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

  (Medip Academy, 2016-12-15)

  Arpitha, Venkatesh Jnanashree

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  Savitha, Channaveeregowda

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  Nagarathnamma, Rangaiah

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  Department of Obstetrics and Gynaecology, RRMCH, Bangalore, Karnataka, India

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  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.

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  A prospective study of the study of maternal and perinatal outcome in cases of eclampsia

  (Medip Academy, 2016-12-15)

  Ponde, Sanjay Ravan

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  Hatkar, Preeti

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  Nandanwar, Y. S.

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  Chavan, Niranjan

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  Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India

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  Background: This is an observational analytical study carried out in the department of obstetrics and gynecology, in a tertiary care center to determine the factors influencing fetal and maternal outcome, prognosis and complications in booked and unbooked eclamptic cases.Methods: The present study is a prospective study of perinatal and maternal outcome in 50 cases of eclampsia, above 32 weeks of gestation, from 1st May 2013 to 30th April 2014. Patients with medical complications like anemia, preexisting hypertension, diabetes, vascular or renal disease, multiple gestation, polyhydraminos, etc. are excluded from the study. Detailed history, physical examinations were carried out and appropriate management instituted as per individual patient need. Follow-up of mothers up to 6weeks postpartum and neonates in the early neonatal period was done.                Results: Incidence of eclampsia is 0.64%, incidence of maternal mortality is 0.4% and perinatal mortality is 24%. 36% of patients developed complications. Maternal mortality was significantly high in patients with 6 or more episodes of convulsions. The most common cause of perinatal mortality is prematurity. Antepartum eclampsia with gestational age less than 36 weeks, BP >160/100, preterm births, low birth weight babies, low apgar scores influenced adverse perinatal outcome.Conclusions: Eclampsia still remains a major problem in developing countries. It is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper ANC, low socio-economic status and lack of education.

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  Role of trans-cerebellar diameter in estimating gestational age in second and third trimester of pregnancy

  (Medip Academy, 2016-12-15)

  Uikey, Prashant Arun

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  Kedar, Kshama Vivek

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  Khandale, Surekha Narayan

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  Department of Obstetrics and Gynaecology, Indira Gandhi Govt. Medical College, Nagpur, Maharashtra, India

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  Background: Uncertain gestational age is associated with higher perinatal mortality rates and an increased incidence of low birth weight and spontaneous preterm delivery. Errors in gestational age estimation can lead to iatrogenic neonatal morbidity from prematurity. Precise determination of gestational age antenatally is a boon to modern obstetrics in context with improved neonatal survival. The most effective way to date pregnancy is by sonography. Several parameters can be considered for estimation of gestational age trans-cerebellar diameter is one such parameter. The objective of this study was to study the role of fetal trans-cerebellar diameter in estimating the gestational age in second and third trimester of pregnancy and its correlation with gestational age, BPD, HC, AC and FL. The design of this study was to hospital based prospective cohort study conducted at department of obstetrics of Government medical College Nagpur, over a period of 1 year.Methods: 500 women with sure dates between 7 and 11 weeks of gestation were booked. First trimester USG using crown rump length for confirmation of gestational age was done. These patients were advised to come for follow up till 40 weeks of gestation and repeat USG was done in second and third trimester. Trans-cerebellar diameter was correlated with expected gestational age with CRL, BPD, HC, AC and FL in weeks.Results: 98.56% of variability in gestational age could be explained by variation in trans-cerebellar diameter (TCD) only. Addition of other variables did not make any significant difference indicating that TCD alone is the strong predictor of gestational age.Conclusions: Normative cerebellar measurements throughout pregnancy permit estimation of gestational age independent of the shape of fetal head and also offer potential for evaluating abnormal fetal growth and anomalous development of central nervous system.

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  Depot-medroxy progesterone acetate as an effective contraception method in lactating mothers

  (Medip Academy, 2016-12-15)

  Babre, Vijaya Monish

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  Phadke, Jyaneshwari Ashok

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  Family Planning Association of India, Kutumb Sudhar Kendra, Mumbai, Maharashtra, India

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  Background: Contraception is the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. Depot medroxy progesterone (DMPA) injection 150 mg intramuscular was used for contraception in this study, once every 3 months±14 days. The objective was to establish safety and effectiveness of DMPA in lactating and non-lactating mothers, observe side effects related to usage of DMPA and also establish its effectiveness as contraception method.Methods: This is retrospective study performed at Family Planning Association of India’s Kutumb Sudhar Kendra. Mumbai Central.Result: Patients who had received first dose at 6 weeks of postpartum period and those who received between 6 weeks to one year showed lactation in 84.16% and non-lactation in 15.84%. 28.71% lactating patients had taken injection at 6 weeks of post-partum period and 71.29% had taken between 6 weeks to 1 year. Lactating patients who had taken injection at 6 weeks and continued DMPA for more than 4 injections were 48.27%. 36.84% non-lactating patients had continued for more than 4 injections. This signifies that acceptance and continuation rate of DMPA is more in lactating patients than in non-lactating patients.Conclusions: DMPA is an effective method of contraception in lactating mothers; proper counseling will increase awareness and acceptance of DMPA in lactating mothers.

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  Maternal and perinatal outcome in meconium stained amniotic fluid at term: a case control study

  (Medip Academy, 2016-12-15)

  Samiyappa, Dhana Priya

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  Ghose, Seetesh

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  John, Lopamudra B.

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  Samal, Rupal

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  Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India

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  Background: Fetal well-being has traditionally been evaluated on the basis of fetal activity, FHR and presence of meconium in liquor in vertex presentation. Passage of meconium is considered physiological sign of fetal maturity on one hand and a sign of fetal distress and response to hypoxic insult on the other hand.Methods: Pregnant women of 37 - 42weeks gestation with singleton pregnancy and cephalic presentation admitted in labour ward of Mahatma Gandhi Medical College and Research Institute with clear or meconium stained amniotic fluid following spontaneous rupture or ARM were included in the study. Outcome measures were fetal heart rate abnormality, mode of delivery, Apgar score, NICU admission and diagnosis of MAS.Results: A total of 678 pregnant women were studied. Of them 226 had meconium stained and taken as study group. Rest 452 served as control group. The average gestational age of study group was 39.26±0.81. Abnormal FHR was observed in 56%.Spontaneous vaginal delivery was observed in 27.9% cases, instrumental delivery in 21.2% and caesarean section was 50.9% cases. Rate of low Apgar score 4.4% and it was two times higher in study group. NICU admission was observed in 46.7% cases of exposed group. Incidence of MAS in our study was 1.3%.Conclusions: In low resource settings where fetal scalp pH, and umbilical card lactate estimation facilities are not available, association of MSL with abnormal FHR can be taken as fetal distress and hence consideration of early operative intervention is necessary.

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