A randomized control study of titrated and oral misoprostol solution for induction of labor at term

Background: Quest for an induction method with safety, efficacy, feasibility, low cost, and patient preference is a constant pursuit for all obstetricians. Oral misoprostol is one such method which has been shown to be effective in achieving vaginal birth and has been recommended by WHO (2011) and FIGO (2012) for induction of labor. This study aimed to evaluate effectiveness and safety of hourly titrated oral misoprostol solution in comparison with two hourly static-dose oral misoprostol solution for induction of labor at term.Methods: Single centre interventional single-blinded randomized controlled trial conducted in a tertiary care centre in Ludhiana. 264 term pregnant women were randomly given titrated (group A) or static oral misoprostol solution (group B) till the onset of active labor. Induction to delivery time was the primary outcome measure while the secondary outcome measures pertained to efficacy and safety of the regimens.Results: 268 women were randomized, 4 patients were excluded from analysis because of drop out, leaving 264 women for intention to treat analysis. The mean interval between induction and delivery was 16.19±10.48 hours in group A and 15.28±8.34 hours in group B (p>0.10, NS). 71 women (53.8%) in group A and 72 women (54.5%) in group B had vaginal delivery within 24 hours (p>0.10, NS). 40.9% women in group B required more than 8 hours to receive the required number of doses as compared with 8.3% women in dose group A (p<0.01, SS). Oxytocin requirement was significantly higher in group A (76.5%) as compared to group B (59.8%) (p<0.05, SS). Incidence of fetal and maternal complications, rate of cesarean section and instrumental delivery was comparable between the two groups (p>0.10, NS).Conclusions: Titrated oral misoprostol, considering its efficacy, safety and time saving is comparable to WHO recommended static oral misoprostol

Pattern of utilization of blood and blood components in obstetrics at a tertiary care center: a cross-sectional study

Background: Blood transfusion is an essential lifesaving component in obstetrics. Extra blood loss in pregnancy can occur due to various gestational disorders and complications during labour and delivery. Reduction in maternal morbidity and mortality has been observed by increased use of comprehensive emergency obstetrics care in which blood transfusion has achieved recognition as one of the important components. In a developing country like India, the need for well maintained and readily available blood and transfusion services becomes paramount to decrease maternal morbidity and mortality. We wanted to determine the clinical characteristics and indication of blood transfusion in obstetrics and also determine any adverse blood transfusion reaction.Methods: This cross-sectional study was conducted in the department of obstetrics and gynaecology, Christian medical college, Ludhiana for a period of eighteen months from 15th October 2018. The study group included all the antenatal and postnatal patients up to 6 weeks postpartum who were admitted in the obstetric unit, requiring blood or component transfusions. Clinical characteristics, indication of blood transfusion and any adverse blood transfusion reaction were recorded.Results: In our study, about 7.84% of obstetric admission required blood and blood components. Most common indication for blood transfusion was anaemia either during antenatal or during postnatal period (33.91%). Majority of the patients were unbooked antenatally (63.91%) and were multiparous (93.91%). 4 or more blood transfusions were given in 28.26% of cases.Conclusions: Blood transfusion is live saving measure in many obstetric patients. Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Severe anaemia is the most common condition requiring blood transfusion, which may be chronic due to nutritional deficiency or following acute blood loss, followed by postpartum haemorrhage, placental abruption and placenta previa. Availability of transfusion facility and blood products in obstetric care setting in peripheral health centres can reduce need for referral of patients and indirectly reduce the maternal morbidity and mortality

Primary ovarian pregnancy a rare clinical entity: a case report

Ovarian pregnancy is a rare form of ectopic pregnancy. It constitutes <3% of all ectopic pregnancies with an incidence ranging from 1:6000 to 1:40000 pregnancies. There has been an increase in the incidence of ovarian pregnancies due to better diagnostic modalities such as transvaginal ultrasonography (TVS) and serum beta-HCG estimation. Though it is usually misdiagnosed as ruptured tubal pregnancy, ruptured haemorrhagic cyst, ruptured corpus luteal cyst, therefore, awareness of this rare condition is important in reducing the associated risk. Hence, we report a case with ectopic ovarian pregnancy managed by conservative surgery at MMIMSR, Mullana, Ambala. Ovarian ectopic pregnancy can be managed by conservative surgeries

Taxonomic redescription of subfamily Scymninae (Coleoptera: Coccinellidae) from Haryana, India

The ladybird beetles of Scymninae, a subfamily of Coccinellidae are efficient biocontrol agents. Many earlier studies document their protective role associated with many crops. This subfamily is represented by 5 tribes,15 genera and 138 species in the Indian subcontinent. However there is no scientific record of taxonomic description of the subfamily Scymninae within the Coccinellidae family of beetles (Coccinellidae: Coleoptera)  in Haryana, India. In the present study, seven species from three genera and two tribes of sub-family Scymninae i.e. Nephus (Bipunctatus) bipunctatus (Kugelann,1794), Nephus regularis (Sicard), Scymnus (Pullus) coccivora Ramakrishna Ayyar, 1925, Scymnus (Pullus) latemaculatus Motschulsky, Scymnus (Scymnus) nubilus Mulsant, Scymnus (Pullus) posticalis Sicard and Stethorus aptus Kapur were identified. It included the generation of keys to the tribes, genera, subgenera and species found during the study. It provided detailed taxonomy of the identified species based on various morphological characteristics such as coxal lines, antennae, mandibles, and male and female genitalia. This study marks the first taxonomic exploration of species within the Scymninae subfamily in Haryana, India. It will significantly contribute to understanding the biodiversity of beetles in the region and will lay the groundwork for further research and conservation initiatives.

Glycopenic endometrium in infertility

Background: Infertility is a global health problem affecting 8-10% couples worldwide. Endometrium is considered to be sensitive indicator of ovarian, pituitary and hypothalamic function. The endometrium, which fails to produce adequate amount of glycogen is termed as ‘glycopenic uteri’. Glycopenic endometrium is said to be unfavourable for early blastocyst implantation leading to infertility in spite of ovulation. Endometrial aspiration/biopsy can be histologically dated based on the Dallenbach-Hellweg criteria which forms an essential part of histopathological examination of endometrium for infertility work-up. The aim of the study was to study the correlation of glycogen content with endometrial histomorphology in infertility.Methods: Cross-sectional observational study in which one hundred twenty-two endometrial specimens sent as curetting/ biopsy were studied. The Glycogen content of endometrium was graded from + to ++++ as given by Arzac and Blanchet. Statistical analysis was done on SPSS version 26.0. The categorical variables were represented by count (percentage) and the continuous variables were represented by mean±SD. The Chi-square test was used to find the association of glycogen content with infertility, the various phases of the endometrium and age.Results: Glycopenic endometrium was seen in 36.9% cases of infertility. Out of which, glycopenic endometrium was much more prevalent in patients with secondary infertility (47%) as compared to patients with primary infertility (35.1%).  Conclusions: Glycogen depletion in secretory phase results in inadequate preparation of endometrium at the time of implantation. Assessment of glycogen is considered to be an essential part of histopathological examination

A comparative study between magnetic resonance imaging and transvaginal sonography for evaluation of uterine fibroid using histopathology as a gold standard

Background: Uterine fibroids constitute a substantial bulk of patients presenting to Gynaecology department. Many newer imaging modalities have evolved for their correct evaluation, but in a developing country like India, ultrasound is still being used as a screening as well as diagnostic modality. So, this study was done to compare ultrasound and magnetic resonance imaging for evaluation of uterine fibroids in terms of their sensitivity, specificity Trans vaginal  and positive predictive value using Histopathology as a gold standard so as to improvise on current clinical practices in this country.Methods: An ethically approved prospective study was done upon 50 patients with suspected uterine masses at SMS Hospital Jaipur. All included patients underwent Trans vaginal Ultrasound (TVS) and Magnetic resonance imaging (MRI) and were accordingly treated surgically. Histopathology report was traced postoperatively. Data was collected and subjected to various statistical tests including Cohen’s kappa.Results: Most of the patients were <50 years and presented with complains of pain abdomen. Among total 50 cases, the sensitivity of TVS and MRI was 44% and 92%, specificity was 96% and 88%, PPV was 91.67% and 88.46%, NPV was 63.16% and 91.67% respectively, kappa was 0.40 and 0.80 i.e. agreement between TVS and MRI v/s HPE was 40% and 80% respectively. The diagonal agreement between transvaginal USG and MRI, was 63%.Conclusions: TVS is a good screening modality but MRI is definitely better for proper characterization and localization of fibroids enabling clinicians to select the most appropriate management in everyday clinical practice

To study the role of visual inspection of cervix with acetic acid (VIA) in cervical cancer screening

Background: Objectives of current study were to evaluate visual inspection of cervix with acetic acid in picking up abnormal cervix and to correlate the findings of VIA with Pap smear, colposcopy and cervical biopsy.Methods: Study was conducted on 300 sexually active women attending the gynaecological OPD at Dayanand medical college and hospital, Ludhiana. All patients underwent VIA & Pap smear screening and if either of the two was abnormal, colposcopy was done & colposcopic guided cervical biopsy was taken if indicated. Total 105 colposcopies were done. Cervical biopsy was taken in 87 cases and the results were compared and statistically analysed.Results: The sensitivity of VIA was 86% and specificity 40.50%. No case was missed by VIA when cut off was taken as moderate dysplasia or higher lesions on biopsy.Conclusions: VIA is a sensitive, practical and a low cost affair in cervical cancer screening

Perception and correlates of excessive vaginal discharge in rural women

Background: Vaginal discharge is one of the most common symptoms of gynecological morbidity. Vaginitis is the most prevalent cause. Gynecological disorders have substantial impact on female health and behaviour. Recent evidence suggests that the association between the complaint of vaginal discharge and the presence of Reproductive Tract Infections is weak. Women who are overanxious, introspective or suffering from fears of venereal disease and cancer tend to exaggerate the complaint of vaginal discharge into something pathological. The objective of the study was to study rural women’s perception and health care seeking behaviour regarding excessive vaginal discharge. To study various psychological and biological correlates of excessive vaginal dischargeMethods: This was a community based cross sectional study, conducted in the rural field practice areas under the Department of Community Medicine, Christian Medical College, Ludhiana. House to house surveys were conducted with semi-structured questionnaire and GAD 7 (Generalised Anxiety Disorder) scale, using systematic random sampling.Results: 160 rural women were interviewed to collect data. Of them, 27.5% reported having excessive vaginal discharge. There was no association observed between menstrual hygiene methods and excessive vaginal discharge (p= 0.77). Association couldn’t be observed with selection of barrier and other non-barrier methods of contraception (p= 0.09) either. Statistically significant association was observed between presence of anxiety and vaginal discharge (p=0.01).Conclusions: All vaginal discharges are not pathological. Causative factor of excessive vaginal discharge may not be infections always. There was a statistically significant association between anxiety and perceived vaginal discharge