Narendra Malhotra

Vaginal agenesis associated with renal ectopia

Abstract Two rare cases of congenital absence of the vagina due to Mayer-Rokitansky-Kuster-Hauser syndrome, the first associated with a crossed pelvic kidney and the second with a solitary pelvic kidney, are presented. Diagnosis was based on the history, gynecological examination, pelvic sonogram, intravenous pyelogram, and laparoscopy. Vaginoplasty was successfully applied in both cases to facilitate sexual intercourse.

Assisted reproductive technology in India: A 3 year retrospective data analysis

Assisted reproductive technology (ART) has grown by leaps and bounds in the last few years. India has one of the highest growths in the ART centers and the number of ART cycles performed every year. Very soon India will be the leader in the world of ART in terms of a number of cycles. With the advances of technology and availability of techniques even in tier II and tier III cities our country, the results still vary dramatically. There is no standardization of protocols and reporting is very inadequate. Furthermore, there are only ART guidelines and no law still exists. Our first and the biggest challenge is to document the tremendous work being done in India and on the basis of analysis of this work, a proper registry can be made and guidance given to all on standardization and improvement. This is the 8th edition of National ART Registry of India being presented and analyzed.

Society of Fetal Medicine Practice Guidelines for the Second Trimester Anomalies Scan

Ultrasound is now an established tool in the clinical management of pregnancy. Consequent to its major role in clinical decision-making and its remarkable operator dependence, it is necessary to have guidelines for minimum standards of performance of this modality in each area of obstetric ultrasound. The Society of Fetal Medicine guidelines have been developed for use by all the practitioners performing antenatal ultrasound scans. They are intended to provide the entire medical community with standards for the performance of quality ultrasound examinations. Practitioners are encouraged to go beyond these standards in relevant clinical situations. Each guideline in this document has undergone extensive discussion followed by a consensus. In a rapidly evolving technological and research environment, it is imperative to constantly re-evaluate and update these guidelines. Practitioners are advised to be aware of these updates and incorporate these into their daily practice.

Principles and Practice of Obstetrics and Gynecology for Postgraduates

In civilized society, citizen is governed by number of laws of the land. Numbers of laws are directly proportional to the state of civilization. India is not an exception. Acts which are applicable mainly to the obstetrician and gynecologist, such as Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, Consumer Protection Act (CPA), criminal laws and Biomedical Waste (BMW), are discussed. Labor laws are just mentioned. The application of certain Acts may vary from state to state as few Acts are central and few are state Acts. Certain rules under the Act may be different in some states.

Assisted reproduction in polycystic ovarian disease: A multicentric trial in India

AIM: The aim of this study is to compare ovarian response, oocyte, embryo quality, ovarian hyperstimulation syndrome incidence, and pregnancy rates in polycystic ovary syndrome (PCOS) and non-PCOS group. MATERIALS AND METHODS: This was a prospective observational study on PCOS carried out in seven assisted reproduction centers in India between August 2008 and July 2010, as part of trial under the Indian Society of Assisted Reproduction. A total of 192 women (77 in the PCOS group and 115 in the non- PCOS group) undergoing in vitro fertilization/intracytoplasmic sperm injection were included. All women had long protocol and recombinant follicle-stimulating hormone stimulation. ANALYSIS: The mean number of follicles and oocytes was higher in PCOS group compared with non-PCOS, being 27.2 (±8.8) and 13.6 (±5.3); 15.9 (±6.3) and 10.9 (±6.2), respectively. The recovery rates of oocytes and mature oocytes per follicle were less in the PCOS group which was 64% and 61.1%, respectively as opposed to 80.3% and 74.5%, respectively in non-PCOS group. The total numbers of top-quality embryos were less in the PCOS group. CONCLUSION: In PCOS women though the number of follicles was more, recovery of mature oocytes, top-quality embryos was less. Pregnancy rates were comparable in both groups.

Prevention of Adhesion Reformation After Hysteroscopic Surgery

Uterine adhesions are significant fertility complications. Intrauterine adhesions are fairly a common finding in cases of oligomenorrhea and amenorrhea, especially in developing countries following various infections and tuberculosis. All efforts for adhesion prevention should be done to have better outcome.

Disseminated Intravascular Coagulation (DIC) and Thrombocytopenia in Pregnancy

Systemic thrombohemorrhagic disorder seen in association with well-defined clinical situations and laboratory evidence of:

Obesity in Obstetric Intensive Care Patient

Obstetric patients are generally young and healthy. However, potential for catastrophic event is real, and despite the therapeutic advances of the last few decades, maternal morbidity and mortality continue to occur. This may be related to pregnancy itself, aggravation of a pre-existing illness or complication of delivery. Every year, more than half a million women—most of them living in developing countries—die from pregnancy- or childbirth-related complications.

Evaluation Prior to Controlled Ovarian Stimulation

The couple needs to be completely evaluated before stimulation for IVF in order to assess the expected response, check fitness for pregnancy and identify correctable factors for a successful outcome. Main part of this evaluation is by various ovarian reserve tests which give a good measure of the number of expected oocytes and help to individualize the cycle. According to current evidence, antral follicle count and anti-Mullerian hormone are good markers of ovarian response and can help in defining strategy for COH.

Paroxysmal Supraventricular Tachycardia: A Complex Dilemma during Pregnancy

The acute and chronic management of paroxysmal supraventricular tachycardia (PSVT) during pregnancy presents a challenging clinical situation as there are no evidence-based guidelines despite being the commonest arrhythmia found in pregnancy. We report a case of paroxysmal supraventricular tachycardia in a 25 years old antenatal woman with no organic heart disease, where she received verapamil followed by diltiazem as antiarrhythmics instead of adenosine for conversion into sinus rhythm. Since she had recurrent episodes in third trimester she received verapamil and metoprolol as prophylaxis with good fetal and maternal outcome. This case highlights the need to understand the complexities in diagnosis and management of paroxysmal supraventricular tachycardia during pregnancy.