Risk Factors of UTI in Pregnant Women and the Maternal and Perinatal Outcome Attending North East Medical College and Hospital, Sylhet
Dr. Nasrin Chowdhury, Dr. Mohammad Shahadat Hossain Mazumdar
Page Numbers : 254-257
DOI : 10.36348/sijog.2021.v04i06.004
Objective: In this study was designed to see the risk factors of UTI in pregnant women and the maternal and perinatal outcome. Methods: In this case control study, women enrolled in antenatal OPD of North East Medical College and Hospital, Sylhet, during July 2020 to December 2020, were randomly allocated into case and control group. The inclusion criteria for pregnant women during the 13th - 26th weeks of pregnancy in the case group was the positive urine cultures of bacteria (more than 10 5 colonies growth in a standard positive urine culture). The same with negative culture was control group. Then parameters such as parity, sexual activity, type of delivery, and infants' birth weight were recorded in questionnaire. Results: Incidence of UTI in mid trimester pregnancy during study period was 26%. Risk factors like previous history of UTI, sexual activity and multipara were higher in case group. Highest age incidence was between 20-30 years. Predominantly patients were asymptomatic. Lower abdominal pain was a common symptom. Eshcherichia coli was commonest organism. Prevalence of bacteriuria was more in women with history of UTI earlier in pregnancy. Premature rupture of membrane was significantly higher in case group. Caesarean section was higher in the case group. According to this study, the average weight of newborns whose mothers had UTI was 2.83 kg and it was 0.44 kg lower than the newborns of healthy mothers. Conclusion: According to the conducted study, UTI in mothers is the major reason for comparatively lower birth weight of infants. Routine urine check during pregnancy is helpful in diagnosing this early and fast care. For better results, more analysis is required.
Original Research Article
June 11, 2021
A Study on Factors Affecting the Perinatal Outcome in Eclampsia of the South Indian Population
Background: The common perinatal complications associated with eclampsia are intrauterine death, intrapartum death, neonatal death, neonatal seizures, and prematurity. Aim: To study the factors affecting perinatal outcome in eclampsia of the south Indian population. Materials and Methods: 50 eclampsia patients (>32 weeks of gestational age) utilized, and the patients with medical complications like anaemia, diabetes mellitus, hypertension, vascular or renal disease, multiple gestations, and polyhydramnios excluded from the study. The patient history followed by physical examination and systemic examination recorded. Results: In 50 cases of eclampsia, 12 perinatal deaths occurred, of which five neonatal deaths (41.6%) and the most common cause for the death are prematurity (60%) in the present study. The majority of perinatal deaths observed in the middle socio-economic group population. The perinatal deaths were significantly higher in unbooked cases. Perinatal mortality increases with parity and found statistically significant. Perinatal mortality was significantly higher in < 36 weeks of gestational ages. Perinatal mortality was considerably higher in patients with the blood pressure of more than 160/100 mm of Hg. Perinatal mortality increases with the number of convulsions and found statistically significant. The perinatal mortality was very high in convulsion delivery interval in more than 24 hours, with an incidence of 30%. Perinatal mortality increases with the duration of labour. The perinatal mortality was more in vaginal delivery (34.4%) in the present study. Conclusion: The better health care facilities, improving socioeconomic status, adequate antenatal supervision will improve perinatal outcome in eclampsia.
Original Research Article
June 6, 2021
“A Comparative Study of Visual Inspection with Acetic Acid and Papsmear in Screening Cervical Intraepithelial Neoplasia”
Dr. N. AieshaKhatun, Dr. Shobha N. Gudi
Page Numbers : 241-249
DOI : 10.36348/sijog.2021.v04i06.002
Background: Cervical cancer ranks as the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women. Almost 70% of the global burden of cervical cancer falls in areas with lower levels development, and more than one-fifth of all new cases are diagnosed in India. Cancer cervix has been considered preventable because it has a long pre-invasive state and availability of screening programs and treatment of pre- invasive lesion is effective. No form of cancer documents the remarkable effects of screening, early diagnosis and curative therapy on mortality rate in a better way than does cancer cervix. Aim: To compare the diagnostic value of Visual Inspection of Cervix with Acetic Acid with Papsmear for screening of Cervical intraepithelial lesions keeping Histopathology as gold standard. Material and Method: It is a cross sectional and comparative study of 522 women who fulfilled inclusion criteria attending outpatient Department of Obstetrics and Gynaecology at St Philomena’s Hospital for a period of 2 years (December 2016 to November 2018). Both pap smear and VIA are done in these cases. In positive cases, colposcopy guided cervical biopsy done and sent for histopathological studies. All results compiled and analyzed. Sensitivity, specificity, positive predictive value and negative predictive value are calculated and compared for pap smear, visual inspection with acetic acid by taking colposcopy guided cervical biopsy (histopathology) results as gold standard. Result and observations: In the present study , diagnostic values of VIA are comparable with papsmear with sensitivity of 86.6% and 80.6% respectively, specificity of 97.8% and 98.9% respectively, PPV of 85.3% and 91.5 % respectively and NPV of 98% and 97.2% respectively with histopathology as the gold standard. Conclusion: VIA has comparable results to Pap smear regarding its sensitivity, specificity, positive predictive value and negative predictive value and can be used as good alternative to pap smear in mass screening of large population. VIA can be combined with Pap smear to improve the efficacy of screening procedures in detection of pre-cancerous and cancerous lesions of cervix.
Original Research Article
June 1, 2021
A Comparative Study of Primary Caesarean Section in Primigravida and Multigravida in a Tertiary Care Hospital in Shillong, Meghalaya
Dr. Wilanika Bamon, Prof. S. N Goswami, Dr. I .Roy, Dr. N. Saikia
Page Numbers : 225-240
DOI : 10.36348/sijog.2021.v04i06.001
Background: Caesarean section when indicated is a life saving procedure but when performed without appropriate indications can add risk to both the mother and baby. However over the past 15 years it has been noted that the incidence of caesarean section has doubled all over the world, different regions having different caesarean rates which has become a serious public health issue as morbidity and mortality from an unindicated caesarean section is more than from a vaginal delivery. The present study was done as there are no studies conducted in Northeast, India and in the tribal population to know the rate of primary caesarean section in primigravida & multigravida and to know the aspects which need due attention in either group (primigravida or multigravida) which can be differentiated for better obstetric management. Aim & Objectives: 1) The primary objective is to compare the rate of primary caesarean section in primigravida and multigravida. 2).The secondary objective is to compare the indications, maternal complications, early neonatal outcome in primigravida and multigravida. Material and Method: Study population- This study consisted of two groups, group A consist of 160 primigravida who fulfil the inclusion and exclusion criteria. Similarly, group B consist of 160 multigravida who fulfil the inclusion and exclusion criteria. Inclusion criteria: 1) All primigravida (booked and unbooked) with gestational age more than 37 weeks and above who have come for delivery. 2) Multigravida upto gravida 5 with gestational age of more than 37 weeks and above who has had one previous viable vaginal delivery. Exclusion criteria: 1).Patient with nonviable pregnancy 2) Patient not willing to participate in this study. 3) Patient having previous history of myomectomy or hysterotomy. 4) Gravida 6 and above as they are prone to complications. Results: The overall incidence rate of primary caesarean section rate in this study is 58.75% in primigravida and 31.87% in multigravida. Maximum patients who underwent primary caesarean section were in the age group 20-25years and 25-30 years for both groups. Maximum of the patients were posted for emergency caesarean section 96.8% in primigravida and 94.1% in multigravida. Foetal distress was the commonest indication 54.95% in primigravida and cephalopelvic disproportion 47.92% in multigravida. Intra-operative complications were common in both groups. In multigravida PPH 77.3% was more common. However uterine wound extension 80% was more common in primigravida. The overall post-operative complications were more common in multigravida (25.49%) compared to 13.82% in primigravida. Early neonatal outcome was good in both the groups. There was only 1 neonatal death during the study period in group B. Conclusion: As we have witnessed an increased rise in the rate of caesarean section over the past few years it is our responsibility to bring out the change and modifications and note that the indications indicated for caesarean section should be genuine. From this study, we can also see many females having no antenatal check-up which we can help by creating awareness and importance of antenatal check-up and should train doctors for timely referral of patients to avoid unnecessary complications. The need to better improve skills of obstetricians and staff to read CTG, perform ECV, perform instrumental deliveries especially in second stage of labour, proper counselling of patients and availability of labour analgesia to decrease the rate of caesarean on request. The overall reduction in caesarean rate can only be reduced if the indications of primary caesarean sections can be analyzed.
Original Research Article
May 30, 2021
A Study on the Incidence of Eclampsia and Factors Influencing Maternal Outcome in Karnataka Population
Background: Eclampsia is a life-threatening emergency that continues to be a significant cause of maternal mortality worldwide Aim: To study the incidence of eclampsia and factors influencing maternal outcome in Karnataka population Materials and Methods: A total of 50 eclampsia cases of > 32 weeks of gestation age utilized for the present study. Patients with medical complications like anaemia, pre-existing hypertensive, diabetes, vascular or renal disease, multiple gestations, and polyhydramnios excluded from the study. The eclamptic management by Zuspan regimen, anti-hypertensive management, and obstetric management by vaginal route or cesarean section was planned for the patients in our study. The mothers followed up for evidence of a decrease in BP followed by other complications of eclampsia for six weeks, and the babies delivered are followed up during the early neonatal period for difficulties in the present study Results: The majorities of the patients belong to low socio-economic status 94%, belong to middle class 6% in the present study. The Maternal deaths occurred in the low socio-economic group with an incidence of 4.3%. Maternal mortality increases with an increase in the first fit-admission interval was observed in the present study. Maternal mortality was higher in patients with higher Blood Pressure levels at the time of admission. The Incidence of eclampsia was 0.64%, followed by maternal mortality was 0.4% in the present study. The maternal mortality was significantly higher in patients who had six or more episodes of convulsions. The maternal mortality was 10% in convulsion delivery interval >24 hours and 4.2% in convulsion delivery interval were 13-24 hours. Maternal mortality was not observed in convulsion delivery interval <12 hours in the present study. Conclusion: The incidence of eclampsia is high due to the high referral of eclampsia cases, and reflecting poor antenatal care in the present study suggests that early attention and intensive management are essential for improving the maternal outcome in eclamptic patients.
Original Research Article
May 29, 2021
Endocrine and Sonographic Evaluation of Severe Male Factor Infertility: A Descriptive Analysis
Dr. Shakeela Ishrat, Dr. Mitu Debnath, Dr. Kazi Shamim Ara, Dr Mehnaz Mustary Shume, Dr. Serajoom Munira, Dr. Sabiha Sultana
Page Numbers : 214-220
DOI : 10.36348/sijog.2021.v04i05.008
Objective: The objective of the study was to explore the prevalence of different conditions in infertile men with severe male factor, based on endocrine evaluation and scrotal ultrasound. Materials and methods: The retrospective study was carried out on 86 infertile men with azoospermia and severe oligospermia who attended the Male infertility clinic of the department of Reproductive Endocrinology and Infertility of Bangabandhu Sheikh Mujib Medical University. They had evaluation with serum testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and thyroid stimulating hormone (TSH). In addition they had scrotal ultrasound. Results: Most (88.37%) of them had azoospermia. Severe oligospermia was present in 11.63%. Testosterone deficiency was detected in 34.9%. Non-obstructive forms (pre-testicular and testicular causes) comprised 62.8%. Scrotal abnormalities suggestive of obstructive and non-obstructive varieties were overlapping with endocrine diagnoses. Conclusion: Majority of men with severe male factor infertility has non-obstructive azoospermia which has poor chance of sperm retrieval for in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI). Substantial proportion of them has testosterone deficiency which needs to be treated if they do not opt for IVF-ICSI with poor prognosis or donor oocytes.
Original Research Article
May 26, 2021
Epidemiology of Cesarean Section in a Single Center Study
Dr. Farida Begum, Dr. Nahid Akter
Page Numbers : 210-213
DOI : 10.36348/sijog.2021.v04i05.007
Introduction: Cesarean delivery is increasing in both developed and developing countries. Though it is considered as a lifesaving surgical procedure for the pregnant women and the neonate, it has various risk factors and complications. Objective: The aim of this study was to assess the epidemiology and the results of the cesarean section in a single center of Bangladesh. Study Design: Retrospective observational study. Place and Duration of the study: The study was conducted in the department of Gynae & Obstetrics, Sher E Bangla Medical College Hospital, Barishal, Bangladesh, during the period from January 2019 to December2019. Methods: This is a retrospective observational study. Among the total number of cesarean patients, we recruited 75 women who were age 25-35 years with gestational age 37-42 weeks of pregnancy. Those who were less than 37 weeks of gestational age, the patients with multiple pregnancy complications, and those who were referred were excluded from the study. Written consent was taken. Collected data were compiled and analyzed using computer-based software, statistical package for social science (SPSS). Result: In this study, a total of 75 women who had a cesarean delivery were included. The baseline characteristics of the study people were: maximum 45(60.0%) study people were from the age group of 25-35, multipara was 54 (72.0%), and primipara was 21 (28.0%), most of the study people 39(52%) had normal BMI 10(25.3%) had overweight, 9(12.00%) had obese, 8(10.7%) had underweight. The majority 22(29.3%) of the study people were secondary educated. Most of the study people 37(49.3%) had 37-42 gestational age. The indications of cesarean delivery, 31 (41.3%) had repeat cesarean delivery, 12 (16.0%) had failed to progress, 9 (12.0%) had fetal distress, 8 (10.7%) breech presentation, 7 (9.3%) had antepartum hemorrhage, 6 (8.0%) had hypertension and 2 (2.7%) had diabetes mellitus. SAB was used in 61 (81.33%), pfannenstiel incision was used in 70 (93.3%), and the average operating time was 51.2 minutes. Subcuticular was mostly used 42(56%) for skin stitch followed by vertical mattress in 33(44.0%). Intraoperative antibiotic was used in 11 (14.7%), postoperative antibiotic was used in 9 (12.0%), both of these mentioned antibiotics were used in 6 (8.0%), and no antibiotic was used for 49 (65.3%). Conclusion: Repeat cesarean deliveries were found in most of the study people of the cesarean section. Surgical site infection was the most common complication.