Association of neonatal respiratory morbidity with timing of elective cesarean delivery

Background: Elective Cesarean Delivery (ECD) rate has increased in both developed and developing countries due to obstetric indications and cesarean section on request. Neonatal respiratory morbidity is one of the complications of elective cesarean delivery performed before 39 weeks gestation. The aim of this study was to compare the risk of neonatal respiratory morbidity of elective caesarean section performed at 37+0 to 38+6 weeks with those delivered at 39 +0 to 41+6 weeks gestation.Methods: A retrospective study was conducted on all pregnant women who were delivered by elective caesarean at a gestational age of 37+0 to 38+6 weeks and were compared with those delivered at 39+0 to 41+6 weeks. Maternal and neonatal characteristics, neonatal respiratory morbidity including: respiratory distress syndrome, transient tachypnea of the newborn, persistent pulmonary hypertension of newborn and serious respiratory morbidity were analyzed.Results: Incidence of neonatal respiratory morbidity was 15.8% and 6.3% in neonates delivered at 37+0 to 38+6 weeks and ≥39 weeks gestation respectively. Combined respiratory morbidity risk (Odds ratio: OR 2.82; 95% Confidence interval CI: 1.34-5.94; P value <0.05) was significantly higher in the neonates delivered at 37+0 to 38+6 weeks compared with those delivered ≥39 weeks. Risk of TTN (OR 2.6; 95% CI: 0.95-7.45; P value 0.08) and RDS (OR 2.42; 95%CI: 0.48-12.15; P value 0.45) increased by two fold in neonates delivered before 39 weeks.Conclusions: Neonates delivered by elective cesarean at 37+0 to 38+6 weeks gestations are at increased risk of developing respiratory morbidity compared with infants delivered beyond 39 weeks. Respiratory morbidity can be reduced by delaying the ECD until 39 weeks of gestation.

Laparoscopic evaluation of tubal factor in cases of infertility

Background: Tubal factor infertility accounts for approximately 25-35% of cases of female infertility. The evaluation of the fallopian tube is necessary to determine the management plan for infertility. Tubal patency can be diagnosed by hysterosalpingography (HSG) or laparoscopy with chromopertubation. The aim of this study was to determine the role of laparoscopy in the evaluation of tubal factor in infertile women.Methods: Fifty women presenting with complaints of primary and secondary infertility were investigated for tubal disease by laparoscopy at K. S. Hegde Charitable Hospital, Mangalore, from January 2007 to July 2008. Tubal patency was tested by chromopertubation using Methylene blue dye. Results: Thirty four (68%) patients were in primary infertility group while 16 (32%) patients were in secondary infertility group. 88% women were in the age group of 21 to 35 years. In 64% of women, the duration of infertility was between 1 to 5 years whereas 32% cases had been infertile for 6 to 10 years. Tubal pathology was detected in 64.7% cases of primary infertility and 68.7% cases of secondary infertility. Bilateral tubal occlusion was found in 8% and unilateral occlusion in 28% cases.Conclusion: Laparoscopy is an effective diagnostic tool for evaluation of tubal pathology. Laparoscopy and chromopertubation test should be recommended as a first step in the investigation of infertile women with tubal factor

Obstetric outcome of teenage pregnancies in a tertiary care centre in Mangalore, Karnataka, India

Background: Teenage pregnancy is a social problem affecting maternal and child health. In India, teenage pregnancy is an important public-health problem, although the national policy of the Government of India advocates the minimum legal age of marriage for girls to be 18 years. The aim of the present study was to observe the obstetric outcome in Teenage pregnanciesMethods: A retrospective analysis of all Teenage pregnancies was done over a period of 1 year from August 2014 to July 2015. Case sheets of all teenage mothers delivered during that period were retrieved. Maternal and neonatal outcome were analyzed and compared with pregnant women ≥20 years of age.  Results: 5859 deliveries occurred during the study period, teenage deliveries were 457.The prevalence of teenage deliveries was 7.8%. Cesarean delivery rate was 56% vs 42% (p value0.05). Teenage mothers had increased Low birth weight rates 24% vs 10% (p<0.05).Conclusions: Teenage pregnancies has a negative impact on maternal and perinatal health. Hence strict laws should be enforced to prohibit teenage marriages. Adolescent girls should be educated about safe sex practices, contraception and complications of teenage pregnancies on maternal and child health.

A rare case of primary vaginal carcinoma with systemic metastasis with uterovaginal prolapses

Primary vaginal cancer in a prolapsed uterus is a very rare condition. Here we report a rare case of carcinoma of vagina with early systemic metastasis presenting in a middle aged women with uterovaginal prolapse. A 46 year old postmenopausal lady presented with complaints of mass per vagina with foul smelling discharge per vagina. On gynaecological examination, an irreducible uterovaginal prolapse and a 6 × 6 cm ulcer was present on upper 1/3 of lateral vaginal wall. Biopsy of the ulcer suggested squamous cell carcinoma of vagina. She was given palliative chemotherapy

Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography:an international expert consensus

The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0–5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management. Graphical abstract: [Figure not available: see fulltext.]

Obstetric outcome of teenage pregnancies in a tertiary care centre in Mangalore, Karnataka, India

Background: Teenage pregnancy is a social problem affecting maternal and child health. In India, teenage pregnancy is an important public-health problem, although the national policy of the Government of India advocates the minimum legal age of marriage for girls to be 18 years. The aim of the present study was to observe the obstetric outcome in Teenage pregnanciesMethods: A retrospective analysis of all Teenage pregnancies was done over a period of 1 year from August 2014 to July 2015. Case sheets of all teenage mothers delivered during that period were retrieved. Maternal and neonatal outcome were analyzed and compared with pregnant women ≥20 years of age.  Results: 5859 deliveries occurred during the study period, teenage deliveries were 457.The prevalence of teenage deliveries was 7.8%. Cesarean delivery rate was 56% vs 42% (p value&lt;0.05) among teenagers compared to non teenage pregnant mothers. Preterm delivery rate was higher in teenagers 24% vs 14 % (p&lt;0.05). 39(8.6%) teenage mothers had developed hypertension in pregnancy and 42(8.3%) among non-teenagers (p&gt;0.05). Teenage mothers had increased Low birth weight rates 24% vs 10% (p&lt;0.05).Conclusions: Teenage pregnancies has a negative impact on maternal and perinatal health. Hence strict laws should be enforced to prohibit teenage marriages. Adolescent girls should be educated about safe sex practices, contraception and complications of teenage pregnancies on maternal and child health.