Significance of cervical length and cervical gland area in cervical maturation

Background: The traditional method of predicting whether an induced labor will result in successful vaginal delivery is based on pre-induction favorability of cervix as assessed by bishop score. Currently assessment of cervical maturation by sonographically at term in induction of labor is most accurate and highly reproducible compared to Bishop score. Shortening of cervix and non-detection of cervical gland area (CGA) could correspond to cervical maturation.Methods: This study was carried out in a tertiary care teaching institute in Karnataka. 180 pregnant women at or beyond 37weeks who were planned for induction, Bishop score assessment of cervix and cervical assessment by ultrasound such as cervical length (CL) and cervical gland area was done one day prior to induction. Induction was with 0.5 mg PGE2gel. Maximum 3 inductions were carried out over a period of 24hrs. Primary outcome of the study was the onset of active labor.Results: Amongst 160 pregnant women who were induced (20 women were excluded has they underwent LSCS for some other reasons during latent phase) cervical length by sonography 4. Cervical length 4.Conclusions: Sonographically detected cervical gland area and cervical length was evaluated in predicting response to induction. Absent CGA and CL < 2cm was associated with greater incidence of successful labor induction. This results show the CL and CGA has significant role in predicting outcome of labor

Diagnosis of genital tuberculosis: correlation between polymerase chain reaction positivity and laparoscopic findings

Background: Female genital tuberculosis (GTB) leads to infertility in young women as it involves the fallopian tube and the endometrium. Since it does not produce any dramatic symptoms, disease remains untreated until the female fertility is totally compromised. Diagnostic hystero-laparoscopy is an integral part of management of infertile women. Visual manifestations of pelvic TB are well described, but subtle signs of subclinical disease are not identified nor correlated with laboratory tests. PCR has been described as a rapid, highly sensitive and specific test for detecting DNA of MTB. Hence it’s worth studying whether positive PCR test will help make early diagnosis of GTB. This study correlates laparoscopic visual inspection (LVI) findings with endometrial TB-PCR positivity to diagnose GTB.Methods: A prospective observational study was done in which infertile women who had clinical and HSG findings suggestive of GTB underwent endometrial TB-PCR and hysterolaparoscopy. Among them 69 endometrial TB-PCR positive cases were included in the study. Clinical and hysterolaparoscopy findings in these cases were reviewed.Results: GTB is the disease of young women and most commonly present with primary infertility (65.2%). On laparoscopy 60% of cases showed positive correlation with endometrial TB- PCR and tubal involvement was seen in majority of cases.Conclusions: Even though PCR is a very valuable tool in diagnosing genital TB, by itself it can neither confirm nor exclude genital TB. The routine application of endometrial TB-PCR assays in addition to clinical and laparoscopic evaluation carries a great potential in improving diagnosis of genital TB

Emergency cervical cerclage and pregnancy outcomes

Background: To evaluate the effectiveness and safety of emergency cervical cerclage in women who presented with advanced cervical changes such as cervical dilatation and bulging foetal membranes.Methods: This is a retrospective study on all women treated with cervical cerclage presented in the late second trimester with advanced cervical dilatation (2 to 4cms) for whom emergency cervical cerclage by McDonald technique.Results: Out of the 24 patients for whom emergency cervical cerclage was performed, three patients had spontaneous abortion after cervical cerclage, two had PROM and eight of these patients had term delivery. Twenty-one fetus were live born after the period of viability. Nine of these babies were admitted to NICU and 50 percent of the neonates required only regular perinatal care.Conclusions: Post emergency cervical cerclage, the outcome in terms of prolongation of pregnancy, live births and neonatal survival is better

Knowledge of obesity and its effects on cardiometabolic and reproductive health in women

Background: Obesity is following a raising trend in India. Being a major risk factor for various diseases, awareness should be raised among people regarding this issue. The objective of the study was to assess knowledge of obesity and its ill effects on cardio metabolic and reproductive health in women.Methods: This was a prospective survey study done on women visiting gynecology OPD at Rajarajeswari Medical College and Hospital. 300 Subjects were randomly picked and were administered a questionnaire on the health risks of obesity, that is,  its effect on cardio metabolic status, reproductive outcome in terms of infertility and spontaneous abortions and obesity related cancers such as endometrial and breast cancers.  Height and weight measurements of the study subjects were measured.Results: Subjects' age ranged from 19 to 47 years (mean SD: 28.72 ± 6.52). subjects who were aware that obesity increases the risk of various diseases were: diabetes  (85.3% ) ,  blood pressure (88.7%), raised cholesterol levels in the blood(90.7%), infertility (84%), irregular periods (62%), abortions (44%),arthritis (86.7% ),  breast cancer (36%) , endometrial cancer (36.7% ).Conclusions: Women in our study have good knowledge about obesity and its effect on general health and cardio metabolic diseases, fair knowledge about reproductive outcomes. They are less aware of the association of obesity and sex hormone sensitive cancers like endometrial and breast cancers.  Public education is needed to increase awareness of obesity and malignancy

Prospective study of primary amenorrhoea and its management in a rural tertiary centre

Background: Amenorrhoea (absence of menstruation) is a symptom of varied causes. It results from dysfunction of hypothalamic-pituitary ovarian axis, uterus and vagina. It is a major concern for pubertal girls and their family members. It has a major impact on the physical, mental, psychological and social life of the girl and her family. The objective of the present study was to evaluate the aetiology and management of primary amenorrhoea in young adolescent girls.Methods: It was a prospective study conducted for a period of 2 years from August 2016 to July 2018 at Rajarajeswari medical college and hospital. Patients presenting with history of amenorrhoea that is, absence of menses by the age of 13 years with no visible development of secondary sexual characteristics or by 15 years of age with the presence of normal secondary sexual characteristics were included in our study. Cases of secondary amenorrhoea were excluded. Detailed history, examination, investigations and management was documented and analysed.Results: A total of 25 patients of primary amenorrhea were studied during the study period. In our study outflow tract anomalies were the commonest cause of amenorrhoea accounting for 84%, of which imperforate hymen (32%) and Mayer Rokitansky Küster Hauser syndrome (MRKH) 36% were the two most common Mullerian anomaly causing primary amenorrhoea. Gonadal dysgenesis accounted for 12% of the cases. Amenorrhoea was the commonest complaint patients presented with accounting to 76%, followed by cyclical pain abdomen accounting for 16% of cases.Conclusions: Primary amenorrhoea is multifactorial and is of major concern among adolescent girls. Early diagnosis and intervention has an impact on the physical and psychological wellbeing of the girl

Comparison of Doppler findings and neonatal outcome in fetal growth restriction

Background: Fetal growth restriction (FGR) affects up to 5-10% of pregnancies. It is associated with increased perinatal mortality and morbidity. Doppler studies identify at risk fetuses and help in timing interventions and prognosticate outcomes. The ability of Doppler studies to predict neonatal outcome is studied here.Methods: Prospective study of seventy-two women with singleton pregnancies with gestational age above 28 week and detected to have FGR was done. The patients were subjected to Doppler analysis. Abnormal Doppler indices were compared with neonatal outcomes such as NICU admission, ventilator or CPAP support, sepsis, phototherapy and perinatal mortality.Results: Elevated umbilical artery PI, reduced middle cerebral artery PI and low CP ratio were found in 14, 18 and 36 fetuses. The sensitivity and specificity in predicting neonatal outcome was 25% & 75%, 58.1% and 62% and 17.9% and 75% for umbilical artery PI, MCA PI and CP ratio respectively. None of the Doppler indices showed significant p value. On testing, gestational age at delivery and length of NICU stay, gestational age was a significant determining factor with ‘p’ value of 0.003.Conclusions: Antenatal Doppler analysis of UA and MCA can predict neonatal outcome in FGR fetuses. Though the ‘p’ value was not significant in this study, the sensitivity, specificity, positive predictive value and negative predictive value are comparable to other studies. Gestational age at delivery significantly influences neonatal outcome

A prospective observational study of thyroid dysfunctions during pregnancy in a tertiary care hospital

Background: Thyroid dysfunctions are the second most common endocrine disorders seen during pregnancy. Overt or subclinical thyroid dysfunction during pregnancy adversely affects maternal and fetal outcomes. Maternal euthyroid status in early gestation period and optimal transfer of thyroxine to fetus is crucial for the optimal growth, development and maturation of fetal nervous system. This study is undertaken to know the magnitude of thyroid dysfunctions during pregnancy in our region and to validate the need for early detection of maternal thyroid dysfunctions by antenatal screening.Methods: It was a hospital based prospective study over a period of one year. According to our study criteria, blood samples were collected from consenting pregnant woman during their first antenatal visit and analyzed for TSH level by ultrasensitive method. Free T3 and Free T4 were assayed in patients showing abnormal TSH level and anti thyroid peroxide antibodies tested in all hypothyroid patients. All pregnant woman enrolled were followed up throughout the pregnancy, labour and postpartum to note any maternal and fetal adverse outcomes. The data obtained were analyzed and pregnancy outcomes compared between women showing thyroid dysfunctions and euthyroid state.Results: Among 800 pregnant women studied 88.75% were euthyroid and 11.25% showed thyroid dysfunction, affecting more in the age group 21-25 years and multigravidae. Prevalence of hypothyroidism was 10.12%, presenting as subclinical hypothyroidism (7.37%) and overt hypothyroidism (2.75%). Hyperthyroidism was seen in 1.12% of cases, 0.87% of them presented subclinically and 0.25% overtly. Risk factor was present in 29.62% of hypothyroid group and 33.33% of hyperthyroid group. Pregnancy complications were seen in 55.55% of thyroid dysfunctional group, preeclampsia being the most common complication.Conclusions: Our study showed 11.25% prevalence of thyroid dysfunction in pregnant women and commonest dysfunction was hypothyroidism in subclinical form. Adverse pregnancy outcomes were seen in 55.55% woman having thyroid dysfunctions. Absence of risk factor was noted in upto 70% of the cases with thyroid dysfunctions hence the diagnosis will be missed if only high risk cases are screened. Therefore universal screening is recommended early in pregnancy to identify and correct thyroid dysfunctions to prevent the associated adverse pregnancy outcomes

The outcome of laparoscopic management of adnexal pathology complicating pregnancies

Background: Adnexal pathology found during pregnancy is relatively common and the reported incidences are population and investigation dependent. The most frequent types of adnexal masses are corpus luteum cysts, endometriomas, benign cystadenomas and mature cystic teratomas. The objective was to study the feasibility of laparoscopic management of adnexal pathology in pregnancy, maternal complications and fatal outcome. We have reported 25 cases of adnexal pathology complicating pregnancy, managed successfully laparoscopically with no maternal and fetal complications.Methods: The study is based on the outcome of laparoscopic management of adnexal pathology in 25 pregnant women over period of eight years. Laparoscopy was done using three port technique, 10 mm umbilical or supra umbilical port for optics and two lateral ports for instrumentation. Cystectomy was the most common procedure.Results: There was no intra or post-operative complication observed in the study. Successful obstetric outcome in all the patients with no complications was observed.Conclusions: Laparoscopy is preferred for exploration and treatment of adnexal masses especially between 14 to 25 weeks of gestation

A cadaveric study on anatomy of axillary nerve and its clinical importance

Background &amp; objectives: The axillary nerve is one of the terminal branches of the posterior cord of the brachial plexus, and it is frequently injured during orthopaedic procedures, shoulder dislocations, and rotator cuff tears. All of these possible iatrogenic injuries are the result of a lack of understanding of the nerve's anatomical differences. As a result, it is critical to investigate its possible variations and provide guidance to surgeons in order to improve clinical outcomes by lowering risk and complications. Materials and methods: 72 cadavers adult embalmed (55 males and 16 females), both right and left sides were dissected as per standard dissection methods. Results: The division of axillary nerve into anterior and posterior branches occur in quadrangular space and within deltoid muscle in 84.5% and 12% respectively.Posterior cord was formed by union of posterior division of C5 and C6 roots with posterior division of middle and lower trunk (there was no upper trunk) in 15.2% (11/72) of upper extremities . Posterior cord of brachial plexus was present lateral to the second part of axillary artery in 18% (13/72) of upper extremities. Axillary nerve was taking origin from posterior division of upper trunk in 9.7 % (7/72) upper extremities and thoracodorsal nerve arising from axillary nerve in 22.2% (16/72) upper extremities. Conclusion: It is important to be aware of such variations while planning a surgery in the region of axilla as these nerves are more liable to be injured during surgical procedures