Monochorionic monoamniotic live twin ectopic pregnancy: a rarity

The incidence of unilateral live twin ectopic pregnancy is approximately 1:1,25,000 but increased in last few decades due to increased use of fertility drugs for ovulation induction, superovulation and assisted reproductive technology. It is also associated with increased incidence of pelvic inflammatory diseases. Patient was 30 years old G3P2L2 who presented to OPD of this LLRM medical college, Meerut with complain of amenorrhoea of two and half months. Pelvic examination revealed tenderness in lower abdomen, left adnexal fullness and tenderness without any bleeding. On USG, left adnexal monochorionic monoamniotic ectopic twins with normal cardiac activity. Exploratory laparotomy followed by left sided salpingectomy was done and patient was discharged with satisfactory condition. This is a very rare case and PID is also among risk factors and may also cause twin ectopic pregnancy

Role of ultrasound in reducing complication during primary trocar insertion in laparoscopic surgery: prospective observational study

Background: Patients presenting to Gynecology OPD at LLRM Medical College, Meerut, UP, India for benign laparoscopic surgery from June 2016 to May 2017 were included in the study. A total of 130 women completed the study of which 30 had history of previous abdominal surgery and 100 had no history of previous abdominal surgery. The ability of the visceral slide test to detect periumbilical adhesions was compared with laparoscopic detection of adhesions.Methods: Patients fulfilling inclusion and exclusion criteria and preanaesthetic clearance were subjected to office based Visceral Slide test using high frequency ultrasound probe (7.5 MHz) in the sagittal plane at the level of umbilicus. Distance between the skin and posterior rectus sheath was measured. Diagnostic accuracy of visceral slide test and mean time taken to perform the test was noted.Results: On laparoscopy 4 women had periumbilical adhesions while 24 women in the total sample had adhesions elsewhere in the abdominal cavity. The visceral slide test had a sensitivity of 75%, specificity of 98%, positive predictive value of 75% and negative predictive value of 99%. The diagnostic accuracy of the test is 97%. The median time to perform the examination was 1.69 minutes.Conclusions: The visceral slide technique was convenient and rapid to perform, and reliably identified adhesions in the periumbilical area

The study of co-relation of pap smear with colposcopy and histopathology in sexually active woman with unhealthy cervix

Background: Unhealthy cervix is a group of cervical lesions, mostly chronic. Cervical cancer is the second most frequent cancer worldwide in women after breast carcinoma cervical cancer is a preventable and curable malignancy if identified and managed early. Primary objective was to study pap smear, colposcopy and histopathology in unhealthy cervix in sexually active woman with secondary objective to screen woman who have abnormal unhealthy, foul smelling cervical discharge.Methods: The present study was conducted in the department of obstetrics and gynecology L.L.R.M. medical College and associated SVBP hospital, Meerut from June 2019 to May 2020 with sample size of 70. Participant who fit the inclusion criteria were included in the study after taking a written and informed consent. The colposcopy finding was correlated with histopath findings of cervical biopsy that was undertaken.Results: Co relation of pap smear with colposcopy had sensitivity of 78% and specificity of 92% with positive predictive value of 52%and negative predictive value of 97%, p value less than 0.0001. The pattern of distribution of histopathological assessment with respect to the pap smear findings was significant statistically (p<0.0001). The proportion of patients with NILM on pap smear was significantly higher in the VILI negative category compared to the VILI Positive category (94.12% vs 77.78%, p=0.0525). In the present study, prevalence of CIN of any grade was detected in 8 (11.4%) cases. With CIN 1 in 5 (7.14%) and CIN2 in 2 (2.86%) and CIN3 in 1 (1.43%) case were seen.Conclusions: Several screening modalities are available of which pap smear is most widely used. colposcopy has been proven very useful to identify and guide the biopsy of dysplastic lesion

Evaluation of pelvic organ prolapse by standardized POP Q system for vaginal hysterectomy

Background: Uterovaginal prolapse is a common condition affecting women in reproductive and perimenopausal age groups. Evaluating pelvic organ prolapse in an objective, reproducible, easy to apply method is required for proper management. Aim of the study was preoperative and postoperative evaluation of pelvic organ prolapse by POP Q system in patients undergoing vaginal hysterectomy.Methods: In this observational study, 100 patients having pelvic organ prolapse, (average age 48±12 years), underwent elective vaginal hysterectomy at Lala Lajpat Rai Memorial Medical College Meerut during June 2015 to July 2016. POP Q was done preoperatively and after completion of surgery by the same surgeon.Results: The mean of genital hiatus preoperatively was 6.4 and post operatively it was 3.64 i.e. the genital hiatus was reduced by 2.76. The mean of total vaginal length pre-operatively was 8.07 and post operatively was 7.2. There was only 0.9 cm reduction in the vaginal length. The mean of perineal body pre-operatively was 2.64 and post operatively was 3.64. The points preoperatively were Aa 2.35, Ba 2.61, C 2.57, Ap 2.24, Bp 0.96, D-4.79 and post-operative the value of the points was -2.19, -2.04,-5.57,-2.98,-2.52 respectively and D point absent due to hysterectomy.Conclusions: The post-operative POP Q was analysed and the patients having grade 0 were 63 (optimum anatomical outcome) and patients having grade 1 were 36 (satisfactory anatomical outcome)

Effect of body mass index on maternal outcome in pregnancy

Background: Maternal body mass index during pregnancy is one of the important parameter which gives us the clue regarding maternal complications. The objectives of this study were to study distribution of antenatal patients in underweight, normal, overweight (and obese) categories according to booking BMI, to examine the association of BMI with obstetric outcomes in singleton pregnancies.Methods: This prospective Study was conducted over a period of 1 year from July 2019 to June 2020 on antenatal women attending OPD in the Department of Obstetrics and Gynecology in LLRM Medical College. The enrolled patients were divided into three equal groups (n=50) according to their BMI. In all the groups obstetric outcome was assessed.Results: In normal BMI group 12% patients had preterm vaginal delivery. While In group of underweight patients 32% patients landed up in preterm delivery which has three times higher incidence. In overweight group 48% patients had caesarean section, while in normal BMI group it is only18% patients i.e. 3 times higher caesarean rate in high BMI group. 10% of patients belonging to normal BMI group needed induction of labor while 26% of patients in overweight group required induction .Thus incidence of induction of labor is more than double in overweight group. While only 16% patients had PPH in normal BMI group, 44% patients had PPH in overweight group i.e. three times higher. The frequency of preeclampsia was 22% in the overweight category and &lt;1% in the normal group.Conclusions: Higher prevalence of complications to the mother when BMI is not in the recommended normal range.

Case series of abdominal sacral colpopexy

Background: Abdominal sacral colpopexy is a transabdominal procedure that suspends vaginal vault to the sacrum using natural or synthetic graft material. We can perform this procedure in patients who have Post hysterectomy vault prolapse. Primary indication of this procedure is to resuspend a prolapsed vaginal apex. Secondary indications include repair of the cystocele, posterior vaginal wall and apical segment descent. The goal of this study was to assess the complications of repair of post hysterectomy vaginal vault proplase with polypropylene mesh.Methods: This study was conducted on 8 patients scheduled to undergo abdominal sacral colpopexy in SVBP Hospital associated to LLRM Medical College, Meerut, UP, India from March 2011 to March 2016 who had vault prolapse after hysterectomy. When patients complained of something coming out of vagina, pelvic examination was done by consultant in OPD during valsalva manoeuvre and per speculum examination. Pelvic organ prolapse quantification classification was used to classify prolapse. Two consultants performed all operations based on a standardized surgical technique.Results: In our study, all patients were followed for up to one year (at 3 months, 6 months, one year) after surgery for following observations- recurrence of prolapse, mesh erosion, dyspareunia, lower abdominal pain, constipation. None of the patient had above complaints in the follow up period.Conclusions: Abdominal sacral colpopexy with polypropylene mesh is a safe, effective treatment in patients having post hysterectomy vaginal vault proplase. When done by experienced gynecologist, major post-operative complications seem to be very few in patients having normal BMI &amp; no major systemic illnesses

Effect of bilateral salpingectomy with hysterectomy on ovarian reserve

Background: Aim of the study was to evaluate the effect of salpingectomy with hysterectomy on ovarian reserve. Methods: This prospective case control study was done in the department of obstetrics and gynaecology from June 2020 to May 2021 on patients who underwent hysterectomy with or without salpingectomy were included in the study. Patients then divided into two groups of 30 in each group. In group A hysterectomy without salpingectomy were included. In group-B patients who underwent hysterectomy with salpingectomy were included, and then both groups were followed through Si-anti-Mullerian hormone (AMH), luteinizing hormone (LH), follicle stimulating hormone (FSH) and ovarian volume.Results: Baseline AMH levels were 1.20 ng/mL for group-A, 1.29 ng/mL for group-B with no statistical significance. It was seen that AMH levels for across the group but of no statistical significance at any given follow up-line point. Baseline LH levels were 7.22 IU/L and 7.27 IU/L for group-A and group-B patients respectively with no statistical significance. The average LH levels seen to increase in the follow up period in both groups, but it was of no statistic significant at any given follow up time point. Baseline FSH levels were 7.58 IU/L and 6.84IU/L for group A and group-B respectively with no statistical significance. The average FSH levels were seen to increase is the follow up period in both groups.Conclusions: The hysterectomy coupled with bilateral salpingectomy (BS) had minimal or no statistically significant impact on the ovarian reserve. Depends on patients’ profile and states of fallopian tube we should take decision of salpingectomy during surgery

A sonographic assessment of previous caesarean section scar: is a reliable safeguard for trial of labour?

Background: Over the time the caesarean delivery rate has significantly increase worldwide from 18.2% in 2002 to 30.3% in 2012. In parous women, previous caesarean section has been found to be the most common indication for caesarean delivery in as high as 67% cases. Unsecure prediction of the integrity of the scarred LUS during labor appears to be one of the reasons for high repeat caesarean rates. The purpose of this study was to assess the usefulness of sonographic measurement of the lower uterine segment scar before labour for deciding whether it is a reliable safeguard for trial of labour or not in a woman having previous one caesarean delivery.Methods: This study was a prospective observational study, carried out on 108 pregnant women having previous one CS, gestational age >37, singleton pregnancy, cephalic presentation. Trans-abdominal USG was done to measure scar thickness. Trial of labour was given to each patient irrespective of scar thickness. Pregnancy outcome were noted in terms of successful VBAC or emergency LSCS and compared with scar thickness. Correlation between sonographic and intra-operative finding of scar were noted.Results: Result shows strong correlation between scar thickness and successful trial of labour. Scar thickness increases chances of successful vaginal deliveries.Conclusions: Sonographic assessment of previous scar has a practical application to predict the thickness and thinness of previous scar and can be taken as a reliable safeguard for trial of labour after previous cesarean but cut off value above which vaginal delivery could be considered safe is yet to be identified

The role of serum beta-human chorionic gonadotropin as a predictor for pregnancy induced hypertension in 12-20 weeks of pregnancy

Background: Pregnancy-induced hypertension occurs in approximately 3 to 5% of pregnancies and is still a major cause of both fetal and maternal morbidity and mortality worldwide. Pre-eclampsia is risk factor for stillbirth, intrauterine growth restriction (IUGR), low birth weight (LBW), preterm delivery, respiratory distress syndrome, and admission to neonatal intensive care unit. Overall, the incidence of preeclampsia ranges from 5 to 15% in India. This study conducted to assess the predictive value of raised beta-human chorionic gonadotropin (β-hCG) levels in development of pregnancy-induced hypertension in antenatal women and follow up the risk patients and reduce both maternal and perinatal morbidity and mortality. Methods: The present study was conducted in the department of obstetrics and gynaecology, L.L.R.M Medical College and associated SVBP Hospital, Meerut during the period of January 2021 to December 2021 on 400 antenatal women with 12 to 20 weeks of gestation. Estimation of serum beta hCG level was done by enzyme linked fluorescence immunoassay. The cases were followed up in antenatal clinics, 4 weekly till 28 weeks, fortnightly up to 34 weeks and thereafter weekly till delivery for the development of PIH. Results: From the study it was found that women with elevated beta hCG values in 12-20 weeks were at increased risk of developing PIH. The sensitivity of β-hCG for development of PIH was found to be 90%. It was found that specificity, positive predictive value (PPV), negative predictive value (NPV) of β-hCG for development of PIH was 82%, 41.7%, 98.3% respectively. However, p value of β-hCG for development of PIH is 0.001 which is highly significant. Conclusions: From this study we found that that measuring second trimester serum beta-hCG levels is a good predictor of pregnancy induced hypertension and showed association with elevated levels of beta hCG with development and severity of PIH, but sensitivity and positive predictive value of beta hCG are low in this study to be useful for mass screening marker on its own

Role of endometrial thickness in natural and stimulated cycles in infertility

Background: The endometrium plays an important role in infertility. The growth of endometrium depends on serum oestradiol level and blood flow to the uterus. A thin endometrium is defined as a lining of less than 7 mm which is associated with infertility. The endometrium is best seen on Transvaginal scan (TVS). The purpose of this study was to evaluate the role of endometrial thickness and its outcome in natural and stimulated cycles in infertile women.Methods: This prospective cohort study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut, Uttar Pradesh, India. Total 150 infertile women of age less than 35 years presented with either primary or secondary infertility were enrolled. Each patient was undergoing transvaginal scan (TVS) to measure endometrial thickness follicular monitoring.Results: The endometrial thickness and pregnancy rate was higher in letrozole induced group as compared to clomiphene with estradiol valerate and clomiphene with sildenafil citrate induced group.Conclusions: Letrozole had better effect on endometrial thickness and pregnancy rate as compared to clomiphene citrate with estradiol valerate and clomiphene citrate with sildenafil citrate