ABSTRACT
Chorioangioma belongs to benign nontrophoblastic primary vascular neoplasms of placenta, originating from primitive chorionic mesenchyme and has a cited prevalence of around 0.6% to 1% of all pregnancies. Though majority of them are asymptomatic, clinical course depends mainly on the size of the neoplasm. Giant chorioangiomas (> 4-5 centimetres in diameter) with an approximate prevalence of around one in 9000 to one in 50,000 pregnancies, have been associated with many adverse maternal and fetal complications. We report a case of 21-year-old primigravida lady, who presented to us at 37weeks 4 days period of gestation with backache and with clinically evident increased liquor. On evaluating the cause of her polyhydramnios, ultrasonography revealed a well-defined echogenic vascular mass measuring ~ 8х8 centimetres in the placenta, suggestive of chorioangioma. Though the condition is infrequent, through this case report, we emphasize that even placental factors need to be ruled out in evaluating causes of polyhydramnios. Despite large size of chorioangioma and associated hydramnios, our patient exceptionally didn’t have any fetal complications. With proper antenatal surveillance, optimal feto-maternal outcome can be expected as seen in our case.
ABSTRACT
Background: Polycystic Ovarian Syndrome (PCOS) is a heterogenous collection of symptoms and signs, which form a spectrum of a disorder with a mild presentation and severe disturbance of reproductive, endocrine and metabolic function. Aim: To compare between metformin and Pioglitazone in treating polycystic ovarian syndrome. Materials and methods: This was a double blinded, randomized comparative study conducted at Government hospital Nizamabad and CKM Hospital, Warangal. 150 PCOS patients in the age group 18-35 years were enrolled, and were allocated to two groups and were given the following modalities for a period of 8 months. Group I: Metformin-500 mg, BID, Group II: Pioglitazone-15 OD. Each group consisted of 75 patients. The minimum sample size required was 50-60. In this study, 75 patients were included in each group to allow dropouts. Oligo or anovulation, hyperandrogenism, polycystic ovaries were included. Results: In group I, 68 (90%) out of 75 patients and in group II, 67(89%) out of 75 patients completed the trial. In group I, all the 68 patients had irregular menstrual cycles at the beginning of the study, and at the end of the study, 34 (47%) had regular menstrual cycles. In group II, 67 patients had irregular menstrual cycles at the beginning of the study, and at the end of the study, 38 (56%) had regular menstrual cycles. In both the groups, there was an increase in HDL levels (statistically significant versus baseline), more in Group II than in Group I. The average increase is 28 % in Group I as compared to 74 % in Group II. There is a trend of decrease in VLDL levels in both groups, the decrease being more in Group II (48 %) than in Group I (26 %) statistically significant when both groups w e re compared. In both the groups, there was a rise in SHBG, (statistically significant versus baseline). In Group I, the mean increase in SHBG was 6.22 nmol/l (22 %), but in Group II, mean rise Allanki Suneetha Devi, Jalem Anuradha. Metfornim and Pioglitazone in polycystic ovarian syndrome: A comparative study. IAIM, 2017; 4(7): 39-44. Page 40 in SHBG was more, i.e.34.56 nmol/l (72.7 %) and this difference is statistically significant (P<0.05). Both the Groups showed a decrease in LH/FSH ratio. The fall in LH/FSH ratio was more in Group II, than in Group I. This fall in Group II was statistically significant P<0.05 versus Group I. Conclusion: Pioglitazone can restore menstrual cycle, a better ovulatory rate is achieved, clinical signs of hyperandrogenism are improved, and type 2 diabetes is prevented or delayed, so pioglitazone is a better treatment in patients with PCOS
ABSTRACT
Background: Compared to cephalic presentation with respect to fetal morbidity and mortality, breech delivery management was a high risk. Aim: To evaluate the outcome of breech deliveries in nulliparous women. Materials and methods: This was a retrospective study conducted from October 2012 till September 2015 .The study was conducted at Government hospital Nizabmabad and CKM hospital, Warangal. The selection criteria were gestational age ≥ 32 weeks which was validated by ultrasound examination performed before 20 weeks gestation when calculated from last menstrual period, a singleton with breech presentation and normal fetal heart beats in nulliparous women. Adequate pelvis, frank or complete breech, estimated weight of foetus lesser than 3500 grams, no other obstetric complication were the inclusion criteria. Results: During these 3 years survey, 12000 deliveries were done. Out of which, 3000 were nulliparous, and there were 400 cases of breech presentation, and there was an incidence of 3.33%. A total of 250 women met the inclusion criteria and had undergone delivery by VBD or by Caesarean section. There were 120 caesarean deliveries, of which 56 (46.66%) were elective and 64 (53.33%) were emergencies. The main indication for emergency CS was acute foetal distress accounting to 42 (65.63%) cases. The main indication for elective CS was foetal birth weight ≥3500 grams accounting to 25 (44.64%) cases. Out of 130, 15 (11.54%) neonates had poor APGAR score (<7) at the 5th minute of birth. In elective caesarean section, none had poor APGAR score at 5th minute. In emergency, caesarean section, 6 (9.38%) had a poor APGAR score at the 5th minute. Out of the 6 cases, the indication for the emergency caesarean section was acute foetal distress, 2 in 35 years old patients carrying foetus of 3300 grams and 3200 grams, others had cord prolapsed. In APGAR score between Allanki Suneetha Devi, Jalem Anuradha. Outcome of breech deliveries in nulliparous women. IAIM, 2017; 4(7): 33-38. Page 34 the group of elective and emergency caesarean section, there was a statistically significant difference in the mean 5th minute. Conclusion: It can be concluded from this study that in cases of inadequate pelvis, foetal weight ≥3500 grams or ≤1800 grams, footling breech presentation, post term pregnancies, vaginal breech delivery is unsafe.
ABSTRACT
Background: Pessary is a medical device inserted into the vagina, either to provide structural support or as a method of delivering medication. For the treatment of urinary incontinence, pelvic organ prolapse, pessaries have been utilized. Aim: The aim of the study was to evaluate the differences in vaginal discharge between postmenopausal women who wear pessaries and those who do not to explain pessary related, bacterial vaginosis vaginal discharge by microscopy, gram staining. Materials and Methods: 150 women were selected for the study and the study was conducted at Government hospital Nizamabad and CKM hospital, Warangal. 75 Women were post-menopausal who had worn Pessaries for at least 4months and were in group A. 75 Women didn’t wear Pessaries and were presenting for pessary fitting. Women who were postmenopausal, women who had worn pessaries for atleast 4 months or had never worn pessary and were presenting for pessary fitting were included. Results: Group A was older and had been for a longer time menopausal when compared to Group B. Years since menopause was higher in group A when compared to group B. Women in group A were more bothered by discharge when compared to group B. Women in group A were more likely to meet amsel’s and nugent’s criteria for bacterial vaginosis. In group A, the WBC’s were greater than 10 per hpf when compared to group B by microscopy. Clue cells were higher in group A when compared to group B. pH also was higher in group A when compared to group B. Conclusion: Bothersome vaginal discharge may be due to vaginal inflammatory process and it develops early and is pessary related
ABSTRACT
Background: The most common infections among all age groups are the urinary tract infections, mostly among pregnant women. Aim and Objective: To screen pregnant women for ASB with wet mount, reagent strip test such as UROCOLOR 10, by which both nitrite and leukocyte esterase was detected. Materials and methods: This was a multi-centric study conducted at Government Hospital Nizamabad and CKM hospital, Warnagal. 150 pregnant women in the age group of 18-40 years without any symptoms of UTI were selected. Control group consisted of 75 non pregnant women who had no signs of UTI and who were within the age group of 18-40 years. Informed consent was taken from all the subjects who participated in the study after explaining the study details in the respective mother's tongue. All the pregnant women without signs and symptoms of UTI were included. Results: Out of 150 pregnant women, 128 (85%) were sterile, in 15% (22), pure growth of organisms in significant numbers >105 CFU/ml were obtained. There was no growth contamination in any of the urine samples. Wet film had highest specificity of 95% and least sensitivity of 35%, Leukocyte esterase had high specificity of 92% and low sensitivity of 44%, and nitrite test had highest specificity of 97% and highest positive predictive value of 80%. Conclusion: UTI’s are more common among pregnant women than non-pregnant women. ASB is present in 22% of antenatal women. This can be prevented by earlier diagnosis and proper antimicrobial treatment in women and thus prevent obstetric complications. Culture is the standard test, but it is time consuming and very expensive, none is 100 % sensitive even though many screening Allanki Suneetha Devi, Jalem Anuradha. Prevalence of Asymptomatic Bacteriuria in Antenatal pregnant women in tertiary hospitals. IAIM, 2017; 4(7): 1-7. Page 2 tests are available now. Leukocyte esterase and nitrite test are a rapid and inexpensive methods to rule out UTI in women. Wet film can also be used as an alternate screening method.