An undiagnosed case of longitudinal vaginal septum in a term woman with obstructed labour: a case report

Congenital anomalies of the female genital tract are often asymptomatic and therefore unrecognized. Longitudinal vaginal septum is a rare Müllerian malformation that may be associated with dyspareunia, dysmenorrhea, primary amenorrhea, and infertility. In this report, the authors present a case of longitudinal vaginal septum in a term primigravida patient with obstructed labour whose diagnosis was only made during labor following bidigital vaginal and speculum examination. After all necessary investigations she was immediately shifted for emergency cesarean section. Patient was discharged under satisfactory condition with healthy baby

Role of non-descent vaginal hysterectomy in previous cesarean section scar women

Background: Non Descent Vaginal Hysterectomy (NDVH) is removal of uterus through vagina in absence of cervical descent. Objective: To assess safety, feasibility of NDVH in patients with previous cesarean section.  Methods: Prospective study was conducted at department of Obstetrics and Gynecology of rural Tertiary care centre of Central India from January 2013 to December 2014. Effort was made to perform hysterectomies vaginally in women with benign conditions in absence of prolapsed uterus with history of one, two or three cesarean sections. Women with adnexal masses, endometriosis/big uterus (>16 weeks) were excluded from study. Information regarding age, parity, uterine size, blood loss, duration of operation, difficulties in separating bladder, intra-operative, post-operative complications, hospital stay were recorded.Results: Total ten cases were selected for NDVH with history of one, two/ three cesarean sections. All successfully underwent NDVH, except one in which bladder injury occurred which was repaired at same time from below. Five patients had previous one Lower Segment Cesarean Section (LSCS), four had two LSCS and one had three LSCS. Commonest indication was leiomyoma of uterus followed by abnormal uterine bleeding. Mean duration of surgery was 50 ± 20.5 min. Mean blood loss was 150 ± 65 ml. Post-operative complications were minimal with no scar, patient mobility, resumption of daily activities was fast. Mean hospital stay was 4-5 days.Conclusions: Vaginal hysterectomy appears to be safe, cost effective alternative to abdominal hysterectomy in women with previous cesarean section scar requiring hysterectomy for benign conditions with fewer complications, shorter hospital stay.

Iodine status and its determinants in subpopulation of pregnant women in rural Central India

Background: There is an increased demand for iodine and thyroid hormones, in pregnancy starting from the early weeks of pregnancy suggesting that there may be a need for additional supplements of iodine in high risk population to prevent iodine deficiency and its associated disorders. Hence this study was undertaken to determine the iodine status and its determinants in a subpopulation of pregnant women from a rural area of Central India.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, use of iodized salt, iodine rich food and goitrogens as part of diet and other determinants. Spot urine samples were obtained, and assessment of urine iodine concentration was done by using Sandell-Kolthoff reaction.Results: Among 250 pregnant women of first trimester, iodine deficiency (ID) was present in 11.8 %, of which 59.25% had mild deficiency, 33.33% moderate deficiency and 7.4% severe deficiency. More women with iodine deficiency were of higher age, had less formal education and belonged to lower middle and lower economic class. Higher number of women with iodine deficiency had family history of thyroid disorders compared to iodine sufficient (18.51% versus 5.58%), more iodine deficient commonly had goitrogens (cabbage, cauliflower, radish, sweet potato, soya etc) as part of their meals (77.77% versus 68.60%), lesser women with ID ate iodine rich food (fish, milk yoghurt, bread) (18.51% versus 68.60%) and fewer of them used iodized salt during food preparation (25.92% versus 69.95%) compared to iodine sufficient, with a significant difference.Conclusions: Iodine deficiency is prevalent in pregnant women in this geographic region of central India. Age, low socioeconomic status, lack of education, family history, low intake of iodized salt and iodine rich food and more consumption of goitrogenic food as part of diet are risk factors. Appropriate health education, promoting use of iodized salt, quality assurance of universal salt iodization by household survey and screening in high risk group is suggested

Determinants of Thyroid Autoimmunity in Pregnant Women of Rural Central India- A Cross Sectional Study

: Background: Thyroid autoimmunity (TAI) is the most common autoimmune disorder in women of reproductive age. TAI in pregnancy is seen to rise markedly all over the world & can remain undiagnosed as it may present without thyroid dysfunction. It is seen to be associated with a number of feto-maternal disorders and may affect pregnancy outcome. The occurrence of TAI in pregnancy, in the present rural community is not known, hence this study was carried out to determine the occurrence of thyroid autoimmunity in pregnant women from rural area.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables. Family history and other determinants. Serum TSH, Free T4, and antithyroglobulin antibody levels were in the first trimester. Thyroid status was labelled as euthyroid, overt hypothyroid, subclinical hypothyroid, overt hyperthyroid and subclinical hypothyroid and correlation was done with antibody positivity and various determinants.Results: Among 250 pregnant women of first trimester, antithyroglobulin antibody was positive in 32 (12.8%) of which 22 (68.75%) had thyroid dysfunction in the form of hypo or hyperthyroidism, and 10 (31.25 %) were euthyroid. Of 218 with negative antibody, 24 (11%) had thyroid dysfunction and 194 (88.99%) were euthyroid with a significant difference. Though TAI was present in all age groups, the numbers increased with increasing age. Among study subjects, 9.95 % from rural compared to 28.20 % from urban residential area had TAI indicating higher occurrence in urban population. TAI was observed in all socioeconomic classes but more so in middle, lower middle and lower economic class. Positive family history was noted in 18.75 % women with positive antibody compared to 3.71 % negative women (p value 10.62, chi square 0.002). More number of pregnant women with negative antibody had an average BMI compared to positive (77.06% vs 31.25%), more positive PW were overweight compared to negative ( 37.5% vs 18.34%) and also obese ( 15.62% vs 0.91%) (Chi square – 26.67, p value – 0.00002). As BMI increased proportion of PW with positive antibody increased with a significant difference Conclusions: Thyroid autoimmunity was seen in 12.8% pregnant women of the rural area of present study site. A substantial number of women with TAI had thyroid dysfunction and some were found to be euthyroid too. Older age, socioeconomic status, urban residence, high BMI and positive family history were risk factors for thyroid autoimmunity. Screening for thyroid antibodies in high risk pregnant women and those with thyroid dysfunction is suggested

Maternal hemoglobin: socio-demographic and obstetric determinants in rural Central India

Background: Maternal Anemia is a global health problem with adverse implications on materno-fetal outcome. Various socio-demographic and obstetric factors affect prevalence of anemia.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, age, gravidity, parity, literacy, area of residence and socioeconomic status. Hemoglobin levels in first trimester and pre delivery were measured by coulter and correlated with socio-demographic and obstetric factors.Results: Among 500 pregnant women of first trimester, 249 (49.8%) had anemia, 154 (30.8%) mild, 86 (17.2%) moderate and 9 (1.8%) severe anemia. More women with anemia were of lesser age, resided in rural area, belonged to middle and lower economic class, lived with joint families and had less than 12 years of formal education.Conclusions: Anemia is prevalent in pregnant women in this geographic region of central India. Age, higher gravidity, higher parity, rural residence, low socioeconomic status and less than 12 years of formal education, are risk factors. Appropriate age at marriage, small family norm, education of girl child, anemia prevention strategy in adolescent girls and financial empowerment of women are suggested strategies for prevention of anemia and improved maternofetal outcome

Clinical profile and obstetric outcome in pregnancies complicated by heart disease: a five year Indian rural experience

Background: Cardiac diseases are a major cause of morbidity and mortality in pregnant women in the developing world. This study illustrates the problem in rural India focusing on patterns of diseases, clinical features, and pregnancy outcome in these women.Methods: A retrospective analysis of five year data, from 2006 to 2010 for all patients admitted with cardiac disease in pregnancy.Results: Past history of heart disease was present in 70%. Rheumatic heart disease was predominant type in 83% and the chief complaint at admission was breathlessness in 44%.   Mitral stenosis was the commonest lesion in 55% and mitral regurgitation with or without stenosis in 48%. Preeclampsia was seen in 20% and preterm labor in 10%. Spontaneous vaginal delivery was seen in 41% and cesarean in 20.6%.Conclusions: Heart disease in pregnancy is a high risk condition has a major impact on pregnancy. Associated obstetric complications along with lack of knowledge and ignorance regarding the pathology lead to unpleasant obstetric outcomes

Newborn birth weight: a trend towards positive paradigm shift in rural central India

Background: Birth weight is one of the important determinants of neonatal wellbeing. It has many determinants including maternal nutritional status and gestational age. Low birth weight is associated with high neonatal and childhood mortality and morbidity. Over the years the birth weight is showing the increasing trend in developing countries like India. The study aimed at finding out the changing pattern of birth weight over a decade in rural India.Methods: Retrospective data of 43,114 births was collected through hospital information system. Neonatal birth weight was analyzed over a period of 10 years from 2007-2016. Demographic data was studied to study the determinants.Results: Over the period of 10 years, proportion of newborn with low birth weight (below 2500 grams) declined from 56.35 % to 43.65 %. The rise in mean birth weight was 147 gram in male infant and 114 grams in female. There was overall reduction in proportion of very low birth weight and extremely low birth weight babies. A linear relationship was observed between improved birth weight, socio economic status, age at marriage and maternal weight gain during pregnancy.Conclusions: A positive trend towards improved newborn birth weight was observed in study site of rural central India. Better antenatal care, improved maternal nutrition and improved social status of women in the community are the determinants found to have a positive correlation

Anaesthesia Management in a Case of Large Ventricular Septal Defect with Eisenmengerisation Undergoing Caesarean Section

Incidence of cardiac disease in pregnancy in developed countries is 0.2-3% and that in developing countries is still higher. Ventricular Septal Defect (VSD) is one of the commonest congenital heart diseases. Pregnant patient with small VSD generally tolerate well but patients with unrepaired large VSD develop pulmonary hypertension and left heart failure over a period of time. If pulmonary pressure reaches systemic levels there is reversal or bidirectional flow. As per WHO classification of maternal cardiac risk disease, pulmonary hypertension is categorized under class 4. Here we report a case management of a pregnant patient with large VSD (15 mm) with severe pulmonary hypertension (105 mmHg) with eisenmengerisation posted for emergency caesarean section. It was done under general anaesthesia with successful maternal and foetal outcome

Iodine status and its determinants in subpopulation of pregnant women in rural Central India

Background: There is an increased demand for iodine and thyroid hormones, in pregnancy starting from the early weeks of pregnancy suggesting that there may be a need for additional supplements of iodine in high risk population to prevent iodine deficiency and its associated disorders. Hence this study was undertaken to determine the iodine status and its determinants in a subpopulation of pregnant women from a rural area of Central India.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, use of iodized salt, iodine rich food and goitrogens as part of diet and other determinants. Spot urine samples were obtained, and assessment of urine iodine concentration was done by using Sandell-Kolthoff reaction.Results: Among 250 pregnant women of first trimester, iodine deficiency (ID) was present in 11.8 %, of which 59.25% had mild deficiency, 33.33% moderate deficiency and 7.4% severe deficiency. More women with iodine deficiency were of higher age, had less formal education and belonged to lower middle and lower economic class. Higher number of women with iodine deficiency had family history of thyroid disorders compared to iodine sufficient (18.51% versus 5.58%), more iodine deficient commonly had goitrogens (cabbage, cauliflower, radish, sweet potato, soya etc) as part of their meals (77.77% versus 68.60%), lesser women with ID ate iodine rich food (fish, milk yoghurt, bread) (18.51% versus 68.60%) and fewer of them used iodized salt during food preparation (25.92% versus 69.95%) compared to iodine sufficient, with a significant difference.Conclusions: Iodine deficiency is prevalent in pregnant women in this geographic region of central India. Age, low socioeconomic status, lack of education, family history, low intake of iodized salt and iodine rich food and more consumption of goitrogenic food as part of diet are risk factors. Appropriate health education, promoting use of iodized salt, quality assurance of universal salt iodization by household survey and screening in high risk group is suggested

Maternal hemoglobin: socio-demographic and obstetric determinants in rural Central India

Background: Maternal Anemia is a global health problem with adverse implications on materno-fetal outcome. Various socio-demographic and obstetric factors affect prevalence of anemia.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, age, gravidity, parity, literacy, area of residence and socioeconomic status. Hemoglobin levels in first trimester and pre delivery were measured by coulter and correlated with socio-demographic and obstetric factors.Results: Among 500 pregnant women of first trimester, 249 (49.8%) had anemia, 154 (30.8%) mild, 86 (17.2%) moderate and 9 (1.8%) severe anemia. More women with anemia were of lesser age, resided in rural area, belonged to middle and lower economic class, lived with joint families and had less than 12 years of formal education.Conclusions: Anemia is prevalent in pregnant women in this geographic region of central India. Age, higher gravidity, higher parity, rural residence, low socioeconomic status and less than 12 years of formal education, are risk factors. Appropriate age at marriage, small family norm, education of girl child, anemia prevention strategy in adolescent girls and financial empowerment of women are suggested strategies for prevention of anemia and improved maternofetal outcome