Neelam B. Vaid

Low‐dose mifepristone in treatment of uterine leiomyoma: A randomised double‐blind placebo‐controlled clinical trial

Aims: To evaluate the effect of low‐dose mifepristone on leiomyoma‐related symptoms, uterine and leiomyoma in women with symptomatic leiomyomata.

Pattern of severe maternal morbidity in a tertiary hospital of Delhi India: a pilot study.

Severe maternal morbidity also known as ‘near miss’ may be a good indicator of the quality and effectiveness of obstetric care, as it may identify priorities in maternal care more rapidly than mortality alone. The objective of the study was to observe the pattern of severe maternal morbidity and its associated factors in a tertiary care hospital in Delhi. All patients admitted to the obstetrics and gynaecology department who fulfilled the definition of severe maternal morbidity conditions were included. A proforma was used to record sociodemographic, obstetric, antenatal care treatment and outcome details. A total of 63 women were included for analysis. The incidence of severe maternal morbidity was 3.3/100 deliveries. The mean age of the patients was 26.3 ± 5 years. More than half (55.5%) were uneducated: almost one-third (32%) were from outside Delhi – the median distance travelled was 10 km. The majority were antenatal admissions (68.3%). The proportion of postdelivery or abortion cases were greater among women who came from outside Delhi. Only 38.1% were registered during the antenatal period. The diagnoses were: eclampsia/pre-eclampsia (35%); haemorrhage (35%); sepsis (13%); obstructed labour (9.5%) and other medical conditions (11%). Severe anaemia was observed in 22% of cases. Only 43.5% were normal vaginal deliveries and 54.5% were delivered by caesarean section or with the use of instruments; 61.3% were live births. Hysterectomy was performed in 14.8%: the proportion of hysterectomy was higher in obstructed labour. Severe maternal morbidity cases constitute a significant burden on health resources.

Maintenance tocolysis with oral micronized progesterone for prevention of preterm birth after arrested preterm labor.

To evaluate the efficacy of maintenance therapy with oral micronized progesterone (OMP) for prolongation of pregnancy in cases of arrested preterm labor.

Transabdominal amnioinfusion in preterm premature rupture of membranes.

To evaluate the effect of transabdominal amnioinfusion on prolongation of pregnancy, and maternal and neonatal outcomes in preterm premature rupture of membranes (pPROM).

Spontaneous rupture of pyometra

Pyometra commonly results from malignancies involving the cervix. In most cases, pyometra intermittently drains via the cervix, though malignant infiltration of the myometrium can occasionally lead to rupture of the uterus and drainage of pus into the peritoneal cavity. A case of spontaneous rupture of pyometra resulting in diffuse peritonitis is reported, with no underlying malignancy. A 65year-old multiparous lady, menopausal for 18 years, presented with abdominal pain, high fever and progressive distension of the abdomen for 10 days. She denied any history of postmenopausal bleeding or vaginal discharge. On examination, her general condition was poor. She was dehydrated, febrile and pale, with a pulse rate of 120/min and blood pressure of 94/60 mmHg. Abdominal examination showed signs of generalized peritonitis. Pelvic and rectal examinations were essentially normal. Her hemoglobin was 7 g%; serum electrolytes and X-ray chest were normal. An X-ray of the abdomen was hazy, but showed no gas under the diaphragm. On abdominal paracentesis, purulent

Salivary progesterone as a biochemical marker to predict early preterm birth in asymptomatic high‐risk women

To evaluate salivary progesterone as a predictor of early preterm birth (PTB) and compare it with transvaginal sonographic (TVS) cervical length in asymptomatic high‐risk women.

A Randomised Controlled Trial Comparing the Efficacy and Side-Effects of Intravaginal Ring (Nuvaring®) With Combined Oral Hormonal Preparation in Dysfunctional Uterine Bleeding

INTRODUCTION Combined Oral Contraceptive (COC) pills are being used in patients of abnormal uterine bleeding, especially adolescents and reproductive age women considering their need for contraception. It decreases the blood loss due to haemostatic effect of estrogen and also regularizes the cycle. Intravaginal route has been found to be effective and acceptable; Gastrointestinal absorption and hepatic first-pass metabolism is avoided and steady, uniform blood concentration is achieved. Bioavailability of estrogen and progestogen through oral and vaginal route are same. The convenience of once-a-month administration is another major advantage. MATERIALS AND MATHODS Sixty women fulfilling inclusion criteria were randomised into 2 groups in 1:1 ratio. In one group (n=30), monthly insertion of Nuvaring(®)) was done for three consecutive months. Nuvaring(®) releases 15μg ethinyl estradiol and 120 μg etonogesterol daily. The other group (n=30) received COC pill containing 30μg EE and 150 μg levonorgestrel for three consecutive months. Primary outcome measures were change in menstrual cycle pattern and pictorial Blood Loss Assessment chart (PBAC) score. Other Parameters included side effects, change in haemoglobin and weight. Data was analyzed by statistical software SPSS 20. RESULTS Both Nuvaring(®) and COC were found to significantly decrease blood loss in each cycle. Decrease in PBAC score was more in Nuvaring(®) group compared to COC, however difference was not significant. Ideal bleed (IB) was frequently higher for Nuvaring(®) group than COC in all 3 cycles, although no statistically significant difference was observed between groups (p-value=0.286). Late withdrawl, intermenstural spotting was higher in COC group. Compliance was better and women were more satisfied in Nuvaring(®) group compared to COC group. Minor side effects like headache, mastalgia, nausea and mood changes were seen in both groups, which were not significant. Continuation rate was significantly higher in Nuvaring® group. 30% women discontinued treatment in OCP group after 3 month compare to 10% in Nuvaring(®) group. CONCLUSION Present study shows Nuvaring(®) to be as effective as COC in controlling heavy menstural bleed, better cycle control, with minor acceptable systemic side effects.

Use of the Sequential Organ Failure Assessment score for evaluating outcome among obstetric patients admitted to the intensive care unit

To evaluate the prognostic value of the Sequential Organ Failure Assessment (SOFA) score among obstetric patients admitted to the intensive care unit (ICU).

Predictors and outcome of obstetric admissions to intensive care unit: A comparative study

This descriptive observational study was carried out in Guru Teg Bahadur Hospital to identify predictors and outcome of obstetric admission to Intensive Care Unit (ICU). Ninety consecutive pregnant patients or those up to 42 days of termination of pregnancy admitted to ICU from October 2010 to December 2011 were enrolled as study subjects with selection of a suitable comparison group. Qualitative statistics of both groups were compared using Pearson′s Chi-square test and Fisher′s exact test. Odds ratio was calculated for significant factors. Low socioeconomic status, duration of complaints more than 12 h, delay at intermediary facility, and peripartum hysterectomy increased probability of admission to ICU. High incidence of obstetric admissions to ICU as compared to other countries stresses on need for separate obstetric ICU. Availability of high dependency unit can decrease preload to ICU by 5%. Patients with hemorrhagic disorders and those undergoing peripartum hysterectomy need more intensive care.

Hematometra formation- a rare complication of cesarean delivery.

Hematometra resulting from partial or complete obstruction of lower genital tract may be congenital or acquired. Commonest congenital causes are imperforate hymen and transverse vaginal septum. Acquired causes are senile atrophy of endocervical canal, scarring of the isthmus by synechiae, radiation and endocervical malignancy or due to surgical procedures. Various surgical procedures associated with hematometra are dilatation and curettage, cone biopsy, endometrial ablation, cryocoagulation and electrocautery. Hematometra following an abortion or cesarean delivery is rare. We report a case of hematometra following obstruction of outflow tract due to prior cesarean delivery.