Evaluation of perinatal outcome in women presented with first trimester vaginal bleeding: our experience

Background: First trimester vaginal bleeding (FTVB) plays a role in occurrence of late pregnancy complications in both mother and infant. Late pregnancy outcomes in mothers and infants are the main concerns for the obstetricians. The purpose of this study was to assess the perinatal outcome of pregnancies complicated by first trimester vaginal bleeding.Methods: The present study included total 100 singleton pregnant women with history of FTVB whose pregnancy was confirmed chemically. Patients were closely observed and follow up done 2 weekly upto 36 weeks and weekly after that. Late pregnancy outcomes such as gestational hypertension, pre eclampsia, placental abruption, preterm delivery and pre mature rupture of membranes in the mothers and  low birth weight, intrauterine growth ristriction, apgar score after 1 and 5 minutes,  and  NICU admission in new born were calculated.Results: Incidence of PROM, gestational hypertension and placental abruption is more in women with FTVB. However there infant had higher rate of IUGR and LBW. Apgar score after 1 and 5 minutes were less than 5 and admission to NICU too.Conclusions: FTVB is an important factor to predict both the maternal and fetal outcomes in late pregnancy. It is therefore important to evaluate and consider these pregnancies as high risk group and provide careful antenatal care

Study of thrombocytopenia in pregnancy: clinical presentation and outcome at tertiary care rural institute

Background: Platelet count below 1.5 lakh/cumm is called as thrombocytopenia. After anaemia it is the second most common haematological disorder in pregnancy. It affects nearly 6 to 15%; on an average 10% of all pregnancies. Gestational thrombocytopenia is a clinically benign thrombocytopenic disorder usually occurring in late pregnancy. It resolves spontaneously after delivery.Methods: It is a hospital based prospective observational study over a period of 1 year. All pregnant women who attended OPD at the department of obstetrics and gynecology, UPUMS, Saifai for antenatal checkup were included for the study and blood sample was withdrawn.Results: Out of 263 cases enrolled for study, 90 women were found to have thrombocytopenia, and 173 had normal platelet count. Thus, incidence of thrombocytopenia was 34%. Gestational thrombocytopenia accounted for majority of cases of thrombocytopenia in pregnancy (50%) followed by hypertensive disorders (22.4%). It was further followed by ITP (11.11%) and dengue (5.5%).Conclusions: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (50%), but other underlying causes must be considered as well. A thorough history and physical examination will rule out most causes

Examining the Need of Digital Citizenship Education for Adolescents in the Current Digital Landscape

Adolescents are growing up in a digital era, and the increasing role of technology in our lives presents both challenges and opportunities. A survey study was conducted to address the need for Digital Citizenship Education (DCE) in school-going adolescents, as they need to learn how to make sound judgments when navigating the digital world. The study found that 79% of students have digital access at home, 83% purchase products online, and 73% have social media accounts, with 24% talking to strangers online. However, only 21% use the internet at school, and 78% are unaware of the term DCE. The survey also revealed that many students lack awareness of cyber laws, struggle to determine the reliability of online information, and believe everything they see online is true. This research emphasizes the importance of developing a customized DCE curriculum for adolescents to participate safely, ethically, effectively, and responsibly in the digital community

Prevalence of hypothyroidism in subfertile women in a tertiary care centre in North India

Background: Thyroid hormones are essential for normal growth, sexual development and reproductive function. The prevalence of hypothyroidism varies between 2-4% in women of reproductive age group. It can affect the fertility in various ways like sex hormone imbalance, anovulatory cycles, luteal phase defects, and hyperprolactinemia. Objectives: To study the prevalence of hypothyroidism in subfertile patients.Methods: A total of 454 subfertile women visiting the Reproductive Biology department for subfertility were investigated for thyroid stimulating hormone (TSH) and prolactin (PRL). Hypothyroidism was considered at TSH levels of >4.5 μIU/ml and hyperprolactinemia at PRL levels of >25 ng/ml.Results: Of 454 subfertile women 24% were hypothyroid (TSH >4.5 μIU/ml) and 12.8% patients had hyperprolactinemia.Conclusions: TSH and PRL should be measured in all cases desirous of issue before proceeding for more costly tests or invasive procedures

Assessment of depression, anxiety and stress among Indian infertile couples in a tertiary health care centre in Bihar

Background: Infertility rate is on rising trend. It is often associated with a chronic state of stress which may manifest itself in anxiety-related and depressive symptoms. Also, the affected family faces social discrimination, ostracism and stigma which leads to increased anxiety or depression among infertile couples. The motive of this study was to assess the quality of life among infertile couples; to determine the relationship between various domains of quality of life of infertile couples i.e. emotional, mind/body, relational, social, environmental and tolerability and to determine the association of levels of quality of life of infertile couples with the selected variables visiting  IGIMS.Methods: This was a cross-sectional based study; carried out in the department of reproductive medicine, IGIMS, Patna, Bihar for one-year duration (January 2017 to December 2017), on 122 infertile patients attending outpatient department for treatment. Data was collected by using self-administered questionnaire i.e. Ferti QoL questionnaire and HADS.Results: Among all these 96 cases was found to be suffering from primary infertility and 26 cases from secondary infertility. In primary infertile patient social domain was the most affected domain having the greatest impact on their quality of life. In secondary infertile patients the tolerability domain was the most affected domain having the greatest impact on their quality of life. The total fertility quality of life score in primary infertility patients showed a lesser quality of life (55.41) than secondary infertility patients (66.29).Conclusions: This study points at the necessity of specific psychological interventions, presently absent from the public healthcare routine, for women struggling with infertility, to help them manage potential mental health problems and meet their reproductive goals

The Study of Serum Uric Acid as a Biochemical Indicator for Maternal and Fetal Outcome in Gestational Hypertension

INTRODUCTION: Hypertensive disorder are amongst the most common medical disorder during pregnancy and considered to be a major cause of maternal and perinatal morbidity and mortality. In India incidence of preeclampsia as recorded from hospital statistics vary widely from 5-15%. Pre-eclampsia and eclampsia are still regarded as “disease of theories” and etiology is still obscured. An association of uric acid with PE has been known since long Several studies have correlated the rise in uric acid with the severity of the PE. Although hyperuricemia does co-relate with maternal morbidity, there is an even stronger association of increased uric acid with risk for small or LBW infants and with overall fetal mortality. OBJECTIVE: We aimed to assess whether serum uric acid can be used as a biochemical indicator in patients with gestational hypertension and its role in determining disease severity and maternal and perinatal outcome. MATERIALS AND METHODS: In this prospective case study conducted at Government Theni Medical College and Hospital, Tamil Nadu between June 2018 and June 2019, 200 singleton pregnant women with gestational hypertension at more than 20 weeks of gestational age were included. Hemoglobin, hematocrit, platelet count, liver function tests, uric acid levels, and maternal and neonatal complications were assessed. The severity of pre-eclampsia and eclampsia, placental abruption, pre-term labour, HELLP syndrome, post-partum hemorrhage, and hospitalization to the ICU were all considered maternal complications. Fetal complications included low birth weight, IUGR, 5-min APGAR scores <7, hospitalization to the NICU, and IUD. RESULTS: Of our 200 participants, 47% were primigravida, 60.5% were at 37 weeks or greater gestational age (USG determined), 45% had pre-eclampsia, 4% eclampsia, and 3% HELLP syndrome. Of all the participants, 33.5% had elevated levels of serum uric acid (>6 mg/dL). Of those with elevated serum uric acid levels (67 subjects), 7.5% (5 subjects) developed HELLP syndrome, 3% developed abruptio placentae, and 14.9% of the neonates died (IUD) (all considered statistically significant with p value < 0.05). There were no maternal death reported in our study. The rates of comparison for IUGR, pre-term birth/low birth weight, and spontaneous expulsion between those with normal versus elevated serum uric acid levels were not considered statistically significant (p > 0.05). CONCLUSION: Our study concludes that the measurement of serum uric acid levels after 20 weeks of gestation is a great diagnostic and prognostic tool to assess fetal outcomes. This study shows that the estimation of serum uric acid levels in pregnancies complicated by hypertension and pre-eclampsia help in assessing the severity of the disease and identifying life-threatening maternal and fetal complications as a result of preeclampsia/eclampsia

Hypertensive disorders of pregnancy: a clinical study in a rural tertiary care centre of western Uttar Pradesh, India

Background: The aim of study was to find out the frequency and clinical outcome in hypertensive disorder of pregnancy (HDP) in a rural tertiary care centre. Hypertensive disorder of pregnancy is a commonest medical disorder which constitutes about 12-22% of all pregnancies and it is a major cause of maternal morbidity as well as mortality world wide.Methods: It is a retrospective hospital-based study to find out the clinical outcome in different hypertensive disorder of pregnancy in a rural tertiary care centre of western Uttar Pradesh.Results: Present study showed the prevalence of HDP was 4.01% among the study population. Most of the patients were primipara ,unbooked and less than 25 years of age. The most common HDP was mild preeclampsia  and HELLP was its commonest  complication.Conclusions: Hypertensive disorder of pregnancy (HDP) is still a major cause of maternal mortality and morbidity. Authors intend to aware the pregnant women regarding high risk factors of pregnancy and motivate them for regular antenatal care so that  complications of  hypertensive disorders can be  managed timely

Analysis of causes and clinical pattern of infertility in couples coming to a tertiary care centre in Bihar, India

Background: Infertility is one of the major health problems and a socially destabilizing condition for couples often causing marital disharmony. Infertility is defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Worldwide, its prevalence is approximately 8-12%.There are numerous factors such as anatomical, physiological and genetic factors that cause infertility. Many environmental and acquired factors also lead to inability to conceive. Objective of the present study was to determine the causes and clinical pattern of infertility in infertile couples.Methods: It was a hospital based observational study carried out on 750 women in reproductive age group attending out-patient clinic of Reproductive Biology Department of Indira Gandhi Institute of Medical Sciences (IGIMS) at Patna during April 2013 to March 2017. All the cases of primary and secondary infertility diagnosed after full examinations and laboratory tests were included and cases lacking of full examinations and laboratory tests were excluded. All the data of infertile couples were recorded in a semi-structured Case Information Performa.Results: Out of 750 women 454 women had all the data and they participated in the study Nearly 68% women had primary infertility and rest had secondary infertility. Male factor was responsible in 37.39%, female factor in 20.48%, unexplained in 22.46% while a combination of both factor was seen in 8.37% cases in our study .135 women had irregular menstrual cycles in which 64(47%) had oligomenohhrea. 79% women had normal ultrasonography and nearly 11% of women had evidence of PCOD. 24% women had hypothyroidism (TSH more than 4.5 IU/L) and 59(13%) were found to have high level of prolactin i.e. &gt;25 ng/ml. Nearly 8% of women had high level of FSH i.e. more than 10 IU/L which is an indicator of ovarian resistance. In nearly 16% women one fallopian tube was found blocked and 8% had both tubes blocked in hysterosalpingography. Husband semen analysis was done to assess male factor. Nearly 14% of their male partners suffered from azoospermia and 23% had at least one abnormal parameter in semen analysis.Conclusions: Etiological pattern of infertility varies in different parts of World. Male and female factors both are responsible for infertility. So, both the partners should be counselled and investigated properly

Role of levonorgestrel releasing intrauterine device in management of heavy menstrual bleeding: a conservative approach

Background: Heavy menstrual bleeding (HMB) is defined as prolonged (>7 days) or excessive menstrual blood loss greater than or equal to 80 ml per menstrual cycle. The objective of the study was to assess the efficacy, acceptability and side effects of LUS IUS in women with heavy menstrual bleeding.Methods: 42 women with heavy menstrual bleeding with or without associated dysmenorrhoea or chronic pelvic pain and had no contraindication to IUS insertion were included in the study. Patients having active genital tract infection, suspicion of pregnancy, uterine fibroids >2.5 cm in size or sub mucosal distorting the uterine cavity, uterine size >12 weeks, atypical endometrial hyperplasia or malignancy, abnormal cervical cytology, coagulopathy or liver disease were excluded from the study. Preliminary endometrial biopsy was done to rule out malignancy and LNG IUS was inserted under anaesthesia. Women were followed for 3,6,12 and 24 months post insertion.Results: In first 3 months, 20% patients achieved normal menstrual cycle, and at 6 months 44.44% had scanty menstrual flow and after 1 year of use 81.5% achieved amenorrhoea. In initial 3 months 37.5% patients had irregular heavy bleeding, which reduced to 13.89% at 6 months and 0% at 1 year follow up. Irregular spotting was second most complaint in 32.5% patients in initial 3 months that persisted in 7.4% patients at 1year follow up. In 5.0% patients, there was spontaneous expulsion of the device in first 3 menstrual cycles. After 3 months of use 57.5% patients were satisfied with the device and at the end of 1 year 92.5% were satisfied.Conclusions: LNG IUS is highly effective in controlling blood loss, well tolerated and better alternative for hysterectomy with higher user satisfaction in all age group of women

Pseudo aneurysm of uterine artery and cesarean scar dehiscence causing secondary post-partum haemorrhage managed by uterine artery embolisation: a case report

Uterine artery pseudo aneurysm is rare but potentially life threatening complication of cesarean section and may present with severe secondary postpartum haemorrhage. Here we report a case of secondary postpartum haemorrhage due to pseudo aneurysm of left uterine artery and cesarean scar dehiscence in 27 yrs old women which was managed successfully with uterine artery embolisation at IGIMS, Patna. These 27 yrs old young women presented with severe secondary PPH forty days following cesarean section. Ultrasound and CT scan abdomen was done which showed full thickness defect in the lower segment of uterus and focal enhancement in the early arterial and late venous phase in left parametrium. Pseudo aneurysm being rare was not suspected and patient underwent laparotomy. Twenty two days after surgery patient again had heavy bout of vaginal bleeding. Doppler Ultrasound was done which showed large pseudo aneurysm of left uterine artery which was then managed successfully with uterine artery embolisation. Although rare but pseudo aneurysm of uterine artery should be suspected in case of secondary PPH where other common causes has been excluded. Angiographic embolisation of uterine artery is safe and effective method for treating secondary PPH due to pseudo aneurysm of uterine artery in haemodynamically stable patient. Therefore, in modern obstetrics hysterectomy should be the last option to treat postpartum haemorrhage