Emergency peripartum hysterectomy: a retrospective study at a tertiary care hospital

Background: The main objective is to study the incidence, demographic profile, indications and feto-maternal outcome associated with emergency peripartum hysterectomy (EPH).Methods: We conducted a retrospective, observational study over a period of 5 years; from January 2011 to December 2015.We studied 81 patients who underwent EPH for various indications in Department of Obstetrics & Gynaecology, MGM Medical College, Indore.Results: The rate of EPH in present study was 1.46 per 1000 deliveries. Uterine rupture (64.2%) was the most common indication followed by morbidly adherent placenta (11.1%), uterine atony (11.1%).The most common morbidities were wound sepsis and pyrexia. Maternal mortality was 8.6% whereas perinatal mortality was 62 %.Conclusions: Proper antenatal intrapartum care, early referral and judicious decision making regarding caesarian section are the potential methods which can be implemented to prevent this catastrophic event

A study of maternal and perinatal outcome in induction of labour at 40 weeks and 41 weeks of gestation

Background: To study and compare the maternal and perinatal outcome of induction of labour in pregnancies at 40 week and 41 week of gestation.Methods: 150 pregnant women who completed 40 weeks of pregnancy and were screened through exclusion and exclusion criteria .They were induced with intracervical PGE2 gel. Maternal and perinatal outcomes were determined and compared in 40 week group (40+0 – 40+6days) and 41week group (41+0–41+6 days).Results: Prolongation of pregnancy is observed frequently in nulliparous  women in both the groups (74% vs 62%).Caesarian rates were more in 41 week group compared to 40 week group (30% vs 12%, p=0.007). Maternal outcome in terms of PPH, perineal tears and sepsis are observed more in 41 week group though it was not statistically significant (p=0.493). Birth asphyxia, MAS and MSL are factors responsible for worse perinatal outcome in 41 week group that was statistically significant (p=0.009). Age and duration of labour showed no difference in both groups.Conclusions: Labour induction should be done at 40 weeks - it is reasonable option because it prevents a lot of maternal and perinatal complications

Assessment of the menopausal symptoms of women by using the menopausal rating scale

Background: Although menopause is a universal phenomenon, there is a considerable variation among women regarding the manifestation of menopausal signs and symptoms. Symptoms experienced with the menopausal transition and early post menopause are varied and span both physical and psychological domains. Therefore, a need is felt to evaluate menopausal symptoms on a pretested scale to provide a subjective and clinically reproducible picture of menopausal symptoms.Methods: A descriptive cross-sectional study was conducted in MYH ,Indore Obstetrics and Gynecology Department, from July 2016 to December 2016.A pretested,  semi structured, interview based, oral questionnaire was used to assess the menopausal symptoms and their severity in women of age group 35 to 65 years attending MYH, Indore OPD, using MRS scale and to evaluate these symptoms in perimenopausal as compared to postmenopausal women.Results: The results were evaluated for psychological (P), somatic (S), and urogenital (U) symptoms. A significantly higher percentage of perimenopausal women  showed a P score of ≥7; while a higher percentage of postmenopausal showed S score and U score ≥7 ;p ≤ (0.001).Working women seem to suffer more from psychological symptoms whereas nonworking women showed a greater incidence of somatic symptoms.Conclusions: The present study revealed that proportion of menopausal symptoms was significantly high and there was variation of severity of menopausal symptoms with any of the socio demographic variables, menopausal status or duration of menopause

A study of vitamin D levels and associated deficiency in pregnancy and its effect on maternal and fetal outcome

Background: From conception the embryo is dependent on the mother for all nutritional requirements until birth. Vitamin D deficiencies have adverse effect on pregnancy outcome result in poor growth, prematurity, NTD, even congenital anomalies. The aim and objectives of the study was to assess the prevalence of deficiencies among pregnant woman attending M.Y. Hospital and assess the correlation with the pregnancy complications.Methods: Total 110 patients were studied for vitamin d levels and associated obstetrical complications and risk factors over a period of six months. 53 pregnant women were found to be deficient with vitamin D.Results: 53 pregnant women out of total of 110 were deficient in vitamin D levels. Maximum patients belonged to group (21-30yr) of age. Vitamin D deficiency was more in housewives (65.3%) and in urban(86.8%). Low birth weight<2.5kg were born 50(45.5%) and 2 IUD. 2 were diagnosed NTD in USG reports. 80% low birth weight babies were born in vitamin D deficient women.Conclusions: Our study fails to show a causal relation between low vitamin D level and adverse maternal and fetal outcome in terms of preeclampsia, cesarean delivery, oligo and diabetes. There was a relation between vitamin D deficiency and low birth weight babies

MR imaging evaluation for the assessment of pelvic organ prolapse: a newer technique

Background: MRI is the newest technique used to evaluate patients with pelvic floor disorders. It allows relatively non-invasive, dynamic evaluation of all pelvic organs in multiple planes and can directly visualize the muscular and ligamentous pelvic floor support structures. Using MRI to evaluate pelvic floor disorders may be most helpful in patients with multicompartment findings or symptoms, posterior compartment abnormalities, severe prolapse, or recurrent pelvic floor symptoms after prior surgical repair. MRI is often able to reveal more extensive organ prolapse than physical examination alone.Methods: The present study was carried out in the Department of Radiodiagnosis and Obstetrics and Gynecology of Mahatma Gandhi Memorial Medical College and M.Y. Hospital, Indore, Madhya Pradesh from November 2014 to October 2015. A total of 43 patients who had symptoms of pelvic floor dysfunction like uterine prolapse, urinary or rectal dysfunction were evaluated by high resolution USG. Patients with low lying uterus on USG were subjected to MRI. Before MRI, these patients were assessed by a Gynecologist, and a clinical diagnosis in form of the organ/organs prolapsed and the grade of individual prolapse was assigned and tabled in the prefixed format.Results: Prolapse is more common in patients with greater than 50 years age (63% patients). MRI picked up more lesions compared to clinical examination, 90% as compared to 82.5% on clinical examination. MRI has good correlation with surgery in diagnosing prolapse. Concomitant prolapse of the Anterior and Middle compartment is the most common clinical entity diagnosed on 52.5% patients in our set up. MRI has poor sensitivity in identifying posterior compartment prolapse. There is good agreement between the clinical grading and MRI grading (81.8% correlation).Conclusions: T MRI offers a novel approach of simultaneous imaging of all compartments of the female pelvis at a single setting. With lesser intraobserver variation and better visualization of the pelvic anatomy MRI would help in accurate staging and hence better outcomes in patients in terms of symptom relief

Intrauterine fetal demise-a tragic event: a study of its epidemiology, causes and methods of induction

Background: Fetal death is a tragedy that causes severe distress to parents and caregivers. Most babies are born healthy, but sometimes, something goes wrong and a baby dies in utero. Present study was conducted to understand the incidence, epidemiological and etiological factors of intrauterine fetal death. Also to study the efficacy of misoprostol and dinoprostone as inducing agents in these cases.Methods: Present study was conducted in the Department of Obstetrics &Gynaecology, M.G.M. Medical College and Associated M.Y. Group of Hospitals, Indore (MP). Pregnancies diagnosed with IUFD were studied from March 2014 to February 2015. A total of 200 cases were studied. Ante partum events leading to fetal demise were recorded, socio-demographic and clinical characters were noted. Induction delivery interval of inducing agents was compared.Results: Incidence of IUFD at our centre was found to be 50 per 1000 deliveries. There was a high incidence in low socioeconomic strata, unbooked cases, primigravidas, preterm with abruption were the leading causes. Misoprostol was found to be more effective in termination of pregnancy in these cases .The induction delivery interval with Misoprostol was 9.64 hrs and that of dinoprostone was 12.63 hrs.Conclusions: Socio- demographic factors like poor socioeconomic class, teenage pregnancy, poor nutrition, lack of health education need to be considered as predisposing factor for prenatal deaths, many of the causes of intrauterine deaths are preventable like abruption hypertensive disorders which can be avoided by proper antenatal care. Misoprostol is cheaper and has a less induction delivery interval; it can be safely used in cases of IUFD

Role of uterine artery Doppler in prediction of FGR in high risk pregnancies in 20-24 weeks

Background: Accurate prediction of fetal growth retardation (FGR) is a long-sought goal of perinatology as it contributes significantly to perinatal mortality and morbidity. It generally manifest later in pregnancy, their underlying pathophysiology is largely established early in pregnancy. Early detection will help in decreasing the associated morbidity.Methods: The study was carried out on 100 pregnant women of 20-24 weeks gestation in the Department of Obstetrics and Gynecology, MGM Medical College and MY Hospital, Indore from March 2015 to February 2016.Presence of diastolic notch in uterine artery waveform was taken as screen positive.Results: Total Diastolic notch positive cases 20/100 out of which 60% developed FGR and 80/100 Diastolic notch negative cases out of which only 4 cases (5%) will developed FGR. The sensitivity of the test was 75% while the specificity was 90.47%. The positive predictive value was 60% while the negative predictive value was 89.74%. 50% of screen positive belonged to 30-39 year age group and 68.75% FGR was seen in primiparous.Conclusions: Study of uterine artery flow velocity waveform seems to be a modern technique which can be used for ruling out the probability of FGR. Presences of diastolic notch in uterine vessels in 2nd trimester are of prognostic value for maternal complications and fetal jeopardy and therefore need of further critical assessment and management

Assessment of patient satisfaction after levonorgestral containing intrauterine system insertion in women with abnormal uterine bleeding

Background: Abnormal uterine bleeding is a common gynecological complaint affecting 10-30% of reproductive-aged women and it can result from different causes which adversely affects the woman’s quality of life, necessitating its appropriate and adequate management. Among all the pharmacological and surgical management options of AUB. LNG-IUS is emerging as a safer and effective treatment option of AUB. However apprehension about discomfort associated with the use of intrauterine device leads to its untimely removal. Aim of current study was to conduct a prospective qualitative study to observe the level of patient satisfaction with the use of LNG-IUS in patients with abnormal uterine bleeding.Methods: This study was conducted in the department of obstetrics and gynecology, MGM medical college and M.Y. Group of Hospitals, Indore from March 2017- March 2018. Follow up was done at 1, 3, 6 months.Results: In our study, majority of the women (90%) had improvement in their abnormal uterine bleeding along with significant increase in mean hemoglobin level from7.30+1.29 gm%  to 8.71+1.27 gm% at the end of six months. 86.66% of these patients were very satisfied with the use of LNG IUS,Conclusions: LNG-IUS is an effective device for medical management of AUB and it should be used as the first line therapy for the same. It should always be considered before surgical interventions. It yields promising result in terms of patient satisfaction.

COMMON FIXED- POINT THEOREM IN NON-ARCHIMEDEAN INTUITIONISTIC FUZZY METRIC SPACE BY USING SUBCOMPATIBLE MAPS OF TYPE (α) WITH SIX MAPS

In this paper, we have generalized the result of Ferhan Sola Erduran [15] and Anupama Gupta [3] using sub compatible map of type (α) and subsequent continuity. We established a common fixed-point theorem for six maps

Role of serum progesterone in threatened miscarriage

Background: Miscarriage is the inadvertent loss of a pregnancy before the fetus is viable. The World Health Organization defines this un-survivable state as an embryo or fetus weighing 500 grams or less, which typically corresponds to a fetal age (gestational age) of 20 to 22 weeks or less.Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, M. G. M. Medical College and M.Y. Hospital, Indore from October 2013 to October 2014 on 100 patients.Results: The incidence of first trimester threatened miscarriage, in the Gynaec O.P.D. of M.Y. Hospital, Indore, was 8.8%. The most common risk factor was a history of previous miscarriages in 38% of cases while 9% had advanced maternal age and 35% had advanced paternal age. History of preterm labour was positive in 25% cases and that of congenital anomaly in previous pregnancy in 7% cases. UTI and vaginitis were diagnosed in 10% and 11% cases respectively. Systemic illness was in 24% cases while 6% cases had endocrine disorders. On USG missed miscarriage was found in 8% inconclusive ultrasound was found in 34% cases, rest were normal. Of the 38 cases giving history of previous 1, 2, 3 and more than or equal to 4 miscarriages were 22%, 6%, 8% and 2 % respectively. 36% of the patients presented with bleeding per vaginum. only while 30% had bleeding with pain and 33% cases had only pain in abdomen. On USG 58% had normal scans. USG scan was inconclusive in 34% and only 35% continued with viable pregnancy, rest aborted. 7 of the 100 cases had preterm labour and 51 cases continued to term. Rest 42 aborted. H/o contact, travel, trauma, heavy work did not have any statistically proven effect on outcome of pregnancy.Conclusions: Progesterone assays are currently available in most immunoassay platforms and have shown excellent performance in terms of assay sensitivity, specificity, accuracy and precision with rapid turnaround times. Furthermore, the cost per test for progesterone assay is affordable. Several studies have shown that progesterone is the most specific biomarker for distinguishing viable from nonviable pregnancies. The downfall of progesterone as a biomarker is due to the different cut-off values used by researchers. The cut-off values were also determined on different study populations