Perinatal outcome associated with oligohydramnios in third trimester

Background: We aimed to evaluate the effect of Oligohydramnios on fetal outcome in terms of fetal distress, Meconium staining of amniotic fluid, birth weight, Apgar score of newborn babies, NICU admission, early neonatal morbidity and mortality.Methods: This was a prospective study of 156 antenatal patients booked at K. J. Somaiya medical college and research centre during the year January 2012 to December 2013 with gestational age between 30-40wks with AFI<5cms with intact membranes were analyzed for perinatal outcome.Results: The Caesarian section rate for fetal distress was 41% in patients with Oligohydramnios. Meconium staining of amniotic fluid was found in 30.7% patients. APGAR score at 5 minutes <7 was found in 6 patients (3.8%).Conclusions: Oligohydramnios has significant correlation with Caesarean section for fetal distress and low birth weight babies. Oligohydramnios is associated with high rate of pregnancy complication and increased perinatal morbidity and mortality. Oligohydramnios is a frequent occurrence demand careful evaluation, intensive parental counseling, fetal surveillance and proper antepartum and intrapartum care

Role of diagnostic hysteroscopy in evaluation of abnormal uterine bleeding and its histopathological correlation

Background: The aims of this study are 1) To study the accuracy of hysteroscopy in evaluation of abnormal uterine bleeding. 2) To correlate hysteroscopic findings with histopathology findings.Methods: This is a prospective interventional study conducted in the dept. of obstetrics & gynecology at K.J. Somaiya hospital in the period between January 2010 to December 2012. Women between 20-60 years of age of any parity who presented with complaints of Abnormal Uterine Bleeding (AUB) and who did not require any emergency management were enrolled in the study after excluding pregnancy, uterine/cervical infection/PID, cervical malignancy, H/o uterine perforation, patients on Oral Contraceptive Pills (OCPs), and presence of medical contraindication to any invasive procedure. A total of 98 women were included in the study. They were counselled and informed consent was taken. Patients were evaluated with detailed history, thorough examination and investigations. Hysteroscopy was done under total intravenous anaesthesia followed by endometrial biopsy. Hysteroscopic findings were then correlated with histopathology reports.Results: The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of diagnostic hysteroscopy in the study was 98.3%, 80.5%, 89.7%, 96.7% and 91.8% respectively. For the diagnosis of endometrial hyperplasia these were 92%, 92%, 89%, 94%, and 92 % respectively. For polyp these figures were 94%, 96%, 87%, 98%, 95% respectively; for endometrial atrophy there were 66%, 95%,  60 %, 98% and 94%; for submucous fibroid 91%, 95%, 78%, 98%, and 94%; for malignancy 75%, 98%, 75%,  98%,  97% respectively.Conclusions: With the above results it can be concluded that hysteroscopy is safe, sensitive and reliable diagnostic procedure. However endometrial biopsy improves the diagnostic accuracy of hysteroscopy.

Rarest variations of ectopic pregnancy: an obstetrician's dilemma

Ectopic pregnancy is an important cause of morbidity and mortality which has always proven to be a challenge to obstetricians. Increased usage of artificial reproductive techniques has not only increased tubal ectopic pregnancies but also other rarer forms of ectopic pregnancies. With newer diagnostic and therapeutic tools, chance of early detection and intervention has increased many fold. Conservative treatment options have also gained importance. Here we discuss 3 peculiar types of rare ectopic pregnancies-heterotopic pregnancy, caesarean scar ectopic pregnancy and rudimentary horn ectopic pregnancy- and their treatment options.

Obstetric outcome in elderly gravida

Background: Maternal age is an important determinant of the outcome of pregnancy. Advanced maternal age generally signify age after 35 years at the time of delivery. It is associated with decreased fertility and increased risk. Elderly gravida is associated with many complications during pregnancy, labour and also for the baby. In recent times women has changed their lifestyles such as pursuit of higher education and entry into work forces and career advancement outside the home.Methods: This was a retrospective study done in 57 elderly pregnant women more than 33 years age, over a period of 18 months, conducted in a multi-specialty hospital.Results: 57 elderly pregnant women were selected for the study. 47% were in age group of 33-35 years and 42% were in age group of 36-40 years. 61.40% patients were housewives and 38.59% were employed. 50.8% of patients had history of previous abortions and 35% were conceived after treatment for sterility. 64.9% of patients conceived spontaneously and 35% by assisted reproductive technology. Majority of patients (33.3%) required Invitro-fertilization. Multiple pregnancy was high- 21.05%. Hypertension was observed in 26.3% of patients, Antepartum haemorrhage in 4.34%,  Preterm delivery  49.1%, Induction of labour in 10.52%, Normal vaginal delivery only in14%. Majority of patients (80.7%) were delivered by caesarean section.Conclusions: Elderly pregnant patients have higher risks of specific pregnancy complications which contribute to a higher frequency of maternal morbidity and greater health care costs. The risks are due to Hypertension, diabetes, multiple pregnancy, preterm labour, antepartum haemorrhage, PROM, malpresentation, prolonged labour, increased caesarean section rate and postpartum haemorrhage

Immediate complications and subsequent reproductive outcome after medical abortion: hospital based cross sectional study

Background: Medical abortion is considered to be a safe, effective and reliable method for termination of pregnancy. The procedure has stood the test of time very well over the last 10 years in terms of results and immediate complications but there are not many reports regarding the subsequent reproductive outcome of these women. Thus, it was decided to conduct a study with special focus on subsequent reproductive outcome in women undergoing medical abortion. The objectives of the study were to determine the source of health care provider for women seeking medical abortion, to study immediate complications of medical abortion, to study acceptance of family planning methods post medical abortion in the study subjects and to study subsequent reproductive outcomes in women who underwent medical abortion.Methods: A cross sectional institution based study was conducted after ethics committee approval in the Obstetrics and Gynecology outpatient department of a tertiary care institute from January 2014 to December 2014. 94 newly registered patients in the age group of 18-35 years who came to the Obstetrics and Gynecology OPD during the study period were interviewed. Amongst these those who have undergone medical abortion in the period between 2010 and 2011 and were willing to participate in the study were enrolled. Diagnosed cases of Diabetes Mellitus, Hypertension and any other major medical or surgical illness were excluded from the study.Study subjects were interviewed with a revalidated, pretested semi structured Questionnaire with due privacy to maintain confidentiality. The data was analyzed by SPSS version 16 software.Results: 13.8% study subjects took their medicines from chemists without consulting any medical professional and 9.5% of them were prescribed these medicines by general practitioners. Prevalence of immediate complications that is incomplete abortion, need for surgical evacuation and excessive bleeding in the study were 17%, 11.7% and 1.1% respectively. Proportion of women who accepted family planning post medical abortion was 62.8%. Prevalence of subsequent reproductive outcomes in females who did not use permanent method of sterilization or got copper T inserted were infertility (7.1%), abortion (8.9%), ectopic pregnancy (3.6%), PIH (10.7%), IUGR (3.6%) and preterm labour (10.7%).Conclusions: Medical abortion using Mifepristone and Misoprostol is a reliable and safe method of termination of early pregnancy (up to 7 weeks period of gestation). These findings are relevant while counseling patients for medical abortion