Rimpi Singla

<b><i>Background:</i></b> Data comparing pregnancy outcome in hyperthyroid women with euthyroid women are scarce. Hence, this study was carried out to assess the maternal and fetal outcome in pregnant women with hyperthyroidism to ascertain the effect of disease on pregnancy. <b><i>Methodology:</i></b> This retrospective study was conducted over a period of 28 years. We compared the maternal and fetal outcomes of 208 hyperthyroid women with 403 healthy controls, between women with well-controlled and uncontrolled disease and amongst women diagnosed with hyperthyroidism before and during pregnancy. <b><i>Results:</i></b> Maternal outcome: women with hyperthyroidism were at increased risk for preeclampsia (OR = 3.94), intrauterine growth restriction (OR = 2.16), spontaneous preterm labor (OR = 1.73), preterm birth (OR = 1.7), gestational diabetes mellitus (OR = 1.8), and cesarean delivery (OR = 1.47). Hyperthyroid women required induction of labor more frequently (OR = 3.61). Fetal outcome: newborns of hyperthyroid mothers had lower birth weight than normal ones (p = 0.0001). Women with uncontrolled disease had higher odds for still birth (OR = 8.42; 95% CI: 2.01-35.2) and lower birth weight (p = 0.0001). <b><i>Conclusions:</i></b> Obstetrical complications were higher in women with hyperthyroidism than normal women. Outcome was worsened by uncontrolled disease. Women with pregestational hyperthyroidism had better outcomes than those diagnosed with it during pregnancy.

Many studies have reported an association between periodontitis and adverse pregnancy outcomes, but there has been little research on the knowledge of obstetricians regarding oral care. The aim of the study was to assess the knowledge and attitudes of practicing obstetricians in India about the relationship between oral health and pregnancy outcomes, as well as their practice behaviors regarding oral healthcare in pregnant women in Indian settings.A structured online questionnaire was sent to 130 obstetricians in the city of Chandigarh and adjoining areas of the union territory. The questionnaire was prepared by dentists and obstetricians and was validated in a prior pilot study. Obstetricians' knowledge of the effects of pregnancy on oral health, and vice versa, were correlated with their experience and practices.A total of 79.2% responded to the questionnaire. More than 70% of respondent obstetricians correctly knew of the effects of periodontitis on preterm birth and low birth weight babies. Only 40% recommended dental examination during pregnancy and 47% advised patients about oral care during pregnancy. There were significant correlations between knowledge of dental health effects on pregnancy and referrals of patients to dentists.This study found that although obstetricians generally were knowledgeable about appropriate dental care practices during pregnancy as well as the relationship between oral health and pregnancy outcomes, this knowledge often did not translate into appropriate practice behavior.

Background: High fertility rate, high maternal mortality and high infant mortality rates are the shared problems of the all the developing countries of the world. According to Directorate of Health Services surveys, 40% of women who intend to use a family planning method in the first year postpartum are not using one. Contraceptive use is negligible among postpartum women, particularly young mothers. We aimed to determine the reasons for acceptability, non-acceptability, side effects and continuation of four contraceptive methods condoms, Depotmedroxyprogesterone acetate, (DMPA), copper intrauterine contraceptive devices (IUCD), progesterone only pills (POPs) in lactating mother after 6 weeks of delivery. Methods: A total of 200 healthy nursing mothers, who needed contraception were enrolled in this prospective observational study. Women were explained about all four contraceptive methods used for the study. The reason for accepting a particular method was sought. The study participant were followed up at third and sixth month and side effects, failure rate, continuation rates, reasons for discontinuation of method were assessed. Results: The most acceptable method was condom (40.5%) followed by DMPA (31%), IUCD (20.5%) and POPs (8%). The most common reason for selection of condom was fear of side effects with other methods (66%). Long acting method like DMPA and IUCD has good continuation rate of 87% and 85% respectively. Failure of contraception was seen only with condoms (2.8%). Conclusions: This study showed condoms was most acceptable method but had failure whereas DMPA and Cu-IUCD have high continuation rate with no failure.

Introduction: Contraceptive methods or devices are used to prevent pregnancy. Contraception enables women to realize their human rights and to choose whether or not to have children, as well as helps people achieve their desired family size. Currently, short-term family planning methods are available at levels of the health sector, but long-term methods are available at all levels. Objectives: To assess the knowledge regarding contraception and previous practices of contraception among antenatal women at term pregnancy attending gynaecology OPD. Methodology: An exploratory cross-sectional study was conducted. The total enumeration sampling technique was used, and 120 study participants were enrolled for the study. Data was collected by interviewing participants as per an interview schedule. Results: The study findings showed that a majority (76.6%) of the antenatal women had poor knowledge regarding contraception and 23.3% antenatal women had average knowledge. A majority (81.07%) of participants had previously practiced contraception. The most commonly used contraceptives were condoms and the calendar method. Conclusion: In the present study, more than half of the participants (antenatal women) had poor knowledge regarding contraception. It indicates the need for awareness regarding contraception and the appropriate use of contraceptive methods when required.

The aim of the study is to identify appropriate definitions and patient-reported outcome measures (PROMs) for each of the eight core outcomes previously selected for genitourinary symptoms associated with menopause: pain with sex, vulvovaginal dryness, vulvovaginal discomfort or irritation, discomfort or pain when urinating, change in most bothersome symptom, distress, bother or interference of genitourinary symptoms, satisfaction with treatment, and side effects.

Background Cesarean hysterectomy for adherent placenta is associated with increased maternal morbidity due to massive hemorrhage requiring large volume blood transfusion, bladder or ureteric injury, intensive care unit (ICU) admission and prolonged hospital stay. There is an ongoing effort to improve the outcome of these women and measures to reduce blood loss. Objective The purpose of the present study was to develop an alternate surgical approach for performing a Cesarean hysterectomy in women with adherent placenta in order to reduce hemorrhage and urinary tract injuries, and thereby improve the maternal outcome. Study design A prospective observational study in a tertiary care hospital in North India. The surgical approach described in the present study was practiced in 12 women who underwent Cesarean hysterectomy for adherent placenta previa. In this approach, dissection of the bladder flap as close as to the cervix was made prior uterine incision and delivery of the baby. During dissection of the bladder flap, the blood vessels traversing between uterus and bladder were ligated and divided. Result These 12 women underwent Cesarean hysterectomy under general anesthesia. The interval from induction of anesthesia to delivery of the baby ranged from 40 to 79 min, and none of the babies had birth asphyxia. No woman had bladder or ureteric injury. All women had histopathological proven adherent placenta, 5 had placenta percreta, one had placenta increta and 6 had placenta accreta. The average blood loss was 1.46 l and the mean number of blood transfusions was 2.1 units. None of the women required post-operative ventilatory support or ICU admission, and all women were discharged from hospital between 4 to 7 days following Cesarean hysterectomy Conclusion The present series describes an alternate surgical approach for Cesarean hysterectomy in adherent placenta. Dissection of the bladder flap prior to delivery of the baby followed by hysterectomy reduced the hemorrhage and there was no bladder or ureteric injury. This surgical approach requires no additional resources and may easily be followed in a low-resource setting.

Studies on pregnancy with rheumatic heart disease (RHD), still common in the developing world, are relatively old and small. This retrospective study was conducted to study the outcome of pregnancy in women with RHD and factors associated with poor outcome. We studied 353 pregnancies in 273 women. In 35% of the patients, the diagnosis was first made during index pregnancy. Women with severe MS had lesser gestational age at delivery and birth weight than those with mild-to-moderate MS. Women with NYHA III-IV status delivered at lesser gestational age had lesser birth weight and had higher perinatal and maternal mortality than NYHA I-II status. Pregnancy outcome was better among women who underwent Balloon mitral valvotomy (BMV) when indicated than those who did not. Cardiac complications were higher in women with severe MS and poor NYHA status. Early booking is important for the optimal outcome. BMV is safe during pregnancy and should be done when necessary.Impact statementWhat is already known on this subject? Rheumatic heart disease continues to be the major cause of maternal morbidity and mortality in developing countries. Most of the recent studies discuss pregnancy with heart disease as a whole with RHD being a part.What do the results of this study add? A large number of women in developing countries conceive with unknown underlying heart disease. Late access to antenatal care is associated with poor outcome. Cardiac and obstetric complications are significantly higher in women with severe mitral stenosis and poor NYHA functional status. Balloon mitral valvotomy (BMV) during pregnancy is safe and technically feasible. BMV averts major complications that may occur due to severe disease. Patients with RHD can undergo labour and vaginal delivery under vigilant monitoring.What are the implications for clinical practice? Thorough clinical examination by the clinician at initial visit is important to detect unknown heart disease. Symptoms pointing towards underlying heart disease should prompt evaluation. This study provides evidence for population-based screening for heart disease in women. Optimal management of compensated mitral stenosis requires weighing the risks and benefits of pharmacological therapy versus BMV in the context of maternal condition. BMV should be performed when necessary.

Objective (s):The aim of the study was to find out the characteristics of emergency obstetric referrals, to evaluate the lapses in the existing referral system and to suggest the plausible solutions to improve the obstetric health care delivery system in India.Materials and methods: This prospective descriptive study was carried out in the Department of Obstertrics and Gynaecology PGIMER Chandigarh India from September 2012 to December 2012.All the obstetric emergency referrals to our institute, a tertiary care centre in North India were critically reviewed for reason for referral, adequacy of care provided before referral, lapses in management, factors behind suboptimal care and remedial measures are suggested.Results: There were 232 emergency referrals available for analysis. Of these 76% patients were referred directly to the institute, the highest level in referral chain in the region. Mean age was 26yrs, 28.6% of the patients were illiterate. In 75.5% of cases, the management of obstetric emergency before referral was suboptimal or poor. In 16% of cases patient failed to seek medical help timely despite emergency. In 40% of cases there was undue delay in referring or failure to provide even the basic care. Anticipated premature delivery and hypertensive disorders of pregnancy were the most common diagnosis at referral.Conclusion: Results from this pilot study shows that in spite of the most extensive health care infrastructure and so- called hierarchal referral system, there is gross inadequacy in referral system in India.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 25-29

Diagnostic hysteroscopy is one of the most commonly performed procedures in the evaluation of infertility. Air embolism is an extremely rare but catastrophic and often fatal complication occurring during hysteroscopy. We present a patient who developed massive air embolism during diagnostic hysteroscopy performed under general anesthesia. During the procedure, she developed sudden onset desaturation followed by cardiac arrest. The procedure was immediately stopped, cardiac massage and inotropic support were started, and the patient was shifted to the Intensive Care Unit on ventilator support. Positive end-expiratory pressure and heparin for emboli, midazolam for brain protection, and inotropes were administered. Despite extensive resuscitative efforts, the patient died 4 h after the event.

Congenital cervical atresia is a rare Mullerian anomaly which presents with primary amenorrhoea and cyclical abdominal pain due to retrograde menstruation, haematometra and formation of endometriot...

How to cite this article: Bhartiya S, Shaarawy T. The Quest for the Holy Grail of Glaucoma Surgery: Does Cypass Herald the End?. J Curr Glaucoma Pract 2018;12(3):99-101.

BackgroundSurgical care is an essential component of global health care but not without adverse events.Major complications rates in surgical procedures are reported to be 3-16% with death rate of 0.4 to 2.7% in well-resourced countries.][3]

IntroductionAdvancements in prenatal diagnostic techniques have led to an increase in demand for termination of pregnancy for fetal anomalies (TOPFA).While relaxation in the legal gestational age limits across various countries relieves an important barrier, there is a need to identify the reasons that lead to delays in seeking abortion for fetal anomalies, because abortion-related complications increase with gestational age. MethodsIn this hospital-based qualitative study, antenatal women referred to a tertiary care institute in North India because of major fetal anomalies were explained about the study.Those women who fulfilled the inclusion criteria were recruited after taking consent.Details of antenatal care and prenatal tests were recorded.An in-depth inquiry was made into the reasons for the delay in prenatal tests, the delay in the decision for abortion, and specific problems that they faced in seeking TOPFA. ResultsOut of 80 women who met the inclusion criteria and consented to participate, more than 75% had received antenatal care in public healthcare facilities.Less than 50% of women received folic acid in the first trimester while 26% had first contact with healthcare facilities in the second trimester.Only 21 women underwent screening for common aneuploidies.Second-trimester anomaly scan was delayed in 35 women due to women-centered reasons (n = 17) or provider-centered (n = 19) reasons.Only 37.5% of women were counseled about fetal anomalies by their primary care provider.Owing to delay at multiple levels, 40 women (50%) could receive counseling about fetal abnormality for the first time after 20 weeks.These women could not be offered abortion because this study was carried out before the amendments in the Medical Termination of Pregnancy Act in India.The older act allowed abortion up to 20 weeks of gestation.Seventeen women could obtain permission for an abortion from a court of law.Arrangements for travel and stay and dependence on family members were the main problems faced by women seeking TOPFA. ConclusionsDelay in diagnosis of a fetal anomaly due to delay in seeking antenatal care, irregular follow-up, and lack of pre-test counseling are the major reasons for the delay in the decision for abortion.This is further compounded by inadequate post-test counseling.Lack of awareness, failure or delay in counseling, need to travel to another facility for abortion, dependence on family members, and financial issues are the major barriers.

Objectives: Many studies showed high rates of noncompliance with preoperative antibiotic prophylaxis (PAP) guidelines but a lack of data on reasons. This study assessed compliance with PAP guidelines, reasons for noncompliance, and its effect on infectious complications. Materials and Methods: This facility-based retrospective study was based on an audit of antimicrobial practices among surgeons after implementing the PAP guidelines. Details of surgery and antimicrobial prophylaxis for patients undergoing cesarean section/gynecologic surgeries were recorded on an Antibiotic Audit Form. Any deviation from guidelines was considered noncompliance, and its reason was assessed. After finding the rate of noncompliance the rate of postoperative infections was compared between patients who received recommended antibiotic prophylaxis and those who did not. Results: Per 532 Antibiotic Audit Forms (114 for gynecologic surgeries; 418 for cesarean sections), there were 196 cases of noncompliance (36.8%), using additional antibiotics. Most commonly, these were given for extensive adhesiolysis (29.7%) in gynecologic surgeries and prolonged rupture of membranes (14.2%) in cesarean sections. Surgical-site infection was more common in obstetric patients receiving additional antibiotics after cesareans. Conclusions: PAP compliance is good if guidelines are locally developed by consensus and are sustainable. An internal audit enhances compliance by exploring reasons for noncompliance, providing self-feedback. Surgeons tend to continue antibiotics for prolonged leakage, extensive adhesiolysis, and comorbidity. (J GYNECOL SURG 39:114)

Purpose While increase in institutional deliveries brings an opportunity to counsel women for postpartum family planning (PPFP), its uptake remains low. Reasons for poor acceptance of postpartum intrauterine contraceptive device (postpartum-IUD), and its relation with the timing of counselling need to be investigated.Methods Women attending the antenatal clinic, reporting in labour, and within 48 h of delivery respectively were invited to participate. Eligible women were asked about awareness and choice for PPFP. After counselling, acceptance for PPFP was compared with the baseline. Acceptance and continuation of postpartum-IUD were compared between women counselled in the antenatal, intrapartum, and postpartum periods.Results Only 23% of 360 women were aware of postpartum-IUD. After counselling, acceptance for PPFP increased from 14% to 97% and for postpartum-IUD, from 0.5% to 33.9%. Acceptance of postpartum-IUD among women counselled in the antenatal, intrapartum and postpartum period was 45%, 35% and 21.7% respectively. Acceptance was higher among the antenatal-counselling group than the postpartum-counselling group (OR 0.45; CI 0.22–0.94; p = 0.03).Conclusion Counselling, irrespective of its timing, improves acceptance for PPFP. Acceptance and continuation of postpartum-IUD are higher following counselling in antenatal period. All eligible women should be counselled irrespective of ‘when’ they approach the facility.

Abstract Introduction : Scrub typhus in pregnancy may present with varying clinical spectrum ranging from mild febrile illness to multi-organ dysfunction. Severe form of untreated disease may result in maternal and/or fetal death. We present the case report of a primigravida in her third trimester of pregnancy with scrub typhus that faced “maternal near miss” and fetal demise. Case : A 25-year-old primigravidaat 36 weeks of gestation was referred to us with fever, headache, and malaise for 15 days and progressive dyspnea for two days. She was being treated with antipyretics and non-specific antibiotics before referral. She had tachycardia, hypotension, tachypnoea, orthopnea, oxygen saturation of 90% on room air, and generalized anasarca. Investigations revealed thrombocytopenia, deranged renal function tests, and increased procalcitonin. Azithromycin and ceftriaxone were started empirically. ELISA for Scrub typhus was positive. Subsequently, an eschar was found below left breast. Her condition improved with resuscitation, supportive therapy, and definitive treatment. Patient had spontaneous labor within 24 hours of admission resulting in vaginal delivery. She had intrapartum stillbirth. After delivery, she again developed respiratory distress requiring intubation. The chest Xray showed a deteriorating picture with consolidation in right upper lung and bilateral reticulo-nodular opacities. Antibiotics were switched to meropenem and doxycycline 100mg twice a day. Fever subsided after day-4 postpartum and she was gradually weaned off from the ventilator. Conclusions : It is important to consider this differential early in the course of illness especially in tropical countries. Delay in diagnosis and hence, treatment can result in catastrophic outcome.

Abstract Disclosure: R. Pal: None. T.N. Prasad: None. S.K. Bhadada: None. V. Singla: None. S. Ram: None. N. Aggarwal: None. A. Kumar: None. People with type 2 diabetes (T2D) are at high-risk of fragility fractures, however, there are no randomised controlled trials (RCTs) evaluating the efficacy/safety of anti-osteoporosis drugs as a primary endpoint in T2D (1). To address this lacuna, we conducted a pilot prospective, open-labeled, blinded-end point (PROBE) RCT (CTRI/2022/02/039978) wherein consecutive postmenopausal female (≥ 50 years) with T2D (duration ≥ 5 years) were screened. Subjects with HbA1c 7-10%, eGFR > 45 ml/min/1.73 m2 and prior history of vertebral (clinical/morphometric), hip, radius, humeral fragility fracture or at high-risk of fragility fractures [defined as areal bone mineral density (BMD) T-score (adjusted for diabetes) at lumbar spine/femoral neck ≤ -2.5 and high FRAX score] and without any secondary cause of osteoporosis were randomised in staggered fashion in a 1:1:1:1 ratio to receive either daily teriparatide, yearly zoledronate, biannually denosumab (in addition to standard of care, i.e., calcium 1000 mg/day and cholecalciferol 1000 IU/day) or only standard of care (control). The primary end points were change in areal BMD and frequency of incident fractures at 18 months. The secondary end point was change in HR-pQCT parameters measured at distal radius and distal tibia (XtremeCT II, SCANCO Medical AG, Switzerland) at 6 and 18 months.Out of 412 participants who were screened, 104 subjects were randomized to any of the 4 arms. Out of these 104 subjects, 53 have completed 6 months of follow-up (teriparatide n=14, zoledronate n=14, denosumab n=15, control n=10). There were no statistically significant differences in age, HbA1c, eGFR, calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D, parathyroid hormone, procollagen type I N-propeptide (PINP), C-terminal telopeptide (CTX), areal BMD, trabecular bone score (TBS), FRAX score or HR-pQCT parameters between the 4 groups at randomisation. At 6 months, there was no significant difference in HbA1c between the 4 groups; PINP and CTX rise was significantly higher in teriparatide arm compared to zoledronate, denosumab or control arms. With regard to HR-pQCT, there were no statistically significant differences in total [total volumetric BMD (vBMD), bone volume fraction], cortical (vBMD, thickness, porosity, pore diameter), or trabecular (vBMD, thickness, number, separation) bone properties at the distal radius and distal tibia between the 4 arms at 6 months of follow-up. To conclude, zoledronate, denosumab or teriparatide were unable to induce any significant microarchitectural changes than standard of care in postmenopausal women with T2D at high-risk of fragility fractures following 6 months of treatment. Longer duration of treatment and follow-up of the cohort is required to arrive at robust conclusions. Reference: (1) Pal et al., Bone fragility in type 2 diabetes mellitus: a lot left to explore. Nat Rev Endocrinol. 2022;18:651-651 Presentation: Thursday, June 15, 2023

People with type 2 diabetes (T2D) are at high risk of fragility fractures; however, there are no randomized controlled trials evaluating the efficacy of anti-osteoporosis drugs as a primary pre-specified endpoint in T2D.To compare the efficacy of anti-osteoporotic drugs in postmenopausal women with T2D.Prospective, randomized, open, blinded endpoint clinical pilot trial.Postmenopausal women (⩾50 years) with T2D (duration ⩾5 years), HbA1c 7-10%, eGFR ⩾45 mL/min/1.73 m2 and prior vertebral (clinical/morphometric), hip, radius, humeral fragility fracture or bone mineral density (BMD) T-score (adjusted for diabetes) at lumbar spine/femoral neck ⩽-2.5 and high FRAX score will be eligible for inclusion. Subjects with secondary causes of osteoporosis, prior exposure to bone-active therapies or history of use of glucocorticoids/pioglitazone/thiazides/canagliflozin will be excluded. Finally, eligible subjects will undergo estimation of serum calcium, phosphate, alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D and bone turnover markers (BTMs) (total procollagen type I N-propeptide, β-CTX) along with trabecular bone score (TBS) and high-resolution peripheral quantitative computed tomography (HR-pQCT) of non-dominant hand and leg. After a 2-week run in phase, they will be randomized in a 1:1:1:1 ratio to receive yearly zoledronate, or biannually denosumab or daily teriparatide (in addition to standard of care, i.e., calcium 1000 mg/day and cholecalciferol 1000 IU/day) or only standard of care (control). The primary endpoints will be change in areal BMD and frequency of incident fractures at 18 months. The secondary endpoints will be change in HR-pQCT parameters, TBS and BTMs at 18 months. Adverse events will be recorded for all randomized participants.The study has been approved by the Institute Ethics Committee. Written informed consent will be obtained from each participant.The trial is expected to provide information regarding optimal anti-osteoporotic therapy in people with T2D and bone fragility.Prospectively registered in Clinical Trial Registry of India (CTRI/2022/02/039978).

Abstract Purpose Neuroendocrine tumors adversely affect the pregnancy outcome, if remain undiagnosed or untreated. Management of such a patient is challenging, especially while weighing the advantages and disadvantages of surgical and medical treatment during early pregnancy. The Case We present the case of a pregnant woman who presented to us with hypertension, episodes of headache, sweating and palpitations. On investigation, she was found to have bilateral heterogenous adrenal masses, a hypervascular lesion inferior to the aortic bifurcation, multiple hypervascular masses with calcifications in the pancreas, and thrombosis of the splenic vein. Twenty-four hour urinary metanephrine measured 350μg. Since she was in first trimester of pregnancy and waiting with such extensive disease was not favorable, she was aggressively treated along with urgent surgery in the form of bilateral adrenalectomy, distal pancreatectomy and splenectomy soon after the diagnosis. Histopathological examination of bilateral adrenal glands confirmed pheochromocytoma, tumour from aortic bifurcation showed paraganglioma, and pancreatic mass showed nodules having neuroendocrine morphology and positivity for chromogranin and synaptophysin. Biochemical studies revealed non- functioning nature of pancreatic tumour. She had a normal labor and delivery of a healthy baby. Genetic analysis revealed missense c.499C>T (p.ARG167TRP) mutation in von Hippel Lindau's gene. Principal conclusions Any advantage of delaying the surgery in a pregnant woman diagnosed of neuroendocrine tumours in first trimester should be weighed against potential hazards of long term medical therapy and the disease itself. We emphasize the importance of timely treatment, particularly in multifocal and extensive neuroendocrine tumours disease, for a favorable pregnancy outcome.

ABSTRACT Pregnancy is a unique physiological state that affects almost all the organs, because of changes in the hormonal milieu meant to support the pregnancy. These changes, generally reversible after delivery, are sometimes not without adverse effects. Recent upsurge in the interest in periodontal disease in pregnancy is attributed to association between periodontitis and adverse pregnancy outcome. Periodontal diseases are a group of infections and conditions that cause inflammation of the gingiva and the surrounding structures, which leads to destruction of the supporting tooth structures. Periodontal infections are predominantly caused by Gram-negative bacteriae that induce local and systemic elevations of proinflammatory cytokines. Transient bacteremia that occurs due to high vascularity of the periodontal tissue may lead to direct bacterial invasion of the fetoplacental unit. The release of toxic products incites host's response and triggers an inflammatory response. As a source of subclinical and persistent infection along with the cascade of systemic inflammatory responses and immune-mediated injury, periodontitis puts the pregnancy at high risk. Evidence for and against association between oral diseases and adverse pregnancy outcome comes from cross-sectional studies and a few trials. Like any other association of obstetric outcome with systemic diseases, this one is also a subject of debate. We reviewed the studies providing evidence for and against effect of periodontal diseases on pregnancy. We found that different investigators have used different parameters to define periodontal disease, hence different results. Larger randomized controlled trials with uniform definitions of disease and outcome are needed to arrive at a definite conclusion. How to cite this article Suri V, Singla R. Effect of Periodontal Diseases on Pregnancy. J Postgrad Med Edu Res 2015;49(3): 132-138.

Background: Vitamin D deficiency (VDD) in pregnancy has been found to be associated with adverse outcome in various observational studies. Evidence from randomized control trials is necessary to change current recommendations. Aims and Objectives: We conducted randomized controlled trial to assess the effect of Vitamin D supplementation on pregnancy outcome. We also looked for predictors of VDD as universal testing is neither recommended nor available. Materials and Methods: Consecutive pregnant women at 12–16 weeks of gestation were invited to participate in the study. Eligible women were assessed for potential risk factors for VDD (serum concentration <20 ng/dl). Serum 25-OH Vitamin D levels were checked. At 20 weeks gestation, consenting women (n=297) were randomized to receive either 60,000 IU Vitamin D (n=151) orally daily for 5 days or placebo (n=146). Maternal and fetal outcomes were compared between the two groups by intention-to-treat analysis. Results: Out of 304 eligible women, 92% had VDD. Mean Vitamin D concentration was 10.04±6.03 ng/dl. Vitamin D concentration was lower among women living in urban areas (P=0.001) and having lower sun exposure time (P=0.013). Vitamin D levels showed negative correlation with socioeconomic score (ρ=−0.131; P=0.023) and BMI (ρ=−0.112; P=0.05). In placebo group, women with VDD had longer duration of labor than Vitamin D replete ones (P=0.031). No significant difference was observed between two groups with respect to maternal and fetal outcomes. No adverse effects were observed. Conclusion: VDD is highly prevalent among pregnant women. It is associated with significantly longer duration of labor.

Implementation research with pre- and post-comparison was planned to improve the quality of evidence-based intrapartum care services in Indian medical schools. We present the baseline study results to assess the status of adherence to intrapartum evidence-based practices (IP-EBP) in study schools in 3 states in India and the perception of the faculty.A concurrent mixed-methods approach was used to conduct the baseline assessment in 9 medical schools in Rajasthan, Gujarat, and Union Territory from October 2018 to June 2019. IP-EBP among pregnant women in uncomplicated first (n=135), second (n=120), and third stage (n=120) of labor were observed using a predesigned, pretested checklist quantitatively. We conducted in-depth interviews with 33 obstetrics and gynecology faculty to understand their perceptions of intrapartum practices. Quantitative data were analyzed using SPSS (version 22). COM-B (Capability, Opportunity, and Motivation Behavior) model was used to understand the behaviors, and thematic analysis was done for the qualitative data.Unindicated augmentation of labor was done in 64.4%, fundal pressure applied in 50.8%, episiotomy done in 58.3%, and delivery in lithotomy position was performed in 86.7% of women in labor.Intrapartum practices that are not recommended were routinely practiced in the study medical schools due to a lack of staff awareness of evidence-based practices and incorrect beliefs about their impact.

"Severe haematuria: an atypical cause of near miss in a woman with acute fatty liver of pregnancy." Journal of Obstetrics and Gynaecology, 39(8), pp. 1169–1170

Nothing is as devastating as experiencing the death of a newborn for a mother, and that is added to coping with pain and other medical problems arising during pregnancy. Early neonatal death is defined as death of a newborn from day 0 to day 7 of birth. This chapter discusses in detail various causes of early neonatal deaths, especially causes in low-middle-income countries where there is a maximum burden of neonatal deaths. Further, subsequent pregnancy following early neonatal death should be managed in a facility that is not only capable of providing standard obstetric care but is also able to address and treat specific causes of loss and psychosocial aspects. This chapter discusses stepwise management of subsequent pregnancy in such a woman beginning from the preconceptual period to essential newborn care. It also provides a brief review of the literature of feasible solutions in low-resource settings.

Background: Pelvic organ prolapse complicating pregnancy is an extremely rare entity.Obstetricians must be familiar with this condition as early recognition and follow up can help to avoid possible fetomaternal risks.Isolated cystocele in pregnancy has not been reported in literature till now.Case reports available mention concomitant uterovaginal prolapse along with cystocele.Case Report: We present a patient with isolated cystocele during pregnancy.She presented to us at 28 weeks gestation with cystocele protruding out of the introitus with complaints of preterm labour pains.She was managed conservatively, but had preterm vaginal delivery at 30 weeks gestation.Both mother and baby are healthy following delivery.

A 21-year-old unmarried and primigravida female indulged in criminal abortion at 18 weeks of gestation with the help of a village midwife.Instrumentation was done, and it led to uterine perforation with prolapse of 200 cm of small bowel through vagina.She was managed with resection of 160 cm of necrotic small bowel, repair of the uterine defect, and end jejunostomy, which was anastomosed with distal ileum three months later.This case highlights the risks of illegal abortion and the primitive societal mindset that forces unmarried women to resort to such means.

Port site metastasis is a rare complication and carcinosarcoma is itself a rare malignant tumour of the ovary. Hereby, Authors report a case of an ovarian carcinosarcoma which was retrospectively diagnosed from the metastasis which developed at the specimen retrieval port site of primary laparoscopic surgery. A 48-year-old nulliparous lady underwent laparoscopic cystectomy previously for endometrioma. Six months postlaparoscopy, she developed pain and palpable mass at the trochar site. Fine Needle Aspiration Cytology (FNAC) showed metastatic adenocarcinoma of ovarian origin confirmed by immunohistochemistry. Six cycles of chemotherapy followed by total hysterectomy, resection of the mass and attached tubal segment, opposite salpingo-oophorectomy and omentectomy was done. Post-surgery, patient was followed-up with three chemotherapy sessions. Final histopathological report showed carcinosarcoma of ovary at port site with omental deposit.

In the second trimester, medical abortion is preferred as it is less invasive, and the surgical method carries more risk. There is a paucity of published literature on medical abortion in women with renal failure requiring haemodialysis. We came across a woman who presented with rapidly progressive renal failure at 18 weeks of gestation and required therapeutic abortion. We are reporting the challenges, outcomes, and precautions to be taken while performing a medical abortion in such a case.

Spontaneous isolated intraperitoneal rupture of urinary bladder is a rare urological complication of normal delivery. This complication is usually related to prolonged labour, failure to empty bladder in second stage of labour, use of forceps/ ventouse, postpartum urinary retention, vaginal birth after caesarean section and usually presents immediately after delivery. We report the case of a patient with spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery in the absence of any risk factor. She presented on day 5 postpartum with features suggestive of puerperal sepsis with pyoperitoneum with acute kidney injury. Absence of unhealthy lochia and later, normal-looking uterus and adnexa during laparotomy led to the suspicion of alternate cause for seropurulent ascites. Further exploration revealed rent in the urinary bladder with necrosed margins. High index of suspicion of alternate diagnosis should be maintained if some of the clinical findings are not supportive of provisional initial diagnosis

Complete heart block is rare during pregnancy. It may be congenital or acquired. There are no proper guidelines regarding its management, posing a great challenge for obstetricians .It is further compounded, if it is associated with severe preeclampsia. Normal physiological hemodynamics and cardiac changes pose challenges in the setting of cardiac lesions like congenital heart block .When it is associated with preeclampsia it has profound effects over the cardiac function. Pregnancy with rare combination of complete heart block and severe preeclampsia warrants cautious use of antihypertensive drugs and pacemaker implantation. Commonly used antihypertensives drugs like labetalol used as the rst line of treatment in preeclampsia is contraindicated in case of complete heart block. Here we present challenges faced and its management by a multidisciplinary team when a case of complete heart block associated with severe preeclampsia reported in emergency at term gestation