Comparison of dinoprostone slow-release vaginal insert with intracervical Foley catheter in cervical ripening for induction of labour: a prospective observational study

Background: Cervical ripening prior to induction of labour is crucial as unfavorable cervix with poor Bishop’s score can lead to caesarean section. Two most widely used methods are vaginal dinoprostone and intracervical Foley catheter. Studies conducted worldwide to determine the efficacy and safety of these methods provided no consensus regarding superiority. Thereby, the present study aims to compare the efficacy of these two methods for successful cervical ripening during induction of labour.Methods: In this prospective observational study, all antenatal women admitted for induction of labour satisfying the inclusion criteria were enrolled. Women in group A were induced with dinoprostone slow-release vaginal insert and those in group B with intracervical Foley catheter. Sample size was 72 in each group. Both the groups were followed till delivery and assessed for improvement in Bishop’s score, induction to active phase duration, induction to delivery time, use of other agents, mode of delivery, incidence of hyperstimulation and neonatal outcomes.Results: Induction to active phase duration and to delivery time was statistically shorter in dinoprostone slow-release vaginal insert group than intracervical Foley group. Improvement in Bishop’s score, mode of delivery and indication for LSCS were not statistically significant. Uterine hyperstimulation was significantly higher in Dinoprostone insert group. Neonatal outcomes were similar.Conclusions: Dinoprostone slow-release vaginal insert resulted in better Bishop’s score during re assessment, reduced need for second agent, shorter induction to active phase and to delivery time when compared with intracervical Foley catheter and so can be used effectively for successful cervical ripening.

Adolescent pregnancy: an overview

A pregnancy can take place at any time before or after puberty. Adolescent pregnancy is defined as pregnancy under the age of 20 years. It is a problem in both developed and developing country. It raises various human right issues i.e. an adolescent pregnant girl is forced to leave school, depriving her right to education; she is prevented from using any contraception or reproductive health related information, so she is also denied her right to health. As many adolescents are neither physically nor psychologically ready for pregnancy or childbirth, this reproductive event makes them more vulnerable to complications resulting in devastating health consequences for them. Early drop out from the school and health problem jeopardize their income-earning potential

Efficacy of prophylactic use of tranexamic acid in reduction of blood loss in benign hysterectomy: a randomised controlled trial

Background: Aim of current study was to determine the efficacy of tranexamic acid in the reduction of blood loss during hysterectomy for benign indications.Methods: This is a randomized controlled trial in a tertiary care teaching hospital in Pondicherry. The study population was 108. Participants were allocated into 2 groups: Group A (N=54) and group B (N=54) based on computer generated random numbers. Group A (N=54) comprised of participants undergoing hysterectomy with prophylactic intravenous tranexamic acid (1 gram in 100 ml of 0.9% normal saline) which was further subdivided into A1 (N=27) and A2 (N=27) undergoing abdominal and vaginal hysterectomy respectively. Group B: comprised of participants undergoing hysterectomy without tranexamic acid, further subdivided into B1 (N=27) and B2 (N=27) undergoing abdominal and vaginal hysterectomy respectively. The mean blood loss during the intraoperative and post-operative periods was calculated and compared between the groups.Results: Participants in Group A who received prophylactic tranexamic acid were found to have less blood loss compared to the control population in Group B. The difference between the means was statistically significant.Conclusions: We concluded that tranexamic acid should be considered as prophylactic treatment for hysterectomy to reduce the risk of substantial blood loss and the need for blood transfusion and early recovery.

Large fibroid complicating pregnancy: a case report

Uterine fibroids are the most common benign tumors of the female reproductive system and are known to occur in 0.1-10.7% of pregnant women and incidence increases with increasing maternal age. Fibroids when present are associated with complications in 10-40% of pregnant patients like abdominal pain, spontaneous abortion, fetal malposition, placental abruption, premature rupture of membranes, cesarean deliveries, postpartum hemorrhage, preterm delivery and low birth weight infants

Correlation of clinical and ultrasonographic features with histopathology in post-menopausal bleeding

Background: Postmenopausal bleeding is generally regarded as an ominous alarm of genital pathologies which requires a thorough evaluation clinically and pathologically to exclude carcinoma as the cause and ensure a benign pathology. This study aims at finding out whether clinical diagnosis and ultrasonographic features can be reliable parameters for the diagnosis of causes and whether the findings correspond with histopathology reports.Methods: This observational study was conducted in a tertiary care centre in Pondicherry between January 2018 to August 2019. 114 women were enrolled for whom detailed history taking and clinical examination was done. All the patients were subjected to transvaginal ultrasonography. Patients with clinically visible lesions on cervix and vulva were subjected to biopsy and the rest underwent fractional curettage and the sample was sent for histopathological examination. Finally, histopathology report was compared with clinical and ultrasonographic findings.Results: With endometrial thickness cut off of 4 mm, the sensitivity, specificity, positive predictive value and negative predictive value in predicting malignancy by ultrasonography were 100%, 12.3%, 4.5% and 100%. Histopathology showed atrophic endometrium (43.8%), endometrial hyperplasia (8%), endometrial polyp (7.9%) and endometrial carcinoma (3%). Clinical and ultrasonographic findings did not show any statistical correlation with histopathology.Conclusions: Authors conclude that clinical findings and ultrasonographic features do not correlate with histopathology in cases of postmenopausal bleeding for which atrophic endometrium was the commonest etiology. However, ultrasound should be done routinely before endometrial sampling as the sensitivity for predicting malignancy was 100% for endometrial thickness cut off of 4 mm

Outcome of clinical hypothyroidism in pregnancy: a case control study

Background: Hypothyroidism in pregnancy is generally associated with various adverse outcomes. Also worldwide, there is an increased awareness about morbidity caused by this endocrinological disorder in pregnancy .This study is undertaken to evaluate the outcome of this condition in pregnancy.Methods: 144 newly diagnosed clinical hypothyroid pregnant women were taken as the case group and 145 age and parity matched euthyroid pregnant women were taken as controls. The outcome compared in between these two groups were pregnancy complications like gestational diabetes and hypertension , oligohydramnios, intrauterine growth restriction , intrauterine demise, Caesarean section rates and it’s indication as well as neonatal outcome like birth weight and need for neonatal intensive care.Results: Clinical hypothyroidism in pregnancy constituted 6.1% of the total number of deliveries. There was a significantly higher number of gestational diabetes in the case group (p=0.0001). Caesarean sections done for the indication of foetal distress was significantly higher when compared with the control group (p=0.00002). Large for gestational age babies were more common in case group.Conclusions: Clinical hypothyroidism in pregnancy even when treated adequately might lead to complications

Maternal factors associated with large for gestational age babies and its outcome when compared with those of appropriate for gestational age

Background: Large for gestational age (LGA) babies are known to have a higher incidence of birth trauma, difficult delivery and Caesarean sections. Knowledge about maternal factors associated with this can help in prediction and prevention of complications.Methods: Maternal factors in 112 cases of LGA babies was studied along with its outcome and compared with an equal number of controls.Results: 0.05% deliveries resulted in LGA babies. Age and parity were not significantly different in the two groups and so were the associated medical disorders of hypothyroidism and gestational hypertension. Significant association was found with post-dated pregnancies (p=0.04) and gestational diabetes mellitus (p=0.05). Also, higher number of primary Caesarean sections resulted in the case group.Conclusions: Post dated pregnancies and gestational diabetes were maternal factors associated with LGA babies and higher number of primary Caesarean sections resulted in these cases

Leading twin in breech presentation, is routine caesarean section necessary?

Background: Multiple gestations and Caesarean delivery are both showing a rising trend worldwide. One major cause for Caesarean section in twin gestations is leading twin in breech presentation. This study is to find out whether vaginal delivery is an option in such cases.Methods: Out of 66 twin deliveries, 27 cases were studied with one twin in breech presentation after excluding the previous LSCS cases. Maternal parameter studied was section rates in primi and multi gravida respectively. Neonatal parameters studied were birth weight and Apgar scores of breech twins and after weight wise distribution of babies into 4 groups the morbidity of those born vaginally were compared to those delivered by Caesarean section.Results: Twin deliveries constituted 2.7 % of total deliveries in one year and combinations of breech with 2nd foetus in breech, cephalic and transverse presentations were 16.8, 9 and 3% respectively. Out of 19 first breech twins, 11 were in primigravida who underwent LSCS and 5 in multigravida of which 60 % underwent LSCS. So 40.6% of primary LSCS were due to first twin in breech. Out of 19 2nd breech twins, 6 delivered vaginally. Irrespective of mode of delivery, morbidity was influenced by birth weight, where babies 2.5kg required NICU care in 100, 64, 20 and 0 % cases in the LSCS group compared to 100, 66.7,0 and0% cases in the vaginal delivery group.Conclusions: Vaginal delivery can be considered as an option for first twin breech specially in multigravida

Gestational diabetes mellitus: does treatment modality predict the obstetric and neonatal outcome?

Background: Gestational diabetes mellitus (GDM) may be controlled with dietary modifications alone or may require insulin treatment. This study aims to find out the impact of these two treatment modalities on the maternal and neonatal outcomes.Methods: This retrospective observational study divided the GDM patients into two groups, A and B, treated with diet and insulin therapy respectively and the maternal and neonatal outcome parameters were compared.Results: 299 (6.7%) GDM patients over a period of two years were divided into group A (n=222) and group B (n=77). Need for induction of labour was significantly higher in group B (p=0.02). More number of history of previous abortions were seen in group A (p=0.1) and higher number of emergency Caesarean sections were observed in group B (p=0.1). Previous history of intrauterine deaths, gestational hypertension and hypothyroidism in the present pregnancy, meconium stained liquor, large for gestational age babies and need for neonatal intensive care were comparable in the two groups.Conclusions: There are no significant differences in the pregnancy outcomes of GDM treated with diet therapy alone or insulin except for a higher number of induced labours in the insulin treated group

Rare case of congenital anomaly in two different gestational ages: a case series

Acrania is a rare congenital anomaly involving faulty development of membranous flat bones of neurocalvarium. Commonest differential diagnosis is anencephaly. The first case was diagnosed in a second gravida at 13 weeks and terminated by vaginal misoprostol instillation. The second case was diagnosed only by scan at 32 weeks in an unbooked second gravida with previous LSCS. She underwent emergency LSCS for failed induction and a fresh stillborn baby of 1.9 kg was born