Intravenous ferric carboxymaltose for anaemia in pregnancy

Background: Anaemia in pregnancy is associated with unfavourable consequences both for the mother and the fetus and is a major cause of maternal and perinatal mortality and morbidity.Methods: The study was conducted over a period of one year in which 100 pregnant females who met the inclusion criteria were administered ferric carboxymaltose (FCM) preparation.Results: There was significant rise in mean haemoglobin and serum ferritin after transfusion of ferric maltose in the patients with very less adverse effects.Conclusions: FCM, because of its high efficacy and safety can revolutionize the management of iron deficiency anaemia (IDA) in pregnancy.

Hysteroscopy in evaluation of intrauterine causes of abnormal uterine bleeding

Background: Various endometrial pathologies contribute to a large proportion of cases of abnormal uterine bleeding (AUB) during the reproductive years as well as after menopause.Methods: This is a retrospective observational study conducted in department of Obstetrics and Gynaecology at SMGS Hospital, Jammu. 200 patients between 20-70 years age presenting to gynaecology OPD with abnormal uterine bleeding between January 2019 to December 2019 were studied. All patients were subjected to thorough clinical evaluation followed by hysteroscopy. Data collected from medical records, analysed and various intrauterine causes of AUB were studied. Hysteroscopy directed biopsies were taken in the same sitting and sent for histopathology and culture. Results: Mean age of patients in our study was 45 years with majority of patients in 40-50-year age group (69%). Most common symptom reported was menorrhagia (48%) followed by menometrorrhagia (18%) and polymenorrhea (10%). Hysteroscopy detected intrauterine abnormality in 59% cases. Most common being hyperplastic endometrium in 52 patients (26%) followed by polyp (20%). 14 (7%) had sub mucous fibroid, 8 (4%) had atrophic endometrium and 2 (1%) had intrauterine adhesions.Conclusion: Hysteroscopy provides a simple & easy method for visualization of the cervical canal & uterine cavity for the evaluation of AUB. Hysteroscopic pattern recognition is a useful concept to triage women who require sampling for histopathological diagnosis.

Risk factors associated with ectopic pregnancy in our sociodemographic setup

Background: Ectopic pregnancy (EP) is assuming greater importance because of its increasing incidence and its impact on woman’s fertility.Aim: To assess the frequency and to determine an association between the studied risk factors and ectopic pregnancy.Methods: A retrospective study was conducted for the role of several risk factors in the occurrence of EP in department of obstetrics and Gynaecology, SMGS Hospital. A total of 110 cases and 110 controls were compared for socio demographic characteristics, cigarette smoking, obstetrical and gynaecological history, PID, past exposure to Chlamydia, surgical histories, the presence of assisted conception and contraceptive usage.Results: The main risk factors for ectopic pregnancy were history of tuberculosis (TB) (odds ratio (OR)=12.11), history of infertility (p=0.001), abortions (p=0.01) and a history of prior ectopic pregnancy (OR=8.549). Other risk factors found to be associated with an increased risk for ectopic pregnancy were Pelvic inflammatory disease (PID)/Chlamydia infection (OR=5.63), endometriosis (5.40), induced conception cycle (OR=3.063), intrauterine device usage (OR=3.55), prior caesarean section (OR=2.83) and appendectomy (OR=2.25). On the contrary, barrier methods (OR=0.28) and oral contraceptive use (OR=0.28) were protective from ectopic pregnancy.Conclusion: Pelvic infection particularly TB was found to be a major etiological factor for EP in our setup. Furthermore, other factors found to be associated with ectopic pregnancy, such as prior ectopic pregnancy and infertility history may be the result of a previous pelvic infection that caused tubal sequele. Thus, these factors are potential targets for intervention and modification. Further, patients with previous abortions, pelvic surgeries, induced conception cycle and intrauterine contraceptive device (IUCD) users should be counselled about the possible risk when they conceive.

Perinatal outcome associated with oligohydramnios at term

Background: Oligohydramnios is a severe and common complication of pregnancy and its incidence is reported to be around 1 to 5% of total pregnancies. The aim of this study was to perinatal outcome of oligohydramnios (AFI <5) at term.Methods: A prospective study was conducted in which 200 patients at term with oligohydramnios AFI <5 cm with intact membranes were analyzed for perinatal outcome.Results: There were increased chances of FHR decelerations, thick meconium, increased LSCS, low Apgar score at 5 minutes, birth weight <2.5 kg, admission to NICU in pregnancy with oligohydramnios.Conclusions: An amniotic fluid index (AFI) of <5 cm detected after 37 completed weeks of gestation is an indicator of poor perinatal outcome. Determination of AFI can be used as an adjunct to other fetal surveillance methods that helps to identify those infants at risk of poor perinatal outcome.

The study of association between maternal serum magnesium levels and preterm labour in a tertiary care hospital

Background: Serum magnesium level in pregnancy is a valuable tool to find out preterm onset of labour. In the asymptomatic group, greater surveillance and administration of steroids, tocolytics and transfer to a higher centre wherever necessary has to be done with mothers with low serum magnesium level. The objective of the study is to find association between serum magnesium levels and women with preterm labour, and to compare these values with those patients who have a term delivery.Methods: The subjects included 100 pregnant women with preterm labour (cases) between 28 and 37 weeks gestation (Group A) and similar number of pregnant women with term labour (controls) between 37 and 40 weeks (Group B). Inclusion criteria for cases was singleton pregnancy, painful uterine contractions more than two in 30 minutes, intact fetal membranes, cervical dilatation (at least 1 cm) and effacement (80%). Serum magnesium levels were done in both the groups. Patients were followed until delivery. Routine antenatal investigations were done. Serum levels of magnesium were estimated by Erba’s semi auto-analyser.Results: 62% patients in Group A were from rural areas. More patients in Group A (70%) were from low socioeconomic class. More women in Group A were anaemic (44%). Mean value of hemoglobin in Group A was 9.93gm/dL. More patients in Group A had muscle cramps (89%). VLBW (<1500gm) neonates were more in Group A (21%). Also, LBW (1500-2499gm) neonates were more in Group A (60%). Mean neonatal birth weight in Group A (1907.3gm) was less. Neonatal morbidity and mortality was observed significantly more in Group A. Mean serum magnesium was less in Group A. Mean serum magnesium levels in primi and multigravida patients were less in Group A. Moreover, mean serum magnesium levels were less in urban and rural patients in Group A. Mean serum magnesium levels were less in normal and overweight patients in Group A. Also, mean serum magnesium levels were less in patients with cervical dilatation <3cm and >3cm in Group A.Conclusions: Low maternal serum magnesium level is associated with preterm labour. Patients with preterm labour have significantly low serum magnesium level when compared with labour at term.

Genital tuberculosis in infertile women: role of hysterolaparoscopy and tuberculosis polymerase chain reaction

Background: Genital tuberculosis is an important cause of female infertility in developing countries like India. It is one of the major causes for severe tubal disease leading to infertility.Methods: A prospective study was conducted in which 100 women presented to hospital with infertility were subjected to hystero-laparoscopy over 1 year. Endometrium sent for tuberculosis polymerase chain reaction (TB-PCR) and HPE and results were formulated.Results: Out of 100 women, 28% were diagnosed with Genital tuberculosis (GTB) using accepted clinical criteria, TB-PCR and endometrial HPE. 25 of these 28 were diagnosed by hysterolaparoscopy (89.24%) alone, 16 by positive endometrial TB-PCR (57.14%) and another 2 by HPE (7.14%).Conclusions: In country like ours where TB is endemic, a multi-pronged approach to diagnosis increases the chances of successfully diagnosing this destructive disease.

Knowledge, attitude and practices of contraception amongst married women

Background: Aim of current study was to assess the knowledge, attitude and practices of contraceptives amongst married women of reproductive age group.Methods: A cross sectional study was conducted in obstetrics and gynaecology out door patient department (OPD) of SMGS hospital Jammu. 100 married women aged between 15-45 years were included in this study. Along with the sociodemographic characteristics of the women, their knowledge, attitude /86*and practices on contraception were evaluated with the help of predesigned questionnaire.Results: It was observed that out of 100 women, majority of them were Hindu (58%), higher secondary educated (21%), housewives (45%) and belonged to low socio economic status (36%). 88% females had knowledge about contraceptive methods that was mainly obtained from health workers (59%) followed by media (23.8%) and social circle (14,7%). 38% women were practicing contraceptive methods, out of which most of them were using condom (39.4%) followed by Oral Contraceptive Pills (OCPs) (21.05%), intra uterine contraceptive device (15.7%) etc. Though most of the women had knowledge about contraceptive methods majority (62%) had negative attitude towards family planning.Conclusions: In spite of having good knowledge, utilization of contraceptives was less because of religious myths and beliefs, fear of side effects, cultural and political barriers.

Correlation of admission labour admission test in low risk pregnancies with pregnancy outcome

Background: Aim of the study was to evaluate the role of NST (labour admission test) as a screening method in management of low risk pregnancies and to study the correlation of NST with fetal outcome.Methods: A prospective observational study conducted over 500 patients managed at our centre after proper evaluation. Patients were evaluated for mode of delivery and neonatal outcome.Results: The maximum number 352 of patients belonged to 20-30 years age group, 113 patients belonged to 31-35 age group. 200 patients were of 37-40 weeks gestation and 185 were of 40-41 weeks gestation. There were 125 patients in the 41-42 weeks gestational period. Among the 500 pregnant mothers who were included in the study 82.6% had Normal NST, 11.6% had suspicious and 5.8% had pathological NST. Cesarean rate was 14.4% in normal NST group, 58.62% in suspicious group and 72.41% in pathological group study. 6.77% in Normal group had meconium stained liquor at delivery whereas 29.31% in suspicious group and 37.93% in pathological group had same.Conclusions: The non-stress test is an important screening tool to identity the fetus in jeopardy in utero. This enables an appropriate timely intervention to achieve the most favorable outcome.

Combined hysteroscopy and laparoscopy in evaluation of female infertility

Background: Infertility has always been one of the most elusive symptom complexes that perplex the best gynecologists and affects about 10-15% of reproductive age couples.Methods: This descriptive study was conducted in the Postgraduate Department of Obstetrics and Gynaecology at Government Medical College, Jammu  for a period of 18 months in which 100 infertile females attending  OPD for infertility workup were subjected to detailed relevant history taking followed by physical examination. Diagnostic hysteroscopy and laparoscopy along with laparoscopic chromopertubation was carried out after written informed consent including minimal therapeutic interventions if required.Results: Out of 100 patients included in the study, 67 (67%) presented with primary infertility and 33 (33%) presented with secondary infertility. Combined laparoscopy and hysteroscopy was normal in 13% (13) of cases. Out of 100 patients, abnormal laparoscopic findings were noted in 73% of patients: Endometriosis ( 13%),Polycystic ovaries (12%), Unilateral tubal block (11%), Pelvic inflammatory disease (9%).Abnormal hysteroscopic findings were noted in 47% of patients: Submucous myoma (8%),unilateral ostial block (8%),Endometrial polyp (7%), Hyperplasic endometrium (7%), Cervical stenois (6%).Most common cause of infertility in present study on Combined hysteroscopy and laparoscopy was Endometriosis (13%) followed by Polycystic ovaries (12%),Uterine myoma (12%) out of which 5% myomas were diagnosed on laparoscopy and 8% on hysteroscopy and 1%  had myoma diagnosed on both hysteroscopy and laparoscopy. In the primary infertility group most, common finding was Polycystic ovaries (16.4%)  followed by Endometriosis (14.9%) and uterine myoma (14.9%) while in patients suffering from secondary infertility, most patients had Bilateral tubal block (18.2%), Pelvic inflammatory disease (12.1%), Unilateral tubal block (12.1%), intrauterine adhesions (12.1%).Conclusions: Combined Hysteroscopy and Laparoscopy is a quintessential tool that provides cost-effective, comprehensive and single set-up diagnostic aid in infertile patients.