Raksha Arora

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.

Human papillomavirus (HPV) DNA detection in self-collected urine

Non‐invasive sampling of human genitals to identify high‐risk individuals with subclinical oncogenic HPV infection remains a challenge. The study was designed to see if self‐collected urine can be used as a simple, non‐invasive sampling for screening HPV, particularly for screening/monitoring general population or young adolescents or infants, if they are to be immunized by HPV vaccines. Method: Self‐collected urine samples from 100 sexually unexposed college going girls and cervical scrapes from 104 normal healthy sexually active married women were used in this study. Additionally, a group of 55 women were recruited for collecting first urine and later scraped cervical cells to validate urine sampling by directly comparing HPV positivity between the two types of biological specimens. A dry ‘paper smear’ method for specimen collection and a simple single tube protocol was employed for PCR detection of HPV infection. Results: Out of 100 sexually inexperienced college going girls, only 6 (6%) were positive for HPV infection as revealed by L1 consensus primer and 4 (4%) of them were positive for HPV 16 but none was found positive for HPV 18 DNA. Out of 104 sexually active married women who were cytologically reported as negative by Pap test, 11 (10.5%) were found HPV positive and 7 (6.7%) of them had infection of high‐risk HPV type 16. Both urine and later cervical scrapes from a group of 55 women collected as dry ‘paper smear’ showed perfect matching positivity for HPV between urine and cervical scrape. Conclusions: The use of urine coupled with its dry collection as ‘paper smear’ facilitating their easy transport, storage and direct PCR detection of HPV DNA opens up an alternative non‐invasive approach for population screening of HPV infection, at least in such cases as children and infants in whom invasive samples are difficult to obtain.

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.

Prevalence and associated risk factors for postpartum depression in women attending a tertiary hospital, Delhi, India.

Background: Maternal mental health is a largely ignored issue in the Indian population. Considering the high prevalence of postpartum depression, mental health assessment and screening of high-risk cases should be a part of routine antenatal care. Aim: To study the prevalence of women at risk for peripartum depression using Edinburgh Postnatal Depression Scale (EPDS) score in a tertiary teaching hospital in New Delhi, and to study the associated risk factors in the Indian population. Method: Five hundred and six (506) peripartum women were interviewed using a structured questionnaire, which included sociodemographic details like socioeconomic status, family structure, relationship with husband and mother-in-law, past obstetric history and gender of children, any history of previous psychiatric illness and outcome of current pregnancy in terms of mode of delivery, gender of newborn and neonatal complications. EPDS scoring was done using a Hindi translated version. Data were analysed using Epi Info version 3.32. Results: Thirty one (6%) out of 506 women scored ≥ 10 on the EPDS. Birth of female child, nuclear family structure and poor marital relationship were found to have a statistically significant correlation with peripartum depression. Conclusion: The 6% prevalence of women at risk of peripartum depression in our study, which is similar to other such studies, is significant and hence maternal mental health assessment should be made a part of routine antenatal and postnatal care.

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.

Sertoli–Leydig cell tumor: A rare ovarian neoplasm. Case report and review of literature

Background. Sertoli–Leydig cell tumor is a gonadal tumor of the sex cord–stromal type. It is a rare tumor comprising 0.1 to 0.5% of all ovarian tumors. Management of these cases poses a difficult therapeutic challenge. Case. A 13-year-old girl presented with acute urinary retention, excessive hair growth and deepening of the voice. A mass the size of a 28-week gravid uterus was arising from the pelvis. Serum testosterone level was raised to 145.2 ng/dl. Computed tomography revealed a heterogeneously hypoechoic, solid cystic mass arising from the left adnexa. Left salpingo-oophorectomy was done. A histopathological diagnosis of Sertoli–Leydig cell tumor (intermediate, Meyers type II) was given. Conclusion. Patients with Sertoli–Leydig cell tumors present with signs of defeminization followed by masculinization. Age of the patient, stage of the disease and degree of tumor differentiation based on morphology are the most important factors to consider in the management of the case.

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.