Intrapartum Amnioinfusion in Meconium-Stained Liquor: A Case–Control Study

Objective

The aim of this study was to investigate perinatal outcome and the rate of cesarean section (CS) following intrapartum amnioinfusion in women with meconium-stained amniotic fluid (MSAF).

Method

A total of 100 women at term in labor with meconium were randomized to infuse transcervical intrapartum amnioinfusion with saline (50) and routine obstetrical care (50). Perinatal outcome and obstetric outcome were recorded and analyzed in both groups by means of Chi-square test.

Result

The CS rate due to fetal distress was 40.0 % in the control group and 20.0 % in the study group. The difference was statistically significant (P < 0.01). Respiratory distress of the neonate was significantly less common in the study group than in the control group (4.0 % vs. 12 %; P = 0.0349).

Conclusion

Amnioinfusion in cases of meconium-stained liquor significantly improved neonatal outcome and CS rate without increasing any maternal and fetal complications.     

A Retrospective Case–Control Study Evaluating the Role of Mifepristone for Induction of Labor in Women with Previous Cesarean Section

Objective

To investigate the role of “mifepristone” for induction of labor (IOL) in pregnant women with prior cesarean section (CS).

Methods

In this retrospective study, all pregnant women with prior CS who received oral mifepristone (400 mg) for IOL (as per clear obstetric indications) [group 1] were compared with pregnant women with prior CS who had spontaneous onset of labor (SOL) [group 2], with respect to incidence of vaginal delivery, CS, duration of labor, and various maternal and fetal outcomes.

Results

During the study period, 72 women received mifepristone (group 1) for IOL and 346 had SOL (group 2). In group 1 after mifepristone administration, 40 (55.6 %) women had labor onset, and 24 (33.3 %) women had cervical ripening (Bishop Score ≥ 8) within 48 h. There were no statistically significant differences with respect to duration of labor (p value: 0.681), mode of delivery (i.e., normal delivery or CS—p value: 0.076 or 0.120, respectively), or maternal (blood loss or scar dehiscence/rupture uterus), or fetal outcomes (NICU admission) compared to women with previous CS with SOL (group 2). However, the need of oxytocin (p value 0.020) and dose of oxytocin requirement (p value 0.008) were more statistically significant in group 1.

Conclusion

Mifepristone may be considered as an agent for IOL in women with prior CS.

     

Comparative Study of Intra-cervical Foley’s Catheter and PGE2 Gel for Pre-induction Ripening (Cervical)

Aim

The success of induction of labor depends on the cervical status at the time of induction.

Objective

For effective cervical ripening both Foley’s catheter and PGE₂ gel are used. The aim of this study was to compare the efficacy of intra cervical Foley’s catheter and intra cervical PGE₂ gel in cervical ripening for the successful induction of labor.

Study Design

A randomized, prospective study was conducted in the Dept of OBGY, GMCH, Aurangabad from July 2005–January 2008. 400 patients at term with a Bishop’s score ≤3 with various indications for induction were randomly allocated to receive (200 pts) intra-cervical Foley’s catheter or PGE₂ gel (200 pts). After 6 h post induction, Bishop’s score was noted labor was augmented if required. Statistical analysis was done using Chi square test and t test.

Result

The groups were comparable with respect to maternal age, gestation age, indication of induction and initial Bishop’s score. Both the groups showed significant change in the Bishop’s score, 5.56 ± 1.89 and 5.49 ± 1.82 for Foley’s catheter and PGE₂ gel, respectively, P < 0.001; However there was no significant difference between the two groups. There was no significant difference in the side effects. Twenty eight cesarean sections (14%) were performed in Group A and 37 (18.5%) were performed in Group B (not significant). The induction to delivery interval was 15.32 ± 5.24 h in Group A and 14.2 ± 5.14 h in Group B (P = 0.291). Apgar scores, birth weights and NICU admissions showed no difference between the two groups.

Conclusion

This study shows that both Foley’s Catheter and PGE₂ gel are equally effective in pre induction cervical ripening.     

Outcome of Gestational Diabetes Mellitus from a Tertiary Referral Center in South India: A Case–Control Study

Background

Carbohydrate intolerance is the most common metabolic complication of pregnancy. Gestational diabetes mellitus (GDM) poses numerous problems for both mother and fetus. The objective of this study was to compare the maternal and perinatal outcome between women with gestational diabetes mellitus and non-diabetic women.

Study Design

A case–control study with 286 cases and 292 age-matched controls was conducted for a period of 11 months (August 2007–June 2008) in Sree Avittom Thirunal Hospital, Thiruvananthapuram, India.

Materials and Methods

Universal screening was applied by means of glucose challenge test (GCT) using 50 g of glucose. If GCT >130 mg%, the patients were subjected to oral glucose tolerance test with 100 g of glucose. National Diabetes Data Group criteria was taken to assign patients to study group. These women were further followed up and the maternal and perinatal outcomes were assessed.

Statistical Analysis

Univariate analysis was done by means of t test, Odd’s ratio, Chi-square test, and Fisher Exact test. P < 0.05 was taken as significant.

Results

The frequency of induction of labor was significantly higher than spontaneous labor (OR = 1.84, P = 0.001). 40.1 % GDM mothers and 35.8 % of non-diabetic mothers were delivered by Cesarean section. Premature rupture of membranes (PROM) was the most common complication of labor (OR = 1.66, P = 0.04). Babies of diabetic mothers had a positive trend toward prematurity (OR = 2.3, P = 0.007). Hypoglycemia was the most common neonatal complication (OR = 11.97, P < 0.001) and nine babies of diabetic mothers were macrosomic (OR = 5.2, P = 0.02).

Conclusions

Maternal morbidities and neonatal complications such as neonatal hypoglycemia, macrosomia, and prematurity were significantly higher in GDM.     

Uterine Artery–sparing Minimally Invasive Radical Trachelectomy: A Case Report and Review of the Literature

Radical trachelectomy is considered in patients with early-stage cervical cancer who desire future fertility. This article is accompanied by a video that provides step-by-step demonstration of a uterine artery–sparing robotic-assisted radical trachelectomy in a patient with stage IB1 squamous cell carcinoma of the cervix, a 2-cm mass, and a desire for future fertility. We also conducted a review of the literature examining the use of uterine artery–sparing techniques among minimally invasive radical trachelectomies. Using PubMed, Google Scholar, and Ovid search tools, 28 total publications were reviewed, of which 16 were eligible for use in our comparison. With the addition of our case report, a total of 154 cases sparing the uterine artery and 40 cases sacrificing the uterine artery were examined, including both conventional laparoscopic and robotic-assisted approaches. Data describing patient demographics as well as surgical, oncologic, and fertility outcomes were collected. The mean age was 30 years for the spared group and 32 years for the sacrificed group. At least 42% of the women in the spared and 53% of the uterine artery–sacrificed group were nulliparous. The majority of cases in both the spared and sacrificed groups represented squamous cell histology (71% for spared and 51% for sacrificed) followed by adenocarcinoma (24% vs 43%). The majority of the patients in both groups had stage IB1 disease (79% for spared vs 65% for sacrificed). The operative times among the 2 groups were similar, with a mean time of 314 minutes (range, 170–420 minutes) in the spared group and 283 minutes (range, 172–345 minutes) in the sacrificed group. The mean estimated blood loss was 173 mL (range, 23–300 mL) in the spared group and 77 mL (range, 50–250 mL) in the sacrificed group. The recurrence rates for the uterine artery–sparing and –sacrificing groups were equal at 2.6% after a mean follow-up of 42 months and 26 months, respectively. The methods of reporting fertility outcomes were varied among the different publications, with 41 patients achieving pregnancy in the spared group and 2 patients achieving pregnancy in the sacrificed group. Among patients who were not trying to conceive or had not conceived, 15 patients in the spared group and 6 patients in the sacrificed group were reported to have normal menses. The successful preservation of uterine arteries supports the maintenance of uterine arterial blood flow and is used by many gynecologic surgeons performing minimally invasive radical trachelectomy, with promising oncologic and obstetric outcomes.     

Pregnancy-Associated Plasma Protein A Levels in Late First Trimester Pregnancies with Small-for-Gestational Age Neonates: A Prospective Case–Control Study

Objective

We aimed to investigate the association of pregnancy associated plasma protein A (PAPP-A) levels in late first trimester with small for gestational age (SGA) neonates and adverse pregnancy outcomes in a low-income setting.

Methods

The inclusion criteria were late first trimester (11–13 + 6 weeks) women with singleton and non-anomalous pregnancy. Enrolled participants were sampled for PAPP-A and prospectively followed up for delivery outcome and antenatal complications. A multiple of median (MoM) was calculated and statistically compared between groups.

Results

Out of total 284 subjects, 14.54% delivered SGA babies and formed cases (Group A), 66.5% delivered appropriate for gestational age (AGA) neonates with uneventful antenatal period (controls, Group B), and 19.3% were AGA group with adverse pregnancy complications (Group C). The late first trimester median PAPP-A MoM was significantly lower (0.61) in Group A compared to Group B (1.47). Using receiver operating characteristic (ROC) curve for PAPP-A MoM, optimal cutoff value was found at 0.45 MoM, with positive predictive value of 56.2%, specificity of 92.6% and sensitivity of 45%. The median interquartile range (IQR) of PAPP-A MoM value in Group C in comparison with Group B was significantly lower except for abruption. At PAPP-A MoM cutoff value <1, <0.8, <0.6 and <0.4, the odds ratio for adverse pregnancy outcome was 8.30, 7.29, 10.97 and 10.60, respectively, indicating an inverse relationship.

Conclusion

With 0.45 MoM cutoff of PAPP-A, the detection rate, specificity and positive predictive value for SGA were 45, 92.6 and 56.2%, respectively. As PAPP-A MoM values decreased, the odds ratio of having adverse pregnancy outcomes increased.

     

Urogenital Infections as a Risk Factor for Preterm Labor: A Hospital-Based Case–Control Study

Purpose

Preterm labor is a leading cause of neonatal morbidity and mortality. Ascending lower genital tract infection leads to preterm labor and adverse pregnancy outcomes. This prospective case–control study was performed to see the association between preterm labor and urogenital infections.

Methods

A total of 104 women were observed for urogenital infections and their association with preterm labor. Case Group I included 52 women with preterm labor after 26 weeks and before 37 completed weeks of gestation with or without rupture of membranes. Control Group II included 52 women at completed or more than 37 weeks of gestation with no history of preterm labor, matched to the case group with respect to age and parity. Midstream urine was sent for cytology and culture sensitivity. Samples from posterior fornix of vagina were taken with two sterilized swabs under direct vision using Cusco/Sims speculum before first vaginal examination and were studied for gram stain characteristics and culture sensitivity by standard methods. Microorganisms isolated on culture were noted, and antibiotics were given according to sensitivity. Data collected were analyzed according to the groups by χ² test for categorical variables.

Results

In our study, urogenital infection was seen in 19 women in Case Group I (36.54 %) compared with 9 women in Control Group (17.3 %), and the difference was statistically significant (p 0.027).

Conclusion

Recognizing and treating the women having urogenital infections at a stage, when it has not become clinically evident, will decrease the percentage of women going into preterm labor and will improve the perinatal outcome.     

HCV and Pregnancy: Prevalence,Risk Factors,and Pregnancy Outcome in North Indian Population: A Case–Control Study

Objectives

The study was carried out to investigate the prevalence, risk factors, and Pregnancy outcome in anti-HCV-positives pregnant women admitted for delivery in the Department of Obstetrics & Gynecology of Guru Gobind Singh Medical College and Hospital, Faridkot between January 2010 and January 2013.

Setting

Department of obstetrics and Gynaecology of GGS Medical College and Hospital, Faridkot.

Material and Methods

A case–control study design was selected for the study. A total of 1412 pregnant women presenting in the labor room of our hospital between January 2010 and January 2013 were subjected to anti-HCV testing by third generation ELISA. Age, parity, and gestational age-matched controls were taken from the women delivering during the same time frame who tested negative for hepatitis C. All the subjects and controls were non-reactive for HIV and HBsAg as well. Risk factors and pregnancy outcome were compared with the control group. Approval was taken from ethic committee of the institute. The women who consented to participate in the study were evaluated on the basis of a questionnaire for the presence of risk factors of hepatitis C and pregnancy outcome. Women with the known previous liver disease were excluded from the study. Data were analyzed using SPSS for Windows version 16.0. p < 0.05 was considered significant.

Results

Forty patients tested positive for anti-HCV antibodies among 1,412 patients subjected to anti-HCV testing during study period. 40 patients were taken as controls, who were negative for anti-HCV antibodies. Prevalence of HCV during pregnancy was 2.8 % in our study. Among the risk factors studied, previous surgery and blood transfusion were the statistically significant risk factors. There was history of previous major surgery in 16 cases versus 4 controls and was statistically significant (p value 0.002) at p < 0.05. History of blood transfusion was present in 4 versus 2 among cases and controls, respectively, and statistically significant (p value 0.004) at p < 0.05. Sexual transmission was not the risk factor as none of the spouse of the pregnant women was positive for HCV antibodies. Neonatal outcome was similar in both groups. Pregnancy complications i.e., Pregnancy-induced hypertension and antepartum hemorrhage were significantly higher in study group compared to control group.

Conclusion

Incidence of hepatitis C virus infection in pregnancy is 2.8 %. Surgical procedures, blood transfusion, are the major risk factors for transmission. There are no identifiable risk factors in 35 % of cases. Pregnancy complications like Pregnancy-induced hypertension and antepartum hemorrhage are more common in HCV-positive mothers. Neonatal outcome is not affected. Universal screening of all pregnant women should be done for HCV as many patients may not have any risk factor.     

Management of ED under the “Severe Distress” Criteria in the NHS: A Real‐Life Study

IntroductionThe United Kingdom is unusual in that a significant proportion of patients with erectile dysfunction (ED) have their treatment fully reimbursed by the National Health Service (NHS). This may have consequences for the choice of treatment and for compliance with treatment.AimsThe aim of this study was to evaluate the use and cost implications of phosphodiesterase type 5 inhibitor in an NHS setting.MethodsBasic demographics and data on ED management for patients treated from January 2000 to April 2011 were obtained from a prospectively accrued database. We reviewed drug usage and costs as well as switching between drugs. Patients were given the choice of all available therapies and were followed up annually.Main Outcome MeasuresSwitching, compliance, and costs of treating ED under the “severe distress” criteria in the NHS were reviewed for this study.ResultsTwo thousand one hundred fifty‐nine patients qualified for reimbursed therapy. Two hundred twenty‐six patients were excluded from further analysis owing to missing data. Patients were followed up on an annual basis. The mean patient age was 60.2 years (min 23, max 90), and the mean follow‐up was 50.8 months (min 1, max 127). Six hundred ninety‐six were started on sildenafil, 990 on tadalafil, 163 on vardenafil, and 84 on intracavernosal alprostadil. Eighteen percent of patients initially started on the scheme and stopped medication unilaterally. Of the patients, 12.3% changed their medication during follow‐up. The cost of drugs increased year by year from £257,100 in 2007 to £352,519 in 2011.ConclusionsOur real‐life observational study shows that in our institution, dropout of therapy is unusual. We hypothesize that this reflects, in part, the reimbursement issue. We also found that switching between drugs was unusual, although there are several possible explanations for that. Although this is a successful system for the patients, the hospital, which bears the costs of medication, is finding this an increasing economic drain. Mohee A, Bretsztajn L, Storey A, and Eardley I. Management of ED under the “severe distress” criteria in the NHS: A real‐life study. J Sex Med 2014;11:1056–1062.     

Management of Turner’s syndrome in adult life: case-series and systematic review

Objective: To assess the symptoms and outcomes of clinical management in adult patients with Turner’s Syndrome. Design: Retrospective case-series and systematic review of the literature. Setting: Gynaecological Endocrinology Unit in a teaching hospital. Patients: Patients followed in the Gynaecological Endocrinology Unit. Interventions: Review of medical records and a computer search via several databases to identify journals relevant to the subject were performed. Main outcome measures: Final height, weight, previous treatments with growth hormone, cardiac or renal malformations, metabolic profile, and additional treatment for osteoporosis. Results: Thirty-one patients were analysed. Differences in final height were found between groups with monosomy and other karyotypes. Four patients bore congenital cardiac malformations, and six, renal congenital malformations. Nine patients had a previous diagnosis of hypercholesterolemia. The most abnormal hepatic parameter was GGT, with fifteen patients having values over the normality limit. Ten patients were receiving treatment for osteopenia or osteoporosis. Conclusions: This case-series provides recommendations for the management of adult patients with Turner’s syndrome and insight into the different medical complaints of this syndrome. A link between karyotypes and clinical features suggests a novel hypothesis to explain the different phenotypes and clinical abnormalities of these patients.     

Common Inflammatory Markers in Polycystic Ovary Syndrome (PCOS): A BMI (Body Mass Index)-Matched Case–Control Study

The Journal of Obstetrics and Gynecology of India -     

Uterine packing versus Foley’s catheter for the treatment of postpartum hemorrhage secondary to bleeding tendency in low-resource setting: A four-year observational study

Objective: To assess the effectiveness and safety of uterine packing versus Foley’s catheter tamponade for controlling postpartum hemorrhage (PPH) secondary to bleeding tendency after vaginal delivery.

Methods: This was a prospective observational study conducted on 92 patients with primary PPH due to bleeding tendency following vaginal delivery who were unresponsive to uterotonics and bimanual compression of the uterus. Patients were divided into two groups, Uterine packing group (n?=?45) and Foley catheter group (n?=?47). The primary outcome was the success rate of the procedure. Secondary outcome addressed the maternal complications.

Results: The use of uterine packing resulted in stoppage of active bleeding in 93.3% of cases compared to only 68.1% in the Foley’s catheter group (p?p?>?0.05). Six cases who failed to Foley catheter tamponade underwent emergency hysterectomy with no cases in the uterine packing group.

Conclusions: The use of uterine packing to arrest PPH is simple, quick and safe procedure to avoid further surgical interventions and to preserve the fertility in low-resource setting.     

Vaginal Metastases of Wilms’ Tumor in a Pediatric Patient: A Rare Case

BackgroundWilms’ tumor is the second most common pediatric abdominal cancer; however, it rarely involves the female reproductive tract. There are few cases reported in the literature describing uterine, ovarian, cervical, and vaginal involvement.CaseWe report the case of a 7-year-old girl presenting with a large renal mass with retroperitoneal nodal and lung metastases; she was diagnosed with stage 4 favorable histology Wilms’ tumor. She was treated with surgery, chemotherapy, and radiation. She presented with vaginal bleeding 10 months after completing treatment; biopsy of a vaginal mass confirmed recurrence, and this was sent for molecular profiling, which did not identify an inherited cancer predisposition or targetable mutation. She was again treated with chemotherapy; examination redemonstrated a small vaginal mass, but re-biopsy of the lesion was negative for malignancy. Due to high risk of local relapse, ongoing chemotherapy and pelvic radiation ensued. End-of-treatment imaging and vaginoscopy showed no residual disease.Summary and conclusionVaginal metastases of Wilms’ tumor are very rare; this is the second reported case in the literature. Pediatric clinicians should have a strong suspicion for vaginal metastases in cancer patients presenting with vaginal bleeding, especially when their pubertal development does not suggest that bleeding would be secondary to menarche. Long-term gynecologic care for these patients is paramount to reduce morbidity from chemotherapy and pelvic radiation. Fertility preservation counselling should be made early, through referral to a specialist.     

Efficacy of Transabdominal Ultrasound–guided Percutaneous Microwave Ablation in the Treatment of Symptomatic Adenomyosis: A Retrospective Cohort Study

Study ObjectiveTo evaluate and compare the clinical efficacy of transabdominal ultrasound–guided percutaneous microwave ablation (PMWA) in the treatment of symptomatic focal and nonfocal adenomyosis.DesignRetrospective cohort study.SettingLongyan First Affiliated Hospital of Fujian Medical University.PatientsFrom May 2019 to October 2021, 107 patients with symptomatic adenomyosis who refused hysterectomy received PMWA.InterventionsPatients were divided into a focal group (n = 47, including 40 focal adenomyosis and 7 adenomyoma cases) and a nonfocal group (n = 60, including 36 diffuse and 24 mixed adenomyosis cases) according to the extent of lesion involvement.Measurements and Main ResultsWe collected and analyzed preoperative baseline data on patient characteristics; postoperative efficacy measures at 3, 6, and 12 months; and intraoperative and postoperative complications. There was a significant post-treatment reduction in the uterine corpus volume and cancer antigen 125 levels, an increase in hemoglobin levels, and an improvement in the Uterine Fibroid Symptom and Health-related Quality of Life scores (consisting of the Symptom Severity Scale and the Health-related Quality of Life scale), dysmenorrhea visual analog scale, and menstrual volume score (MVS) (all p <.05). One patient had recurrence. Most adverse events (72.0%) were mild. Although the nonfocal group had significantly greater anemia severity, higher Symptom Severity Scale and MVS, lower Health-related Quality of Life scale, greater extent and severity of myometrial involvement, and larger uterine corpus volume, after treatment, the uterine corpus volume, uterine corpus reduction rate, cancer antigen 125 levels, hemoglobin levels, Uterine Fibroid Symptom and Health-related Quality of Life score, dysmenorrhea visual analog scale, MVS score, and clinical response rate were similar between the groups (p >.05).ConclusionPMWA had good, similar, short-term efficacy for symptomatic focal and nonfocal adenomyosis.     

A pilot study of Foley’s catheter balloon for prevention of intrauterine adhesions following breach of uterine cavity in complex myoma surgery

Purpose

During abdominal myomectomy for removal of multiple fibroids, the uterine cavity may be breached. Repair of the breach is associated with a risk of development of intrauterine adhesions. We conducted a pilot study to evaluate the effectiveness of temporary placement of a Foley’s catheter balloon inflated with 30 ml normal saline into uterine cavity at the end of surgery to prevent this complication.

Methods

Retrospective cohort study. When the uterine cavity was breached during open myomectomy, it was repaired with a No. 2-0 vicryl suture. A Foley catheter balloon was inserted into the uterine cavity at the end of the procedure, and the balloon distended with 30 ml of normal saline. The balloon was removed on the fourth post-operative day. Follow-up hysteroscopy was performed after 6 months.

Results

At the time of follow-up hysteroscopy 6 months after the myomectomy, we found no intrauterine adhesions in 16 consecutive women treated with balloon, compared to 3 out of 10 (30 %) historical controls where the balloon was not used.

Conclusion

A Foley catheter balloon inserted into the uterine cavity following breach and repair of the uterine cavity at open myomectomy appears to prevent the formation of intrauterine adhesions.