Anti-mullerian hormone as an emerging promising marker in the prognosis of PCOS

Aims: To correlation of AMH with clinical, hormonal and ultrasound findings; and determine the role of AMH as prognostic marker. Methods: This was a prospective cross sectional study on women attending Gynaecology outpatient department of Medial College and Hospital, Kolkata, from January 2018 to June 2019. Study comprised of 70 newly diagnosed cases of PCOS using Rotterdam criteria 2003. Clinical history included menstrual complaint, hirsutism and weight gain; examination included BMI and Ferriman-Gallwey score; and investigations included FBS, 2hr PPBS, TSH, Prolactin, total testosterone, LH, AMH level and pelvic USG before starting intervention and same parameters were rechecked after 3 months of treatment completion. Results: A total of 70 PCOS patients were included in a study conducted within 1 year time period. The most common Phenotype in our study is Phenotype A (O+H+P) which was almost 85.71%, followed by Phenotype B (O+H) 7.14% and the least we got Phenotype C (H+P) that is 2.86%. There was statistically significant (p<0.05) decrease in AMH level following treatment of PCOS (before treatment mean AMH level was 9.634.42 and after treatment the level was 5.812.77). Conclusions: The most frequent PCOS phenotype in Indian women is A (O+H+P). Therapy in PCOS women with raised AMH reduces the AMH levels. Measurement of serum AMH provides a high specificity and sensitivity by which it can act as a prognostic marker for PCOS.

Bladder Injury: A complication of Transobturator Tape Surgery

Minimally invasive vaginal surgeries are often a preferred mode of surgical treatment of stress urinary incontinence. It is associated with fewer complications. However, complications including hemorrhage, voiding dysfunction, infection, pain, skin infection and erosion, and bladder injuries are observed. We encountered intraoperative bladder injury in a 40-year-old female patient with stress urinary incontinence who underwent transobturator tape (TOT) surgery. Cystoscopy demonstrated a small defect post procedure. She was managed conservatively with foley catheterization for 2 weeks following TOT procedure. She was dry and continent upon follow up.

Clinical profile of Female Urinary Incontinence: A Hospital Based Study

Aim: To determine the prevalence of urinary incontinence of women attending gynae outdoor patient department. Method: It is a prospective cross sectional study conducted at Paropakar Maternity and Women’s Hospital for three months. Types of incontinence, their presentation, associated factors, age and parity were the variables studied. Data were analyzed by descriptive statistics. Results: Out of 950 gynaecological out-patients, 97 had urinary incontinence(10.2%); 34.1% were in 50- 59 years and 37.2% were multipara. Stressurinary incontinence (SUI) was the most common incontinence (56.7%) followed by mixed urinary incontinence (22.7%) and urge urinary incontinence (20.6%). Common complaints were leakage during coughing (63.6%) and sneezing(18.2%) in SUI;urgency and frequency were main problem in mixed and urge urinary incontinence. Three-fourth cases had associated medical conditions and rest had gynecological factors. Conclusions: Urinary incontinence is common in the fifth decade of life of women and more than half had stress incontinence.

Surgical Morbidity and its Associated Factors in Ovarian Carcinoma

Aims: To estimate 30-day surgical morbidity in patients with ovarian carcinoma and identify its associated factors. Methods: This was an observational study conducted at two cancer hospitals, from October 2020 to March 2021. All women with ovarian carcinoma that underwent surgery were enrolled in the study. Incidence of surgical complications was recorded. Patients were followed up to the 30 th day post- operatively. Logistic regression analyses were used to evaluate the factors affecting surgical complications and their association was determined. Results: A total of 31 patients were analyzed in this study. The incidence rate of surgical complications was 29%. Total 11 complications occurred in nine patients (one intra-operatively and 10 post-operatively). Post-operative complications were wound infection (n=4; 12.9%), urinary tract infection (n=2; 6.4%); one each had post-op ileus, hemorrhage and deep vein thrombosis; and one mortality. Advancing age, increased Body Mass Index, primary surgery, higher surgical complexity score, increased operative time, increased blood loss, higher American Society of Anesthesiologists (ASA) score, presence of chronic disease were associated with surgical morbidity; and their hospital stay was longer (p=0.04). Conclusion: The common complications were wound infection and urinary tract infection.

Association of laboratory parameters with chest CT findings in COVID-19 patients

Aims: To analyze the Chest CT Scan and association of the severity score with the serum biomarkers D- dimer, C-reactive protein (CRP), Lactate dehydrogenase (LDH) and Ferritin levels. Methods: This is a retrospective study done from the database of Department of Radiology and Department of Pathology at Nobel medical college and teaching hospital during the peak of the second wave of the pandemic from 1st April 2021 to 31 st May 2021. Data for the Chest CT scan and lab parameters were analyzed and correlated. Ethical approval was obtained from the Institutional review committee of Nobel Medical College and Teaching Hospital. Descriptive statistical analysis was performed. Results: A total of 263 cases of Chest CT scan were done in 2 months period who were diagnosed as cases of COVID 19. In this study the severity and scores were taken from the database in the Radiology department. The lab parameters like D-dimer, CRP, LDH and Ferritin levels were studied from the database in the lab. Age of the patients ranged from 19 to 89 years with maximum cases 68 (25.8%) seen in the age group of 50-59 years. According to the chest CT Scan the severity score was in between 11-15 in 92 (48.3%) cases. Fifty six cases showed abnormal levels of D-dimer, Ferritin, CRP and LDH. D-dimer was raised in 26 (46.4%), LDH was raised in 48 (87.2%) while Ferritin and CRP was also raised in all 56 cases. Conclusions: There was a positive correlation between the biomarkers and the Chest CT severity score. The severity of the disease with involvement of the lungs can be estimated by correlating with the lab parameters.

Prevalence of Anxiety in Pregnancy during COVID 19 pandemic in Shree Birendra Hospital, Chhauni

Aim: To determine the prevalence of anxiety in pregnancy during COVID19 pandemic in Shree Birendra Hospital, Chhauni Method: It is a cross sectional study conducted at Shree Birendra Hospital Chhauni from July to October 2020 following the ethical approval from IRC. All the pregnant women from first to last trimester attending outdoor visit were included; they were asked to fill up Beck Anxiety Index form. The level of anxiety was compared with demographic data like age, race, parity, and period of gestation, education and occupation. Data were analyzed by using SPSS 20 software. Results: A total of 385 presumably uninfected pregnant women were surveyed in 20-40 (28.45±3.95) years age group from 4 to 41 (27.15±9.4) weeks of pregnancy and 55.6% were multipara. Low-grade anxiety was found 99.5% (BAI= 3.06±3.66). Conclusions: Low-grade anxiety was found in almost all pregnant women during covid pandemic and there was no significant difference by demographic variables.

Choice of temporary contraception based on client’s demographic status and parity

Aim: To analyse the demographic factors and parity in women influencing choice of contraceptive methods. Methods: This is a hospital record based retrospective study at Bhaktapur hospital, a tertiary hospital in a span of 6 months from October 2020 to March 2021. Data were collected from medical record and descriptive analysis was done. Results: There were 142 women taking contraceptive service in six months.Implant was the most commonly used method of contraception (48%), followed by the IUCD (26%), Injectable (16%) and OCP (10%). Age group of 20-39 had more acceptance of contraception as compared to adolescent and women above 40. More the parity more usage of long acting reversible contraception was found. Conclusion: The most common contraceptive method used among women was implant. Client having two or more children are more to receive long acting contraception.

Quintuplet Pregnancy in a women with HIV positive status

Quintuplets are a rare occurrence and even rarer if they are born to a woman without fertility treatment. It is associated with not only high rates of obstetric complications but also increased perinatal morbidity and mortality. We here report a case of a woman with HIV positive status under ART with Quintuplets who delivered on her second trimester.

Correlation of palpation versus ultrasound-assisted approach for locating the level of lumbar puncture used for subarachnoid block in elective cesarean delivery

Aims: To correlate the level of lumbar puncture used for subarachnoid block in parturient undergoing elective cesarean delivery between palpation and ultrasound method; and to find its accuracy. Methods: This is an observational study, conducted in 314 parturient undergoing elective caesarean delivery under spinal anesthesia over the period of three months at Paropakar Maternity and Women's Hospital Kathmandu. The interspinous space identified by palpation method on lateral position for subarachnoid block and later the site confirmed by ultrasound. Results: In this study, intervertebral space identified by palpation was matched in 38.1% (i.e. 107 in 281 patients) when assessed with ultrasound (USG). In 166 (59.1%) patients, skin puncture level was determined by palpation was found to be one intervertebral space cephalic. In eight (2.8%) patients, one intervertebral space caudal while assed with USG. The correlation between intervertebral space determined by palpation and by ultrasonography was poor (correlation coefficient r=0.288).The kappa was 0.293±0.015. Conclusions: The level of lumbar puncture used for subarachnoid block in elective cesarean delivery by palpation method is poorly correlated (38.1%) with ultrasonographic identification of corresponding interspinous level.

Maternal and perinatal outcome in Rh-Negative women

Aim: To find out the Maternal and perinatal outcomes in Rh-Negative mothers. Methods: This is a cross sectional study of all Rhesus negative mothers giving childbirth at Department of Obstetrics and Gynecology, Nobel Medical Col- lege Teaching Hospital from March 2020 to February 2021. Maternal variables like age, parity, mode of delivery, and complications were recorded. Fetal vari- ables like period of gestation, fetal outcomes, hemoglobin, indirect bilirubin, fetal weight were noted. Results: There were 108 cases of Rh negative pregnancy and 95 of them deliv- ered Rh positive fetuses. Prevalence of Rh negative pregnancy was 1.68%. Half of them (51; 53.6%) underwent caesarean section due to obstetric indications with 20 repeat cesarean sections and 9 (17.7%) cases for fetal distress. Gross perinatal death was 9; none of the patients received antepartum im- munoprophylaxis; and 86 received postpartum Anti-D Rh IgG. There was only one case of proven isoimmunisation presented as hydrops fetalis in a grand multiparous woman with positive Indirect Coomb Test; and two newborn re- ceived exchanged transfusion. Conclusion: Rhesus negative rate was 1.68% and proven isoimmunization rate was 1%.