Feto-maternal outcomes in near miss events in obstetrics

Background: Maternal near miss is defined by world health organization as a woman, who being close to death survives a complication occurring during pregnancy, delivery or upto 42 days after her end of pregnancy.It is a retrospective diagnosis. Evaluation of near miss maternal morbidity and mortality is a surveillance method to assess the quality of obstetric care and determinants of poor maternal outcome. It is an indicator of quality of obstetrical care. Aims and objectives for current study was to evaluate the cause of near miss maternal morbidity in our hospital which occurred either in admitted patients or were referred from elsewhere and to study the maternal and fetal outcomes in all near miss cases.Methods: A retrospective review of obstetrical records as well as prospective analysis was done at Christian medical college and hospital, a tertiary care teaching institute in North India and referral centre. The study was done for a period of one year from November 2018 to October 2019 retrospectively and for 6 months from November 2019 to April 2020 prospectively. The maternal near miss cases were taken as per WHO criteria.Results: The age ranged from 19 years to 49 years with maximum belonging to age group of 20-24 years. Maximum number of cases was primigravida and was in third trimester. The primary obstetric complication evaluated were hypertensive disorders followed by hematological diseases, viral hepatitis, haemorrhage, and obstructed labour or ruptured uterus.Conclusions: All the causes of MNM observed in this study are preventable causes, which can be identified timely and treated early to prevent maternal mortality, thereby, improving obstetrical and neonatal outcome

Vulvar hamartoma in pregnancy: a case report

Hamartoma is a benign lesion composed of various native tissues, but growing in a disorganized manner. It is not considered to be a malignant growth. It may be a diagnostic dilemma and challenge treatment options during pregnancy. We present the case of a rare vulvar hamartoma in a young pregnant woman

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

Histopathological examination of emergency obstetric hysterectomy specimens

Background: Obstetric hysterectomy is done as a lifesaving procedure in very trying circumstances of life threatening severe hemorrhage. The study was undertaken with the aim to evaluate the relative frequency of hysterectomy done for obstetric indication among the hysterectomy specimens and also to assess the histopathological findings in the hysterectomy specimens.Methods: The study was conducted at a tertiary care center over a period of two and half years. Consecutive specimens of hysterectomy done for obstetrical indication were included. Gross and microscopic findings noted and data analysed. The study was approved by the Institute Ethical Committee.Results: Of the total hysterectomy specimens received obstetrical hysterectomy comprised only 1.3%(12/915) of all the hysterectomies. Patient’s age ranged from 20-36 years; mean 28.6 years. Parity ranged from 1 to 5; mean 2. More multiparous women 91.7%(11/12) had hysterectomies as compared to primiparous 8.3%(1/12) cases                         (p value <0.0001). All patients had single pregnancy. All (100%) patients underwent surgery through abdominal route with subtotal hysterectomy with preservation of the bilateral adnexae undertaken in most (11/12; 91.7% cases). About 5(41.6%) cases hysterectomies were performed after previous caesarean section and had abnormal placentation. Histopathological examination revealed adherent placenta in 33.4%(4/12), endometritis in 25%(3/12), rupture in 25%(3/12) and histologically unremarkable in 16.6%(2/12) cases.Conclusions: Obstetric hysterectomy is an emergency lifesaving procedure done in situations of uncontrolled post-partum hemorrhage. In recent years with more number of caesarean sections the incidence of abnormal placentation has drastically increased, thus making adherent placenta as the most common histopathological finding

Prevalence and predictors of metabolic syndrome among women above 35 years of age: a cross sectional study from northern India

Background: In India, as more and more people are adopting sedentary lifestyle the prevalence of metabolic syndrome is increasing. Metabolic syndrome (MS) is a cluster of risk factors for future development of type 2 diabetes mellitus and cardiovascular diseases. The objectives of the study was to determine prevalence of metabolic syndrome among women above age of 35 years in northern India attending a gynecological outpatient department of a tertiary hospital and to find out predictors of metabolic syndrome.Methods: Premenopausal and postmenopausal women above 35 years of age attending gynecological outpatient department were screened for the presence of metabolic syndrome, according to the criteria of modified NCEP-ATP III (National Cholesterol Education Program). Data was collected and analyzed. A p-value <0.05 was considered statistically significant.Results: The prevalence of metabolic syndrome was 49.3% among women above 35 years of age. In the logistic regression analysis it is found that body mass index and menopausal status were two variables which significantly affected occurrence of metabolic syndrome.Conclusions: The present study shows a high prevalence of metabolic syndrome amongst women above 35 years of age. The prevalence was higher in postmenopausal women than in premenopausal women. In logistic regression analysis it was found that menopause and body mass index are independent predictors of metabolic syndrome

Case report of ruptured ovarian ectopic pregnancy

Ectopic pregnancy occurs very rarely with an incidence of 1.5% to 2% in all pregnancies and more commonly, in young highly fertile multiparous women using intrauterine device. Here, we presented a case of young multiparous lady who presented with irregular bleeding since the last 2 months. Ultrasound was done which showed a large right sided ovarian mass with free fluid in the abdomen. She was taken up for exploratory laparotomy followed by right oophorectomy after a verbal and written consent in view of ruptured corpus luteal cyst/ruptured ovarian ectopic pregnancy. Intraoperatively, a large right ruptured ovarian ectopic pregnancy was seen, which was also confirmed on histopathological examination.

First trimester uterine artery Doppler screening in the prediction of adverse pregnancy outcomes

Background: Uterine artery Doppler waveform has been extensively studied as a predictive marker for the later development of preeclampsia and fetal growth restriction. Therefore, uterine artery doppler has emerged as a good test for the prediction of preeclampsia, being simple to perform, reproducible and non-invasive. The present study was done to evaluate the first trimester uterine artery Doppler in the prediction of adverse pregnancy outcome.Methods: This was a prospective cohort study for all pregnant women attending antenatal clinic during 11-14 weeks of gestation at Christian medical college and hospital, Ludhiana, during a period of 18 months. Study population of (n~270) was taken. A pre-designed case record was filled at the time of registration. After taking informed consent, these women underwent ultrasound for uterine artery Doppler pulsatility index along with nuchal translucency & nasal bone scan by transabdominal ultrasound. Patients were followed up throughout the gestation to find out the development of any adverse pregnancy outcomes (early onset preeclampsia, early onset fetal growth restriction, late onset preeclampsia, late onset fetal growth restriction, oligohydramnios, placental abruption and stillbirth).Results: In our study, about 75% of antenatal women were found to have normal first trimester uterine artery pulsatility index and the rest 25% had abnormal pulsatility index. About 40% of women with abnormal dopplers developed complications associated to hypertensive disorders and adverse pregnancy outcomes, while 60% went on to have a normal pregnancy. It was observed that 13.2% developed gestational hypertension, 10.29% developed pulmonary embolism, 1.47% developed eclampsia, 22.05% developed oligohydramnios, 42.64% developed fetal growth restriction, 4.41 % developed placental abruption and 5.88% delivered stillbirth neonates.Conclusions: As hypertensive disorders of pregnancy pose a great risk of maternal and fetal morbidity and mortality, an evolution of Doppler studies have proven to be beneficial. Doppler ultrasound was found to be a valuable modality in the evaluation of fetal and placental circulation as well as in the prediction of pregnancy outcomes. According to the receiver operating characteristic curve obtained in our study, sensitivity and specificity of first trimester uterine artery pulsatility index was predictive for pregnancy complications and adverse outcomes

Bilateral benign cystic teratoma of ovary concomitant with an occult gall bladder carcinoma in a post-menopausal woman

Mature cystic teratomas are the most common benign germ cell tumours, and commonly seen in the reproductive age group. It rarely occurs in postmenopausal women. We report a case of bilateral dermoid cyst with cholelithiasis and occult gall bladder carcinoma in a postmenopausal woman.