International Journal of Obstetrics and Gynecology

International Journal of Obstetrics and Gynecology ISSN 2326-7234 ISSN 2326-7234 Vol. 6 (7), pp. 238-240, July, 2018. © International Scholars Journals

Case Report

A case report of body stalk anomaly at 15 weeks and management in a patient with a previous cesarean

Ayamo Oben, Jason Morris, Angela Boyd and Michael Berkus

Center for Pregnancy and Newborn Research University of Texas Health Sciences Center at San Antonio San Antonio, TX 78229.

Accepted 26 March, 2018

Abstract

Body stalk anomaly is a fatal disfiguring abdominal wall defect resulting from abnormalities in the development of the cephalic, caudal, and lateral embryonic body folds¹. The inability to fold in the correct axes leads to these body wall deformities. Daskalakis et al. reported an incidence of 14/106,727 fetuses². There are few cases of this complex in the United States and little is known about the cause of this abnormality. Proposed mechanisms include early amnion rupture, vascular disruption of the early embryo, or an abnormality in the germinal disk (X). Given that body stalk anomaly is a fatal anomaly, early diagnosis is critical to the counseling and management of affected patients. Herein, we present a case of body stalk syndrome and discuss management in a patient with a history of a prior cesarean delivery who declined termination.

Keywords: Body stalk anomaly, body stalk syndrome, abdominal wall defects.

International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 6 (4), pp. 219-222, April, 2018. © International Scholars Journals

Full Length Research Paper

Association of angiotensin converting enzyme gene I/D polymorphism with vitiligo in South Indian population

Debi Dutt¹, Nitin Sunil² and Verma Satya²

¹Department of Endocrinology, Faculty of Medicine,  Amity University, Raipur, India

²Department of Gastroenterology, Faculty of Internal Medicine, Kalinga University, Naya Raipur, Chhattisgarh, India.

³Department of Medical oncology, School of Life and Allied Sciences, Naya Raipur, Chhattisgarh, India.

*Corresponding author. E-mail: [email protected].

Accepted 12 February, 2016

Abstract

Vitiligo or leukoderma is a chronic skin condition that causes loss of pigment due to destruction of melanocytes, resulting in irregular pale patches of skin. Vitiligo is polygenic disease and associated with autoimmunity. Angiotensin converting enzyme (ACE) is capable of modulating cutaneous neuro-genic inflammation. An insertion/deletion (I/D) polymorphism of a 287-base pair repetitive sequence in intron 16 of the ACE gene was reported to have been associated with autoimmunity and with the development of vitiligo. In our study, the distribution of ACE gene I/D genotype was investigated in a population of 186 South Indian vitiligo patients and 201 healthy controls using polymerase chain reaction genotyping method. The ACE genotype and allele frequency ( ² = 9.576, P= 0.008) ( ² = 10.68, P = 0.001) were significantly different between vitiligo patients and healthy controls.However there was no significant difference between the segmental and non-segmental vitiligo( ² = 0.182, P = 0.91) detected in ACE gene genotype distribution .This study suggests that the ACE genepolymorphism confers susceptibility to vitiligo.

Key words: Angiotensin converting enzyme, gene polymorphism, vitiligo, autoimmunity.

International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 6 (3), pp. 211-218, March, 2018. © International Scholars Journals

Full Length Research Paper

Interobserver agreement and reliability in intrapartum cardiotocography interpretation, using the 2015 FIGO consensus guidelines

Louise PARET^1,2, Virginie EHLINGER^1, Catherine ARNAUD¹ and Christophe VAYSSIERE^1,2

¹Inserm, UMR1027, team SPHERE, Toulouse, France.

²Département de gynécolgie-obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, France.

Corresponding author E-mail: [email protected]; Tel. +33567771282

Accepted 05 December, 2017

Abstract

To assess interobserver reliability and agreement in the classification of cardiotocograms (CTGs) according to the 2015 revision of the FIGO (International Federation of Gynecology and Obstetrics) CTG classification. Six observers (3 obstetricians and 3 midwives) applied the 2015 FIGO guidelines and independently interpreted 60 intrapartum CTGs, randomly selected after stratification for arterial umbilical pH (pHa) at birth: 1/3 with pHa>7.15, 1/3 with pHa=7.05-7.15, and 1/3 with metabolic acidosis defined by pHa<7.05 and base deficit>10 mmol/L. Interobserver reliability was assessed by the Fleiss kappa coefficient and interobserver agreement by the proportion of agreement (Pa), calculated according to Grant. The overall interobserver reliability was good (kappa=0.62, 95%CI=0.52-0.73). Interobserver agreement was good for CTGs classified as normal by the observers (Pa=71.5%, 95%CI=67.5-75.2), moderate for those classified as pathological (Pa=57.4%, 95%CI=51.3-63.5) and poor for those classified as suspicious (Pa=36.4%, 95%CI=30.9-41.9). Interobserver reliability was good for baseline, moderate for variability assessment and presence of decelerations, but poor for classifying the decelerations. Results did not differ significantly between obstetricians and midwives. Application of this FIGO classification produced good interobserver reliability and agreement on CTG classification overall, but poor reliability for suspicious CTGs and for determination of the type of deceleration.

Keywords: Fetal heart rate, cardiotocography, interobserver variability, interobserver agreement, reliability, reproducibility.

International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 6 (2), pp. 207-210, February, 2018. © International Scholars Journals

Full Length Research Paper

Fetomaternal outcome in second stage Caesarean section - An audit

Sandya MR^1*, Shirley George² and Lissy Varghese³

Senior Resident^1*, Professor and HOD², Junior Resident³

Department of Obstetrics and Gynaecology, St John’s Medical College Hospital Bangalore, Karnataka, India.

Corresponding author. Email: [email protected]

Accepted 05 January, 2017

Abstract

Caesarean section (CS) at full dilatation of cervix has many implications for maternal & neonatal morbidity and mortality. The objective of the study was to analyse the indication for second stage CS & its associated fetomaternal outcome. This cohort study was carried out in the Department of Obstetrics & Gynaecology for a period of one year during which we analysed 42 women who underwent second stage CS. Data was obtained by reviewing medical records. During the study period total number of CS performed were 1951 (36.42%), of these 42 (2.15%) was performed at full dilatation of cervix. Majority were primigravidae (92.8%), mean age was 25.38 ± 3.72 years and mean gestational age was 38.8 ± 1.16 wks. Duration of second stage was <2hrs in 47.6% & >2hrs in 26.2%. Significant caput was present in 85.7%. The most common indication for second stage CS was secondary arrest of descent seen in 54.7%. Commonest maternal complications were haematuria 76.1%, atonic PPH 26.1% and extension of uterine incision in 14.3%. Fourteen babies (33.3%) required NICU care. There was no maternal or perinatal mortality in the present study. Involvement of skilled obstetrician in decision making and delivery is crucial to minimise the complications.

Keywords: Second stage caesarean section, Fetomaternal outcome, maternal complications, neonatal complications.

Full Length Research Paper

Which is more effective sildenafil citrate therapy or transdermal nitroglycerin in management of intrauterine growth restriction?

Shahinaz H.El-Shorbagy¹, Abd-el ghaffar Dawood¹ and Abeer Elshabacy²

Obstetrics & Gynecology Department, Faculty of Medicine; Tanta University, Egypt¹

Fellow of Obstetrics & Gynecology; Benha Teaching Hospital, Egypt²

Corresponding author's E-mail: [email protected]

Accepted 25 December, 2017

Abstract

Intrauterine growth restriction (IUGR) is the failure of fetuses to achieve their full growth potential, and is a major cause of perinatal mortality and morbidity. The etiology of IUGR is multifactorial and is thought to include a combination of maternal, environmental, fetal and placental factors with a resultant decrease in fetal growth. Sildenafil citrate and transdermal nitroglycerin affect uteroplacental blood flow and potentiate fetal growth. The objective of this study is to evaluate the effects of sildenafil citrate (SC) and transdermal nitroglycerin (GTN) in management of intrauterine growth restriction. Fifty patients' singleton pregnancies (gestational age, 22–34 weeks) with IUGR in the present study were subjected to; complete history taking; clinical and blood pressure evaluation. Ultrasonographic examination was done every 2 weeks including fetal biometry:  Biparietal Diameter "BPD", Head Circumference "HC", Abdominal Circumference "AC", HC/AC ratio, Femur Length "FL", Estimated Fetal Weight "EFW" to monitor fetal growth and assessment of biophysical profile. We compared every week mean arterial blood pressure (MAP) with Doppler ultrasound of the uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) arteries in pregnancies with IUGR before and after the use of 20 mg sildenafil citrate oral tablets twice daily or after application of a transdermal GTN (Novartis Ireland Limited) 5mg patch/day. Statistical analysis was performed by ANOVA for paired samples. The use of sildenafil citrate or transdermal GTN in pregnancies with IUGR is associated with non significant difference (>0.05) in demographic data, clinical characteristics and baseline values of fetal biometry in the two treated groups of IUGR. There was a significant reduction in PI, RI waveforms of UtA and UA arteries and MAP in pregnancies with IUGR after administration of either SC or GTN therapy. No significant change in MCA Doppler was observed in both groups. IUGR patients treated by either SC or GTN showed significant reduction in both UtA and UA Doppler wave (PI&RI) as well as MAP, with no effect on MCA Doppler wave (PI&RI). Therapy with either Sildenafil citrate or GTN improves uteroplacental (uterine arteries) and fetoplacental (umbilical arteries) circulation and potentiates fetal growth. Sildenafil citrate could normalize the uteroplacental insufficiency with a favorable fetal outcome better than GTN. Sildenafil citrate could be suggested as first line of the treatments for IUGR patients as it is cheaper, has less maternal or fetal complications.

Keywords: Sildenafil citrate, transdermal GTN, IUGR, EFW, gestational age, Doppler ultrasound. 

International Journal of Obstetrics and Gynecology ISSN 2326-7234 Vol. 5 (7), pp. 191-199, November, 2017. © International Scholars Journals

Full Length Research Paper

Effect of opportunistic salpingectomy on ovarian reserve in patients undergoing hysterectomy for benign indications

¹Deniz Şimşek*, ²Ali Akdemir, ²Ahmet Mete Ergenoğlu, ³Çağrı Güven, ⁴Dilek Taşkıran, ²Ahmet Özgür Yeniel, and ²Serdar Özşener

¹Ahlat State Hospital, Department of Obstetrics and Gynecology, Bitlis, Turkey,

²Ege University School of Medicine, Department of Obstetrics and Gynecology, Izmir, Turkey,

³Denizli State Hospital, Department of Obstetrics and Gynecology, Denizli, Turkey,

⁴Ege University School of Medicine, Department of Physiology , Izmir, Turkey.

*Corresponding author E-mail: [email protected]. Tel: +902323901700, Fax: +902323430711

Accepted 09 May, 2017

Abstract

Epithelial ovarian cancer is the gynecologic cancer with the highest mortality in the western world. Distal part of tuba uterine is accused of being the origin of this cancer type. Thus, prophylactic salpingectomy has been suggested by several societies however this procedure can also cause early ovarian ageing. We aimed to elucidate the effect of salpingectomy additional to hysterectomy on ovarian reserve appraising ultrasonographic scanning and AMH. Prospective, randomized analytical study is achieved comparing patients who have underwent solely hysterectomy (N:29) and underwent hysterectomy and prophylactic salpingectomy (N:34). Comparison of AMH values between groups did not differ statistically significant whereas pre-operative and post-operative values of AMH were significantly decreased in both groups. Comparison of ovarian volume and AFC did not differ statistically significant. Ovarian blood flow doppler ultrasonography parameters were (PSV, PI) generally (10/12 parameters) did not differ significantly between groups. Prophylactic salpingectomy during hysterectomy did not cause additional ovarian reserve impairment without any operative and post-operative complications. Patients scheduled hysterectomy for benign reasons, could be informed about retained fallopian tubes and the benefit and harm of prophylactic salpingectomy precisely.

Keywords: Prophylactic salpingectomy, hysterectomy, ovarian reserve, AMH, doppler ultrasonography.