Manisha Kumar

Contraceptive Use Among Low-Income Urban Married Women in India

INTRODUCTION The reports of a rise in contraceptive practices have not been matched by a similar decrease in population, so there is a need to look into the causes of this discrepancy. AIM To obtain information from low-income urban married women regarding their contraceptive knowledge, practices, and utilization of the services. MAIN OUTCOME MEASURE Percentage of low-income urban married women using contraception, different types of contraception used, influence of education on choice of contraception. METHODS All nonpregnant married women between the ages of 18 and 45 years, belonging to low-income groups were selected for study. Statistical analysis was done using EPI Info ver-5.0. Chi square test was used to test the significance of data. RESULTS Contraceptive use among these women was 52%; the most common method was tubal ligation. Educated women used spacing methods more often than uneducated women. Women had adequate awareness regarding type of contraceptives available but had no idea about the timing of starting contraception after delivery and about emergency contraception. CONCLUSION The low-income urban population is aware of the importance of limiting the family size and has family planning facilities yet has less contraceptive usage because of low level of education, increased rate of discontinuation, and lack of proper knowledge of the use of contraception.

Fetal renal anomaly: Factors that predict survival

OBJECTIVE To find out the relative prevalence of renal anomalies detected in the antenatal period, and to look at factors that predict the postnatal outcome. METHODS In this prospective study, all antenatal-detected renal anomalies booked at the tertiary health centre were evaluated and counselled. Aspects such as type of renal anomaly, oligohydramnios and presence of additional anomalies were noted. Stillborn babies underwent autopsy; all live born babies were followed for one year. Appropriate statistical analyses were performed to compare the antenatal factors with outcomes. RESULTS Renal anomalies were detected in 136 out of 587 cases with major fetal anomalies. Most of the women were primiparous (65.4%). The mean gestation at presentation was 30 weeks; in 12 cases, diagnosis was possible before 20 weeks (8.8%). Antenatal hydronephrosis was the most commonly seen anomaly, with 61 cases; this was followed by bilateral cystic kidney in 50 cases. Out of the 136 cases, 12 (8.8%) underwent termination of pregnancy and 60 (44.1%) babies were stillborn. Autopsy was performed in 58 out of 72 (80.6%) cases after consent. Karyotyping was performed in 49 cases and abnormalities were detected in two (4.1%) of them. A total of 64 (47.1%) babies were live born; after one year, 49 (36.0%) of them were alive. Postnatal survival was highest in unilateral disease (85.7%). In cases with oligohydramnios, there was only 3.4% survival after one year; none of the cases with cystic kidney and oligohydramnios survived. The period of gestation at presentation of non-survivors was 25.9 weeks compared to 32.5 weeks with survivors. Among the cases with extra renal anomaly, 7.0% survived; none of the cases with associated cranio-vertebral defect or polydactyly survived after a year. CONCLUSION Out of the different renal pathologies that were diagnosed, survival was highest in the unilateral group. The factors associated with poor prognosis included bilateral disease, absence of amniotic fluid and presence of associated malformation.

Adverse fetal outcome: is first trimester ultrasound and Doppler better predictor than biomarkers?

Abstract Aims and objectives: To evaluate the predictive value of first trimester biomarkers and ultrasound in determining adverse fetal outcomes in a low risk Asian population. Material and method: All low risk, singleton pregnancies between 11 and 14 weeks gestation underwent ultrasound with uterine artery Doppler along with PAPP-A and free β-hCG estimation, and were followed till delivery to observe the outcome. The adverse fetal outcomes detected were structural anomaly, aneuploidy, intrauterine growth restriction, preterm birth and stillbirth (SB). Results: Out of 3500 women screened, 417 cases had adverse fetal outcome in the absence of maternal complication, 2151 had normal outcome. Major structural anomaly was detected in first trimester in 17/28 (60.7%) cases. The most important markers for adverse fetal outcome were increased uterine artery pulsatility index (UPI) (p = 0.028, OR 1.5, 95% CI: 1.05–2.38, AUC 0.56) for IUGR, nuchal translucency (p = 0.001, OR 1.7, 95% CI: 1.11–2.77, AUC 0.60) for major anomaly and low PAPP-A (p = 0.017, OR −0.075, 95% CI: 0.87–0.98, AUC 0.621) for SB. Conclusion: UPI, NT and PAPP-A in the first trimester are significant markers of adverse fetal outcome, although the sensitivity and specificity are not high they have a high negative predictive value.

Endodermal sinus tumor of vagina posing a diagnostic challenge and managed by chemotherapy and novel posterior sagittal surgical approach: Lessons learned

Vaginal germ cell tumor (GCT) is a rare gynecological malignancy with no more than 100 reported cases in the international medical literature. It is an unusual, but an important, cause of premenarchal vaginal bleeding in a child. This article describes a 2‐year‐old child with vaginal GCT, initially misdiagnosed as rhabdomyosarcoma (on imprint smear cytology) and then as clear cell adenocarcinoma. The authors highlight the salient differentiating clinical, radiological and histological features to prevent misdiagnosis in future. The report emphasizes the need for increased awareness and screening for vaginal GCT by estimation of serum α‐fetoprotein levels, in all patients with premenarchal vaginal bleeds, to prevent inadvertent operative interventions.

Fetal ascites and hydrometrocolpos due to persistent urogenital sinus and cloaca: a rare congenital anomaly and review of literature

Fetal ascites can occur due to many heterogeneous disorders. Its association with hydrometrocolpos because of persistent urogenital sinus and cloaca is extremely rare. A 29-year-old primigravida presented at 32 weeks of gestation with ultrasonographic evidence of fetal ascites, a cystic pelvic mass, hydronephrosis and oligohydramnios. Fetal ascites in this case was due to fetal urine draining through fallopian tubes into the abdomen as a result of vesicovaginal fistula and distal vaginal atresia. The antenatal ultrasound results along with autopsy findings are discussed. Though rare, a persistent urogenital sinus is to be suspected in isolated fetal ascites cases where the viral tests are negative and there is no evidence of cardiac anomalies as this is a treatable anomaly if diagnosed at early gestational age.

Postnatal outcome of congenital anomalies in low resource setting

This study aimed to determine the postnatal outcome of congenital malformations in a tertiary care hospital of India.

Early prediction of hypertension during pregnancy in a low-resource setting

To evaluate the role of maternal factors, biomarkers, and uterine‐artery Doppler in the prediction of hypertension during pregnancy.

Role of maternal factors, PAPP-A, and Doppler in screening for early- and late-onset pregnancy hypertension in Asian population

ABSTRACT Objective: To determine the predictive value of biochemical markers, uterine artery Doppler, and maternal factors in predicting early-onset (EO) and late-onset (LO) pregnancy hypertension. Methodology: All singleton pregnancies between 11 and 13 weeks and 6 days gestation underwent estimation of body mass index (BMI), mean arterial pressure (MAP), uterine artery Doppler pulsatality index (PI, and resistance index), biomarker PAPP-A, and free β-hCG. Women who developed hypertension were treated as cases and normotensives were taken as controls. The cases were further divided into EO and LO hypertension. The comparison was undertaken by appropriate statistical analysis. Results: Pregnancy hypertension was seen in 399 (13.2%) women. EO hypertension was seen in 153 (38.3%), whereas LO was observed in 246 (61.7%). The significant markers for predicting hypertension in pregnancy were maternal age, BMI, MAP, uterine artery Doppler PI, and PAPP-A. A combination of MAP and BMI was a better predictor (sensitivity and specificity 80% and 52%, respectively) than PAPP-A and Doppler combined (sensitivity and specificity 62% and 52%, respectively). When all the above markers were combined, the sensitivity and specificity of the test was 73% and 70%, respectively. EO hypertension was better predicted compared with LO. The negative predictive value (NPV) of the test was above 90%, suggesting that if a woman had the marker below the cutoff, there was more than 90% chance that she would not develop hypertension later in pregnancy. Conclusion: A combination of variables increased the sensitivity and specificity of the test for hypertension in pregnancy. The markers examined were a predictor of EO hypertension, with a high NPV, making it a good screening test.

Relevance of labor room fetal autopsy in increasing its acceptance

Abstract Background: Fetal autopsy is included in the basic protocol of investigating a perinatal death, parental refusal is the main reason for its low rate. Aim: To increase acceptance of fetal autopsy and to provide better counselling to the couple regarding risk of recurrence in future pregnancies. Materials and methods: All cases with antenatally diagnosed congenital anomaly resulting in stillbirth or termination before 20 weeks were offered fetal autopsy and it was performed in labor room itself by the fetal medicine specialist after consents. External and internal examination, photograph, infantogram and karyotyping were done, and relevant tissue was sent for histopathology. Correlation between the ultrasound and autopsy finding was done. Results: Total 674 cases of antenatally detected major congenital anomaly were included in the study. Out of 403 cases of stillbirth and abortion, consent for autopsy was given in 312. Most common defect was cranio-vertebral defect followed by genitourinary anomaly. The autopsy finding correlated with USG findings fully in 63.5% cases, there were additional findings altering diagnosis in 24.7% cases, the diagnosis completely changed in 11.8% cases. Conclusion: Autopsy if done in labor room increases its acceptance by the couple. Additional findings on autopsy helped in reaching at diagnosis and counseling accordingly.

Prenatal sonographic evaluation and postnatal outcome of renal anomalies

OBJECTIVE: To determine the prognosis of antenatally detected renal anomalies by sonographic evaluation. MATERIALS AND METHODS: This was a follow-up study of all antenatally detected renal anomalies from January 2008 to Dec 2009 referred to fetal medicine clinic. Prenatal evaluation was done and cases were divided into four groups depending upon their prenatal sonographic findings. Post natal follow-up was done up to one year in cases of live babies. Autopsy was carried out in still born fetus after consent. RESULTS: The renal anomaly was detected in 55 cases, which were fully followed. The prognosis was said to be poor for group I cases with gross extra renal anomaly along with the renal anomaly, and for group II in which there was organic renal pathology with loss of renal function suggested by non-visualization of bladder and almost absent liquor. Prognosis was guarded and depended upon the gestational age of presentation in group III, which had obstructive uropathy; prognosis was good in group IV cases, which were mild, unilateral or which presented late. CONCLUSION: Prenatal sonographic evaluation gives reasonably accurate picture of the prognosis and can be very helpful in counseling the parents regarding prognosis and help in deciding the timing and route of delivery.