International Journal of Clinical Obstetrics and Gynaecology

Journal Information
ISSN / EISSN : 2522-6614 / 2522-6622
Published by: Comprehensive Publications (10.33545)
Total articles ≅ 878
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Karali Hf, Farhad Es, Poh Dawn Siaw Celine, Phong Yen Wen, Soorianarayanan Parveena, Ting Jason Siong, Zaigham Mt
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 46-57; https://doi.org/10.33545/gynae.2021.v5.i6a.1057

Abstract:
Introduction: Early pregnancy loss is still arguably considered primarily a
Karali Hf, Poh Dawn Siaw Celine, Phong Yen Wen, Soorianarayanan Parveena, Ting Jason Siong, Zaigham Mt, Farhad Es
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 17-21; https://doi.org/10.33545/gynae.2021.v5.i6a.1052

Abstract:
Introduction: Pregnancy loss is a phenomenon mostly researched from the perspectives of expectant mothers. Nevertheless, the loss is equally a painful experience for the male partners as well. Therefore, excluding them during early pregnancy loss management has created a research gap that needs to be addressed.Methodology: This review analysed international guidelines on early pregnancy loss management to understand the consideration of male partner management during the early pregnancy loss process. The research team reviewed twelve (12) international guidelines written in English from official websites until August 2020. Through this review, the research team answered the study’s research question and aim.Results: There are limited guidelines and no clear protocols in involving, care, counselling, or support of male partners during or after the process or even psychological care for males victimised by early pregnancy loss. In general, specific guidelines considering male partners with specifications on each time loss are necessary to provide sufficient emotional and psychological support. Molar and ectopic pregnancies’ impact on men must be investigated further. Insufficient recognition and support provided to the grieving couples post an early pregnancy loss for men. Society and healthcare providers and practitioners must pay attention to the lack of support given post-loss, especially male partners.Conclusion and Recommendations: Thorough steps need to be taken to acknowledge the gravity of including male partners in early pregnancy loss management and validating that they are also emotionally affected like their women partners. Specific guidelines, which include male partners, are recommended for the management of early pregnancy loss.
Ponnam Chandramathi, V Rama Devi, Ponnam Vaishnavi
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 08-10; https://doi.org/10.33545/gynae.2021.v5.i6a.1049

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Background: Out of 100 pregnancies, approximately 15 to 25 women have vaginal bleeding in first trimester. This vaginal bleeding usually occurs 1 to 2 weeks after fertilisation during implantation of fertilized egg in uterus lining. Aim: The present study evaluated the maternal and perinatal outcomes in women with first trimester vaginal bleeding. Materials and Methods: The present study is a cross sectional study which was conducted between February 2017 to March 2019. 50 pregnant women with vaginal bleeding in the first trimester of pregnancy were admitted in Department of Gynecology and Obstetrics. Results: Premature labour was found to be highest complication during first trimester vaginal bleeding which was 28%, other complications were premature membrane rupture (8%), placental abruption (14%), intrauterine death (2%), Intrauterine growth retardation (4%) and there were no complication in 14%. Caesarean section (28%) was highest pregnancy outcome in women with first trimester vaginal bleeding. 7 women had abortion. Conclusion: The present study concluded that predicting factors of mother and infant consequences of pregnancy might be first trimester vaginal bleeding.
Karali H F, Farhad E S, Zaigham M T, Poh Dawn Siaw Celine, Phong Yen Wen, Soorianarayanan Parveena, Ting Jason Siong
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 22-33; https://doi.org/10.33545/gynae.2021.v5.i6a.1053

Abstract:
Introduction: Parents with early pregnancy loss uses various coping models, men cope with the loss differently, with immediate and long-term psychiatric consequences. As men’s emotional coping mechanisms are heavily affected by societal dilemmas, they hide their emotions. This study aims to determine how different types of early pregnancy loss affect male partners responses, coping strategies and expectations.Method: The study used the PICO approach and searched for relevant articles from June 15th, 2020, to December 15th, 2020. Forty-eight (48) articles were selected based on pre-determined inclusion and exclusion criteria from Ovid MEDLINE® without Revisions and Embase database.Summary of evidence: Male partners are equally psychologically involved as women but are often overlooked. There is a lack of a strong support system from society and professional caregivers to help these men. They are generally seen as the family’s source of strength. Men feel uncomfortable when emotionally affected by the event as they cannot channel their emotions out due to societal pressures and expectations. Men need to be supported by providing the necessary grief management.Conclusion: Male partners responses, their coping strategies and what they expect from society and healthcare providers require an in-depth investigation to determine the support they need.
Deepika Verma, Nutan Verma
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 11-13; https://doi.org/10.33545/gynae.2021.v5.i6a.1050

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Background: Ectopic pregnancy is one of the most emergency condition during the pregnancy period, in which the fertilized egg implanted outside the uterine cavity. The present study was conducted to compare laparoscopy and laparotomy for ruptured tubal ectopic pregnancy.Materials & Methods: 92 patients of ectopic pregnancy were divided into 2 groups of 46 each. Group I patients were managed with Laparoscopy and group II with Laparotomy. Parameters such as gravida, parity, previous spontaneous loss, previous MTP, Hb at admission, period of gestation, total blood loss and hemoperitoneum were recorded. Results: The mean age in group I was 31.1 years and in group II was 32.4 years, parity was 1 in each group, gravida was 2 and 3, previous spontaneous loss (%) was 14.5 and 21.6, Hb at admission (mg) was 7.5 and 8.2, previous MTP (%) was seen in 16.7 and 18.2, acute abdomen (%) was seen in 82 and 70 and incidental (%) was 14 and 28 in group I and II respectively (P< 0.05). The location was ampula in 56% and 60%, corneal in 12% and 15%, fimbrial in 11% and 11%, interstitial in 21% and 14%. No of PRBC transfusions (%) was 11.2 and 13.4 and duration of hospital stay was 4.1 days and 7.3 days in group I and II respectively. The difference was significant (P< 0.05).Conclusion: Laparoscopy was advantageous over laparotomy in terms of shorter hospital stay and speedy recovery.
Mamta Sharma, Dharmaraj Mahawar, Mukesh Meal
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 83-86; https://doi.org/10.33545/gynae.2021.v5.i6a.1058

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Objectives: To classify adolescent abnormal uterine bleeding (AUB) according to PALM COIEN classification and its outcome in tertiary care centre.Material and Methods: This study is observational study, conducted in J K Lone Mother and child hospital, Medical College Kota, from June 2019 to June 2020. Out of all the girls attending OPD, adolescents with non-menstrual complaints, primary amenorrhea and dysmenorrhea were excluded. Finally girls with complaints of heavy period, irregular cycles and oligomenorrhoea (AUB) formed the study group. Complete blood count, PT/aPTT, kidney function test, liver function test and random blood sugar and Thyroid Function Test (TFT) were done in all girls. If PT/aPTT was dear ranged then further coagulation profile was done. Trans abdominal ultrasonography (USG) was done and MRI and CT were also done as per needed. In suspected PCOS cases and girls with obesity, oligomenorrhoea and hirsuitism additional tests like Follicle Stimulating Hormone (FSH), Leutinizing Hormone (LH), Serum Prolactin level, Free Testosterone and insulin level done. The Prevalence of menstrual disorder in adolescent was calculated. Management of cases according to FIGO guideline was done. Treatment of AUB would be based on underlying etiologic and severity of bleeding. Evaluation of menstrual blood loss was assessed using The pictorial blood assessment chart (PBLAC) [1-3]Results: The mean age of patients was 15.08 years with majority (47.5%) having age between 13-15 years followed by 40% in age group 16-19 years and 12.5% in age group 10-12 years. Here, 90% patients were inn AUB-O class followed by 4.5% in AUB-N, 2.5% in AUB-C, 2% in AUB-I, 0.5% in AUB-L and AUB-P class. According to palm 1% and coein 99%.Out of 180 patients which were in AUB-O class according to Palm Coein classification, 47.2% had immaturity of hypothalamic pituitary ovarian axis followed by 39.4% had PCOS and 13.3% had thyroid disorder.Conclusion: The study concluded that Menorrhagia in adolescents can be caused by a number of condition, the most common being the immature hypothalamic-pituitary-ovarian axis. Assessment of each case with through history, physical examination, and laboratory in investigation is crucia in reaching the diagnosis. We see that we can successfully apply palm coein approach to adolescent AUB. Although bulk of adolescent. AUB is due to ovulatory disorder. We can conclude from the present study that commonest cause of puberty menorrhagia is immaturity of the hypothalamic- pituitary ovarian axis resulting in anovulation. Anatomical abnormalities like fibroid or polyp are also to be ruled out. Once the diagnosis is made medical or surgical treatment as appropriate is to be administered. Early innervation as soon as students are admitted into higher school of learning would be beneficial in helping them to manage this unavoidable experience without any effect on their health and academic work.
Kiran Naik, Suma Moni, Soumya Patil
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 01-07; https://doi.org/10.33545/gynae.2021.v5.i6a.1048

Abstract:
Background: The thyroid dysfunctions are quite common endocrinal disorders seen during pregnancy and the maternal thyroid dysfunctions may go unnoticed due to nonspecific symptoms. The maternal thyroid dysfunction has an adverse impact on both maternal and fetal outcome. The evaluation of thyroid functioning during first trimester avoids complications both in mother and fetus. The present study was conducted to assess the maternal thyroid functions (T3, T4, &TSH) during first trimester of pregnancy and also to determine the proportion of thyroid dysfunction in these subjects. Method: One hundred and thirty five apparently normal first trimester pregnant women were randomly selected in the age group of 18-45 years from obstetric outpatient department of S.D M Medical College, Dharwad. The FT3, FT4 &TSH values were estimated using chemiluminescent immune assay method and TPO antibodies for abnormal thyroid functions. Conclusion: A high proportion of hypothyroid (15.5% hypothyroid range) was observed in first trimester of pregnancy, and hence a routine antenatal screening is suggested to diagnose the thyroid dysfunction at the earliest gestation.
C Rajani, S Vanitha
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 87-89; https://doi.org/10.33545/gynae.2021.v5.i6b.1059

Abstract:
Background: Subfertility is defined as one year of unprotected intercourse without conception. This study evaluates the efficacy of sonosalpingography (SSG) as an alternative to Diagnostic laparoscopy (D’Lap) in assessment of tubal patency in patients with primary/secondary subfertility. Objective: To find out whether Sonosalpingography, which is a less invasive method, can be used for assessment of tubal factor in cases of primary and secondary subfertility initially instead of Diagnostic laparoscopy with chromopertubation. Methods and Materials: The study is conducted in the Dept. of Obstetrics and Gynaecology, Govt. KMCH among women with primary/secondary subfertility attending Gynaec OP. SSG is done on 7th or 8th day of the menstrual cycle. Diagnostic laparoscopy with chromopertubation was performed under general anesthesia on the following day to evaluate pelvic pathology and tubal patency. Results: Of the 23 tubal blocks detected by SSG, 14 were primary and 9 were secondary subfertility cases. Of the actual 20 tubal blocks detected by D’Lap, 12 were primary and 8 were secondary subfertility cases. It was found that SSG has a sensitivity of 97% and specificity of 90% and a diagnostic accuracy of 96%. Conclusion: SSG offers a much less invasive method of diagnosing tubal pathology while maintaining a high sensitivity and specificity similar to that of laparoscopic chromopertubation.
Deepak Patil, Shahla Yazdani Abraham
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 37-42; https://doi.org/10.33545/gynae.2021.v5.i6a.1055

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Background: Rescue Intra Cytoplasmic Sperm Injection (ICSI) is an emergency micromanipulation endeavour aimed at salvaging the IVF ET cycle. It is aimed to save the situation in which the ART team and the couple has invested so much. Aim: The aim of this study was to assess the option of recue ICSI in cases of Fertilisation Failure (FF) in order to salvage the IVF ET. Material and Methods: This retrospective study was done in a tertiary care Assisted reproductive techniques centre of Armed Forces. Records were assessed to study the cases of fertilization failure. All those cases which had an obvious etiology for probable FF were excluded. Remaining cases where rescue ICSI was done were studied to assess its role. Study design: Retrospective Observational study Study location: A tertiary care ART centre in Armed Forces Hospitals Study duration: Dec 2018 to Dec 2020 Subjects and selection method: All couples going IVF ET for various etiologies were studied for fertilization failure. Only cases with unexplained FF were studied to assess the role of rescue ICSI. Inclusion criteria 1. Normal BMI (in the range of 18.5 to 24.5 kg/m2) 2. Normal ovarian reserves (AMH above 1.0 ng/ml) 3. Conventional IVF used for fertilization Exclusion criteria 1. Male factor infertility 2. Prior fertilisation failures 3. Advanced maternal/paternal age (Below 40 yrs) Procedure methodology: Records of all patients meeting the inclusion and exclusion criteria were studied Stimulation protocol: Antagonist protocol was used universally for stimulation in our centre. Patients were started on Inj Recombinant Follitropin Alpha (Merck Pharmaceuticals) 1050 IU/1.75 ml powder with solvent for stimulation. Personalised Stimulation protocol was started based on Age, BMI, Ovarian volume, AMH and previous stimulation data if any. Inj Ovurelix containing Citrorelix 0.25 mg from Sun Pharmaceuticals was started as antagonist on evidence of sufficient endogenous Estrogen production. Namely ultrasounds follow up showing follicular size reaching 12mm or endometrial thickness more than 6mm. On adequate stimulation with a cohort of at least 4 follicles of size 18mm, trigger was given with inj Ovitrelle 250 mcg (Contains Recombinant Choriogonadotropin Alpha,250 mcg, Merck Ltd)) and ovum pickup was done after 36-40h. Conventional Insemination was done only if post wash specimen shows a sperm concentration of more than 20 million/ml with more than 50% grade 4 motility. After denudation metaphase 2 mature oocyte without two Pronuclei stage were reassessed after 2h to rule out delayed fertilization. Those m2 oocytes which failed to fertilize were provided rescue. ICSI was done using micromanipulation disposable Injecting and holding needles from Vitromed, with bend angle of 30 degree. The holding needle had an inner diameter of 20 micro meters and injecting needle had an inner diameter of 5 micrometer. The freshly prepared semen sample was taken in PVP media under oil overlay and ICSI performed in the standard way. Results: The incidence of fertilization failure in our clientele was about 11%. Out of 415 cases, 45 patients had complete fertilization failure. Patients meeting our inclusion and exclusion criteria for FF were 23 cases. Most common cause of FF was unexplained infertility with mean duration of marriage as 9y 7mo.Overall 15% cases were due to poor ovarian reserve and with poor yield on OPU. Male factor infertility in spite of ICSI failed to fertilize in 6 cases. We obtained a fertilization rate of 41% with rescue ICSI and on further growth 56% reached 4 cell stages. Off these 21 had minimal fragmentation. Those embryos which had minimal fragmentation and equal blastomere were allowed to grow and 6 of 73 fertilized oocyte reached 8 cell stage. Conclusion The emergency rescue ICSI, in window of 18-20 hours can help salvage a cycle faced with complete fertilisation failure. It will reduce the physical and financial burden of IVF ET cycle to some extent. We conclude it is a viable option in a perplexing situation of complete fertilisation failure
Deepika Verma, Nutan Verma
International Journal of Clinical Obstetrics and Gynaecology, Volume 5, pp 14-16; https://doi.org/10.33545/gynae.2021.v5.i6a.1051

Abstract:
Background: Implantation of a fertilised ovum outside the normal uterine cavity is called ectopic pregnancy. The present study was conducted to assess cases of ectopic pregnancy.Materials & Methods: 58 cases of ectopic pregnancy in age ranged 18- 40 years were subjected to urine pregnancy test and transvaginal ultrasound examination. Parameters such as age, blood group, parity, history of previous ectopic pregnancy, previous abdominal surgery etc. were studied. Results: Common risk factors for ectopic pregnancy was ART in 7%, spontaneous abortion in 10%, previous abdominal surgery in 46%, infertility in 12%, previous ectopic pregnancy in 8%, dilatation and curettage in 7% and TB in 10% cases. Common clinical features were bleeding pv in 24%, vomiting in 14%, syncope in 6%, amenorrhea in 75%, pain abdomen in 84%, fever in 15% and passage of clots in 23%. The difference was significant (P< 0.05).Conclusion: Common risk factors for ectopic pregnancy was ART, spontaneous abortion, previous abdominal surgery, infertility and previous ectopic pregnancy.
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