Evaluation of preventable causes and risk factors of maternal mortality

Background: The primary objective was to evaluate preventable causes of maternal deaths at tertiary, second and primary care in Patiala district, Punjab. Secondary objective was to determine impact of socio-demographic characteristics, anemia and three delays on maternal death.Methods: This is a retrospective observational study carried out between 1. 7. 2013 till 30. 6. 2014, for period of one year in department of a tertiary care hospital and district health authorities catering to secondary and primary care deaths for evaluation of preventable causes and risk factors for maternal deaths at tertiary, secondary and primary level.Results: A total of 54 maternal deaths with MMR of 170.42/100000 live births, occurred in stipulated period, 87.03% at tertiary care, one at second care, 7.41% at home and 3.7% on the way to tertiary care. Majority of maternal deaths (92.6%) were unbooked, between 21-30 years (64.82%) of age, primi or second gravida (35.18%), para 1 or 2 (37.03%), illiterate (40.74%), low income group (57.41%) with rural background (59.26%). Majority of maternal deaths (77.7%) occurred in postpartum period. Most of maternal deaths (75.93%) were due to direct causes, pre-eclampsia 25.93% followed by sepsis (22.2%) and haemorrhage (20.3%). Anemia was contributory factor in 79.63% maternal deaths. 7.4% maternal deaths occurred at home with delay in seeking care while 29.62% died due to delay in reaching care. In 40.42% maternal deaths, it took more than two hours to reach tertiary care hospital.Conclusions: Skilled antenatal, intranatal and postnatal care, women empowerment, counseling, early diagnosis and referral of pre-eclampsia and other high-risk cases with curbing anemia at grass root level is need of millennium. Preventing delay in seeking care or reaching care-a step towards sustainable development goals (SDG) to reduce MMR

Laproscopic evaluation in primary female infertility

Background: Infertility is defined as inability to conceive within one or more years of regular unprotected coitus. Infertility has now a days not only a medical but a social problem as well. Ignorance and illiteracy, coupled with hesitancy to discuss the problem, complicates the matter further. WHO has listed infertility as a global health issue.Methods: The present study was conducted on 64 patients with female factor primary infertility admitted in department of obstetrics and gynecology at Rajendra Hospital, Patiala over a duration of 1 year (December 2013- November 2014). All the patients had normal semen study of their partner.Results: In our study mean age was 27.87±4.57. No patient was above 40 years of age. Duration of infertility between 1-5 years was in 47 patients (73.43%), nine patients (14.06%) were infertile for 6-10 years. Out of 64 patients of primary infertility, majority of patients were of endometriosis 15(23.43%), followed by pelvic inflammatory disease14(21.87%), tubal blockade in 7(10.9%), PCOD in 6(9.37%). 14.08% patients had normal laproscopic study. 34 patients (53.12%) had bilateral spill while no spill was seen in 12 patients (18.75%). Unilateral spill was seen in seven patients (10.93%) while six patients (9.37%) had delayed spill.Conclusions: Prevalence of infertility is increasing, so is the awareness and treatment seeking behavior. The present study assures that in evaluation and workup of primary infertility patients, after baseline noninvasive investigations, endometrial sampling and HSG, the diagnostic and operative laproscopy is an excellent tool for evaluation of tubal factor. Least expected conditions like endometriosis on clinical evaluation, can be diagnosed and treated with ease on laproscopy. Although tubal factor has been considered to be responsible for a large percentage of cases with female secondary infertility since decades, but in present study laproscopic evaluation confirmed tubal factor in 85.01% cases with female factor infertility

Para vaginal dermoid cyst: a rare occurrence

Dermoid cyst (cystic teratoma) showing well differentiated derivatives of all three germs cell layers, is a benign germ cell tumour. Ovaries remain the commonest site. Paravaginal dermoid cyst is a rare occurrence. Pre-operative diagnosis is usually difficult in majority of cases. They constitute less than 4% of all extragonadal teratomas. A 28-year old, P2L2 female presented with paravaginal cyst, 10×10cms, non-tender, soft swelling, cystic in consistency occupying posterior and left part of rectovaginal septum. Trans vaginal excision of cyst under regional anaesthesia done. Cyst was ruptured while excision showing putty material with tuft of hairs. A retrospective diagnosis of mature teratoma/paravaginal dermoid cyst was made on histopathological examination. Paravaginal dermoid cyst, a benign cystic teratoma is a very rare occurrence. Transvaginal excision of dermoid cyst under anaesthesia remains treatment of choice. Retrospective diagnosis on histopathological examination remains confirmatory as it may be missed on sonography if teeth are not present in dermoid cyst

Hysteroscopic evaluation in infertility and abnormal uterine bleeding

Background: Hysteroscopy an endoscopic procedure for visualization of uterine cavity may be extensively used in both primary and secondary infertility and abnormal uterine bleeding for evaluating intrauterine pathology. The objectives of this study were to visualize and identity intrauterine pathology in both primary and secondary infertility and abnormal uterine bleeding (AUB) by hysteroscopic evaluation and to perform hysteroscopic guided therapeutic procedures like endometrial currettage, polypectomy, adhesiolysis.Methods: Hysteroscopic evaluation of uterine cavity for any intrauterine pathology in AUB and Infertility. Adhesiolysis, polypectomy, endometrial biopsy misplaced copper T removal were carried out under hysteroscopic vision.Results: Intrauterine synechia in 20.51%, Submucous fibroid in 5.13%, bicornuate uterus, endometrial hyperplasia and endometrial polyp were seen in 2.56% patient each were detected in infertility group while 81.95% cases with AUB had abnormal intrauterine pathology commonest being endometrial hyperplasia in 33.33% followed by endometrial polyps in 23.81% cases, submucous fibroid and misplaced copper T in 9.52% each and intrauterine synechia in 4.76% patient. Endometrial biopsy and polypectomy was done in 23.80% each with AUB, misplaced copper T removal in 9.52% and adhesiolysis in 4.76% patient with AUB.Conclusions: Hysteroscopy remains gold standard for evaluating intrauterine lesions in abnormal uterine bleeding and infertility. A safe, simple minimally invasive procedure not only diagnostic but therapeutic modality for adhesiolysis, endometrial biopsy/curettage, polypectomy, misplaced copper T removal under direct vision with minimal complication within reach of every Gynaecologist thereby reducing burden of major surgical intervention

Aggressive angiomyxoma of vagina: a rare entity

Aggressive angiomyxoma a soft tissue tumor arising in the pelvis and perineal regions of women in reproductive age group is a rare entity. It is slow growing locally aggressive myxoid mesenchymal tumor, with a marked tendency to local recurrence. Preoperative clinical diagnosis is usually difficult due to absence of diagnostic features as well as rarity of the disease. We describe a case of aggressive angiomyxoma of vagina in a 47-year-old para 4 woman with multiple fibromyoma (upto 22-week size of pregnant uterus) with 10*10 cms posterior vaginal cyst. Total abdominal hystrectomy with surgical excision of vaginal wall cyst done. A retrospective diagnosis-Aggressive Angiomyxoma of the vagina was made after histological confirmation. Surgical excision with wide margins and long term follow up remains treatment of choice

Elevated serum CA 19-9 levels in dermoid cyst: a predictor of ovarian torsion and tissue necrosis?

Dermoid cyst (mature cystic teratoma) with well differentiated derivatives of all the three-germ cell layer is a benign tumour with ovaries being the commonest site. Dermoid cyst accounts for more than half of ovarian tumours in girls below 20 years of age. 80% of dermoid cyst are seen in reproductive age group between 20-40 years. Size of dermoid cyst usually varies between 5-10 cm and it may be bilateral in 10% of cases. Malignant transformation is very rare occurrence only in 1-3% cases, however torsion may occur in 15% of dermoid cyst. Carbohydrate antigen or cancer antigen 19-9 is usually raised in gastrointestinal tumours, pancreatic malignancy, pseudocyst of pancreas. However, it may be raised in some other malignancies and benign condition like torsion of dermoid cyst. Authors report an unusual case of torsion large dermoid cyst with tissue necrosis along with significantly elevates levels of serum CA 19-9. A 30-year-old P1L1 female presented with chief complaint of heaviness and pain lower abdomen and loss of five kilogram weight for last three months. A provisional diagnosis of dermoid was made. Serum CA 19-9 level were 1126 IU significantly raised. An exploratory laparotomy done under regional anaesthesia. A large demoid cyst 12*10 cm with torsion and areas of gangrene in ovarian tissue was seen replacing left ovary. Large and small intestine, stomach, pancreas were explored to rule out any pathology. Histopathology confirmed diagnosis of mature cystic teratoma. There was significant fall in serum Ca 19-9 levels to 247 U/ml two weeks after surgery and levels returned to normal limit six weeks after surgery

Sociodemographic and seroprevalence profile of sexually transmitted infections (HIV, Hepatitis B, Hepatitis C and Syphilis) in asymptomatic pregnant females

Background: Globally 499 million new episodes of curable STIs occur in the age group of 15-49 years, 80% in developing countries and 79 million in India alone. There is an increasing trend for viral STIs while bacterial STIs are on decline. Number of pregnant women with STIs is increasing by about 250 million a year in developed world and double that number in developing countries. The objective of the study was to estimate seroprevalence of STIs (Hepatitis C, Hepatitis B, HIV and Syphilis) and to evaluate impact of sociodemographic profile and sexual behaviour on STIsMethods: This observational study was carried out on 1000 asymptomatic pregnant females attending antenatal clinics, Department of Obstetrics and Gynecology, Government Medical College Patiala, Punjab.Results: Seroprevalence for STIs in asymptomatic pregnant females was 22.5%. Hepatitis C-9%, Hepatitis B-6.3%, HIV-5.5%, and Syphilis 1.7%. Illiteracy, low socio economic status, homemakers, rural background with multiple sex partners in the 21-30 years age group is associated with increasing trends of STIs in pregnancy.Conclusions: Screening asymptomatic pregnant women for STIs remains a key programme strategy for quadruple (Hepatitis C, Hepatitis B, HIV and Syphilis) prevention. Mandatory screening for STIs to reduce perinatal transmission is need of the millennium– a step toward ending STI epidemics as a global priority.

Menstrual Hygiene Awareness, Challenges and Management for Improving Quality of Life

Menstruation is a normal and necessary part of life, and maintaining proper menstrual hygiene is crucial for women's and girls' health as well as their right to access basic services for sanitation, hygiene, and reproductive health.Thesafe drinking water, sanitation, and hygiene (WASH) aspectof menstrual hygiene has significantly gained attention in recent times. In lowand middle-income nations, womenface significant menstrual hygiene management challenges. These problems stem from a lack of information and inadequate water, sanitation, and hygiene facilities.Women frequently struggle with a lack of access to menstrual hygiene products, or if they do, the high priceof sanitary pad render them unaffordable. The lives of vulnerable women are significantly impacted by stigma and period poverty, forcing them to use unhygienic alternatives like dried leaves and soiled old clothes as sanitary pads. The Menstrual Hygiene Day is observed on May 28 because women menstruate on average five days per month and menstrual cycles last an average of 28 days. 25 percent of World Bank education projects included menstrual hygiene management components, such as the provision of sanitary and hygienic restrooms or separate restrooms for boys and girls in their schools.To empower women and tackle misinformation, this study will contribute to raising awareness regarding the management of menstrual hygiene

A Cluster-Based Energy-Efficient Secure Optimal Path-Routing Protocol for Wireless Body-Area Sensor Networks

Recently, research into Wireless Body-Area Sensor Networks (WBASN) or Wireless Body-Area Networks (WBAN) has gained much importance in medical applications, and now plays a significant role in patient monitoring. Among the various operations, routing is still recognized as a resource-intensive activity. As a result, designing an energy-efficient routing system for WBAN is critical. The existing routing algorithms focus more on energy efficiency than security. However, security attacks will lead to more energy consumption, which will reduce overall network performance. To handle the issues of reliability, energy efficiency, and security in WBAN, a new cluster-based secure routing protocol called the Secure Optimal Path-Routing (SOPR) protocol has been proposed in this paper. This proposed algorithm provides security by identifying and avoiding black-hole attacks on one side, and by sending data packets in encrypted form on the other side to strengthen communication security in WBANs. The main advantages of implementing the proposed protocol include improved overall network performance by increasing the packet-delivery ratio and reducing attack-detection overheads, detection time, energy consumption, and delay