Monika Malhotra

Maternal and perinatal outcome in varying degrees of anemia

Objectives: To analyze the maternal and perinatal outcome in varying degrees of anemia. Methods: A total of 447 pregnant women were divided into group I (Hb>11 g%, n=123 women), group II (Hb 9–10.9 g%, n=214 women), group III (Hb 7–8.9 g%, n=79 women) group IV (Hb<7 g%, n=31 women). Their maternal and perinatal outcome, mode of delivery, duration of labor and postpartum complications were noted and analyzed using multiple logistic regression to calculate odds ratios (95% CI) for duration of labor, mode of delivery and low birth babies. Chi square or Fishers exact test was employed for difference in proportions and Students t‐test for testing difference between means. Results: Mean age (27±4.25 years) and number of women with parity >3 were highest in group IV. The patients with Hb<8.9 g% had a 4–6‐fold higher risk of prolonged labor compared to Hb>11 g%. The odds ratios for abnormal delivery (cesarean and operative vaginal deliveries) showed a 4.8‐fold higher risk (95% CI 1.82, 12.7) in patients with Hb ≤7.5 g%. The mean birth weight was maximum in the 9.6–10.5 g% category that fell with both increasing and decreasing hemoglobin values, being lowest in Group IV. Women in Group II had lowest number of low birth weight and IUGR babies, no stillbirths and neonatal deaths, lowest induction and operative delivery rates. Conclusions: Mild anemia fared best in maternal and perinatal outcome. Severe anemia was associated with increased low birth weight babies, induction rates, operative deliveries and prolonged labor.

Effect of lycopene on pre-eclampsia and intra-uterine growth retardation in primigravidas

Objectives: To observe the effect of the antioxidant lycopene on the occurrence of pre‐eclampsia and intrauterine growth retardation in primigravida women. Methods: A total of 251 primigravida women were enrolled in this prospective, randomized controlled study in the second trimester. A total of 116 women were given oral lycopene (Group I) in a dose of 2 mg twice daily while 135 women were given a placebo (Group II) in the same dose until delivery. The criteria for recruitment included gestational age of 16–20 weeks, singleton pregnancy, absence of any medical complication and willingness on the part of the women to participate in the study. The women were followed‐up until delivery for development of pre‐eclampsia, mode of delivery and fetal outcome. Results: The two groups were comparable in their maternal characteristics. Pre‐eclampsia developed in significantly less women in the lycopene group than in the placebo group (8.6% vs. 17.7%, P=0.043 by chi‐square test). Mean diastolic blood pressure was significantly higher in the placebo group (92.2±5.98 mmHg vs. 86.7±3.80 mmHg, P=0.012). Mean fetal weight was significantly higher in the lycopene group (2751.17±315.76 g vs. 2657±444.30 g, P=0.049). The incidence of intrauterine growth retardation was significantly lower in the lycopene group than in the placebo group (12% vs. 23.7%, P=0.033). Conclusions: The results of the present study suggest that the antioxidant lycopene reduces the development of pre‐eclampsia and intrauterine growth retardation in primigravida women.

Maternal and fetal outcome in valvular heart disease

Objectives: To compare the pregnancy outcomes of women having valvular heart disease with the pregnancy outcomes of healthy women. Methods: A retrospective comparison of the maternal and fetal pregnancy outcomes of 312 women with valvular heart disease and 321 healthy women cared for at a tertiary care hospital during the same period. Statistical analysis was done using the χ2‐test, with significance fixed at 0.05. Results: Women with valvular heart disease had a significantly higher incidence of surgical interventions during pregnancy than women in the control group [13.4% (balloon mitral valvotomy) vs. 0.6% (ovarian cystectomy)], congestive heart failure (5.1% vs. 0%, P<0.001), and mortality [0.64% (two women) vs. 0%]. Perinatal outcome was also more adverse in the valvular heart disease group than in the control group, with increased preterm delivery rate (48.3% vs. 20.5%), reduced birth weight (2434±599 g vs. 2653±542 g; P<0.001), and a higher incidence of APGAR scores less than 8 (8.3% vs. 4%; P<0.01). There was also a higher rate of instrumental delivery (9.9% vs. 3.4%). However, the rate of cesarean deliveries was similar in the two groups. Conclusions: Pregnancy in women with valvular heart disease is associated with significantly higher maternal morbidity and adverse fetal outcomes and requires a team approach for optimal management.

Effect of dietary habits on prevalence of anemia in pregnant women of Delhi.

Aim:  To see the effect of various dietary habits, such as a vegetarian diet or various types of meat, on the prevalence of anemia in pregnant women.

Laparoscopic oxidized cellulose (Surgicel) application for small uterine perforations

Objectives: To test the efficacy and safety of laparoscopic oxidized cellulose application at the uterine perforation site. Methods: In a prospective study over a 3.5‐year period a total of 30 women undergoing combined surgical termination of pregnancy and laparoscopic sterilization who had a small uterine perforation were recruited. Oxidized cellulose (Surgicel) was inserted and attached to the perforation site with a laparoscope. The end point was sealing of the perforation and complete hemostasis. Laparotomy was performed if hemostasis was not achieved. Results: The mean age, parity and gestation were 31.4 years, 3.8 and 9.3 weeks. The perforations occurred in the fundal region (60%), anterior wall (16.7%), posterior wall (13.3%), upper lateral wall (3.3%) and lower lateral wall (6.7%). Mean size of perforations, respectively according to site were 4.3 mm, 3.2 mm, 3.4 mm, 3mm and 3.5 mm in the five groups. Laparoscopic oxidized cellulose application was successful in all women with fundal, anterior, posterior and upper lateral uterine wall perforations. In two women with perforations on the lower lateral wall, due to excessive blood loss, oxidized cellulose fell off; laparotomy was performed and hemostasis was achieved with sutures. All 28 laparoscopically‐treated women were discharged on the next day in good condition with no complications. Conclusions: Laparoscopic oxidized cellulose application appears to be a safe and effective treatment for small uterine perforations that are bleeding moderately.

Prospective study of glove perforation in obstetrical and gynecological operations: Are we safe enough?

Objectives:  To assess the glove perforation rate, efficacy of double gloving, effect of duration of surgery, expertise of surgeon and operative urgency on the glove perforation rate in obstetrical and gynecologic operations.

Mitral valve surgery and maternal and fetal outcome in valvular heart disease

Objectives: To compare maternal and fetal outcomes in patients with non‐operated valvular heart disease and patients who had surgery before or during pregnancy. Methods: The 308 women with valvular heart disease who delivered in this hospital in the last 8 years were divided into three groups. The 218 (70.7%) women in group 1 had no surgical intervention; the 42 (13.6%) women in group 2 underwent balloon mitral valvotomy during pregnancy; and the 48 (15.5%) women in group 3 had surgical intervention before pregnancy (35 had balloon mitral valvotomy, eight had mitral valve replacement, and five had mitral valve repair). Maternal and fetal outcomes were compared for these three groups. Results: The antenatal events differed significantly: 175 (80.3%), 40 (94.2%), and 46 (95.8%) patients in groups 1, 2 and 3, respectively, had uneventful pregnancies. In group 1, 14 (6.4%) patients had congestive heart failure (P>0.05) and 24 (11%) patients had cardiac arrhythmias, which was statistically significant. The rate of preterm deliveries did not differ significantly among the three groups. The groups did not differ in mean birth weight, mode of delivery, low birth weight, Apgar scores less than 8, stillbirths, neonatal death, or congenital anomalies. Conclusions: Mitral valve surgery before or during pregnancy did not significantly improve maternal and fetal outcomes but decreased adverse events such as congestive heart failure and cardiac arrhythmias. It should be therefore performed only in selected cases.

Topical oxidized cellulose for tubal hemorrhage hemostasis during laparoscopic sterilization.

Laparoscopic sterilization is safe and effective. Complications rarely occur in the form of injury to abdominal viscera or vessels, or tubal hemorrhage, which may be managed conservatively by cautery or by laparotomy. A prospective study was performed over 3 years on 28 hemodynamically stable women undergoing laparoscopic sterilization(alone or with termination of pregnancy ) on request. Oxidized cellulose(Surgicel; Johnson and Johnson, Mumbai, India ) was placed in the prongs of the laparoscope and taken to the tubal hemorrhage site. It was allowed to soak in the blood for easy application. When it turned brown, the tubal hemorrhage site was wrapped in it and observed for approximately 10 min for hemostasis. The peritoneal cavity was thoroughly explored to rule out any other injury or abnormality. In cases where hemostasis could not be achieved, or when there was excessive hemorrhage or an enlarging hematoma, laparotomy was performed and hemostasis achieved with polyglactin sutures (Vicryl; Johnson and Johnson, Mumbai, India ) after draining the

Incidential Fitz-Hugh-Curtis syndrome at laparoscopy for benign gynecologic conditions

Objectives: To assess the prevalence of incidental Fitz‐Hugh–Curtis syndrome in women undergoing diagnostic laparoscopy for sterilization, infertility or chronic pelvic pain. Methods: This was a prospective study over a 4‐year period in which a total of 320 women undergoing diagnostic laparoscopy for sterilization [Group I, 200 women (62.5%)], infertility [Group II, 60 women (18.7%)], or chronic pelvic pain [Group III, 60 women (18.7%)] were enrolled. After examination of the pelvic area and abdominal cavity, the liver area was visualized in all cases for evidence of perihepatitis and adhesions between liver and anterior abdominal wall or diaphragm (Fitz‐Hugh–Curtis syndrome). Statistical analysis was performed using the chi‐square test, with a P‐value set at 0.05 for significance. Results: The mean age was similar in the three groups, while mean parity was obviously less in the infertility group. Fitz‐Hugh–Curtis syndrome was observed in 16 women (8%) in Group I, 10 women (16.6%) in Group II, and 18 women (30%) in Group III. The prevalence was highest in Group III and the difference was statistically highly significant in Group III vs. Group I (P<0.001), and in Group III vs. Group II (P<0.01). It was higher in the infertility group than in the sterilization group (P<0.05 in Group II vs. Group I). Conclusions: There was a very high prevalence of incidental Fitz‐Hugh–Curtis syndrome in the chronic pelvic pain and infertility groups, and even in the sterilization group.

Huge localized vaginal neurofibromatosis: An unusual cause of postmenopausal bleeding

A 55‐year‐old lady, menopausal for 8 years, presented with vaginal swelling for the preceding 6 months and with post menopausal bleeding (two bouts). Examination revealed a vaginal mass of 7 × 5 cm which was ultrasonically diagnosed as vaginal fibroid. The vaginal mass was excised and confirmed to be a vaginal neurofibroma on histopathology.