease by itself. Hypertensive disorders of pregnancy, including chronic hypertension, with or without superimposed pre-eclampsia/eclampsia, gestational hypertension, HELLP syndrome, pre-eclampsia with or without severe features or eclampsia present a significant risk of morbidity to both mother and fetus. Effective pharmacologic therapy modifies the course of the disease. The effective use of anti-hypertensive therapy should be based on well designed controlled clinical trials and the experience of the clinician with the drugs. Hypertensive disorders complicate 5-10% of all pregnancies worldwide. 1 Dangerous hypertension is a harbinger of cerebrovascular accidents, eclampsia, hypertensive encephalopathy and other end organ damage with a poor perinatal outcome. 2 Methods: This prospective randomized double blind comparative clinical trial with randomization done using computer generated numbers study was carried out in 100 cases being brought in OBG department of AL Ameen Medical College, Bijapur, from July 2023 to December 2023. A detailed data of sociodemographic profile, general examination and obstetric examination were carried out. The pregnant women were randomized with computer generated numbers into two groups to receive either oral nifedipine or intermittent intravenous labetalol injections. Results: There is no significant difference in the parity of both the groups. Majority of the patients constituting 80% of group A and 58% of group B were primigravida. 69% enrolled in the study were primigravida. There is a higher incidence of pre-eclampsia in the first pregnancy. The majority of the patients had gestational age of 34 to 36 weeks constituting 48% on the whole with 50% and 46% respectively in group A and B. The recruited patients did not significantly differ in gestational age
Ovarian ectopic pregnancy is rare and constitutes around 3% of all ectopic pregnancies. Its presentation is similar to tubal ectopic pregnancy and is difficult to diagnose based on the presentation and ultrasound findings. Here, we describe one such case which we encountered in our practice. Primigravida patient at early gestation presented with vaginal spotting and pain in lower abdomen. She was suspected as ruptured ectopic pregnancy based on examination and ultrasound findings. Immediate laparotomy was performed and patient was diagnosed to have ruptured ovarian pregnancy intraoperatively. Partial ovariotomy was performed and the case was successfully managed. Histopathology confirmed the diagnosis. Surgery is the mainstay of definitive diagnosis and treatment. Identifying these cases early is imperative as such patients can collapse suddenly and there are high chances of maternal morbidity and mortality.
Background: Women who had undergone hysterectomy have to overcome problems related to physical, social and emotional well being. As the hysterectomy is one of the most common surgeries, a study was conducted to answer the question for the optimal surgical recovery. This study aims to describe the relationships between recovery time and the components of quality of life after hysterectomy. Aims and Objectives: To study the physical, social, and emotional well being of post hysterectomised patient. Methodology: Study was conducted in Department of Obstetrics and Gynaecology at Bharati hospital, Pune. It was a prospective observational study of patient related outcomes to study the physical, social, and emotional well being of post hysterectomised patient. Post hysterectomized women above 40 years were included in this study. 196 post hysterectomised women were included. Study was conducted from October 2021 to January 2024. Results: From third month onwards, degree of difficulty of majority of patients was reduced in all mentioned activities. Majority of cases there was gradual health improvement noted. The pain score was reduced over 3 months in 92% cases and in almost all patients over 6 months. Conclusion: It is important to assess quality of life after any surgery, so timely intervention suchasphysiotherapy, counselling,psychotherapy and medical therapy canaidin improvement of both physical and emotional health for betterment of patient care.
Background: Xanthogranulomatous salpingo-oophoritis is an infrequent and challenging diagnosis of the female genital tract. It involves the destruction of the fallopian tube and ovarian tissue by infiltrating inflammatory cells comprising lipid laden macrophages, lymphocytes, plasma cells, and multinucleated giant cells. While more commonly found in gall bladder and kidney, its occurence in female genital tract is rare. This is a case of Xanthogranulomatous salphingo-oophoritis in a 48 year woman who presented with chronic lower abdomen pain and frequent heavy menses for two months. On per abdomen examination a non tender 24 weeks size mass was felt and on vaginal examination the same mass was appreciated, seperate from the uterus. PAP was reported NILM. Ultrasound revealed uterine adenomyoma with bilateral endometrioma of ovaries and associated left hydrosalphinx. Patient underwent hysterectomy with bilateral salphingo-oopherectomy. Histopathological examination revealed uterine adenomyosis, chronic cervicitis with xanthogranulomatous salpingo-oophoritis. The patient recovered well and doing good on follow-up. Conclusion: Xanthogranulomatous salpingo-oophoritis, though rare is a significant entity because clinically it can mimic chronic pelvic inflammatory disease or endometrioma and even in some cases malignancy. Even clinical examination and imaging might not help much. Therefore, knowledge and awareness about the condition with the help of histopathology can clinch the diagnosis and also prevent radical cancer surgery
Background: A High risk pregnancy is identified as pregnancy in which there is a risk of adverse outcome in the mother and / or baby that is greater than the incidence of that outcome in general population. All pregnancies are at risk even though most of the pregnancies and childbirth worldwide are uneventful. Almost 15% of all the pregnant women can develop potentially life-threatening complications which mightrequire skilled care with some requiring major intervention for survival. Methods: This prospectivestudy was carried out in 220 cases being brought in OBG dept of AL Ameen Medical College, Bijapur, from July 2023 to December 2023. A detailed data of sociodemographic profile, general examination and obstetric examination were carried out. Results: Of the 220 antenatal cases studied, 99 cases (45%) of them had pre-eclampsia. Malpresentation pregnancies contributed to about 36% of cases and Anemia were seen in 13 cases (6%). The mode of delivery was caesarean section in 70 cases (31.2%). Normal vaginal delivery were done in 94 cases (42.8%). Instrumental deliveries were seen in 11 cases (5%). Conclusion: High risk pregnancy, Caesarian section, Normal vaginal delivery of active phase of labour by making cervical dilatation faster and lowering the duration of usage of labour analgesics, which makes labour a pleasant experience for woman.
Introduction: Labour pain is one of the most severe types of pain ever to be experienced. Entonox is a nitrous oxide (N2O), a self administered patient controlled inhalational analgesia. Our research is focused to study about this aspect of Entonox that is reduction in the duration of labour by making cervical dilatation faster. The aims and objectives of our study was to determine the effect of entonox on duration of first stage of labour and to determine the effect of entonox on rate of cervical dilatation. Methodology: A prospective observational study was carried out Pushpagiri Institute of Medical Sciences and Research Centre in Kerala, India, for a period of 6 months consecutive sampling: sample size obtained is 20 per group, grouped them into two groups depending upon the analgesic of choice. The study tool was a Performa and variables entered into Microsoft excel spreadsheet and analysed SPSS 18.0 software package. Results presented as frequency and percentages for categorical data and descriptive statistics for continuous data. The duration of labour was presented as mean and SD and cervical dilatation rate is calculated as cm in dilatation divided by duration of first stage and this also was presented as mean and SD. These two outcome variables was compared between entonox and control Mann-Whitney U Test. Results: There was 20 study participants each in the two groups. 10 primigravidas and 10 multigravidas, with mean age was 28.15 ± 2.66 years and majority of them belong to normal BMI. Although there was no difference with respect to the cervical dilatation at the onset of usage of Entonox, it was observed that there was significant reduction in the duration of labour and usage of Entonox as there was a increase in cervical dilatation rate when compared to women who chose other analgesics. All these factors also found to be statistically significant. Conclusion: A part from analgesic effect nitrous oxide also is shown to decrease the duration of active phase of labour by making cervical dilatation faster and lowering the duration of usage of labour analgesics, which makes labour a pleasant experience for woman.
Background: Maternal perception of reduced fetal movements (RFM) is associated with increased risk of still birth, preterm labor & fetal growth restriction. RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen & nutrient transfer resulting from placental insufficiency. Intrauterine fetal death is preceded by RFM for 24 hours in up to 50% cases. In infants who are alive at presentation, RFM is associated with increased incidence of still birth, fetal growth restriction & feto-maternal hemorrhage. However RFM is may also occur in non pathological conditions such as anterior placental site, increased maternal activity & standing position. Inadequate clinician response to complaint of RFM is important contributory factor to still birth. Aims and objectives: To assess association between maternal perceptions of reduced fetal movements and fetal outcome. Methodology: Study was conducted in Department of Obstetrics and Gynecology at Bharati hospital, Pune. It was a prospective observational study of fetal outcomes in mothers perceiving reduced fetal movements. Women after 28 weeks of pregnancy presenting with reduced fetal movements out of that 202 pregnant women were included. Study was conducted from October 2020 to October 2022. Results: Majority of the fetuses were healthy. There was strong association between reduced fetal movements and Oligohydramnios. We found significant association between NICU admission, birth weight, APGAR, and RFM category, while no significant association between RFM category and status at birth and type of delivery. There were 2 IUD’s noted. Conclusion: Fetal movements monitoring is necessary during antenatal period, after 28 weeks of pregnancy, it is a good predictor of fetal outcome, and helps in timely intervention.
The yolk sac and the allantois give rise to and are preserved in the umbilical cord. By the fifth week of development, it has formed and is the embryo's new source of nutrition, taking the place of the yolk sac. The cord joins the placenta, which transports substances to and from the mother's blood without allowing them to directly mix, rather than being directly attached to the mother's circulatory system. The umbilical cord can be clamped at various times, although postponing it until at least one minute after delivery improves results, provided that the minor risk of jaundice can be treated if it does occur. Clamping is followed by a painless cord cutting procedure because there are no nerves present. Out of those 20 studies, only 5 studies discuss the risk associated with delayed cord clamping, 2 studies discuss the benefit associated with good nutritional status, 2 studies discuss the benefit associated with good neurodevelopment, and the remaining studies discuss the increase in hemoglobin due to delayed cord clamping.
Aim & Objective: Demographic datas like the patients age, gestational age, admission BP, blood and urine investigation, neuroimaging, Management, mode of delivery, neonatal and maternal outcomes were analysed in patients presenting with eclampsia in a tertiary care centre. Introduction: The onset of convulsions in a woman with pre eclampsia that cannot be attributed to other causes is termed eclampsia. Eclampsia is a major cause of maternal and neonatal morbidity and mortality. Magnesium sulfate is the drug of choice for reducing the rate of eclampsia and also to prevent recurrent convulsions in eclampsia. Materials and Methods: The study was conducted retrospectively on cases presenting with eclampsia in the OBG department, Government Rajaji Hospital for a period of 6 months from July 2019 to December 2019. Results: During the 6 month study period, total 26 cases of eclampsia was reported out of 5843 deliveries (0.4%). Total 657 cases of hypertensive disorders of pregnancy (11.2%) was reported out of which 65 cases were severe pre-eclampsia (9.8%). 65% (11) of eclampsia presented as Antepartum eclampsia, 30.7%(11) cases presented as postpartum eclampsia, 3.8%(1) case as intrapartum eclampsia. One case presented as both antepartum and postpartum eclampsia. No case of maternal mortality was reported during the study period. Conclusion: Early detection of cases of pre-eclampsia and imminent eclampsia, proper evaluation and treatment with anti-hypertensives and Magnesium sulphate will reduce the occurrence of eclampsia. Multidisciplinary approach in a tertiary care centre can reduce the maternal mortality and morbidity. Proper knowledge of management of eclampsia can reduce the mortality. IV labetalol and its careful use is mandatory. Perinatal mortality is high mainly because of prematurity.
Background: Hypertensive disorders of pregnancy are among the most common medical problems in pregnancy with an incidence of between 5-10%.1 The incidence varies amongst different hospitals, regions and countries. Hypertensive disorders in pregnancy are a major cause of maternal and perinatal morbidity and mortality worldwide. Methods: This prospective observational study was conducted by the department of OBG at Sri Muthu Kumaran medical college hospital and research institute, Shikkaraya puram Chennai from December 2019 to May 2020. Results: Out of 100 subjects enrolled into the study, Primigravidas constituted for 66% of pregnancies and multigravidas constituted for 34% of pregnancies. Maximum cases 60 (60%) were in the age of 25-30 yrs followed by 22 (22%) in the age group <20 years. The mean age of the patients was 24.57(SD 6.54) years. Caesarean was the most common mode of delivery constituting for 70% of deliveries where as vaginal delivery constituted for 30% of cases.
Aims and objectives: • To use Robson’s Ten Group Classification System to evaluate caesarean sections in present institution. • To understand the reasons behind the CS rates for different groups of Ten Group Classification System specific to present institution. Study Design and Settings: The prospective observational study conducted for a period of one year from 15th July 2020 to 15th July 2021 which included all women admitted in the labour room of GMERS medical college and general hospital, Gotri, Vadodara, Gujarat for delivery over in the analysis. Methods and Material: The data compilation and statistical analysis was performed according to Robson’s Ten Group Classification using Microsoft excel version 2011 and Med Calc software. For each group, we have calculated the caesarean section rate within the group and its absolute and relative contribution to the overall caes arean rate. Results: A total 1768 patients delivered in the present institute and out of which 1069 were vaginal deliveries and 699 were caesarean section over this study period of one year. The overall caesarean section rate (CSR) was 39.54%, maximum contribution to total CS was from group 5, followed by group 1, group 2, group 10, and group 3. Less contribution from group 4, group 7, group 6, group 8 and least from group 9. Group 1, 2, 3 & 4 were low risk group.
Background: Pre-eclampsia is the leading reason for referrals to a specialized healthcare facility, as it represents a significant contributor to maternal and perinatal morbidity and mortality. Objective: The objective of this study is to examine the maternal and fetal outcomes associated with severe pre-eclampsia in a Tertiary Care Center. Design: Prospective observational study. Methodology: This prospective observational study took place at Dr. Prabhakar Kore Hospital and MRC, located in Belagavi and affiliated with KAHER's Jawaharlal Nehru Medical College, Belagavi. The study spanned from January 1, 2021, to December 31, 2021. Pregnant women diagnosed with severe Pre-eclampsia, which met the specified inclusion and exclusion criteria, and were admitted to the labor room at the tertiary care center, were enrolled in the study. Results: Participants in the study ranged in age from 19 to 41 years, with a mean gestational age at diagnosis of 35.32 weeks ±3.7 weeks. Among the participants, 73.4% underwent lower segment cesarean section (LSCS), while 22.4% had vaginal deliveries, including 3 cases with instrumental delivery (ventouse). The study observed increased incidences of Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome (32.4%), placental abruption (30%), postpartum hemorrhage (22%), partial HELLP syndrome (16.2%), pulmonary edema (11%), eclampsia and disseminated intravascular coagulation (DIC) (8.1%). The incidence of prematurity was 55%, and intrauterine fetal demise (IUFD) occurred in 7% of the cases. Conclusion: Maternal and perinatal problems are more common in eclampsia patients. Better prenatal care, early detection, and timely treatment of severe pre-eclampsia can lower the incidence of eclampsia.
Background:- Fever in pregnancy is a common clinical problem worldwide. The risk to the mother and fetus is significantly increased in pregnancy complicated by infection and fever. Aim and objective:- To determine etiological spectrum of febrile illnesses in pregnancy and its association with maternal & fetal outcomes. Methodology :- Prospective observational study was conducted in the Department of obstetrics and gynecology in a tertiary care center in western Maharashtra. A total 105 pregnant women reported with fever during the study periods, out of which 37 were followed up longitudinally till delivery and were included in the study analysis. Results:- In the present study, Fever of unknown origin(32.43%), Dengue(24.32%), COVID-19 (24.32%), Urinary tract infections(16.21%) Malaria(2.7%) were the common cause of febrile illness. Out of 37 pregnant women with febrile illness, 31 (83.8%) had live births, 5 (13.5%) had intrauterine death (IUD) and there was one case of abortion. In 10 (27%) patients, there was a requirement for NICU admission. It was observed that more is the number of febrile episodes higher is the chance of neonatal morbidity and mortality. Conclusion :- High grade fever with multiple febrile episodes due to any underlying etiology in pregnancy is harmful to the fetal-maternal health.
Background: Early identification of sepsis is essential as the mother has a risk of chorioamnionitis. C-reactive protein levels are done along with placental histopathology to detect chorioamnionitis. It is one of the most significant causes of high perinatal morbidity and mortality. Aim and Objective: To determine c-reactive protein levels and placental histopathology in premature rupture of membranes for maternal chorioamnionitis. Methodology: A prospective study was conducted in a tertiary care university medical college hospital and research center in western Maharashtra. A total of 250 pregnant women were reported per vaginal leak during the study period and CRP levels were sent along with urine culture sensitivity and high vaginal swab, post-delivery the placenta was sent for histopathology and were included in the study analysis. Results: The histopathology was done in all 250 pregnant women, and chorioamnionitis was evident in 46 pregnant women. This gives the incidence of 18.4% of chorioamnionitis in the study population. The sensitivity for CRP was calculated to be 15.22%, with a specificity of 99.02%, positive and negative predictive values of 77.78% and 83.82%, respectively, with an accuracy of 83.60%. Conclusion: Normal CRP level has good predictive values to rule out maternal chorioamnionitis. A raised single CRP level has low sensitivity to predict histological chorioamnionitis prior to its clinical expression.
Background: Multiple pregnancy is defined as pregnancy with 2 or more fetuses. It is termed as twins for 2 fetuses, triplets for 3 fetuses, Quadruplets for 4 fetuses, Quintuplets for 5 fetuses, Sextuplets for 6 fetuses and Septuplets for 7 fetuses and so on. The incidence of multiple pregnancies varies significantly. In several overview studies (since the early 1970) it was found that natural twinning rates were less than 8 twin births per 1000 births in East Asia and Oceania, 9-16 per 1000 births in Europe, USA and India and 17 and more per 1000 births in African countries. Methods: This prospective observational study was conducted by the department of OBG at Sri muthukumaran medical college hospital and research institute, Shikkarayapuram, Chennai from December 2019 to May 2020. Results: Primigravidas constituted for 43% of pregnancies and multigravidas constituted for 57% of pregnancies. The maximum cases 42 (42%) were in the age of 25-29 yrs followed by 31(31%) in the age group 21-24 years. The mean age of the patients was 26.87 (SD 9.67) years. The discordant growth constituted for 12% of pregnancies in both monochorionic and dichorionic twins where as it was absent in 88% of cases.
Background: The aim is to examine bacterial vaginosis (BV) in women with preterm and term labor, explore the link between bacterial vaginosis and preterm labor (PTL), and analyze complications for both mother and baby related to bacterial vaginosis. Design: Hospital based cross sectional study. Materials and Method: We had conducted an observational study at Basaveshwara Medical College and Hospital, involving 100 pregnant patients with preterm and term labor (50 patients in each group). Eligible patients attending the Obstetrics and Gynecology Outpatient Department (OBG OPD) and inpatient department will be included. Bacterial vaginosis will be determined using Amsel's criteria, which include evaluating discharge characteristics, vaginal pH, amine odor with KOH test, and presence of clue cells under microscopic examination. Additionally, vaginal swabs will undergo Gram staining. Results: The percentage of patients meeting Amsel's criteria for diagnosing bacterial vaginosis was significantly higher in the preterm labor group compared to the term labor group, with a statistically significant difference. According to Amsel's criteria, the prevalence of bacterial vaginosis was 30% in the preterm labor group and 2% in the term labor group. Conclusion: Bacterial vaginosis is a significant risk factor for preterm labor. Hence, conducting tests for bacterial vaginosis and promptly treating it can help reduce the risk of preterm labor.
Bladder perforation during laparoscopy is a seldom recognized, uncommon complication. We present a case of distended urosac bag secondary to bladder injury. Repair was done laparoscopically in two layers, Catheter was kept for 3 weeks. Patient had no complaints later on.
Pregnancy induced hypertension (PIH) is a type of hypertension that occurs during pregnancy, affecting 6-10% of pregnancies. The study aimed to evaluate the role of Beta Human Chorionic Gonadotropin (β-hCG) levels in second trimester in predicting the on set of pre-eclampsia. The study population included 120 pregnant women in their second trimester who were normotensive and non-proteinuric, selected using consecutive sampling. The blood pressure of the participants was monitored, and the occurrence of pre-eclampsia, method of delivery, gestational age, and fetal outcome were documented. The level of Beta HCG was measured using the ELISA method, and the results were statistically analyzed. Among a total of 120 pregnant women were analyzed, with 21.5% having hypertension in pregnancy. The results showed a relationship between maternal serum β-hCG levels and the development of Pregnancy Induced Hypertension (PIH), but the sensitivity was only 25% with a specificity of 75.93%. The study found that β-hCG MOM levels alone are not a highly reliable predictor for PIH, with the model having limited ability to differentiate between women who develop PIH and those who don't. The study also showed a strong statistical association between gestational age and NICU admission as potential risk factors for the development of PIH. In conclusion, β-hCG levels may have some utility in predicting PIH, but further studies are needed to determine the most effective markers and understand the underlying mechanisms.
