Journal of Obstetrics and Gynecology of India最新文献

{"title":"Cervical Insufficiency Management with Elective Transvaginal Cervicoisthmic Cerclage.","authors":"Vakkanal Paily Paily, Soumya Ramakrishnan, Afshana Sidhik, Raji Raj Girijadevi, Ajithakumari Sudhamma, Joshy Joseph Neelankavil, Usha Govindan Menon, Raymond George, Sara Cheriyan, Teena Eliz John, Divya Vishnu, Manu Pradeep, Suhail K Shafeek","doi":"10.1007/s13224-025-02101-z","DOIUrl":"https://doi.org/10.1007/s13224-025-02101-z","url":null,"abstract":"<p><strong>Background: </strong>Transabdominal cervicoisthmic cerclages (TACIC) are currently recommended for cervical insufficiency, which is-(1) refractory to the conventional vaginally applied cervical cerclages or (2) in an anatomically short cervix. We aim to determine the feasibility and effectiveness of the cervicoisthmic cerclage applied transvaginally (TVCIC), instead of the invasive TACIC, in preventing preterm births (< 32 weeks of gestation) in women with previously failed cervical cerclages.</p><p><strong>Materials and methods: </strong>This retrospective case series included consecutive patients who had a history of elective cervical cerclage failure in the previous pregnancy and, therefore, underwent elective TVCIC (preconceptionally or antenatally) in the current pregnancy between 2015 and 2023 in our tertiary care setting. Fetal survival-to-discharge rate was analyzed as a secondary outcome. The TVCIC technique is performed as follows: The bladder is reflected away from the cervix by sharp dissection, leaving the utero-vesical fold of the peritoneum intact. With a posterior colpotomy, the Pouch of Douglas is entered. Bilaterally, a 5-mm Mersilene tape is passed anteroposteriorly, cranial to the uterosacral ligaments, encircling through the lateral cervical tissue, and tied posteriorly. The anterior and posterior colpotomies are then closed with interrupted sutures-burying the knot in the Pouch of Douglas. Ideally, at term, the women undergo an elective cesarean delivery, and the cerclage may be left in situ-if the woman desires future pregnancies.</p><p><strong>Results: </strong>In twenty-seven women with previous cervical cerclage failure, TVCIC was electively performed (twenty-three during 7-16 weeks of gestation and four preconceptionally). All but one (<i>n</i> = 26/27, 96.3%) of the gestations carried beyond 32 weeks of gestation, whereas 77.8% (<i>n</i> = 21/27) gestations completed 37 weeks. The fetal survival-to-discharge rate was 96.3% (<i>n</i> = 26/27). There were no procedure-related maternal or neonatal complications.</p><p><strong>Conclusion: </strong>TVCIC can be further explored as an alternative to transabdominal cervicoisthmic cerclages in a larger, multicentric study in a similar population.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13224-025-02101-z.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 2","pages":"142-147"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aetiology and Clinical Characteristics of Primary Amenorrhoea with Hypothalamic or Pituitary Disorders at a Quaternary Hospital.","authors":"Krantarat Peeyananjarassri, Satit Klangsin, Saranya Wattanakumtornkul, Kriengsak Dhanaworavibul, Chainarong Choksuchat, Chatpavit Getpook, Chariyawan Charalsawadi, Worathai Maisrikhaww","doi":"10.1007/s13224-025-02112-w","DOIUrl":"https://doi.org/10.1007/s13224-025-02112-w","url":null,"abstract":"<p><strong>Background/purpose of the study: </strong>To identify the causes and clinical characteristics of women with primary amenorrhoea and hypothalamic or pituitary gland disorders.</p><p><strong>Methods: </strong>This retrospective study was conducted at a quaternary hospital in southern Thailand. The medical records of women diagnosed with primary amenorrhea and hypothalamic or pituitary gland disorders (hypogonadotropic hypogonadism [HH]) were reviewed. HH was defined as an oestradiol level of < 20 pg/mL, decreased (< 5 mIU/mL) or normal serum follicle-stimulating hormone (FSH) levels, and no organic disease of the uterus or ovaries.</p><p><strong>Results: </strong>Fifty-five women with HH were included. The median (interquartile range [IQR]) age at presentation was 18 years (range, 17-20 years). Most patients presented with primary amenorrhoea (50/55), followed by primary infertility (3/55). All women had low levels of oestradiol (5 pg/mL [5.0-12.1]), FSH (0.8 mIU/mL [0.3-3.7]), and luteinising hormone (0.5 mIU/mL [0.1-2.3]). The most common cause was hypothalamic dysfunction (80%); including congenital hypogonadotropic hypogonadism (CHH) (43.6%), constitutional delay of growth and puberty (CDGP) (14.5%), and functional hypogonadotropic hypogonadism (FHH) (10.9%). Regarding hypothalamic dysfunction, patients with CHH were significantly older than those with CDGP (20 years [17.0-26.5] vs. 16.5 years [15.8-17.2]; P = 0.014) and had significantly lower FSH levels compared to those with FHH (0.6 mIU/mL [0.3-1.0] vs. 4.5 mIU/mL [2.8-5.7]; P = 0.026).</p><p><strong>Conclusion: </strong>Hypothalamic dysfunction, particularly CHH, is the most common cause of primary amenorrhoea and HH.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 2","pages":"122-128"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of Correlation of HbA1c with Anemia in Pregnancy.","authors":"Shalini Mishra, Vinita Das, Smriti Agrawal","doi":"10.1007/s13224-025-02108-6","DOIUrl":"https://doi.org/10.1007/s13224-025-02108-6","url":null,"abstract":"<p><strong>Introduction: </strong>HbA1c is a biochemical marker to evaluate hyperglycemia status in past 2-3 months. HbA1c ≥ 6.5% is diagnostic criteria for diabetes mellitus according to the American Diabetes Association. Recent studies suggest that anemia alters HbA1c levels, but results are conflicting. This study was planned to understand utility of HbA1c in relation to hemoglobin (Hb) for the diagnosis of gestational diabetes mellitus (GDM) and also to understand if HbA1c can be used as a screening modality for diagnosis of GDM in countries with higher anemia prevalence.</p><p><strong>Materials and methods: </strong>An observational study was conducted on 193 pregnant women of < 16-week gestation attending antenatal OPD of Department of Obstetrics and Gynecology, KGMU, Lucknow, over a period of one year. Blood glucose levels 2 h after ingestion of 75 gm glucose load irrespective of last meal (DIPSI criterion) were determined at 3 antenatal visits along with HbA1c and Hb level and categorized into diabetic and nondiabetic and anemic and non-anemic group. These patients were followed up till delivery to look for various maternal and neonatal outcomes.</p><p><strong>Results: </strong>A total 416 tests were done for hemoglobin and HbA1c in 193 women. Prevalence of GDM was 32.1%. Cutoff level of HbA1c was 4.8% in our study which also varied according to gestation. Mean HbA1c level found to be higher in anemic compared to non-anemic (4.5 vs. 3.96%) in nondiabetic women. Similar to that in women with GDM, mean HbA1c in anemic women (5.1) was higher compared to non-anemic (4.6) women.</p><p><strong>Conclusion: </strong>This study clearly shows that mean HbA1c varies across all trimesters; even though in diabetic women, mean HbA1c was higher as compared to nondiabetic, and it showed a statistically significant difference in the presence of anemia. HbA1c showed an inverse correlation with hemoglobin in women with or without GDM. Mean HbA1c level was higher among anemic women in both diabetic and nondiabetic group.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 2","pages":"160-165"},"PeriodicalIF":0.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bidding Adieu to a Golden Chapter…….","authors":"Madhuri Patel","doi":"10.1007/s13224-025-02102-y","DOIUrl":"https://doi.org/10.1007/s13224-025-02102-y","url":null,"abstract":"","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 1","pages":"12"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Complexities: Social, Ethical & Medicolegal Dilemmas of Hysterectomy in Young, Unmarried Women with Disabilities.","authors":"Jyotsna Yadav, Richa Sharma, Kiran Guleria, A G Radhika","doi":"10.1007/s13224-024-02043-y","DOIUrl":"https://doi.org/10.1007/s13224-024-02043-y","url":null,"abstract":"<p><strong>Purpose of study: </strong>The decision for hysterectomy in unmarried, young females, especially those with disabilities, is laden with many social, ethical and medicolegal dilemmas.</p><p><strong>Methods: </strong>In this case series, we present our challenges in the management of three disabled & unmarried girls who made a request for hysterectomy.</p><p><strong>Discussion and conclusion: </strong>Universal declaration of human rights, Constitution of India and the courts guarantee various rights to people with disabilities. However, there is a lack of comprehensive medicolegal framework to guide management in such cases especially in developing countries like India. This is an attempt to emphasise the need for specialised laws and medical board, for example '<i>Board for hysterectomy in special circumstances'</i> to help provide one-stop solutions to these women.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 1","pages":"89-91"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Management of Pelvic Abcess Post Oocyte Retrieval.","authors":"S Krishnakumar, Shrutika O Makde","doi":"10.1007/s13224-024-02036-x","DOIUrl":"https://doi.org/10.1007/s13224-024-02036-x","url":null,"abstract":"","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 1","pages":"92-94"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charged Up and Marching Ahead….","authors":"Sujata Dalvi","doi":"10.1007/s13224-025-02103-x","DOIUrl":"https://doi.org/10.1007/s13224-025-02103-x","url":null,"abstract":"","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 1","pages":"1-2"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"President's Address.","authors":"Sunita Tandulwadkar","doi":"10.1007/s13224-025-02098-5","DOIUrl":"https://doi.org/10.1007/s13224-025-02098-5","url":null,"abstract":"","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"75 1","pages":"3-11"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age of Viability: Clarifying Prenatal Documentation and Definitions in India's Contemporary Medical Landscape.","authors":"Girija Wagh","doi":"10.1007/s13224-024-02096-z","DOIUrl":"https://doi.org/10.1007/s13224-024-02096-z","url":null,"abstract":"<p><p>The concept of foetal viability has evolved significantly and has been influenced by advancements in neonatal care and legal frameworks. This review explores the complexities of defining foetal viability in India's contemporary medical landscape, particularly in light of the recent extension of the Medical Termination of Pregnancy (MTP) Act to 24 weeks. The article examines the confusion surrounding the classification of extreme preterm births, Medical Termination of Pregnancy (MTP) Act, and prenatal documentation during sonography. It addresses the challenges in distinguishing between preterm birth and abortion and proposes solutions to standardize definitions and practices.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"74 6","pages":"484-488"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Trends in Medical Management of Endometriosis.","authors":"Madhuri Patel","doi":"10.1007/s13224-024-02097-y","DOIUrl":"https://doi.org/10.1007/s13224-024-02097-y","url":null,"abstract":"<p><p>Endometriosis affects about 10 percent women in the reproductive age group globally and approximately 42 million in India. Managing the patient's pain symptoms associated with endometriosis appears to be the cornerstone in endometriosis disease management. The ideal medical treatment in endometriosis would be suppressing estradiol enough to alleviate symptoms of endometriosis but maintain sufficient levels to mitigate hypoestrogenic side effects. NSAIDs are generally prescribed for the initial management of pain symptoms in endometriosis along with hormonal agents like progestogens or combined oral contraceptive pills (COCPs). Injectable depot gonadotropin-releasing hormone (GnRH) agonists such as leuprolide acetate and letrozole are effective as second-line agents in the management of endometriosis-associated pain. Dienogest is a 19-nortestosterone derivative which has a high specificity for progesterone receptors and improves endometriosis-related symptoms and the overall quality of life. Dydrogesterone is quite effective in the treatment of endometriosis-associated pelvic pain without causing suppression of ovulation. GnRH agonists and GnRH antagonists both have been used in the treatment of endometriosis. Elagolix a first oral, non-peptide gonadotropin-releasing antagonist for the management of moderate to severe pain associated with endometriosis is successfully used. Aromatase inhibitors are used as second-line drugs in the management of endometriosis-associated pelvic pain. They prevent the conversion of steroid precursors to estrogens, both at the periphery and at the ovarian level. Tamoxifen, raloxifene and bacidoxifen have an anti-proliferative effect and regress the endometriotic implants. Mifepristone (progesterone receptor antagonist) and Ulipristal acetate (SPRM) have been used for medical management of endometriosis. LNG-IUS is emerging as a good option for patients with endometriosis who are not desirous of conception. Hormonal management is one of the effective management options in endometriosis. One has to be mindful of molecule-specific adverse effects while prescribing drugs.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"74 6","pages":"479-483"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}