Abnormal liquor volume and mode of delivery

Introductions: Sonographic assessment of four quadrant measurement of amniotic fluid index (AFI) is an integral part of antenatal evaluation of pregnancies, especially in the third trimester. Decreased (oligohydramnios, AFI 0-9.9 cm) or increased (polyhydramnios >25 cm) increases the risk of intrauterine growth retardation, birth asphyxia and induction or operative interference. The aim of this study was to analyse abnormal liquor volume and mode of delivery. Methods: This retrospective cross-sectional study analysed the cases of abnormal liquor volume in term pregnancies during 2013-2016 at Patan Hospital. Patient's files were traced from medical record section. We analysed the abnormal liquor volume based on amniotic fluid index (AFI) and the mode of deliveries. Results: Among 15,272 term pregnancies scanned, 130 had abnormal AFI, 128 oligohydramnios and 2 polyhydramnios. Out of 128 oligohydramnios, 40 (30.8%) were severe, 54 (41.5%) moderate and 34 (26.2%) mild. Two cases had polyhydramnios. The emergency lower uterine segment caesarean sections (emLSCS) were performed in 99 (76.1%) oligohydramnios. Conclusions: This study suggests that oligohydramnios measured by AFI at term pregnancy required more emLSCS. Keywords: amniotic fluid index, oligohydramnios, polyhydramnios, emergency caesarean sections, spontaneous vaginal deliverie

Comparative efficacy of admission cardiotocography in high risk and low risk pregnancies in predicting neonatal outcome

Background: Admission cardiotocography (CTG) is a test of fetal wellbeing performed during labor. A normal CTG is for 20-30 minutes and ranges from 110-160 bpm with beat to beat variability, two accelerations and no decelerations with two contractions (as per NICE 2018 guidelines). To study comparative efficacy of admission CTG in predicting neonatal out in high risk, low risk and universally in all pregnancy.Methods: All high risk as well as low risk patients coming to labor room in labor were included in the study. CTG print was taken, and neonatal outcome as NICU admission were noted after taking written consent.Results: 189 cases were taken.138 were high risk cases, CTG was taken: 91were reassuring, 47were abnormal (non-reassuring +abnormal). In terms of NICU admission, 21 and 26 neonates were admitted. Out of 51 low risk cases, 33 had reassuring CTG, and18 had abnormal; 7and 6 was the number of NICU admission, respectively. When compared, highest sensitivity, specificity and positive predictive value of 55.31%, 77% and 55.3% was seen in high risk pregnancy, whereas negative predictive value (78.8%) was slightly higher in low risk cases.Conclusions: Admission CTG is a good predictor of neonatal outcome. Its predictive efficacy is more in high risk cases. It’s practicality in revealing poor neonatal outcome is more

Correlation of ultrasound imaging with histopathological findings in gestational trophoblastic disease

Introduction:  Gestational trophoblastic diseases (GTD) include a spectrum of pregnancy-related diseases caused by abnormal proliferation of the placenta .  The main aim of this study to study the Correlation of ultrasound imaging with histopathological findings in gestational trophoblastic disease. Method: This is the retrospective study consisting of 155 sonographically diagnosed cases of GTD collected for three years 2016-2019. These patients were evaluated by transabdominal sonography. All these patients underwent Evacuation of product of conception (POC) and samples were subsequently sent for histopathological examination Their histopathological reports were followed up. The Correlation between USG and histopathological findings in GTD was studied. Result :  Among these 155 sonographically diagnosed cases of GTD 141 (91.0%) were  histologically confirmed GTD,  14 (9.0%) were  non-molar miscarriages on histological examination. In 141 cases of histologically confirmed GTD, 110 (71.0 %) were partial mole, 15 (9.7%) complete mole, 12 (7.7%) invasive mole and 3 (1.9 %) persistent mole, 1(0.6%) was choriocarcinoma. Conclusion :  The diagnostic accuracy of ultrasound to be 90% in the diagnosis of GTD, increasing its reliability. Thus ultrasound seems to be an initial modality of choice in the workup of every woman suspected of having GTD

Congenital anomalies in antenatal ultrasound scan at a tertiary care teaching hospital

Introductions: Early detection of congenital fetal anomalies by ultrasonography (USG) helps to identify the severity and termination of pregnancy in severe cases. Anomalies cause significant perinatal morbidity and mortality. Aim of this study was to analyse real-time USG detection of prenatal anomalies. Methods: This was a cross-sectional descriptive study of fetal anomalies detected during 2nd and 3rd trimester antenatal USG scan done from 2011 to 2015, in Patan Hospital. Age of mother, parity, gestational age when anomalies detected and, anomalies of previous child, use of folic acid were analysed. Descriptive analysis was done. Results: There were 35,571 deliveries in four years period with 134 (0.37%) congenital anomalies, 99 (79.2%) detected during antenatal USG during 2nd and 3rd trimester. Among 99 anomalies, 29 (29.29%) were detected before 22 weeks. Central nervous system (CNS) anomalies were 47, gastrointestinal 23, renal 12, skin and fetal compartment 8 and rest were less common. Young mothers of less than 30 years were 109 (81.34%) and primi were 85 (63.4%). Conclusions: Antenatal ultrasound can detect fetal anomalies in 2nd and 3rdtrimester with higher frequencies belonging to the central nervous system followed by gastrointestinal tract anomalies and renal. Keywords: congenital anomalies, gestational age, prenatal ultrasound sca

Primary Ewing sarcoma of squamous temporal bone with intracranial extension: A case report

Primary Cranial Ewing sarcoma (ES) is rare and that of temporal bone is even rarer entity. Only a few sporadic cases have been reported and no such case has been reported from Eastern India In this report we describe a case of 18 yrs old male with primary cranial ES of squamous temporal bone involving intracranial and extracranial compartment. The patient presented with swelling in zygomatic fossa and imaging studies showed a mass originating in the right temporal bone. Gross total resection of the tumor was done and sent for histopathological study. The case was referred for radio-chemotherapy and had no recurrence up to eight months of follow up

Comparison of the various diagnostic criteria used in polycystic ovary syndrome

Background: Polycystic Ovary Syndrome (PCOS) represents one of the major causes of infertility in women. Various criteria are set to diagnose PCOS, some over diagnose and some underdiagnose it. The objective of the study was to compare the various criteria used for the diagnosis of PCOS: NIH 1990 criteria, Rotterdam 2003 criteria and AE-PCOS Society 2006 criteria.Methods: This was a cross-sectional study conducted over a period of one year. Patients with suspicion of PCOS were selected. After complete history and examination, blood samples were collected and androgen levels were measured. They were labeled as PCOS based on their fulfillment of the criteria as per Rotterdam, NIH and AE-PCOS Society.Data was analysed and conclusions drawn.Results: Of the participants, 25.7%, 28.5%, and 62.8% were diagnosed with PCOS using NIH, AE-PCOS Society, and Rotterdam criteria, respectively. Phenotypes that included hyperandrogenism and/or hyperandrogenemia as part of their criteria showed increase in values of DHEAS and S. testoterone as compared to the normoandrogenic phenotype included in only the Rotterdam criteria.Conclusions: It is crucial to establish the diagnostic criteria for PCOS and initiate early treatment as this may play a role in the prevention of metabolic and cardiovascular diseases

Association of biochemical markers with time of onset and severity of hypertensive disorder of pregnancy

Background: Hypertensive disorders of pregnancy (HDP) are a common cause of morbidity and mortality. Inflammation is considered as one of the etiologic factors along with a complex interplay of multiple genetic, nutritional and other environmental agents. This study was undertaken to find association of biochemical markers with severity and time of onset of HDP. Methods: Institutional review board and ethics committee approval was taken prior to the study. History and examination was done. Blood pressure was recorded at each antenatal visit. Blood samples were taken for the study of biochemical markers-hsCRP and interleukin 6 levels. Data was analyzed. P value <0.05 was taken as significant. Results: Of the 80 women, 27.5% had early onset HDP. 72.5% had severe HDP. Inflammatory indices were altered as compared to the range of normal pregnant women. Mean IL-6 and hsCRP levels were found to be raised but no statistically significant association was observed between IL-6 levels or hs-CRP levels and time of onset of HDP (p value = 1 and 0.5859 respectively and severity of onset of HDP (p value = 0.197 and 0.453 respectively). Conclusions: Biochemical indices, IL-6 and hs-CRP levels were elevated in women with HDP, indicative of increased inflammation

Secure Image Transmission using Visual Steganography

In today’s information age, information sharing and transfer has increased exponentially. The threat of an intruder accessing secret information has been an ever existing concern for all. Cryptography and Steganography are the most widely used techniques to overcome these threats. Steganography is a branch of security technique which involves the art of hiding the existence of the message between sender and the intended recipient. Here, steganography has been used to hide digital images. Cryptography involves converting the message text into an unreadable cipher. To overcome this predictability, we propose the concept of visual cryptographic steganography where slices of original secret image upon encryption are embedded within a cover image. The resultant stego image is then decrypted to recover the original image

Sonographic and histopathological findings in ovarian dermoid cyst

Introductions: Ovarian dermoid cyst occurs most commonly in reproductive age group. It consists all three layers of germ cells, in variable composition resulting in wide spectrum of USG findings. This study aimed to find the association between sonographic and histopathological findings of dermoid cyst. Methods: This was a retrospective study consisting of 55 cases of complex ovarian cysts with features of dermoid cyst, during two years 2013-2015. The diagnostic accuracies of trans-abdominal sonography findings were compared with post-operative histopathology reports. Results: Among 55 cases of complex ovarian cyst with sonographic features of dermoid, histopathology was benign in 52 (94.5%) and malignant in 3 (5.5%). In 52 benign cysts, 25 (48.0%) were teratoma and 27 (51.9%) were other benign masses. Conclusions: The accuracy of ultrasound was 95% in the diagnosis of ovarian cyst and is the modality of choice for initial workup of ovarian mass. Keywords: complex ovarian mass, dermoid cyst, histopathology, sonograph

Echogenic liquor at term pregnancy on ultrasonography is not always meconium

Introductions: The presence of echogenic amniotic fluid at term pregnancy on sonography is uncommon. Finding of meconium in the amniotic fluid by ultrasound is used to predict mode of delivery of fetus, fetal wellbeing and risk of intrauterine fetal demise. We aim to observe the clinical significance of echogenic liquor at term pregnancy.Methods: This was a retrospective study of 102 cases of echogenic liquor at gestation age between 36 and 41 weeks (term pregnancy) during five years 2010 to 2015. Amniotic fluid index (AFI) was calculated. Fluid was observed for presence of vernix caseosa or meconium stain during spontaneous and artificial rupture of membrane. The APGAR score of baby was taken twice at 5 and 10 minutes.Results: Among the 102 patients with echogenic amniotic fluid at term, 83 (81.4%) were vernix and 19 (18.6%) had meconium stain. Low APGAR scores were found in 5 (0.9%) and normal score in 97 (95.1%) indicating good fetal outcome. Among these cases, 89 (87.3%) had normal AFI and 13 (12.7%) had decreased liquor.Conclusions: There were no association between echogenic liquor and meconium stain, AFI or APGAR score of the baby in term pregnancy.Keywords: AFI, echogenic liquor, fetal outcome, prenatal ultrasound, term pregnancy, vernix or meconiu