K. K. Roy

Prevalence of urinary incontinence and other urological problems during pregnancy: a questionnaire based study

ObjectiveTo find out the prevalence of various urological symptoms in pregnant women, the status before pregnancy, and their perceived impact.MethodsA questionnaire incorporating various urological problems was prepared and used over 240 pregnant women to know their prevalence in different trimesters of pregnancy and compare them with prevalence before pregnancy.ResultsIncreased urinary frequency (>10/day) (40.8 vs. 3.8%), nocturia (72.9 vs. 50.6%), burning micturition (21.3 vs. 3.8%), UTI (4.6 vs. 1.6%), urinary hesitancy (14.6 vs. 1.6%), urinary incontinence (25.8 vs. 8.2%) and botheration (22.1 vs. 2.7%) were seen during and before pregnancy, respectively. These also show an increment with advancement of gestation. Urinary incontinence was seen more often with advancing age and parity.ConclusionThere is a very high prevalence of urological symptoms during pregnancy as compared to before pregnancy.

Maternal antenatal profile and immediate neonatal outcome in VLBW and ELBW babies

ObjectiveTo evaluate the antenatal profile of the mother and the immediate neonatal morbidity and mortality till discharge.MethodsThe study was a retrospective analysis of 92 patients of preterm labour who delivered babies weighing <1500 gms at 26 weeks to 34 weeks of gestation. The maternal demographic profile, causes of preterm labour, treatment profile and delivery outcome were recorded. Similarly the immediate neonatal morbidity and mortality were recorded in our case file. Both these data of maternal and neonatal profile were pooled and analysed.ResultsA total of 92 mothers in preterm labour at 26 to 34 weeks were admitted and subsequently delivered 70 VLBW babies (<1500 gms) and 36 ELBW babies (<1000 gms) including 8 pairs of twins and 3 triplets pregnancies. Majority of the patients (93.4%) were booked. Amongst the various high risk factors for preterm labour, anaemia, during pregnancy (32.6%), bacterial vaginosis (26%), gestational hypertension (18.4%) and pervious history of preterm labour (18.4%) were common associations. Calcium channel blocker (Depin) tocolysis was effective in postponing labour, from 48 hours to more than 2 weeks. The cesarean section rate was very high (67.3%) in our study. The commoner neonatal complications in both VLBW and ELBW babies were RDS, neonatal jaundice and sepsis. Features of IUGR were seen in both the groups (22.8% in VLBW and 22.2% in ELBW babies). The neonatal mortality rate till discharge was 15.7% in VLBW group and 33.3% in ELBW group. The morality rate was highest in 26 to 30 weeks gestation babies and in babies weighing <800 gms.ConclusionAntenatal profile of preterm labour in our series showed a number of high risk factors. The identification of common high risk factors is important for appropriate prenatal care. A better neonatal survival rate was possible due to timely intervention, appropriate management and NICU care facility available in our tertiary care centre.

Cesarean section for suspected fetal distress, continuous fetal heart monitoring and decision to delivery time

ObjectiveTo find out the efficacy of continuous fetal heart monitoring by analyzing the cases of cesarean section for nonreassuring fetal heart in labor, detected by cardiotocography (CTG) and correlating these cases with perinatal outcome. To evaluate whether a 30 minute decision to delivery (D-D) interval for emergency cesarean section influences perinatal outcome.MethodsThis was a prospective observational study of 217 patients who underwent cesarean section at ≥ 36 weeks for non-reassuring fetal heart in labor detected by CTG. The maternal demographic profile, specific types of abnormal fetal heart rate tracing and the decision to delivery time interval were noted. The adverse immediate neonatal outcomes in terms of Apgar score <7 at 5 minutes, umbilical cord þH <7.10, neonates requiring immediate ventilation and NICU admissions were recorded. The correlation between non-reassuring fetal heart, decision to delivery interval and neonatal outcome were analyzed.ResultsOut of 3148 patients delivered at ≥ 36 weeks, 217 (6.8%) patients underwent cesarean section during labor primarily for non-reassuring fetal heart. The most common fetal heart abnormality was persistent bradycardia in 106 (48.8%) cases followed by late deceleration in 38 (17.5%) cases and decreased beat to beat variability in 17 (7.8%) cases. In 33 (15.2%) babies the 5 minutes Apgar score was <7 out of which 13 (5.9%) babies had cord þH <7.10. Thirty three (15.2%) babies required NICU admission for suspected birth asphyxia. Rest 184 (84.7%) neonates were born healthy and cared for by mother. Regarding decision to delivery interval of ≤30 minutes versus >30 minutes, there was no significant difference in the incidence of Apgar score <7 at 5 minutes, cord pH <7.10 and new born babies requiring immediate ventilation. But the need for admission to NICU in the group of D-D interval ≤ 30 minutes was significantly higher compared to the other group where D-D interval was >30 minutes.ConclusionNon-reassuring fetal heart rate detected by CTG did not correlate well with adverse neonatal outcome. There was no significant difference in immediate adverse neonatal outcome whether the D-D time interval was ≤ 30 minutes or >30 minutes; contrary to this, NICU admission for suspected birth asphyxia in ≤ 30 minutes group was significantly higher.

A prospective study on role of dehydroepiandrosterone (DHEA) on improving the ovarian reserve markers in infertile patients with poor ovarian reserve

Abstract Aim: The aim of this study was to evaluate the role of dehydroepiandrosterone (DHEA) supplementation on the ovarian reserve markers in infertile patients who were poor responders in previous in vitro fertilization (IVF) cycles. Study design: A prospective clinical trial was conducted on 30 patients with history of poor response in previous IVF cycles. These patients were treated with DHEA, (Tab Eema-D, Corona Remedies Pvt Ltd., Ahmedabad, Gujurat, India) 25 mg thrice a day for four months. Ovarian stimulation was done using the previous protocol. Clinical parameters were measured before and treatment with DHEA. Results were analysed using Student’s “t” paired test. Results: DHEA resulted in a significant increase (p < 0.05) in the serum Antimullerian hormone in all age groups (35, 36–38 and >38 years). Peak estradiol level on the day of human chorionic gonadotrophin administration also increased significantly (p < 0.05). A significant decrease (p < 0.05) was noted in Day 2 follicle-stimulating hormone (FSH) in all age groups. There was no statistically significant difference in the antral follicle count (AFC). Pregnancy rate was 16.7% after treatment. Thus, DHEA has a significant effect in improving the ovarian reserve in poor responders with previously failed IVF cycles. It can help in enhancing clinical pregnancy rate in these patients.

A rare case of primary malignant melanoma of cervix

Primary malignant melanoma (MM) of the uterine cervix is a rare neoplasm. Historically all MMs of the cervix were thought to be metastatic. But after the discovery of melanocytes in the cervix in 1959, it was recognized that primary MM of the cervix exists as a separate entity. The treatment of this condition is not yet standardized and the overall prognosis of these patients is very poor. We present a 40-year-old patient of primary MM of cervix including its diagnosis, management, follow-up and a brief review of literature.

Antenatal ultrasound and MRI findings of Pena-Shokeir syndrome

IntroductionPena–Shokeir syndrome is an autosomal recessive disorder characterized by arthrogryposis, facial anomalies (micrognathia), camptodactyly, polyhydramnios and lung hypoplasia.Case reportWe report prenatal ultrasonographic, antenatal MR and postnatal examination findings of a fetus with Pena–Shokeir syndrome.ConclusionPena–Shokeir syndrome is a potentially lethal condition and most cases are diagnosed prenatally by ultrasound. Fetal MR can be performed to look associated neurological malformation.

Control of presacral venous bleeding, using thumbtacks

BackgroundMassive life threatening bleeding from presacral venous plexus in gynecological surgery, though uncommon can be fatal when conventional methods fail.CaseIn the present case, a 55-year-old woman undergoing radical hysterectomy for cancer cervix was saved using thumbtacks to control bleeding from presacral vessels when conventional methods were ineffective.ConclusionUse of thumbtacks in such patients is simple, cost effective and life saving.

Six months versus nine months anti-tuberculous therapy for female genital tuberculosis: a randomized controlled trial

OBJECTIVE To compare six months versus nine months anti-tuberculous therapy in patients of female genital tuberculosis. STUDY DESIGN It was a randomized controlled trial in a tertiary referral center teaching institute on 175 women presenting with infertility and found to have female genital tuberculosis on clinical examination and investigations. Group I women (86 women) were given 9 months of intermitted anti-tuberculous therapy under directly observed treatment short course (DOTS) strategy while Group II (89 women) were given 6 months of anti-tuberculous therapy under DOTS. Patients were evaluated for primary end points (complete cure, partial response, no response) and secondary end points (recurrence rate, pregnancy rate) during treatment. All patients were followed up further for one year after completion of therapy to assess recurrence of disease and further pregnancies. RESULTS Baseline characteristics were similar between two randomized groups. There was no difference in the complete clinical response rate (95.3% vs 97.7%, p=0.441) between 9-months and 6-months groups. Four patients in 9-months group and two patients in 6-months group had recurrence of disease and required category II anti tuberculous therapy (p=0.441). Pregnancy rate during treatment and up to one year follow up was also similar in the two groups (23.2% vs 21.3%, p=0.762). Side effects occurred in 27(31.4%) and 29(32.6%) in 9-months and 6-months of therapy and were similar (p=0.866). CONCLUSIONS There was no difference in complete cure rate, recurrent rate and pregnancy rate for either 6-months or 9-months of intermittent directly observed treatment short course anti-tuberculous therapy in female genital tuberculosis. CLINICAL TRIAL REGISTRATION The trial was registered in clinicaltrials.gov with registration no: CTRI/2009/091/001088.

Non-puerperal incomplete uterine inversion due to large sub-mucous fundal fibroid found at hysterectomy: a report of two cases

Two cases of non-puerperal incomplete uterine inversion due to large sub-mucous fundal fibroid are presented. This is rare and the diagnosis is often difficult. In both the cases diagnosis was made only during surgery.

Successful maternal and fetal outcome in a rare case of essential Thrombocythemia with pregnancy using Interferon alpha

Through your esteemed journal, we are pleased and honored to write a case of uneventful pregnancy in a young woman suffering from essential thrombocythemia treated with interferona. Physicians caring for pregnant women with essential thrombocythemia face a difficult therapeutic decision. Careful observation might lead to thrombotic and obstetric complications, whereas cytoreductive therapy might have deleterious effects on the fetus. There is no consensus on the optimal treatment during pregnancy. Essential thrombocythemia (ET) is a chronic myeloproliferative disorder with increased risk of vascular complications [1]. It is characterized by platelet count 4600 000/ml, megakaryocytic hyperplasia, and splenomegaly with no alternative cause [2]. Two to three cases of ET are diagnosed per 100 000 individuals annually [3]. The median age of ET patients at presentation is around 60 years, though 20% of patients are women of child-bearing age [4]. It is more common in females, sex ratio M:F – 2:3 [5]. The risks of infertility, teratogenesis, and unfavorable pregnancy outcomes associated with the use of cytotoxic agents and/or with the disease itself cause concern with regards to the management of this subset of ET patients [6–8]. There is no consensus on the optimal treatment during pregnancy. Our patient 27 years primi-gravida with history of essential thrombocythemia (ET) for last 2 years, was referred to us at 9 weeks. She was diagnosed as ET during medical check-up for a job. She was on Hydroxyurea for last 2 years. This was a planned conception; she stopped Hydroxyurea, received periconceptional folic acid and continued low dose aspirin. Platelet counts at the time of her first visit were 5.3 lacs. JAK2 (V617F) mutation was found to be negative. Fortnightly platelet count monitoring was done. Aspirin and folic acid were continued. At 17 weeks period of gestation, platelet count was 13 lacs, and she was started on interferon , 3 miu, (s.c.) thrice weekly. She was diagnosed Gestational Diabetes Mellitus at 28 weeks, controlled on diet and insulin. At 29 weeks, she developed diagnosed Intra hepatic cholestasis of pregnancy and started on ursodeoxycholic acid. Her platelet counts gradually dropped to 3.5 lacs on Interferon alpha. At 34 weeks, Interferon alpha was stopped in view of her platelet counts being normal. While platelet counts monitoring was continued. Aspirin was stopped at 35 weeks. Fetal monitoring was done. She underwent elective caesarean section at 37 weeks for cephalopelvic disproportion. She delivered a 3.8 kg baby with no gross congenital anomaly. Injection Clexane 60 mg s.c. was started in view of her higher chances of thrombosis after 12 hours post op and continued for 2 weeks. Aspirin was started after 48 hours. Platelet counts started rising again and after 2 weeks. Platelet count was found to be 13 lacs and she was started on interferona. There were no signs of immunosuppression in baby. ET in pregnancy has been reported to be complicated by spontaneous abortion (25–50%), intrauterine death (3–5%), stillbirth, premature