Role of urodynamics in evaluation of lower urinary tract dysfunction in women of pelvic organ prolapse

Background: Utero-vaginal prolapse is a common gynecological disorder, result from weakness of musculoskeletal structure that support the pelvic organ. Although it is not an emergency situation but severely affect the quality of life. Women with utero-vaginal prolapse may present with lower urinary tract dysfunction but association of urological changes with UV prolapse and beneficial effect of surgery on these changes is still debatable. Urodynamic study such as cystometry and uroflowmetry help in better understanding of lower urinary tract dysfunction and assist to plan appropriate surgical management thereby reduce chances of postoperative voiding dysfunction.Methods: A total of 30 women of pelvic organ prolapse with lower urinary tract dysfunction, over a period of one year, were subjected to urodynamic studies after thorough evaluation by history, examination and standardized questionnaire both pre and post operatively and data analysed.Results: In present study, urodynamic study identified urinary dysfunction in 93.34% of women recruited in study. Obstruction was present in 36.67% of women. Detrusor overactivity along with obstruction was seen in 20.00% of women. Urodynamic stress incontinence and urodynamic stress incontinence along with obstruction was identified in 13.33% of women each and detrusor overactivity was observed in 10.00% of women.Conclusions: In present study it was found that, if surgical management of pelvic organ prolapse is planned according to urodynamic study, it will improve urologic profile of patients. To conclude that urodynamic study should be an integral part of diagnostic work up of uterovaginal prolapse patients require larger sample size and at least 6 months follow-up duration after surgery

Histopathological evaluation of endometrium and its clinical correlation in patients of abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is a very common, challenging gynaecological problem in all age group women. Neoplastic lesions are responsible for very less number of cases but they should be diagnosed early. Endometrial biopsy is necessary for histopathological diagnosis of endometrial lesions and to rule out any malignancy. In present study, we evaluated histopathological pattern of endometrium and different clinical parameters in AUB patients.Methods: A retrospective observational study done in Obstetrics and Gynecology department of SSMC Rewa, Madhya Pradesh in 2 year from 1st October 2017 to 30th September 2019. AUB patients who fulfilled inclusion criteria were included in study. All data were collected from department records in predesigned proforma and statistically analyzed by statistical package for the Social sciences (SPSS) version 20.Results: Total 366 AUB patients were included in study; most frequent clinical presentation was HMB (56%). Mostly patient’s age ranged from 24-84 years, belonged to 41-50 years age group (44%), multiparous (78%), and premenopausal (53%). On histopathological evaluation of endometrium most commonly nonneoplastic lesions (75%) were seen, out of which proliferative phase endometrium was most frequent. Neoplastic lesions were seen in 25% cases. Out of which benign lesions were noted in 7%, premalignant in 17.3% and malignant in 1% (all in >45 year patients).Conclusions: Endometrial biopsy should be done in all AUB patients >45 years and in selected premenopausal in order to get early diagnosis, to rule out malignancy and to help in management. Endometrial biopsy should be considered as first diagnostic modality

Postpartum intrauterine contraceptive device: effect of antenatal versus postpartum counselling in acceptance of postpartum intrauterine contraceptive device

Background: The acceptance for PPIUCD in our country, especially in rural areas is very low despite all the efforts. Counselling during the antenatal visits may play a vital role in improving the acceptance of PPIUCD. Objective of this study was to assess the factors associated with the acceptability of immediate PPIUCD insertion in women; counselled during antenatal and postpartum period; according to their sociodemographic and obstetric characteristics, and future pregnancy desires.Methods: One-year prospective study carried out in the department of obstetrics and gynecology, S. S. Medical College Rewa, Madhya Pradesh, India. a total of 4850 women were counselled for PPIUCD insertion; 2540 during their antenatal visits, and 2310 during postpartum period who visited in study centre for first time and their follow up was done. Chi square tests were applied to compare proportions.Results: After antenatal counselling in 2540 women, (with multiple counselling sessions) about half of the women gave verbal acceptance for PPIUCD. However, during postpartum counselling in 2310 women, (where only single short session of counselling could be done) majority of the women declined (80.9%) for PPIUCD insertion with only about a fifth (19.1%) of the women giving verbal acceptance. Women who had antenatal counselling one third of them had PPIUCD insertion. In the postpartum counselling group, a meagre 15.1% women had PPIUCD insertion.Conclusions: Counselling during antenatal and postpartum period is the key to improve the awareness and acceptance of PPIUCD in our community. Multiple counselling sessions during antenatal visits make it easier for the women to slowly understand the process and accept PPIUCD as compared to the short counseling during postpartum period

Expectant versus surgical management of incomplete abortions caused by self-intake of abortifacient drugs: results from a randomized controlled trial

Background: Termination of unwanted pregnancies with medical method using recommended protocol based abortifacient drugs is a standard practice followed by obstetricians and gynaecologists worldwide which has a very successful outcome. However, self-administration of these drugs has become rampant because of certain social and practical issues resulting in complications and incomplete abortions as when these drugs are self-administered, recommended protocol is not generally followed. Traditionally incomplete abortions are managed by surgical curettage which itself is associated with procedure related complication and has been challenged by recent studies. Based on these studies many international guidelines have come out in support of expectant management of incomplete abortions. This study compared both of these management protocols to treat incomplete abortions caused by unprescribed intake of abortifacient drugs.Methods: This was a one-year long prospective randomized controlled study in which total 782 females were randomized into two groups of 371 and 411. Group 1 was offered expectant management while group 2 was offered surgical curettage. Results were analysed using appropriate statistical tests.Results: Group 1 showed a success rate of 86% while group 2 showed a success rate of 90% which was comparable. Overall complication rate was found to be higher in Surgical curettage group than in the group which underwent expectant management group.Conclusions: Considering a very high number of patients coming with incomplete abortions caused by self-medication in present practice, expectant management seems to be a safer and more effective method and should be practice more widely

Emergency peripartum hysterectomy: a 3 year review at a tertiary care hospital in Vindhya region of India

Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetric, still performed as lifesaving surgical procedure to control haemorrhage that is unresponsive to conservative treatment. The objective of this study was to review the incidence, indications, and predisposing factors and associated complications of EPH.Methods: The present study is a retrospective study included 37 women who underwent EPH over a period of 3 year. The records were collected from medical record department.Results: 37 patients underwent EPH during this period making an incidence of 1.1 per 1000 deliveries. Most common indication of EPH in present study was morbidly adherent placenta (MAP) seen in 19 cases (51.4%). 36 patients (97.4%) patient underwent cesarean section at the time of their index pregnancy and 25 out of 37 (67.6%) patient had undergone prior cesarean delivery. 20 (54%) patients underwent total abdominal hysterectomy (TAH) and 17 (46%) patients underwent subtotal hysterectomy (STH). Mean operative time, estimated blood loss, injury to urinary tract, febrile illness and duration of hospital stay was higher in TAH group as compared to STH group but difference was not statistically significant except for estimated blood loss. Maternal mortality was seen in 20% of cases and neonatal mortality was seen in 56.8% of cases.Conclusions: EPH although lifesaving but have devastating consequences. EPH should be performed with a multidisciplinary team approach. Measures should be taken to reduce caesarean section rate

IDENTIFICATION OF POSSIBLE MOLECULAR TARGETS OF POTENTIAL ANTI-PARKINSON DRUGS BY PREDICTING THEIR BINDING AFFINITIES USING MOLECULAR DOCKING TECHNIQUE

Objective: Mechanistic study of newly reported anti-Parkinson agents by molecular docking to predict possible target.Methods: Structures of newer drugs known anti-Parkinson agents were drawn using ChemBioDraw 2D software. Thereafter, they were converted to 3D structures using ChemBioDraw 3D software in which they were subjected to energy minimization using the MM2 method and then saved as PDB extension files, which can be accessed using the AutoDock Vina (ADT) interface. ADT 1.5.6 software version was used for molecular docking study.Results: Various molecular targets were selected (D2/D3, D2, A2A, and MAO-B) and studied for Pardoprunox, Istradefylline, Rasagiline, and Bromocriptine. Pardoprunox, Istradefylline, and Bromocriptine had more affinity with their corresponding receptor with −6.9, −8.5, and −9.4 kcal/mol binding affinity, respectively, except Rasagiline, who has less affinity with its corresponding receptor (−6.4kcal/mol) and shown better affinity with 3pbl receptor (−6.7 kcal/mol).Conclusion: Pardoprunox, Istradefylline, and Bromocriptine were found to act on D2/D3 (3pbl), A2A (3pwh), and D2 (4yyw), respectively, whereas Rasagiline found to be act on D2/D3 (3pbl) receptor. The results help in prediction of mechanism and interaction to various Parkinson's disease targets

Reassessing contemporary labour curves

OBJECTIVES: Our purpose was to analyse the pattern of labor progression in Low risk parturients in contemporary obstetric practice. STUDY DESIGN: We extracted detailed labor data from 1531 low risk parturients with a term, singleton, vertex fetus of normal birth weight after spontaneous onset of labor. Cesarean deliveries,instrumental deliveries and those needed oxytocin augmentation  were excluded.Those women whose new born needed resuscitation were also excluded. We used statistical measures to discover the average labor curve under contemporary practice.  We also computed the expected time interval of the cervix to reach the next centimeter, the expected rate of cervical dilation at each phase of labor.  RESULTS: Our average labor curve differs markedly from the Friedman curve . The cervix dilated substantially slower till 6 cm cervical dilatation. It took approximately 3.66 hours from 4 cm to 10 cm, compared with 2.5 hours under the Friedman curve. We observed no deceleration phase . Mean rate of cervical dilatation in active phase of labour was 1.42 cm/hr which is less than friedman’s rate of cervical dilatation which was 3 cm/hr. As per Zhang et al labour progress differentially at different degree of dilatation. &nbsp

Analysis of demographic characteristics affecting labour curve in low risk pregnant woman in tertiary care hospital in Central India

Background: Since decades  labour curve given  by E. Friedman in 1950 is used in  obstetrics practices all over the world; but recent studies have highlighted labour progression pattern which deviates from Friedman’s curve. Recently there have been many studies done to focus on progress of labour in contemporary labouring females. Till date no other study has been focused on developing labour curves for Indian origin females. This study is done to evaluate pattern of labour progress in  central Indian origin female. Objective: To analyse demographic  characteristics  affecting spontaneous  labour progression in low risk pregnant females of central Indian origin. Material and methods: It was prospective observational study done from August 2017 to July 2018. Low risk term pregnant women with spontaneous onset of labour were included and findings were entered in a pre-structured format. Results: Mean age of study population was 24.43 years with a range of 18 to 35 years. Mean body mass index (BMI) of study population was 21.49 with a range of 18.5 -30 kg/m2. Maximum number of females were nulliparous i.e 79.10%. Mean cervical dilatation at admission was 4 cm. Mean duration of active phase of labour was 3.66 hrs.  &nbsp

Association of cervical effacement with spontaneous labour progression in low risk pregnant females

Aim: This study was conducted to evaluate the effect of the cervical  effacement  to rate of cervical  dilatation in spontaneous onset labour in low risk pregnant women in order to improve the accuracy of the current partogram. Method: We conducted an observational study of women who were admitted for vaginal delivery at SSMC, Rewa from august 2017 to july 2018. During labor, dilatation curve was plotted in different graphs for women with spontaneous onset labour admitted at SSMC,Rewa during this time period..They were divided into 2 groups based on degree of effacement at admission,whether it was more than 80% or less than equal to 80% and then their labour curve was separately evaluated and compared with each other . Results: From 8839 women admitted during this time period, 1386 nulliparous and primiparous and 145 multiparous women were eligible for the study. An adjusted generalized estimating equations multivariable model showed that effacement had a significant relationship with rate of cervical dilatation and speed of labour progression .&nbsp

Association of body mass index with rate of cervical dialatation in spontaneous onset labour

Objective: To determine association of cervical dialatation rate with body mass index (BMI). Introduction: The prevalence of overweight and obesity is increasing among women of childbearing age. Observational studies show that obese women have up to a 2-fold increased risk for a cesarean delivery compared with normal-weight women. The purpose of this study was to examine the effect of maternal overweight and obesity on the pattern of labor progression in pregnant women with a singleton, term pregnancy with spontaneous onset labour. Methods: We analyzed data from 1531 pregnant women with a term pregnancy those were admitted in SSMC ,Rewa from August 2017- July 2018 with spontaneous onset labour pain at term. The median duration of labor by each centimeter of cervical dilation was computed for under weight(Body mass index BMI<18.5 kg/m2), normal-weight (BMI_ 18.5 –24.9 kg/m2), overweight (BMI >24.9-29.9 kg/m2), and obese (BMI>30 kg/m2) women and used as a measurement of labor progression.  Results: After considering inclusion and exclusion criteria all laboring females were allowed to progress naturally and four hourly partogram was recorded. All females who required augmentation ,caesarean or instrumental delivery were excluded from the study.&nbsp