Publications by authors named "Jyoti Meena"

28 Publications

  • Page 1 of 1

A Cross-Sectional Analysis to Evaluate Knowledge, Attitude And Practices Among Pregnant Women During COVID-19 Pandemic.

J Obstet Gynaecol India 2021 Sep 4:1-10. Epub 2021 Sep 4.

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: To assess knowledge, attitude and practices (KAP) towards COVID-19 among pregnant women at a tertiary care hospital.

Methods: This was a questionnaire-based cross-sectional analysis pertaining to COVID-19 which was conducted at a tertiary care obstetric facility in India among 200 consecutive consenting pregnant women. They were assessed for demographic details and KAP score (knowledge-17 questions, attitude-9 questions and practice-8 questions). Analysis of data was done using Statistical Package for the Social Sciences (SPSS) version 25.0.

Results: The participants had adequate mean knowledge score (± SD) of 22.5 (± 3.5) were following good practices [mean score (± SD) = 15.5 (± 2.6)] and showed positive attitude for preventive measures against COVID-19 [ (%) = 194(96%)]. Low knowledge score (-value 0.030) was seen in non-health care workers.

Conclusion: This study demonstrated that majority of the pregnant women had satisfactory knowledge, positive attitude and were following practices in right manner regarding COVID-19 but continued efforts for generating awareness were warranted. As India is battling the second COVID-19 wave and in the absence of definitive cure, strengthening of health policies directed at pregnant women should be prioritized with special focus on significant gaps in KAP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13224-021-01558-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8416569PMC
September 2021

Adjuvant treatment in cervical, vaginal and vulvar cancer.

Best Pract Res Clin Obstet Gynaecol 2021 Aug 5. Epub 2021 Aug 5.

Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Primary surgical management is successful as the sole therapeutic modality in the majority of women with early-stage cervical, vaginal and vulvar cancer, but the presence of certain risk factors in the surgico-pathological specimen indicates a poorer prognosis. Adjuvant treatment can improve overall survival in such cases. Important risk factors in cervical cancer include intermediate-risk factors (large tumor size, deep cervical stromal invasion, lymph-vascular space invasion) and high-risk factors (positive or close margins, lymph nodes, or parametrial involvement). In vulvar cancer, positive margins and lymph nodes are the two most important factors for adjuvant therapy. Radiation therapy has been the mainstay of adjuvant therapy in these cancers, supplemented by chemotherapy. Recent advances have witnessed the inclusion of newer therapeutic modalities such as immunotherapy. This review addresses the current status of various adjuvant therapeutic modalities for these gynecological cancers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bpobgyn.2021.07.005DOI Listing
August 2021

Maternal and Perinatal Outcomes of Pregnancy in Women With Autoimmune Disorder.

Cureus 2021 Jun 29;13(6):e16024. Epub 2021 Jun 29.

Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND.

Objective Pregnancy with an autoimmune disorder is faced with several risks for mother and fetus. The aim of the present study is to analyze the course and outcome of pregnancy in women with autoimmune disorders (AIDs). Methods A retrospective cohort study was conducted at a tertiary care teaching hospital. The hospital records of 153 pregnancies with autoimmune disorders and 1095 low-risk pregnant women who served as controls were reviewed. An adverse perinatal outcome was defined as the presence of any obstetric complications, including preeclampsia, eclampsia, abruption, antepartum hemorrhage (APH), prematurity, fetal growth restriction (FGR), intrauterine death (IUD), intrapartum event, mode of delivery, birth weight, neonatal intensive care unit (NICU) stay, or disease-specific neonatal complications. For all statistical tests with two-tailed probability, p<0.05 was considered statistically significant. Results A high incidence of adverse perinatal outcomes was observed in all women with AIDs when compared with age-matched controls. The highest incidence of adverse perinatal outcomes was observed in women with Takayasu's arteritis. The incidence of abortions was more in women with antiphospholipid antibody syndrome (APS) and Grave's disease (22.2% and 33.3%, respectively). The incidence of prematurity, fetal growth restriction (FGR), and low birth weight were highest in women with systemic lupus erythematosus (SLE). Pregnancy with myasthenia gravis and rheumatoid arthritis did not have any significant adverse impact on pregnancy outcomes. Conclusion We found a strong association between autoimmune disorders and obstetric complications. The multidisciplinary team approach and pre-pregnancy optimization of the disease improve maternal and fetal outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.16024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320712PMC
June 2021

Cervical Cancer Prevention Efforts in India.

Indian J Gynecol Oncol 2021 2;19(3):41. Epub 2021 Jun 2.

Department of Gynaecologic Oncology, Cancer Institute (WIA) Adyar, Chennai, Tamil Nadu 600020 India.

Purpose: Cervical cancer is one of the leading cancers among women in India. Its prevention and control require a concerted effort to improve awareness among women regarding primary and secondary prevention strategies as well as access to care for treatment and palliation. A focused strategy is important to reach the World Health Organization's targets for cervical cancer elimination, due to be completed by 2030.

Methods: Currently available literature was reviewed regarding cervical cancer prevention strategies in India including various national programmes and other initiatives on the part of government, non-governmental organizations and professional organizations. Their applicability to the present situation was assessed.

Results: National programmes need to build on success stories of various states and neighbouring countries as well as to audit the performance. Strengthening of cancer registries and improvement of linkages between different healthcare levels with incorporation of task-shifting, adding digital technology and supporting programmes that promote women's welfare and health will also provide synergy to cancer control programmes. In the current pandemic era, HPV self-sampling can be an ideal method for screening. The development of an affordable, point-of-care HPV test is urgently needed to facilitate its introduction in low- and middle-income countries. HPV vaccination efforts need to be speeded up.

Conclusion: Scaling up of cervical cancer prevention with inclusion of widespread HPV vaccination and primary HPV test should be the new standard of care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40944-021-00526-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170054PMC
June 2021

Endovascular management of episiotomy site hematoma: Two cases and a brief review

Turk J Obstet Gynecol 2021 06;18(2):163-166

All India India Institute of Medical Sciences, Department of Radiology, New Delhi, India

Episiotomy site hematoma, though uncommon, can be associated with serious maternal morbidity. It arises mostly due to tissue trauma or injury to blood vessels, leading to the formation of a pseudoaneurysm. Sometimes, when surgical management fails, embolization of the bleeding vessel is a lifesaving option. Here, we report two cases of episiotomy site hematoma that required selective arterial embolization for management, following the failure of surgical management. A 28-year-old G6A5 woman underwent forceps delivery following which she developed a 6*6-cm right-sided vulvovaginal hematoma at the episiotomy site. After failed surgical management, arterial embolization was performed and hemostasis was achieved. A 26-year-old P2L2 woman with a history of surgical exploration for episiotomy site hematoma, presented postdelivery on postpartum day seven with profuse vaginal bleeding. Her computed tomography angiogram revealed a pseudoaneurysm of around 2.1*1 cm in length with a vaginal hematoma of 4*5 cm. Selective artery embolization performed and complete hemostasis was achieved with no complications. Selective arterial embolization is a safe therapeutic option for episiotomy site hematoma, especially if surgical management fails.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4274/tjod.galenos.2021.43958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191329PMC
June 2021

A descriptive audit of healthcare workers exposed to COVID-19 at a tertiary care center in India.

Int J Gynaecol Obstet 2021 Jun 18;153(3):393-397. Epub 2021 Apr 18.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: To provide a descriptive audit of healthcare workers (HCWs) exposed to COVID-19, and their contacts, to understand the dynamics of transmission among HCWs.

Methods: Retrospective analysis of contact tracing data of infected HCWs was done from March 1, 2020 to July 31, 2020 at a tertiary care center in New Delhi, India. Contacts were categorized according to the nature of contact and followed for 14 days.

Results: Qualitative RT-PCR testing was performed on 106 HCWs (from a total of 257) owing to exposure or development of symptoms. Positive results were found in 16 HCWs (6.2%) who were exposed to 120 other HCWs, generating 197 exposure incidents. Of these, 30 (15.2%) exposure incidents were high risk with multiple exposures in 48 (40.0%) HCWs. Exposure to infected HCWs was noted in 3 (18.8%) of 16 positive cases. Of the 197 exposure incidents, 54 (27.4%) were deemed avoidable exposures. Infection prevention and control policies were periodically reviewed, and the department implemented mitigating steps to minimize the risk to healthcare providers.

Conclusion: Instituting appropriate infection prevention and control policies and use of adequate precautions by HCWs is vital to minimize high-risk exposure to COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.13691DOI Listing
June 2021

Retrospective analysis of surgically treated cases of squamous cell carcinoma vulva.

J Cancer Res Ther 2021 Jan-Mar;17(1):186-190

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

Context: Vulvar carcinoma accounts for 3%-5% of gynecologic malignancies. The past three decades has observed changes in the trends of clinical characteristics and treatment modalities used in managing this disease.

Aims: The aim of the present study is to analyze the clinic-pathological characteristics and survival of women with squamous cell carcinoma vulva who underwent primary surgical management.

Settings And Design: This was a retrospective observational study.

Subjects And Methods: Case records of 30 consecutive patients with squamous cell carcinoma of vulva during the period of 2010-2016 were retrospectively reviewed and their clinical profile, treatment details, complications, and survival were analyzed.

Statistical Analysis Used: Kaplan-Meier survival analysis, followed by logrank test, was used for survival outcome, and Cox proportional hazard model was used to assess significant risk factors.

Results: The mean age of patients was 58 ± 12.9 years. The most common symptom was growth over vulva (73.3%), itching (63.3%), and nonhealing vulval ulcer (26.6%). The most common site for disease was labia majora. The surgical treatments ranged from wide local excision to radical vulvectomy. Postoperative adjuvant therapy was required for 16 patients. The median (95% confidence interval [CI]) overall survival was 27 (21.7-32.2) months. Five-year survival probability for early-stage disease (I + II) was 49% (95% CI: 12.9, 78.4) and for advanced disease (III + IV) was 24.8% (95% CI: 4.8, 42.6). Lymph node-positive status was found to have a significant impact on survival (hazard ratio of 4.9 [95% CI: 1.15-21.02, P = 0.02]).

Conclusions: Despite advances in detection and management modalities, the survival for vulval malignancies has not improved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jcrt.JCRT_9_19DOI Listing
March 2021

The impact of a segregated team roster on obstetric and gynecology services in response to the COVID-19 pandemic in a tertiary care center in India.

Int J Gynaecol Obstet 2020 Dec 22;151(3):341-346. Epub 2020 Oct 22.

Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India.

Objective: To determine the impact of roster reorganization on ensuring uninterrupted services while providing necessary relief to healthcare workers (HCW) in the obstetrics department of a tertiary care center amid the COVID-19 outbreak.

Methods: The COVID-19 rostering response began in April 2020 and evolved in two phases: (1) development of new areas for screening and managing suspected/positive cases of COVID-19; and (2) team segregation according to area of work. The impact of these changes on HCWs and patients was assessed 3 months later.

Results: Developing separate areas helped to minimize the risk of exposure of patients and HCWs to those with COVID-19. Residents and consultants worked intensively in clinical areas for 1 week followed by 1-2 weeks of non-clinical or standby assignments, providing adequate opportunity for isolation. Frequent re-evaluation of the roster was nevertheless required as the pandemic progressed. Segregating teams vertically significantly reduced the number of contacts identified on contact tracing and quarantine leaves, while maintaining patient satisfaction with no increase in adverse events. Residents found the roster to be "smart" and "pandemic-appropriate."

Conclusion: The "COVID emergency roster" helped ensure quality care with minimum risk of exposure and sufficient breaks for physical and psychological recovery of HCWs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ijgo.13408DOI Listing
December 2020

Automated human mind reading using EEG signals for seizure detection.

J Med Eng Technol 2020 Jul;44(5):237-246

Department of Computer Engineering, National Institute of Technology, Kurukshetra, India.

Epilepsy is one of the most occurring neurological disease globally emerged back in 4000 BC. It is affecting around 50 million people of all ages these days. The trait of this disease is recurrent seizures. In the past few decades, the treatments available for seizure control have improved a lot with the advancements in the field of medical science and technology. Electroencephalogram (EEG) is a widely used technique for monitoring the brain activity and widely popular for seizure region detection. It is performed before surgery and also to predict seizure at the time operation which is useful in neuro stimulation device. But in most of cases visual examination is done by neurologist in order to detect and classify patterns of the disease but this requires a lot of pre-domain knowledge and experience. This all in turns put a pressure on neurosurgeons and leads to time wastage and also reduce their accuracy and efficiency. There is a need of some automated systems in arena of information technology like use of neural networks in deep learning which can assist neurologists. In the present paper, a model is proposed to give an accuracy of 98.33% which can be used for development of automated systems. The developed system will significantly help neurologists in their performance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/03091902.2020.1791988DOI Listing
July 2020

Human papillomavirus vaccination: Good clinical practice recommendations from the Federation of Obstetric and Gynecological Societies of India.

J Obstet Gynaecol Res 2020 Sep 6;46(9):1651-1660. Epub 2020 Jul 6.

Breach Candy Hospital and Research Centre, Mumbai, India.

Human papillomavirus (HPV) vaccination offers an excellent prospect for the primary prevention of cervical cancer. The bivalent and quadrivalent vaccines are both available in India. The nonavalent vaccine is licensed but not yet available. However, there still remain controversies regarding the vaccination of older women, immunocompromised females and other special groups. To provide recommendations for HPV vaccination in India. The Federation of Obstetric and Gynecological Societies of India (FOGSI) convened an expert group on cervical cancer prevention to formulate good clinical practice recommendations (GCPR) with respect to vaccine efficacy and safety, target groups, optimal timing and dosing schedules. HPV vaccines are licensed for females aged 9-45 years in India and have been seen to be safe and effective. FOGSI recommends HPV vaccination of all girls <15 years of age as the best target group, in whom two-doses at an interval of 6 months, extendable to 18 months, are recommended. Three-doses are recommended in girls >15 years of age, immunocompromised persons and sexual assault survivors. Older women and women with abnormal screening results may be vaccinated with an understanding that vaccination does not protect against already acquired infections and screening has to continue. Single-dose vaccination results are promising. Increased awareness is required to reduce vaccine hesitancy. HPV vaccination should be the priority to achieve the elimination of cervical cancer. The introduction of affordable HPV vaccines and reduced dose schedules will improve coverage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jog.14345DOI Listing
September 2020

A clinicopathological study of granulosa cell tumors of the ovary: Can morphology predict prognosis?

Indian J Pathol Microbiol 2020 Jan-Mar;63(1):53-59

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Objective: Granulosa cell tumors (GCT) are low-grade malignant sex cord-stromal tumors (SCST) with late metastasis/recurrences and long disease-free periods. We performed a clinicopathological evaluation of GCT to ascertain features having prognostic impact.

Materials And Methods: All cases of GCT of ovary from January 2006 to December 2018 were assessed for architectural patterns, nuclear grooves, and Call-Exner bodies. Each feature was graded on frequency of occurrence: not present (0)-very frequent (3). Anisonucleosis, necrosis, and inflammation were noted. Cases were grouped on mitotic count; <10 mitosis/10 High power field (HPF) or >=11 mitoses/10 HPF and Ki-67 index; <10% Ki-67 and >=11% Ki-67.

Results: GCT formed 60.1% of SCST. Sixty cases' ages were in the range of 15-78 years (median 45). Clinical details were available in 37. Commonest presentation was abnormal uterine bleeding. Serum CA125 was raised in 16.1% and Inhibin in 58.8%. Seventy percent were in stage I. Disease recurrence was associated with higher stage (P = 0.007). The most frequent pattern was diffuse sheets (47%). Call-Exner bodies were absent in 22.2%. Grooves with score 1, 2, and 3 were seen in 35.8%, 23.5%, and 13.6%, respectively. Anisonucleosis was present in 26.7%, necrosis in 11.1%, and lympho-plasmacytic infiltrate in 43%. Out of total, 93.3% had <10 mitosis/10 HPF and 43.2% had recurrence, most with high Ki-67 (P = 0.064).

Conclusion: Our study outlines histomorphological spectrum of GCT and emphasizes its frequent occurrence in lower stages with late recurrences. The presence of grooves may indicate granulosa-cell origin. Call-Exner bodies are not a necessity. Histomorphological features are not prognostically important. However, prognostic value of Ki-67 cannot be excluded. Limitation of the study was a small number of cases with follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/IJPM.IJPM_403_19DOI Listing
October 2020

Pilimiction: A Rare Presentation of Ovarian Dermoid.

J Obstet Gynaecol India 2019 Aug 7;69(4):377-379. Epub 2019 Jun 7.

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, Delhi India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13224-019-01245-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661053PMC
August 2019

Pregnancy with massive splenomegaly: A case series.

Natl Med J India 2018 May-Jun;31(3):146-148

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

Background: Pregnancy with massive splenomegaly is a rare entity and is associated with increased risk to both mother and foetus. There is paucity of studies in the literature to guide clinicians for the management of this condition.

Methods: We reviewed the course of pregnancy, maternal and foetal outcomes of 5 pregnant women with massive splenomegaly who were managed in our unit during 2015-16.

Results: All 5 women had anaemia and thrombocytopenia, and had different causes for splenomegaly. One patient had chronic malaria, 2 had portal hypertension with cirrhosis and the remaining 2 had non-cirrhotic portal hypertension. Life-threatening complications were present in 2 patients; one of them had severe pre-eclampsia complicated by pulmonary oedema, cardiac arrest and the other patient developed spontaneous bacterial peritonitis. Intrauterine growth restriction and meconium-stained liquor were the most common perinatal complications. Two patients had vaginal delivery and 3 required emergency caesarean section. Postpartum haemorrhage was present in 2, and the hospital stay was prolonged in all the patients. All mothers and babies were discharged in a satisfactory condition.

Conclusion: Pregnancy with massive splenomegaly poses a challenge because of diverse aetiology and potentially adverse outcomes. Multidisciplinary care in a tertiary centre can help optimize the outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0970-258X.255756DOI Listing
October 2019

Bicornuate Uterus with Complete Cervico-Vaginal Agenesis and Skeletal Deformity: A Case Report.

J Obstet Gynaecol India 2019 Apr 15;69(Suppl 1):67-70. Epub 2018 Mar 15.

Department Of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), B2/20, 3rd Floor, Safdarjung Enclave, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13224-018-1107-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431703PMC
April 2019

Frontline use of bevacizumab in ovarian cancer: Experience from India.

Natl Med J India 2018 Jan-Feb;31(1):15-18

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

Background: Ovarian cancer is the second most common gynaecological malignancy in India. Despite relatively high response rates to first-line carboplatin and paclitaxel-based chemotherapy in epithelial ovarian cancer (EOC), the majority of patients experience multiple relapses and finally become resistant. Vascular endothelial growth factor (VEGF) promotes progression of ovarian cancer. Bevacizumab, a recombinant humanized monoclonal antibody directed against VEGF-A is an anti-angiogenesis agent. Data on the use of bevacizumab for EOC from India are not available. We, therefore, studied the use of bevacizumab in ovarian cancer.

Methods: In this prospective, non-randomized study, 10 patients who received bevacizumab were compared with 20 age- and stage-matched controls. After maximal surgical debulking, patients in the bevacizumab arm received bevacizumab 15 mg/kg i.v. on day 1 every 3 weeks followed by paclitaxel and carboplatin from cycle 1. After 6 cycles, bevacizumab was continued for 1 year. Controls received paclitaxel 1 75 mg/m and carboplatin only for 4-8 cycles. The outcome measures were adverse effects and progression-free survival.

Results: Haematological toxicity (i.e. neutropenia, thrombocytopenia and anaemia) was similar in both arms. Hypertension (40% v. 10%, p = 0.04) and bleeding-related complications (50% v. 0%, p = 0.002) were more in the bevacizumab arm. However, gastrointestinal (GI) perforations were not increased. The median progression-free survival was similar in both arms; 26 months versus 21 months (p = 0.57).

Conclusion: In this small group of patients, addition of bevacizumab increased the toxicity of chemotherapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0970-258X.243406DOI Listing
September 2019

Management of CHAOS by intact cord resuscitation: case report and literature review.

J Matern Fetal Neonatal Med 2019 Dec 12;32(24):4181-4187. Epub 2018 Jun 12.

Lady Hardinge Medical College, New Delhi, India.

Congenital high airway obstruction syndrome (CHAOS) is a near fatal condition, except when the intrapartum treatment (EXIT) procedure is performed as rescue. After antenatal diagnosis of the condition, counseling regarding prognosis and outcome needs to be provided. We describe here a case with CHAOS due to isolated fetal laryngeal atresia, presented at our center at 33-week gestation. After counseling regarding the uncertain outcome, consent for elective caesarean was not given. Intact cord resuscitation (ICR) was done as a rescue by a well-coordinated team during delivery. Tracheostomy was performed successfully under local anesthesia within five minutes, while the cord was still attached to the placenta. The baby had supraglottic stenosis on CT scan. Reconstructive surgery is planned after 8 months. The literature review showed 24 reports of 28 cases with intrinsic airway obstruction managed by EXIT, laryngeal atresia was the most common cause (18/28). The outcome was poor in tracheal agenesis (1/4 survived) whereas those having laryngeal web or small communication (4/4 survived) had better outcome. Tracheal reconstruction was done in 3/28 cases only. The case emphasizes that ICR and tracheostomy during vaginal delivery can rescue the baby. The literature reviewed provided insight into the outcome of CHAOS cases in world literature.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14767058.2018.1481951DOI Listing
December 2019

Impact of energy devices on the post-operative systemic immune response in women undergoing total laparoscopic hysterectomy for benign disease of the uterus.

J Turk Ger Gynecol Assoc 2018 Mar;19(1):1-6

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: Laparoscopic surgery is associated with reduced surgical stress response, lesser post- operative immune function, and consequent early recovery compared with conventional open surgery. There is a lack of evidence regarding the inflammatory stress response with the use of different energy devices. The present study was conducted to evaluate and compare the inflammatory response in total laparoscopic hysterectomy (TLH) using three different energy devices.

Material And Methods: A prospective randomized controlled study was conducted in 60 women with abnormal uterine bleeding undergoing TLH. They were divided into three groups based on the energy devices used, namely integrated bipolar and ultrasonic energy (Thunderbeat), ultrasonic (Harmonic) and electrothermal bipolar vessel sealing system (Ligasure). Cytokines and chemokines were measured in all three groups at different time points.

Results: Serum levels of interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) increased postsurgery in all three groups and gradually declined by 72 hours. The geometric mean serum (IL)-6 levels was highest with Ligasure at 24 hours as compared with the other groups. Levels of TNF-α, macrophage inflammatory protein (MIP-1) α, MIP-1 β were also higher at 3 hours in the Ligasure group. When the differences between the groups were measured at different time points, there was a significantly greater increase in serum IL-6 levels in the Ligasure group at 24 hours (p=0.010). No significant difference was found in the post-operative course between the groups.

Conclusion: A greater inflammatory response was seen after the use of Ligasure indicating greater tissue damage. However, this response was not correlated with any difference in postoperative recovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4274/jtgga.2017.0076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838771PMC
March 2018

A Pilot Study Comparing Hysteroscopic Adhesiolysis by Conventional Resectoscope Versus Mini-resectoscope.

Oman Med J 2017 Nov;32(6):492-498

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Objectives: To compare the feasibility and efficacy of the mini-resectoscope with the conventional resectoscope in terms of the operative, menstrual, and reproductive outcome in hysteroscopic adhesiolysis in infertile women.

Methods: We conducted a parallel prospective randomized study at All India Institute of Medical Sciences, New Delhi. A total of 60 patients underwent hysteroscopic adhesiolysis using either conventional resectoscope (n = 30) or mini-resectoscope (n = 30). The primary outcome measures were pregnancy-related indicators. Secondary outcome measures were the operative parameters (cervical dilatation time, operation time, postoperative pain scores, fluid deficit, and preoperative and postoperative sodium levels), second-look hysteroscopy findings, and improvement in the menstrual pattern after surgery.

Results: Cervical dilatation time and pain score 30 minutes after the procedure were significantly lower in the mini-resectoscope group. Out of the total 21 cases with hypomenorrhea, 12 cases (57.1%) started having normal menstrual flow postsurgery. All amenorrheic patients resumed menstruation after surgery. However, nine cases continued to have hypomenorrhea. Over long-term follow-up, 16 patients out of 60 had conceived (seven in the conventional resectoscope group and nine in the mini-resectoscope group). There were three ongoing pregnancies, three abortions, one ectopic pregnancy, and nine term pregnancies. The difference between the two groups was not statistically significant.

Conclusions: The use of mini-resectoscope for hysteroscopic adhesiolysis is associated with reduced operative morbidity. Use of the mini-resectoscope is an effective and safe alternative to the conventional system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5001/omj.2017.94DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702989PMC
November 2017

Evaluation of amnion in creation of neovagina in women with Mayer-Rokitansky-Kuster-Hauser syndrome.

Fertil Steril 2017 08 16;108(2):341-345. Epub 2017 Jun 16.

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: To assess the outcome of amnion vaginoplasty in cases of vaginal agenesis due to Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome managed at the authors' institution.

Design: Retrospective study.

Setting: Tertiary care hospital.

Patient(s): Fifty women with MRKH who underwent neovaginoplasty.

Intervention(s): Modified McIndoe's vaginoplasty was done in all the patients, using human amnion graft.

Main Outcome Measure(s): Functional status assessed by Female Sexual Function Index, anatomic status (length and width of neovagina), and epithelialization of vagina.

Result(s): Mean (±SD) vaginal length after surgery was 8.2 ± 1 cm. Mean vaginal length at 6-month follow-up in sexually active patients was significantly longer as compared with the patients who were not sexually active after surgery (8.4 ± 1.04 cm vs. 6.6 ± 2.4 cm). Mean Female Sexual Function Index score was 30.8 ± 2.1. Vaginal biopsy showed complete epithelialization of vaginal mucosa.

Conclusion(s): In a developing nation like India, McIndoe's method with amnion graft seems to be a promising option owing to its low cost, easy availability, and safety, ease of the procedure not requiring any special instrument, physiologic outcome with respect to epithelialization of the vagina without hair growth, and satisfying functional outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fertnstert.2017.05.026DOI Listing
August 2017

Urinary fistula-A continuing problem with changing trends.

J Turk Ger Gynecol Assoc 2017 Mar;18(1):15-19

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: Urinary fistula is a distressing complication after difficult vaginal deliveries, obstetric, and gynecologic surgeries. The present study describes a single center's experience in the management of urinary fistula at a tertiary care hospital. It was performed to analyze the etiology of genitourinary fistula, to assess the outcome after surgical repair, and to determine the changing trends in the etiology and management of urinary fistula.

Material And Methods: This retrospective study was conducted over 5 years in the department of obstetrics and gynecology, All India Institute of Medical Sciences, New Delhi. Twenty patients who underwent surgical repair of urinary fistula were included in the study and analyzed for their etiology, presentation, site, size, previous failed repair, approach of surgical repair, and outcome. The findings of the present study were compared with a previous study at our center to determine the changing trends of urinary fistula.

Results: The mean age of the study population was 37.05±8.08 years. The majority (65%) of the fistulae occurred following gynecologic surgeries, whereas 25% were due to obstructed labor, and 10% after cesarean section for other indications. The vaginal approach was used in all except one case of uterovesical fistula, which was repaired abdominally. The outcome was successful in 85% of cases. The success rate was similar in primary versus previous failed repair (p=0.270).

Conclusion: The most common cause of urinary fistula in the present study was gynecologic surgery. The vaginal approach can be used even in cases with previous failed repairs with a high success rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4274/jtgga.2016.0211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450205PMC
March 2017

Aggressive Angiomyxoma of Vulva in Pregnancy: A Case Report.

J Obstet Gynaecol India 2016 10 31;66(Suppl 2):610-612. Epub 2016 Mar 31.

Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13224-016-0870-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5080253PMC
October 2016

Pregnancy with chronic kidney disease: maternal and fetal outcome.

Eur J Obstet Gynecol Reprod Biol 2016 Sep 3;204:83-7. Epub 2016 Aug 3.

Department Of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.

Objective: Pregnancy with chronic kidney disease (CKD) is considered to be high risk. The purpose of this study was to assess the effect of pregnancy on CKD and the fetomaternal outcome in these patients.

Study Design: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of medical sciences, New Delhi over a period of 11 years. A total number of 80 pregnant patients with CKD were reviewed. Staging of CKD was done according to glomerular filtration rate (GFR). Maternal demographic profile, stage of CKD, biochemical profile, antenatal and neonatal records were analyzed. The course of pregnancy was then reviewed and note was made of any maternal or fetal complication. At the time of analysis, patients were divided into early (Stage 1, 2) and late stage (Stage 3-5) disease. All the variables were compared between two groups. Data analysis was carried out using SPSS software version 20.0.

Results: There was significantly increased incidence of preeclampsia (p=0.001) and moderate to severe anemia (p=0.001) in late stage disease as compared to early stage. The renal parameters including mean GFR and serum creatinine deteriorated with pregnancy in both the groups. Among fetal complications, the patients in late stage had significantly increased incidence of small for gestational age, low 5min Apgar score and increased NICU admissions. The overall preterm delivery rate was 57.5%. There was an overall increase in the incidence of caesarean section (CS) rate (64%).

Conclusions: Despite advances in antenatal care, incidence of adverse events in mother and fetus remain high in these women of CKD as compared to the rates expected in the general population. In all patients of CKD planning for pregnancy, the pre-existing disease should be optimized before conception.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejogrb.2016.07.512DOI Listing
September 2016

Health profile of urban adolescent girls from India.

Int J Adolesc Med Health 2014 ;26(2):233-7

Context: Adolescents comprise 22.5% of the population, which forms a significant part of the entire population. It is only recently that we have acknowledged the need for a separate specialty to handle adolescent problems and ailments.

Aims: The aim of the present study is to study the health profile of the adolescents girls presenting to the tertiary care hospital situated in New Delhi, India.

Materials And Methods: The study was conducted on 316 adolescent girls who presented to the adolescent clinic at Smt Sucheta Kriplani Hospital, New Delhi. Apart from recording the various health problems to which they presented, a detailed HEADSS assessment was done for each case.

Results: Majority of the adolescents (60.74%) presented with menstrual problems, 78.48% discussed their problems with their parents, and 91.77% agreed on common things with them. About 69.62% were attending school or college, while 30.37% had either left or never attended school. Majority of the adolescents (77.84%) had only a few friends, 62.96% watched TV in their free time, and only 7.27% performed regular exercise. In addition, 0.94% adolescents in the study group were married. Among the 313 unmarried adolescents, 3.83% were dating and 4.47% were sexually active. There was a low incidence of teenage pregnancy (0.94%) reported in the unmarried study population. History of contraceptive use was present in only 1.26% cases, and only 5.06% of the adolescents had knowledge of HIV.

Conclusions: Adolescent health must be viewed with a comprehensive approach comprising of social, mental, physical and emotional aspects. The active involvement of the entire society, including parents and teachers, must also be encouraged towards the healthy development of adolescents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/ijamh-2013-0513DOI Listing
September 2014

A rare case of vaginal delivery after uterine rupture.

J Obstet Gynaecol India 2012 Oct 20;62(5):566-7. Epub 2012 Mar 20.

Department of Obstetrics and Gynecology, Lady Hardinge Medical College & SK Hospital, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13224-012-0124-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526700PMC
October 2012

Unintended pregnancy among low income urban married women in India.

J Obstet Gynaecol India 2012 Feb 20;62(1):52-6. Epub 2012 Apr 20.

Lady Hardinge Medical College & SK Hospital, Delhi, India.

Introduction: The most common reason for demand for abortion in India is unintended pregnancy.

Aim: To obtain information from low income urban married women regarding incidence and cause of unintended pregnancy.

Methods: All pregnant married women belonging to low income group were selected for study. The incidence and cause of unintended pregnancy among low income group was noted. Comparison was done between education of the women and parity at which they came with unintended pregnancy also the reasons women gave for nonuse of contraception were compared with their education. Statistical analysis was done using EPI Info ver-5.0. Chi square test was used to test the significance of data.

Results: The total 7,146 women comprised the study group. The incidence of unintended pregnancy was 15.5 %. Educated women came with unintended pregnancy at lesser parity than illiterate women. The most common reason given by women for not using contraception was that they did not think they could become pregnant (42.6 %).

Conclusion: The incidence of unintended pregnancy in low income urban population is low because there are fewer pregnancies which were wanted. There is need to create awareness regarding use of contraception. Education plays a major role in improving the acceptance of contraception.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13224-012-0157-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366579PMC
February 2012

Prenatal sonographic evaluation and postnatal outcome of renal anomalies.

Indian J Hum Genet 2012 Jan;18(1):75-82

Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India.

Objective: To determine the prognosis of antenatally detected renal anomalies by sonographic evaluation.

Materials And Methods: This was a follow-up study of all antenatally detected renal anomalies from January 2008 to Dec 2009 referred to fetal medicine clinic. Prenatal evaluation was done and cases were divided into four groups depending upon their prenatal sonographic findings. Post natal follow-up was done up to one year in cases of live babies. Autopsy was carried out in still born fetus after consent.

Results: The renal anomaly was detected in 55 cases, which were fully followed. The prognosis was said to be poor for group I cases with gross extra renal anomaly along with the renal anomaly, and for group II in which there was organic renal pathology with loss of renal function suggested by non-visualization of bladder and almost absent liquor. Prognosis was guarded and depended upon the gestational age of presentation in group III, which had obstructive uropathy; prognosis was good in group IV cases, which were mild, unilateral or which presented late.

Conclusion: Prenatal sonographic evaluation gives reasonably accurate picture of the prognosis and can be very helpful in counseling the parents regarding prognosis and help in deciding the timing and route of delivery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0971-6866.96656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385184PMC
January 2012

Management of early onset severe preeclampsia in a tertiary hospital in India: does expectant management alter perinatal outcome?

Indian J Med Sci 2011 Dec;65(12):535-42

Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India.

Objective: The aims of the study were to find out the maternal and perinatal outcome of early onset severe preeclampsia (PE) in a tertiary care center in a developing country like India and to determine whether expectant management in such a setup improves the perinatal outcome.

Materials And Methods: It was a retrospective study. All women with early PE were admitted stabilized and evaluated. Expectant management was given whenever there was no indication for eminent delivery. The perinatal outcome of the expectant group was compared with that of the aggressive group, and appropriate statistical analysis was carried out.

Results: A total of 106 women were admitted with severe PE, 61 were treated aggressively, and 45 were stable enough to receive expectant management. The total days gained on expectant management was 7 days. Perinatal mortality was 31.13%. Perinatal outcome of the expectant and aggressive management groups did not differ (P = 0.141); there was no increase in maternal complications on expectant management. There were 2 cases of maternal mortality in the aggressively managed group.

Conclusion: Perinatal mortality in severe PE is high. There was no increase in maternal morbidity on expectant management; however, there was no difference in perinatal mortality on expectant management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0019-5359.109903DOI Listing
December 2011

Contraceptive use among low-income urban married women in India.

J Sex Med 2011 Feb 4;8(2):376-82. Epub 2010 Oct 4.

Lady Hardinge Medical College-Department of Obstetrics and Gynecology, New Delhi, India Balak Ram Hospital, Timarpur, Delhi, India.

Introduction: The reports of a rise in contraceptive practices have not been matched by a similar decrease in population, so there is a need to look into the causes of this discrepancy.

Aim: To obtain information from low-income urban married women regarding their contraceptive knowledge, practices, and utilization of the services.

Main Outcome Measure: Percentage of low-income urban married women using contraception, different types of contraception used, influence of education on choice of contraception.

Methods: All nonpregnant married women between the ages of 18 and 45 years, belonging to low-income groups were selected for study. Statistical analysis was done using EPI Info ver-5.0. Chi square test was used to test the significance of data.

Results: Contraceptive use among these women was 52%; the most common method was tubal ligation. Educated women used spacing methods more often than uneducated women. Women had adequate awareness regarding type of contraceptives available but had no idea about the timing of starting contraception after delivery and about emergency contraception.

Conclusion: The low-income urban population is aware of the importance of limiting the family size and has family planning facilities yet has less contraceptive usage because of low level of education, increased rate of discontinuation, and lack of proper knowledge of the use of contraception.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1743-6109.2010.02047.xDOI Listing
February 2011
-->