Aetiology and trends of rates of stillbirth in a tertiary care hospital in the north of India over 10 years: a retrospective study.

OBJECTIVE: To analyse the aetiology of stillbirth and its changing trends in a single tertiary care referral institute of northern India over a 10-year period (2007-2016). DESIGN: Retrospective study. SETTING: Tertiary care hospital in the north of India. SAMPLE: Medical records of all mothers who delivered a stillborn at the institute. METHODS: Data was collected from monthly and annual perinatal audits and causes of stillbirths were classified using Simplified CODAC classification. Annual reduction rate was calculated by linear regression analysis and Cusick test for the changing trends over 9 years. MAIN OUTCOME MEASURES: Of 54 160 births, 3678 babies were stillborn. Over 9 years, the annual stillbirth rate has reduced significantly from 73.6 to 62.0 per 1000 total births with an average annual reduction rate of 1%. The most common causes of stillbirths were hypertensive disorders of pregnancy (27.6%), antepartum haemorrhage (19.5%), and congenital anomalies (9.3%). CONCLUSION: The annual reduction rate (1%) of stillbirth remains low. The aetiology of stillbirths remains unchanged over a 10-year period and hypertensive disorder of pregnancy remains the single most preventable cause of stillbirth. TWEETABLE ABSTRACT: Analysis of stillbirths over a 10-year period in an Indian institute showed a high but declining trend with annual reduction rate of 1%.

Obstetric Teleconsultation by Using Mobile Phone Technology in COVID Pandemic.

Introduction: Obstetrics teleconsultation is a new concept to enable health-care services in the COVID pandemic by limiting in-person visits. This study describes the methodology of mobile-based teleconsultation, preliminary findings, and the experience of the obstetricians. Material and Methods: The data of pregnant women who got registered for teleconsultation in early phase of COVID pandemic lockdown were reviewed and analyzed. A qualitative analysis was performed to assess the experience of obstetricians (consultants, senior residents, and junior residents) via an online electronic survey. Results: The majority of obstetrics teleconsultations were for routine antenatal care (75%) and fetal medicine consultation (12.3%). Out of 187 women, 29.9% were advised to continue antenatal care at local hospitals, whereas 33.6% were asked to follow up via teleconsultation. Most of the obstetricians (73.68%) felt that they were able to satisfy the pregnant women and rated the teleconsultation satisfactory. Conclusion: Obstetrics telemedicine found to be beneficial for providing routine antenatal care services via reducing physical visits and overcrowding in outpatient departments, promoting antenatal care at local hospitals, and making specialized (maternal-fetal medicine) care accessible even during COVID-19 pandemic.

The Management of Scar Ectopic: A Single-Center Experience.

PURPOSE: This study aimed to highlight the clinical features, diagnosis, and different modalities of the treatment of cesarean scar pregnancy (CSP). METHODS:  This study was done in the tertiary referral hospital of India for one year. A total of 11 cases were enrolled prospectively. In each case, the diagnostic ultrasonography and measurement of baseline beta-human chorionic gonadotropin (ß-HCG) levels were done. The treatment was given based on the hemodynamic status of the patient and desire for future fertility. Various treatment modalities used were medical, surgical, or interventional digital subtraction angiography to control hemorrhage. Also, in some cases, ultrasound-guided methotrexate was injected into the scar ectopic. Medically treated cases were followed up until their ß-HCG levels became normal. RESULTS: Out of 11 patients, six had a history of two cesarean sections in the past, four patients had a history of one cesarean section and one patient with a previous three low segments cesarean section (LSCS). Seven out of 11 patients underwent medical management with either methotrexate with potassium chloride (KCl) or methotrexate alone. The success of the medical management was monitored by serial ß- HCG values. The mean time for the resolution of these 10 patients was 86.7 ± 53.6 days. Three patients underwent emergency uterine artery embolization due to uncontrolled bleeding and one patient required laparotomy. CONCLUSION: CSP is a life-threatening condition that can be diagnosed with the help of transvaginal ultrasonography. The treatment, however, depends on the hemodynamic status of the patient and desire for future fertility. Well-defined diagnostic criteria coupled with structured management and follow-up protocol can help in treating this challenging form of ectopic pregnancy.

Pelvic artery embolization in the management of obstetric hemorrhage.

We studied the role of pelvic artery embolization in management of obstetric hemorrhage by retrospective analysis of 50 cases of obstetric hemorrhage in a tertiary care referral hospital where this procedure was used. Uterine and or internal iliac artery embolization was performed for the management of postpartum hemorrhage (39 cases; 78%), post abortal bleeding (6 cases; 12%) and gestational trophoblastic disease (4 cases; 8%). In one case of postpartum hemorrhage procedure could not be performed due to arterial spasm (2%). Prophylactic embolization was carried out in one case of placenta accreta. The mean age of the women was 27 years and 54% were primiparas. In six women embolization was done after hysterectomy failed to control pelvic hemorrhage. One fourth of women had coagulopathy at the time of presentation. There were five cases of pelvic hematoma and three cases of arteriovenous malformations. The success rate of the procedure was 94% and the procedure was unsuccessful for controlling bleeding in three women. There were no major procedure related complications. Thus, pelvic artery embolization is an effective alternative to surgery in controlling obstetric hemorrhage and as a fertility and life-saving procedure.

Scrub typhus in pregnancy: a case series.

Scrub typhus, an acute febrile illness caused by Rickettsia and transmitted by mites, is a re-emerging endemic zoonosis in the Asia Pacific region. It is an uncommon entity and very few cases of this disease in pregnant women have been reported. We present a series of six such cases collected over 1 year with poor feto-maternal outcome in 50%.

Bilateral sertoli-leydig cell tumor in a primigravida: a rare case.

We present a unique case of incidentally discovered bilateral Sertoli Leydig cell tumour in a primigravida who displayed no features of virilization. The apha fetoprotein levels were elevated. Magnetic resonance imaging was suggestive of ovarian tumors, possibly germ cell tumor. Bilateral salpingo-oophorectomy was performed and histopathology showed features of Sertoli Leydig cell tumor with intermediate to poor differentiation. Immunohistochemistry was positive for calretinin and inhibin, while cytokeratin was negative. Four courses of bleomycin-, etoposide- and cisplatin-based chemotherapy regimen was started, but the patient aborted while receiving the second cycle of chemotherapy. She received the remaining two cycles of chemotherapy and is now on close follow up with monitoring of serum inhibin levels to detect any tumor recurrence. Bilateral Sertloli Leydig cell tumor has not been reported previously in a pregnant female. The aim of this article is to describe the clinical, radiological and pathological features and management of this rare entity.

The Accuracy of Integrated [(18)F] Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Detection of Pelvic and Para-aortic Nodal Metastasis in Patients with High Risk Endometrial Cancer.

Lymph nodal (LN) metastasis is the most important prognostic factor in high-risk endometrial cancer. However, the benefit of routine lymphadenectomy in endometrial cancer is controversial. This study was conducted to assess the accuracy of [(18)F] fluorodeoxyglucose-positron emission tomography/computed tomography ([(18)F] FDG-PET/CT) in detection of pelvic and para-aortic nodal metastases in high-risk endometrial cancer. 20 patients with high-risk endometrial carcinoma underwent [(18)F] FDG-PET/CT followed by total abdominal hysterectomy, bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy. The findings on histopathology were compared with [(18)F] FDG-PET/CT findings to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [(18)F] FDG-PET/CT. The pelvic nodal findings were analyzed on a patient and nodal chain based criteria. The para-aortic nodal findings were reported separately. Histopathology documented nodal involvement in two patients (10%). For detection of pelvic nodes, on a patient based analysis, [(18)F] FDG-PET/CT had a sensitivity of 100%, specificity of 61.11%, PPV of 22.22%, NPV of 100% and accuracy of 65% and on a nodal chain based analysis, [(18)F] FDG-PET/CT had a sensitivity of 100%, specificity of 80%, PPV of 20%, NPV of 100%, and accuracy of 80.95%. For detection of para-aortic nodes, [(18)F] FDG-PET/CT had sensitivity of 100%, specificity of 66.67%, PPV of 20%, NPV of 100%, and accuracy of 69.23%. Although [(18)F] FDG-PET/CT has high sensitivity for detection of LN metastasis in endometrial carcinoma, it had moderate accuracy and high false positivity. However, the high NPV is important in selecting patients in whom lymphadenectomy may be omitted.