Study of gestational trophoblastic diseases at a tertiary care hospital in India

Background: Gestational trophoblastic disease refers to the heterogeneous group of interrelated lesions that arises from abnormal proliferation of placental trophoblasts. GTNs are among the rare human tumours that can be cured even in the presence of widespread dissemination. Although GTNs commonly follow a molar pregnancy, they can occur after any gestational event, including induced or spontaneous abortion, ectopic pregnancy, or term pregnancy. The study was conducted to know the incidence of different types of gestational trophoblastic diseases in the local population and the percentage of people ultimately requiring chemotherapy.Methods: The retrospective analysis of case record of 124 women with a diagnosis of GTD admitted to Karnataka Institute of Medical Sciences Hubli between November 2008 to November 2017.Results: A total of 124 cases of GTD were reviewed. Hydatidiform mole was diagnosed in 91 patients; of those experienced spontaneous remission after evacuation. 04 patients had persistent gestational trophoblastic Neoplasia and 13 cases of invasive mole (GTN) 1 case of epitheloid trophoblastic tumors and 15 cases of choriocarcinoma 99 (80%) had low-risk GTN, 25 (20%) had high-risk GTN.Conclusions: Hydatidiform mole was found to be the most common form of gestational trophoblastic diseases. Majority of the cases got cured by simple surgical evacuation. During the course of our study some rare cases of gestational trophoblastic diseases were noted. Patients’ compliance for serial follow up is a highly challenging task in developing countries. Registration of women with GTD represents a minimum standard of care

Hysterolaparoscopy in the evaluation and management of female infertility

Background: To study the role of hysterolaparoscopy in the evaluation and management of female infertility.Methods: A retrospective study of the 677 case files of all the patients who underwent diagnostic hysterolaparoscopy for infertility between January 2011 to December 2016 at Karnataka Institute of Medical Sciences, Hubli and Sushruta Multispeciality hospital, Hubli. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interven-tions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized.Results: Out of 677 cases, 74% patients had primary, 26% patients had secondary infertility. As a whole pelvic pathology was confirmed in 59.5% and intrauterine pathology in 22.3% patients by hysteroscopy. The most common laparoscopic abnormality detected was Polycystic ovaries (27.1%), followed by pelvic adhesions (18.7%). Tubal block comprised 8.1% whereas distorted uterus by fibroid in 6.2% and pelvic endometriosis in 8.7%. In hysteroscopy, the incidence of uterine anomaly was 54 (7.9%). Septate uterus is the most common with a mean incidence of approximately 37 (67.8%).Conclusions: Diagnostic hysterolaparoscopy is an effective diagnostic and therapeutic modality for certain significant and correctable abnormalities in pelvis, tubes and uterus which are missed by other imaging modalities

Sexually transmitted diseases in laboring women: trend over a decade

Background: Center for Disease Control (CDC) recommends routine screening in all pregnant women at first visit for syphilis, HIV, Hepatitis B infection as they have high vertical transmission rate. Syphilis is brought to control by screening and early treatment with penicillin, whereas HIV and Hepatitis B are incurable viral infections till date. Hence prevention is the only way to control the disease in the population. The purpose of the study is to know the burden of sexually transmitted diseases, so that prevention programme is better planned.Methods: This is a retrospective analytical study conducted from January 2005 to December 2014, in Karnataka Institute of Medical Sciences, Hubli, Karnataka. All the patients who delivered in septic ward, who were more than 28 weeks of gestation and who were HIV, HBsAg or VDRL positive were included in the study.Results: Among the total of 79,472 deliveries, the prevalence of HIV, HBsAg and VDRL were 0.90, 1.06 and 0.31 respectively. There were 4 cases of co-infection. The prevalence of HIV was 0.79 in 2005 and reached its peak of 1.33 in 2008 and then showed a steady decrease, reaching a lowest of 0.52 in 2014. The prevalence of HBsAg was 0.70 in 2005 and reached a peak of 1.57 in 2014. The prevalence of VDRL was highest of 0.08 in 2005 and lowest of 0.02 in 2014. Highest operative deliveries were seen in HBsAg positive women. Stillbirths were maximum in VDRL positive women and least in HBsAg positive women. There were 9 maternal deaths in HIV positive women and 3 maternal deaths in HBsAg positive women.Conclusions: In our study HIV prevalence is showing a down trend and syphilis is at the verge of elimination as seen globally. However prevalence of Hepatitis B has shown a rising trend over a decade in our institute, unlike a down trend seen globally. Intensifying the screening of Hepatitis B in pregnancy and Immunisation programme of neonates, reducing overcrowding and providing better living conditions, improving hygiene and health education should be done in order to reduce the prevalence of Hepatitis B infection

11 year retrospective study of tubal reanastomosis by microsurgical technique

Background: Tubal reanastomosis is a procedure to anastomose the cut ends of the fallopian tube. Laparotomy is the most frequently used microsurgical technique for this reversal, with results showing intrauterine pregnancies ranging from 50 to 80% and a rate of ectopic pregnancy less than 5% in these series. The objective of this study was to determine the pregnancy rate and live birth rate achieved through laparotomy tubal reanastomosis.Methods: Data from 152 consecutive laparotomy tubal reanastomosis procedures done between January 2004 and December 2014 were retrospectively analyzed. All procedures were performed by the same surgeon by laparotomy using microsurgical instruments. The main outcome measures were: total pregnancy rate and live birth rate.Results: Out of 152 women, who were willing for reversal operation, 4 had fimbriectomy, 8 had residual tube length <4 cm. Remaining 140 patients underwent tubal reanastomosis. 2 patients died, 2 patient’s husband died, 22 patients were lost to follow-up, and 9 are still in follow up period. Hence 105 patients were analyzed. Total pregnancy rate was 82.8% and live birth rate 73.3%.Conclusions: Tubal reanastomosis by laparotomy with microsurgical instruments results in a satisfactory pregnancy rate

Study of mullerian anomalies over 5 years in a tertiary care centre

Background: Mullerian anomalies-developmental anomalies of the mullerian system might involve the uterus, cervix, fallopian tubes and vagina of which anomalies of the uterus are the most common. They are often regarded as a treatable form of infertility and have a prevalence of 0.5% in the general population. Though most of them remain asymptomatic, they contribute a good proportion of recurrent pregnancy losses, obstetric complications and infertility. Their timely diagnosis, management and evaluation of associated anomalies proves to be necessary.Methods: A prospective observational study was undertaken at KIMS, Hubli from 2014 to 2018. The study involved those women who were admitted in the department of obstetrics and gynecology at KIMS, Hubli for various reasons and were detected to have a mullerian anomaly. Their mode of presentation, method of detection, associated anomalies were analysed and statistical conclusions drawn from the same.Results: During the study period of 5 years, a total of 85 cases of mullerian anomalies were detected amounting to an incidence of 0.15%. 35% of them were asymptomatic, infertility (24%) being the next common mode of presentation. Septate/sub-septate uterus was found to have the poorest obstetric outcome. Mullerian anomalies were seen in combination in 14% of the cases and had an association with other anomalies like renal anomalies in 10% of the cases. Surgical correction was done for most of the cases of vaginal septum and septate/sub-septate uterus.Conclusions: Mullerian anomalies are often regarded as an uncommon but treatable form of infertility. Their timely detection, treatment and watchful obstetric management is in need

Evaluation of postpartum intrauterine contraceptive devices (IUCD) insertion: 5 years study

Background: The intrauterine contraceptive device (IUD) primarily in the form of copper T is used by more than 150 million women around the world making it the most widely used reversible method of contraception with a remarkably low failure rate of less than 1 per 100 women in the first year of use for cu T 380 A. It is more suitable for a country like India which is in urgent need of population control methods.Methods: A Prospective observational study was under taken where in a series of women who delivered either vaginally or through caesarean section during the period of November 2013 to October 2017 in the Department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli counseled for PPIUCD insertion were included in the study. Mothers who were suffered from Chorioamnionitis, Puerperal sepsis, Postpartum haemmorrhage, PROM more than 18 hours, extensive genital trauma, uterine abnormalities, Multiple sexual partners and obstructed labour were excluded from the study. Since it was a time bound study, a total of 16009 cases were enrolled in the study after counseling them.Results: A total of 16009 women were counseled to undergo PPIUCD, out which 5144 women accepted for PPIUD amounting to a total acceptance rate of 32.1%.Out of the 10865 women who did not accept device, the reason for non-acceptance preference another contraception 60%, family opposition was reason in 21% of women, while 08% of women had side effects from their previous use. 11% of women said that they were not desire to use contraception.Conclusions: Family planning and mother and child health services are supplied to the people free of cost in India. Use of an intrauterine device is simpler , less expensive, and immediately reversible

Cause of death and associated conditions of stillbirths

Background: Fetal death is a psychological trauma for the expecting mother and their family. Most of the countries worldwide lack data on stillbirths. Simply counting stillbirths is the first step in analysis and prevention and hence stillbirths need to count. Purpose of the study is to know the incidence, cause of stillbirths and to plan cause specific interventions to reduce stillbirths.Methods: This is a prospective cross-sectional study of patients with stillbirths from September 2014 to August 2015 in Karnataka Institute of Medical Sciences, Karnataka.  All the cases who delivered stillbirths  of  weight more than 1kg, were  grouped into  the following CODAC (causes of death and associated conditions)  simplified classification and were analysed.Results: The total number of births during the study period was 9,863.  Total number of stillbirths in our study period was 563. In the study period, the stillbirth rate was 57.9 per 1000 births, out of which 56.3% were in preterm pregnancy and 43.69% in term pregnancies. The three common causes of stillbirths were hypertensive disorders (34.63%), intrapartum fetal loss (27.17%) and abruptio placenta (11.54%).  In 7.9% of cases the cause of stillbirth was unknown. Nutritional anaemia, teenage pregnancy and intrauterine growth restriction were the most common associated conditions of stillbirths.Conclusions: Anaemia and teenage pregnancy are the two important risk factors associated with stillbirths. Adolescent health education, folic acid and iron supplementation in schools has to be planned as a primary prevention of stillbirth. Early detection and treatment of hypertensive disorders and good intrapartum care, will help us in reducing the stillbirth rate to a large extent, as these are the two important causes of stillbirth

Study of gestational trophoblastic diseases at a tertiary care hospital in India

Background: Gestational trophoblastic disease refers to the heterogeneous group of interrelated lesions that arises from abnormal proliferation of placental trophoblasts. GTNs are among the rare human tumours that can be cured even in the presence of widespread dissemination. Although GTNs commonly follow a molar pregnancy, they can occur after any gestational event, including induced or spontaneous abortion, ectopic pregnancy, or term pregnancy. The study was conducted to know the incidence of different types of gestational trophoblastic diseases in the local population and the percentage of people ultimately requiring chemotherapy.Methods: The retrospective analysis of case record of 124 women with a diagnosis of GTD admitted to Karnataka Institute of Medical Sciences Hubli between November 2008 to November 2017.Results: A total of 124 cases of GTD were reviewed. Hydatidiform mole was diagnosed in 91 patients; of those experienced spontaneous remission after evacuation. 04 patients had persistent gestational trophoblastic Neoplasia and 13 cases of invasive mole (GTN) 1 case of epitheloid trophoblastic tumors and 15 cases of choriocarcinoma 99 (80%) had low-risk GTN, 25 (20%) had high-risk GTN.Conclusions: Hydatidiform mole was found to be the most common form of gestational trophoblastic diseases. Majority of the cases got cured by simple surgical evacuation. During the course of our study some rare cases of gestational trophoblastic diseases were noted. Patients’ compliance for serial follow up is a highly challenging task in developing countries. Registration of women with GTD represents a minimum standard of care

Sexually transmitted diseases in laboring women: trend over a decade

Background: Center for Disease Control (CDC) recommends routine screening in all pregnant women at first visit for syphilis, HIV, Hepatitis B infection as they have high vertical transmission rate. Syphilis is brought to control by screening and early treatment with penicillin, whereas HIV and Hepatitis B are incurable viral infections till date. Hence prevention is the only way to control the disease in the population. The purpose of the study is to know the burden of sexually transmitted diseases, so that prevention programme is better planned.Methods: This is a retrospective analytical study conducted from January 2005 to December 2014, in Karnataka Institute of Medical Sciences, Hubli, Karnataka. All the patients who delivered in septic ward, who were more than 28 weeks of gestation and who were HIV, HBsAg or VDRL positive were included in the study.Results: Among the total of 79,472 deliveries, the prevalence of HIV, HBsAg and VDRL were 0.90, 1.06 and 0.31 respectively. There were 4 cases of co-infection. The prevalence of HIV was 0.79 in 2005 and reached its peak of 1.33 in 2008 and then showed a steady decrease, reaching a lowest of 0.52 in 2014. The prevalence of HBsAg was 0.70 in 2005 and reached a peak of 1.57 in 2014. The prevalence of VDRL was highest of 0.08 in 2005 and lowest of 0.02 in 2014. Highest operative deliveries were seen in HBsAg positive women. Stillbirths were maximum in VDRL positive women and least in HBsAg positive women. There were 9 maternal deaths in HIV positive women and 3 maternal deaths in HBsAg positive women.Conclusions: In our study HIV prevalence is showing a down trend and syphilis is at the verge of elimination as seen globally. However prevalence of Hepatitis B has shown a rising trend over a decade in our institute, unlike a down trend seen globally. Intensifying the screening of Hepatitis B in pregnancy and Immunisation programme of neonates, reducing overcrowding and providing better living conditions, improving hygiene and health education should be done in order to reduce the prevalence of Hepatitis B infection