Observational Study to Evaluate the Indications of Cesarean Section in Primigravida at Tertiary Care Health Center in Northern Maharashtra
Sapna Bharti, Kiran Rajole, Reema Abhyankar
Page Numbers : 481-487
DOI : 10.36348/sijog.2021.v04i11.012
Background: Over last decade progressive increase in the rate of deliveries by cesarean section, is a cause of major public health concern due to potential maternal and perinatal morbidity. The driving factor leading to steady increase in cesarean delivery is not completely understood and there is lack of consensus on the appropriate cesarean section rate. This study will present the cesarean section rate in primigravida at our institute, indications of cesarean section and associated maternal and fetal morbidity. Methods: This was a retrospective study done on primigravida who delivered by cesarean section in the department of Obstetrics and Gynecology, SMBT institute of medical sciences & research center during one-year period. Result: The incidence of cesarean section in primigravida in our study was 29.09%. Most common indication of cesarean section in primigravida was fetal distress 39.81%. Amongst 41 cases of cesarean sections done for fetal distress, 33 cases had spontaneous onset of labor, 5 cases were induced with pgE1. Other common indication of cesarean section was cephalopelvic disproportion in 12.62% of cases, oligohydramnios in 11.65% of cases and breech presentation in 9.71% of cases. Most common antenatal high-risk factor was hypertensive disorder of pregnancy in 18.44% of cases. Blood transfusion and postpartum hemorrhage were the maternal morbidities noted in our study. Common cause for NICU admission was respiratory distress syndrome. Conclusion: Standardization of indications of primary cesarean section at tertiary center level is required. So that sequential annual audit of cesarean sections can help to strategize improvement of antenatal care for the reduction of primary cesarean section rate.
Original Research Article
Nov. 30, 2021
The Syndromic Management of Vaginal Discharge Using One-Day Combination Kit Therapy: A Randomized Controlled Trial
Khatun R, Yousuf S, Sultana R, Begum S, Ferdous N, Akther N
Page Numbers : 488-494
DOI : 10.36348/sijog.2021.v04i11.013
Introduction: Vaginal discharge is one of the most common problems faced by women in reproductive ages. Most of the time it caused by bacteria, fungi or parasites and many times these infections are sexually transmitted. Aim of the study: The aim of this study is to observe the responses of improvement symptoms and to reduce the risk of complication. Methods: This randomized study was conducted in Department of Obstetrics and Gynaecology OPD in Shaheed M. Monsur Ali Medical College and Hospital. Two hundred and nineteen patients were selected with the complaints of vaginal discharge with or without urinary symptoms, pruritus vulvae and lower abdominal pain. Couple were given one day combination kit therapy, containing (Fluconazole 150 mg, Azithromycin 1 gm, Secnidazole 2 gm). They were called after two weeks to know about their outcome of treatment or persisting symptoms. Result: In the study population, 55% women had excellent response for vaginal discharge, 46.8% women had excellent response for urinary symptoms and 62.3% women had excellent response for pruritus vulvae. Most common adverse effects of kit therapy were anorexia 44.54%, metallic taste 32.77% and nausea 38.66%. Conclusion: This strategy has had a considerable impact in decreasing the burden of STD in society with high cure rate for vaginal discharge.
Original Research Article
Nov. 30, 2021
Association between Thyroid Disorders and Abnormal Uterine Bleeding in Reproductive Ages in a Private Medical College Hospital, Dhaka, Bangladesh
Dr. Monowara Begum, Sumia Bari Sumi, Dr. Tania Akbar, Dr. Khirun Naher
Page Numbers : 476-480
DOI : 10.36348/sijog.2021.v04i11.011
Background: Abnormal uterine bleeding (AUB) means any bleeding that is not normal in amount, duration, frequency, and cyclicity. It is a common disorder occurring in reproductive age group females. It can be understood as bleeding that occurs from the uterus outside the normal parameters and there are no structural defects in the genital tract. One of the most common associations with AUB is thyroid dysfunctions. Hence, this study aimed to see the incidence of thyroid-related disorders in AUB and also to assess the menstrual pattern. Methods: A total 145 women suffering from AUB who presented to OPD of the gynecology department of Enam Medical College & Hospital (EMCH), Dhaka, Bangladesh were recruited in the study. All females in 19 to 45 years of age group with abnormal uterine bleeding were included excluding those with a previously known thyroid disorder, abortion history within 3 months, etc. Thyroid function tests were done in all along with ultrasonography of the pelvis region. Data were analyzed using SPSS software v.23.0. and Microsoft office 2007. Results: The bleeding abnormality that was found in most of the women was heavy menstrual bleeding. Out of the 145 patients taken into study 21(14.48%) had thyroid disorders, out of which subclinical hypothyroidism was most prevalent accounting for 16(11.03%) cases, 5(3.45%) cases were found to have hypothyroidism and 2(1.38%) case of hyperthyroidism was detected. Conclusions: Abnormal uterine bleeding has a strong association with thyroid disorders. The most common type of disorder is subclinical hypothyroidism. Thus, all patient of AUB must be evaluated for thyroid dysfunction.
Original Research Article
Nov. 27, 2021
Laparoscopic Diagnosis of Genital Tuberculosis during Infertility Work Up, a Retrospective Study
Dr. Sumaiya Akter, Dr. Shakeela Ishrat, Dr. Jesmine Banu, Dr. Mohammad Ahad Hossain, Dr. Nishat Jahan, Dr. Shirin Jahan
Page Numbers : 471-475
DOI : 10.36348/sijog.2021.v04i11.010
Background: Genital Tuberculosis is one of the leading causes of infertility in Bangladesh which is a high tuberculosis burden country. As the patients are mostly asymptomatic and diagnostic tests have low sensitivity and specificity, diagnosis of genital tuberculosis is very much challenging. The aim of this study is to evaluate the patients of genital tuberculosis diagnosed at laparoscopy. Methods: A retrospective study was performed on 12 patients who underwent laparoscopy and hysteroscopy. Cases were analyzed according to history, relevant pre surgery investigation findings, laparoscopic and hysteroscopic findings, histopathology, MTB PCR and Acid-Fast Bacillus (AFB) tests reports. Results: Mean age 25 years, range (22 -33), ten (83.3%) with primary subfertility and two (16.6%) with secondary subfertility. Two had secondary amenorrhea, two women presented with scanty menstrual flow and seven women with regular cycle with average flow and duration. Two (16.6%) had previously completed treatment for pulmonary tuberculosis, 4(33.3%) had history of exposure to tuberculosis patient. Hysterosalpingography showed eleven (91.6%) cases with bilateral tubal block, one (8.3%) with only left tubal block. At laparoscopy all women had tubal involvement, ovarian involvement in 6(50%), frozen pelvis or dense pelvic adhesion in one. At hysteroscopy 11 (91.6%) cases had intrauterine adhesion. Histopathology of endometrial tissue revealed tubercular granuloma in two (16.6%) cases; MTB PCR was detected in 6(50%) cases and acid-fast bacillus was negative in all cases. Conclusions: Laparoscopic and hysteroscopic findings are more suggestive than history, microscopic, histopathological and molecular examination of endometrial tissue in diagnosing genital tuberculosis in infertile women.
Original Research Article
Nov. 25, 2021
Comparative Study of Extra Amniotic Saline Infusion Through Intracervical Balloon Catheter and Prostoglandin E2 Gel for Induction of Labour
Dr. Kannappa Durga, Dr. Dhanalaxmi, Dr. Rekha R Jaichandra
Page Numbers : 466-470
DOI : 10.36348/sijog.2021.v04i11.009
Introduction: Induction of labor is an artificial initiation of uterine activity before the spontaneous onset of labor with the aim of achieving vaginal delivery. To assess the effectiveness of extra amniotic saline infusion and prostaglandin E2 gel for induction of labour. Methods: A randomized, comparative study was conducted in the Department of Obstetrics and Gynaecology, Ayaan Institute of Medical Sciences over a period of 6 month. 260 patients at term with a Bishop's score ≤5 with various indications for induction were randomly allocated to group E (extra amniotic normal saline) and group P (PGE2 gel) with 130 women included in each group. Results: 61.5% of Primi delivered within 12 hrs in the extra amniotic saline infusion group compared to only 44.4% in the PGE2 gel group. 96% of Multi delivered within 12 hrs in extra amniotic saline infusion group compared to only 55.6% in the PGE2 gel. The mean Induction delivery interval in Primi with Extra amniotic saline infusion was 12.34 hrs. The mean Induction to delivery interval in Primi with PGE2 gel was 14.43 hrs. The mean Induction to delivery interval in Multi with Extra amniotic saline infusion was 10.54 hrs. The mean Induction to delivery interval in Multi with PGE2 gel was 13.64 hrs. The difference between the two group is statistically significant. Conclusions: Cervical ripening was more effective in the Extra amniotic saline infusion group when compared to PGE2 group. Oxytocin usage was lower in the Extra amniotic saline infusion group when compared to PGE2 gel group.
Original Research Article
Nov. 24, 2021
Fetomaternal Outcome of Vaginal Birth after Previous Cesarean Section (VBAC): Study on Tertiary Level Hospital in Bangladesh
Dr. Shahana Parvin, Dr. M. Sharif Uddin, Dr. Shahela Jesmin
Page Numbers : 440-451
DOI : 10.36348/sijog.2021.v04i11.006
Background: Cesarean sections have been a part of human history from the beginning of time. There are legends from both western and eastern civilizations of this technique leading to live mothers and children. In today's obstetrics practice, pregnant women who have had cesarean sections in the past are becoming more commonplace. There are proven hazards to the mother's health following a cesarean section in subsequent pregnancies, such as placenta praevia or rupture of the uterine scar. Premature birth, low birth weight, and perinatal mortality have also been linked to it. Because of the risk of harm to the surrounding structures, repeat cesarean sections are extremely difficult to perform. Aim: To evaluate the outcome of vaginal birth after cesarean section (VBAC) of patients admitted into a tertiary level hospital. Methods: It was prospective, non-randomized, and observational, which involved interviewing all pregnant patients admitted in Gynae and Obstetric Department of RMCH with a history of one or more cesarean sections were included in this study. Results: Out of 50 cases mean age of the study population was 26.92±4.67. Eighty-four percent of study subjects received a regular antenatal check-up during their present pregnancy. A maximum number of 29 patients (58%) had BMI < 20. Before VBAC 40% of subjects had previous vaginal delivery followed by cesarean section, 4% of subjects had previous cesarean section followed by vaginal delivery, and 56% of subjects had only one delivery by caesarean section. All the caesarean sections were done due to nonrecurrent causes. Bishop's scoring during admission for present pregnancy was the highest number i.e., 30(60%) had dilatation ≥4 cm, 60% of the subjects had ≥80% effacement. Women presenting with established labor had a greater chance of successful VBAC. Most of the patients 39 had spontaneous onset of labor while in 11 cases were induced. Eighty-six percent underwent VBAC successfully, and 14% of cases failed to undergo VBAC. Six subjects (12%) had undergone caesarean section. During caesarean section, peritoneal adhesion (83.33%), bladder adhesion with lower segment (66.67%), liquor-stained amniotic fluid (66.67%), cord around the neck (33.33%) were found. It was observed that the majority (76%) of the neonates were born with a birth weight between 2.5 to 3 kg, and 92% of the neonates had an APGAR score 7 at 1 min and 10 at 5 min. Only 2 neonates died after VBAC, but they died a few hours after admission in the Neonatal ward. The mother of these two neonates was in a prolonged 2nd stage of labor on admission. Peripartum hysterectomy was done in one case due to extension of cervical tear up to the body of the uterus following precipitate labor. The average length of hospital stay was about 24 hours. after delivery for most (86%) of the mothers (after VBAC), whereas only 2% stayed for more than 5 days (who underwent peripartum hysterectomy). Conclusion: From the Study, it could be concluded that if a mother fulfilled the criteria, VBAC could be attempted as it has a few maternal and fetal complications. If risk factors are identified and proper antenatal care is given, VBAC could be successfully undertaken without any grave maternal and fetal outcomes.
Original Research Article
Nov. 24, 2021
“Awareness about Cervical Cancer among the Woman Attending in the Out-Patient Department in a Tertiary Level Hospital, Dhaka, Bangladesh”
Farzana Islam Khan, Rawshan Ara, Nahid Sultana, Naireen Sultana, Farhana Hossain, Umme Hafsa, Hasinatul Ferdous Lopa
Page Numbers : 452-457
DOI : 10.36348/sijog.2021.v04i11.007
Introduction: Cervical cancer is one of the most common causes of cancer death in the world. It constitutes about one fourth of the total number of female cancers patient in our country. Cervical cancer is the second leading cause of cancer in females in developing countries and first in developed countries. Objective: To assess the level of awareness among the women attending the OPD of DMCH regarding cervical cancer. Materials and Methods: The cross sectional study was conducted among the outdoor patients of Obstetrics & Gynecology wards of Dhaka Medical College Hospital, Dhaka, Bangladesh from 1st July 2015 to 30th December, 2015. The study period was only 6 months. 95 patients included in your study. The aim of the study is to assess the level of awareness among the women attending the OPD of DMCH regarding cervical cancer. The sample was collected from the women attending GOPD of DMCH by random sampling. The sampling was done to select the patient according to the eligibility criteria. Results: This study age of maximum women was within below 30 years and the minimum numbers of women were from above 30 years out of 100 women. The numbers of women in these two categories were 84% and 16% respectively. The mean age and standard deviation of total study population was 24.184 ±6.63years.Maximum respondents of our study received education up to primary level (43%)followed by illiteracy (31%). Risk factors were mentioned as genital infection (15.79%), OCP (21.93%), multiple sexual partners (10.53%), white discharge (21.93%), repeated MR (12.28%), many children in early age (8.77%), smoking (8.77%). They heard of cancer from various sources such as Uthan boithok (28%), electronic & Print media (27%), Miking of VIA camp (25%). A greater percentage of the sample 91% reported having information on cervical cancer. However, when asked to describe cervical cancer 50% of the respondents could not. Of those who had some information about cervical cancer, a greater percentage (32%) of respondents gave a general description of a bad disease or fatal disease of the uterus which is curable when diagnosed early. Conclusion: Cervical cancer is a common female cancer but apt knowledge regarding the risk factors and prevention way of this disease may show excellent response. Keeping that in mind, the country policy maker took many projects to campaign against cervical cancer to improve the awareness of community people. As female of reproductive age are one of the principle group of sufferer of the disease so the research work was operated on the married, unmarried, widow and divorced women of this age group. This study proved that the awareness regarding the disease just now is almost unsatisfactory.