Comparison of Keyes Punch Biopsy Instrument with Cervical Punch Biopsy Forceps for Diagnosing Cervical Lesions.

OBJECTIVE: To assess the feasibility and efficacy of Keyes punch biopsy instrument (KP) in diagnosing cervical lesions and compare it with cervical punch biopsy forceps (CP). METHODS: 75 women having satisfactory colposcopy with abnormal transformation zone were included and paired colposcopic directed biopsies were taken using KP followed by CP from the same target area. RESULTS: It was feasible in all cases to take cervical biopsy with KP after increasing its effective length. The volume of gross specimen obtained by KP was less than CP (0.076 ± 0.097 vs. 0.101 ± 0.156 cm3, p = 0.061), however on microscopic examination, mean length and mean depth of tissue in KP was greater than CP by 0.06 mm (p = 0.810) and 0.14 mm (p = 0.634) respectively. Exact agreement was found with the final surgical specimen in 42% of cases in both the biopsy forceps. CONCLUSION: KP is almost at par with CP for diagnosing preinvasive cervical lesions and is a useful adjunct to the existing armamentarium of biopsy forceps.

Spectrum of Maternofetal Outcomes during Dengue Infection in Pregnancy: An Insight.

Dengue is a vector transmitted viral infection; tropical and subtropical countries see outbreaks of dengue each year. There is a paucity of literature on effects of dengue infection on pregnancy outcome and this prompted us to undertake a study for better understanding of pregnancy implications with dengue infection. Pregnant women admitted during the seasonal outbreak of dengue between September 2015 and October 2015 were studied and maternal and fetal outcomes in sixteen NS1Ag positive women were analysed. Out of sixteen women diagnosed with dengue fever, three had dengue shock syndrome (DSS) and eight had dengue haemorrhagic fever (DHF). The most common obstetric complication seen in 43% of the cases was oligohydramnios. Bleeding manifestations occurred in seven women and there were three maternal deaths. Perinatal complications included three intrauterine deaths, six nursery admissions, and one neonatal death. Thus dengue infection was associated with high maternal and perinatal mortality. In view of poor obstetric outcomes, this viral infection warrants early admission and prompt management.

Is nuchal cord justified as a cause of obstetrician anxiety?

PURPOSE: Birth asphyxia leading to acidosis comprises 20-60 % of perinatal mortality. Nuchal cord (NC) is one of the possible causes of birth asphyxia. Majority of fetuses who are antenatally detected to have nuchal cord are able to achieve successful vaginal birth. The purpose of this study was to analyze the effect of nuchal cord on fetal acid base status and perinatal outcome in vaginal deliveries. STUDY DESIGN: 150 parturients were equally divided into three groups after vaginal delivery based on no NC, single and multiple loops. Umbilical cord arterial blood was analyzed for biochemical markers i.e. pH, PO2, SPO2, PCO2, HCO3 (-), standard base excess and lactate for acidosis. Labor complications like abnormal FHR, meconium-stained liquor, prolonged second stage, instrumental vaginal delivery, third stage complications were compared. In neonates, birth weight, Apgar score ≤7 at 5 min, NICU admission and other morbidity and mortality during hospital stay were compared among groups using suitable statistical tests. Above parameters were also compared between tight and loose loops. RESULT: Nuchal cord groups had significantly higher frequency of labor complications than no NC group, especially tight loops. Neonates with NC had significantly higher frequency of meconium-stained liquor, Apgar score ≤7 at 5 min, deranged biochemical markers, NICU transfer. However, none of the neonate had pH in acidosis range and majority were discharged in healthy condition. CONCLUSION: Patients with NC are likely to have uneventful labor and delivery as cord compression is transient and most fetuses are able to compensate for reduce umbilical blood flow. Routine antenatal ultrasound scan is not advisable, as mode of delivery and labor management does not change with detection of NC antenatally. Therefore, vaginal delivery with routine labor protocol can be allowed in cases of nuchal cord.

Craniofacial fibrous dysplasia with facial asymmetry, canted occlusion and open bite: a case report with 2 years follow-up.

AIM: Fibrous dysplasia is a benign fibro-osseous disorder of unknown etiology that may affect the craniofacial region causing significant impairment of facial esthetics and function. This paper reports a case of a 21-year-old male, which was investigated and diagnosed with craniofacial fibrous dysplasia involving an overgrowth over right maxillary and mandibular region associated with facial asymmetry, severe occlusal cant and anterior open bite. Management of the case included surgical excision, cosmetic contouring and orthodontic intervention. The case was reviewed over a period of two years, which demonstrate stable treatment outcome.

Abnormally invasive placenta: changing trends in diagnosis and management.

Trends in patient profile, clinical presentation, diagnosis, management options and outcome of abnormally invasive placenta (AIP) were retrospectively evaluated at a tertiary care centre from 2001 to 2010. AIP was diagnosed when confirmed by ultrasound or MRI, when complete manual removal of placenta was not possible or when histological confirmation was achieved in a hysterectomy specimen. The first and second halves of the time period were compared. The total number of cases was 56 and the incidence increased significantly in the second half. Main risk factors were placenta previa and previous cesarean section. Antenatal diagnosis by ultrasound was made in 72% in the second half, compared with 35% in the first half (p = 0.009). Maternal mortality was 29% in the first half and 21% in the second half. Hysterectomy was the mainstay in management; elective procedures being significantly higher in the second half.

A novel technique of vagino-hysteroscopy using alginate gel interface: A proof of concept study.

OBJECTIVE: To compare the feasibility of vagino-hysteroscopy using alginate gel Interface (VAGI) with conventional vaginoscopic hysteroscopy (CVH). METHODS: Thirty women undergoing diagnostic vagino-hysteroscopy were randomly allocated into Group I (VAGI): Alginate occluder was used at introitus to facilitate hydrodistension during hysteroscopy; or Group II: Underwent no-touch hysteroscopy. Primary outcome was feasibility, defined as successful visualization of uterine cavity. Secondary outcomes included operative time, hydrostatic pressures for optimum visualization, pain experienced by patient on visual analog scale, maneuverability and surgeon satisfaction. Data analysis was performed using χ2 and Fisher exact tests for qualitative variables and Student t test for quantitative variables. RESULTS: VAGI was significantly better than CVH (80% vs. 33.3%; relative risk 8, P = 0.025). With VAGI, optimum visualization was achieved at significantly lower pressures at all levels (vagina, P = 0.034; cervix, P = 0.01; uterus, P < 0.001), in less time (P = 0.007), and using less irrigation fluid (P < 0.001). Surgeon satisfaction was significantly higher for VAGI (P = 0.009). Subgroup analysis showed higher likelihood of success of VAGI in women who were premenopausal (P = 0.015), younger than 45 years (P = 0.024), and had a history of vaginal birth (P = 0.03). CONCLUSIONS: VAGI is quicker to perform and provides optimum visualization at much lower pressures than CVH. Use of alginate is patient friendly and yields higher surgeon satisfaction rate.

Impact of Birth Companionship on Maternal and Fetal Outcomes in Primigravida Women in a Government Tertiary Care Center.

BACKGROUND: Studies have shown that the support provided by birth companions during labour and childbirth improves maternal and neonatal outcomes and helps women in having a positive childbirth experience. OBJECTIVE: To study the role of birth companionship on maternal and foetal outcomes along with their satisfaction rates in primigravidas supported by birth companions compared to those receiving routine care in the labour room. DESIGN: The study was a prospective comparative observational study. One hundred fifty primigravida women were randomly divided into two groups, one group (n = 75) who were allowed a female companion of their choice (A) and the other group (n = 75) who did not have a birth companion receiving routine standard care as routinely practised in our hospital. The data was entered in MS Excel Sheet and analysis was done using the statistical package for social sciences (SPSS) version 21.0 (IBM Corp., Armonk, NY). A p-value of <0.05 was considered statistically significant. RESULTS: Spontaneous vaginal births were significantly higher in group A (Group A: mean = 67; SD = 89.3%, Group B: mean = 57; SD = 76 %; p = 0.03) along with a favourable trend in a shorter duration of the first stage of labour (9.96±1.09 vs 11.95±3.11 hours) and decreased need of augmentation (Group A; mean = 10; SD = 13.3, Group B: mean = 23; SD = 30.7; p = 0.01). Maternal satisfaction was significantly higher in group A (Group A: mean = 60; SD = 80, Group B: mean = 44; SD = 58.7; p <0.01) and in the early initiation of breastfeeding (Group A: mean = 70; SD = 93.3, Group B: mean = 55; SD = 73.3; p <0.01). No statistical difference was observed between the mean duration of labour, mode of delivery, and NICU stay of the baby. CONCLUSIONS: Companionship during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter labour duration, a low five-minute Apgar score, and higher satisfaction rates with childbirth experiences.

Perinatal Outcome in Overweight Women: An Audit.

BACKGROUND: Obesity in pregnancy is associated with a myriad of well-documented complications. However, the outcomes of pregnancy in overweight females, who are not classified as obese, have not been studied. The aim of the study was to assess foeto-maternal outcomes in primigravida who are overweight and compare them to normal-weight patients. MATERIAL AND METHODS: This was a prospective observational cohort study and included primigravida with full-term gestation (between 38 and 42 weeks), with a single live foetus in vertex presentation, who were admitted for labour induction. Based on pre-pregnancy weight, patients were divided into normal weight (body mass index, BMI<23kg/m2) and overweight (BMI≥23kg/m2 and<25kg/m2) categories labelled as groups A and B, respectively. Data was collected for gestational age, demographics (age, education, occupation), and obstetric and labour-related parameters per pre-designed proforma. Parameters included were the reason for induction, number of doses of prostaglandin E2 (PGE2) gel used, duration of labour, induction to delivery interval, and mode of birth- operative/ non-operative. Data was also collected for peri-partum maternal complications, neonatal Apgar score, and need for Neonatal Intensive Care Unit (NICU) admissions. RESULTS: One hundred and fifty patients were recruited in the study and divided based on weight into two groups- 115 in Group A (normal weight) and 35 in Group B (overweight). Compared to Group A, a higher proportion of patients in Group B needed a third dose of PGE2 gel (n=24, 20.8% vs n=18, 51.4%). Also, more patients in Group B had an induction to delivery time of longer than 30 hours (n=7, 20% vs n=5, 4.3%) and had a higher incidence of failed induction needing caesarean section (n=9, 25.7% vs n=13, 11.3%). Neonates born to overweight mothers had a poor Apgar score at 1 min. However, on reassessment, Apgar improved at 5 minutes, and no statistically significant difference was seen for admission to NICU- 5.7% (n=2) in Group B vs 1.7% (n=2) in Group A Conclusion: Pregnancy in overweight females is associated with prolonged labour, higher instances of failed induction, and poor neonatal outcomes at initial assessment. Thus, perinatal counselling and management should focus on weight control while also planning appropriate strategies for monitoring and treating pregnancy-related complications if weight control measures fail. Although obesity is the main focus of research, we suggest including overweight but non-obese females in such studies as they have similar adverse outcomes and complications.

Cerebroplacental Ratio as a Predictor of Perinatal Outcome in Hypertensive Disorders of Pregnancy and Its Comparison With Its Constituent Doppler Indices.

Objective Doppler velocimetry is an established method of antepartum fetal surveillance in pre-eclampsia. Cerebroplacental ratio detects the centralization of fetal blood flow and the insufficiency in placental circulation. It is postulated to be a better marker of perinatal outcome than either vessel Doppler alone. The current study aims to assess the cerebroplacental ratio as a predictor of adverse perinatal outcomes and compare it to the systolic/diastolic (S/D) ratio of umbilical artery (UA) and middle cerebral artery (MCA) in hypertensive disorders of pregnancy. Material and methods The present prospective observational cohort study included 100 patients with hypertensive disorders of pregnancies between 32 and 37 weeks. Ultrasound with Doppler was done and the following parameters were assessed: fetal biometry, amniotic fluid index, umbilical artery pulsatility index, middle cerebral artery pulsatility index, S/D ratio of umbilical artery, S/D ratio of middle cerebral artery, and cerebroplacental ratio. Sensitivity, specificity, positive and negative predictive values were calculated for the cerebroplacental ratio and S/D ratios of umbilical and middle cerebral arteries. McNemar's test was used for the comparison of sensitivity and specificity. Results Thirty-two patients had an abnormal cerebroplacental ratio. Adverse perinatal outcomes such as a cesarean section for fetal distress, small for gestational age, APGAR < 7 at 1 and 5 minutes, NICU admission, and perinatal mortality were more in the group with abnormal cerebraplacental ratio and the difference was statistically significant. Conclusion The cerebroplacental ratio is a more reliable predictor of adverse perinatal outcomes and should be routinely calculated during obstetrical Doppler for antepartum fetal surveillance in case of hypertensive disorders of pregnancy.It suggested that the cerebroplacental ratio may be calibrated in the software ofthe Doppler ultrasonography machine for routine use in high-risk pregnancies.

Labor induction with combined low-dose oral misoprostol and Foley catheter vs oral misoprostol alone at term gestation-a randomized study.

BACKGROUND: The ideal method for induction of labor is still not clearly defined. Recent reports in literature have shown that oral administration of low-dose misoprostol is as effective as vaginal administration for induction of labor. The use of vaginal misoprostol in combination with Foley catheter has been shown to shorten the period of induction. However, there are limited reports on the use of oral misoprostol in combination with Foley catheter. Given the convenience of oral administration, improved compliance relative to other methods is probable. This study proposed that the combination of oral misoprostol and Foley catheter would be a better means of inducing labor. OBJECTIVE: To compare the efficacy of combined low-dose oral misoprostol and Foley catheter with oral misoprostol alone for induction of labor at term gestation. The efficacy was compared in terms of the induction-to-delivery interval and the number of women delivering vaginally within 24 hours. The second objective was to document adverse events, if any, of the 2 protocols. STUDY DESIGN: The study was conducted at a tertiary care center and included 200 patients with indication for induction, randomly allotted to either of the 2 groups: group A (a combination of Foley catheter and 25-µg misoprostol every 2 hours orally) and group B (only 25-µg misoprostol every 2 hours orally), using computer-generated random number sequence. The obstetrical and neonatal outcomes were recorded and compared between the 2 groups. Quantitative variables were compared using unpaired and paired t-tests within the groups across follow-ups. RESULTS: Group A had significantly shorter mean induction-to-active-labor interval (10.67±1.75 vs 16.28±1.69 hours), mean induction-to-full-dilation interval (11.49 vs 19.00 hours), and mean induction-to-delivery interval (16.85 vs 21.90 hours). The proportion of women delivering vaginally within 24 hours was higher in group A (76 vs 57 women). In comparing maternal side effects, the only significant difference between the 2 groups was found in postpartum hemorrhage. A 5-minute Apgar score <7 was significantly more frequent in group B. CONCLUSION: The combination of oral misoprostol with transcervical Foley catheter reduced the induction-to-delivery interval significantly (P=.001). In addition, the proportion of women delivering vaginally within 24 hours was significantly higher. Hence, the use of oral misoprostol with Foley catheter for induction of labor would be beneficial for patients.

PAX1 Methylation Status in Cervical Scrapes as Novel Diagnostic Biomarker in CIN 2/3 and Invasive Squamous Cell Carcinoma.

Objectives: DNA methylation of paired box-1 (PAX-1) gene has been shown to be a potential biomarker for the detection of high-grade cervical intra-epithelial neoplasia (CIN) and invasive cervical cancer. The objective of this pilot study was to quantify and compare methylation percentage of PAX1 gene in benign cervical lesion, pre-invasive and invasive cervical cancer. Methods: A total of 200 screen positive women (VIA, VILI and Pap test) underwent colposcopy. Cervical scrapes taken were taken and stored for DNA analysis and PAX 1 methylation status. Women with Swede score of 5 or more (n = 98) were biopsied. Cervical scrapes and biopsy were taken from women with obvious cervical growth (n = 14), without prior colposcopy. Sixty women were recruited to the study and allocated into three groups on the basis of histopathology, i.e., benign cervix (Group 1; n = 20), CIN 2/3 (Group 2; n = 20) and invasive cervical carcinoma (Group; n = 20). PAX 1 methylation percentage was calculated from the DNA extracted from the cervical scrapes of the women recruited. Results: The mean PAX1 methylation percentage in benign lesions, CIN 2/3 and invasive cancer was 9.58% (SD ± 2.37%), 18.21% (SD ± 2.67%) and 24.34% (SD ± 4.09%), respectively, with p-value of < 0.001. Conclusions: PAX 1 gene methylation has a promising role in identifying high-grade lesions and invasive cancer.

Elongated styloid process: an unusual cause of neck pain and difficulty in swallowing.

An elongated styloid process is an unusual source of craniofacial and cervical pain. This condition is characterized by a dull, nagging pharyngeal pain and a palpatory finding in the tonsillar fossa. Eagle described it for the first time in 1937 as Eagle's Syndrome and divided it into two subtypes: the "classic syndrome" and the "stylo-carotid syndrome." The syndrome generally follows tonsillectomy or trauma. Diagnosis is confirmed by radiological findings. Palpation of the styloid process in the tonsillar fossa and infiltration with anesthetic are also used for making a diagnosis. This article presents a case report of a patient with a history of throat pain that was relieved after surgical treatment.

Incidentalomas of the female genital tract on 64-slice MDCT: a clinico-radiological pictorial review.

Sonography is the imaging modality of choice for diagnosing diseases of the female genital tract due to its high resolution, easy availability, low cost and lack of radiation. CT is not advocated for the primary evaluation of the female pelvis. However, with the advent of Multidetector CT (MDCT), females of all ages undergo CT scan of the abdomen and pelvis for myriad non-gynaecological diseases, e.g. subacute intestinal obstruction, abdominal lump, abdominal tuberculosis, appendicitis, ureteric colic, pancreatitis, oncological staging, follow-up, etc. Incidental female genital tract disorders were seen on these scans that are a dilemma for both, the radiologists and the clinicians. The objective of this pictorial review is to characterise the incidentally detected lesions of the female genital tract observed on 64-slice MDCT by correlating with sonography, if necessary, and establishing a clinico-radiological diagnosis. Our aim is to emphasise that the radiologist may be the first person to recognise a gynaecologic disorder and hence can play a significant role in patient management.

Evaluation of frozen section biopsy for fast track diagnosis of endometrial pathology in high-risk women with abnormal uterine bleeding.

OBJECTIVE: To study the accuracy of frozen section biopsy for endometrial pathology in high-risk women with abnormal uterine bleeding (AUB). STUDY DESIGN: A case-control study was conducted between November 2017 to April 2019, a total of 150 women with postmenopausal bleeding, perimenopausal AUB, and high-risk women of age < 40 years with AUB were recruited. All women underwent transvaginal sonography and Doppler, based on age-appropriate endometrial thickness cut-offs 80 women then underwent hysteroscopy. Based on hysteroscopy, women suspicious of malignancy were taken as cases (n = 40) and those with benign findings as controls (n = 40). All cases and controls underwent dilatation and curettage (D & C) with frozen section (FS) and routine histopathology. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR), negative LR, and overall test accuracy of FS were 90.9%, 93.19%, 83.33%, 96.19%, 13.8, 0.1 and 86.25% respectively for diagnosing endometrial hyperplasia and cancer taking histopathology as the gold standard. Correlation between frozen section biopsy and histopathology was highly significant (p < 0.001) on D & C specimens and the level of agreement was good (K = 0.778). CONCLUSION: In women suspicious of malignancy on hysteroscopy, frozen section has high accuracy on D&C specimen and can be used to diagnose endometrial hyperplasia and cancer in an effort to fast-track investigations and work-up for definitive treatment while awaiting final histopathology.

Prevalence of Developmental Dental Anomalies of Number and Size in Indian Population According to Age and Gender.

INTRODUCTION: Dental anomalies arise due to genetic and environmental factors in the morphodifferentiation stage of odontogenesis lead to alteration in the number and size of the tooth as well as the root.1-3 The knowledge of their prevalence and the extent of involvement can provide valuable information for phylogenic and genetic studies and also help in the understanding of differences among the population and between various population groups.4 We aim to identify the prevalence and distribution of such anomalies according to age and gender. The acquired details of cases will further help the dental clinicians to understand their etiology which can further facilitate their diagnosis and effective management. Also, timely intervention can be achieved. MATERIALS AND METHODS: Retrospective study of 4,000 subjects (equal proportion of males and female) of age range from 10 to 40 years were studied. Their radiographs, dental casts, and clinical findings were evaluated for number and size developmental dental anomaly. RESULTS: Incidence of overall 331 cases (8.27%) of number and size developmental dental anomalies were recorded with 173 (8.6%) males and 158 (7.9%) females. Hypodontia was the most frequently found dental anomaly in both males (4.9%) and females (4.4%) followed by hyperdontia and supernumerary roots. Microdontia was the most frequently found size anomaly in both males (1.6%) and females (1.9%). CONCLUSION: Hypodontia (4.7%) is the most frequently found numeral anomaly in both males and females. Intergroup study shows a significant statistical difference in cases of hypodontia in the 10-25 years of age-group (6.2%) with a p value ≤ 0.00001. HOW TO CITE THIS ARTICLE: Jain A, Saxena A, Jain S, et al. Prevalence of Developmental Dental Anomalies of Number and Size in Indian Population According to Age and Gender. Int J Clin Pediatr Dent 2021;14(4):531-536.

Mandibular symphysis morphology and lower incisor angulation in different anteroposterior jaw relationships and skeletal growth patterns - a cephalometric study.

OBJECTIVE: The purpose of the present study was to assess the symphyseal morphology and lower incisor angulation in different anteroposterior relationship and in different growth patterns and to investigate whether the symphyseal morphology had any correlation with dentofacial parameters. METHOD: Random Sampling method and lateral cephalograms of 90 subjects, age group 16-30 years, were divided into 30 in each group, i.e. Class I, Class II & Class III after calculating the following parameters (ANB angle, wits appraisal). After that, groups were again divided into 10 in each subgroup i.e. Average, Horizontal and Vertical growers. RESULTS: Results showed the increase in actual symphysis width, inclination of the alveolar part, total height of symphysis and reduction in overall width along with retroclination of lower incisors in class III subjects as compared to class I and class II. Similarly actual and overall width of the symphysis were decreased and inclination of the alveolar part, symphyseal height and symphyseal ratio were increased in vertical growers. CONCLUSION: The dimensions and configuration of Mandibular Symphysis in class III was found to be different than those in Class I and Class II relationships; the alveolar part of Mandibular Symphyseal compensated for the skeletal relationship in the Class III pattern. Mandibualr Symphysis dimensions were strongly correlated to anterior facial dimensions. Similarly the dimensions and configuration of Mandibular Symphysis was also different in vertical growers as compared to horizontal and average growers, moreover symphyseal morphology and lower incisor angulation had a correlation with dentofacial parameters.