Effect of Pre-pregnancy Maternal Body Mass Index on Obstetric Outcomes in a Tertiary Care Hospital in Goa, India.

Introduction: Maternal body mass index (BMI) is a vital predictor of the nutritional status of any pregnant woman. Several developing countries like India are facing the double burden of both obesity and malnutrition due the extreme socioeconomic distribution of our population. Thus, this study was undertaken to study the effect of pre-pregnancy maternal BMI on the obstetric outcomes. Materials and methods: A retrospective observational study was conducted during the time period of 1 year (December 2018-December 2019), wherein we analysed 3940 women who delivered in Goa Medical College. Depending on the maternal BMI calculated at the first antenatal visit, all the study participants were divided into five BMI groups and their obstetric outcomes were studied. Results: Majority of the study participants were in the normal BMI category (49.8%); however, a large number of women were overweight (37.3%), 3.2% were obese, 0.1% were morbidly obese, and 9.6%were underweight. Antenatal complications like anaemia and IUGR were more common in underweight women, whereas pre-eclampsia, GDM, macrosomia, antepartum haemorrhage and preterm labour were more common in obese women. Increased rate of Caesarean sections and postpartum complications like PPH, wound sepsis and puerperal sepsis were observed in overweight and obese women. Conclusion: Thus, adverse obstetric outcomes were observed in extremes of maternal BMI. Hence, there is a need to provide pre-conception counselling to all women in the reproductive age group so that they can achieve normal BMI prior to conception and thus reduce maternal morbidity and mortality rates in our country.

Using Sonographically Estimated Myometrial Thickness in Prediction of Latency Interval in Cases of Preterm Premature Rupture of Membranes (PPROM).

OBJECTIVES: To study myometrial thickness (MT) sonographically as a predictor of latency interval in women with preterm premature rupture of membranes (PPROM). STUDY DESIGN: The data were collected in a prospective manner from the antenatal patients between November 2011 and June 2013 during the follow-up of patients in the Department of Obstetrics and Gynecology, Goa Medical College. 100 patients with the periods of gestation of 28-36 weeks were studied, out of which 50 were PPROM cases and 50 were controls, both not in labor. The demographic factors and MT of uterine wall are measured at four different levels: midanterior, posterior, lower uterine segment (LUS), and fundus, which are then compared with the latency interval which is defined as the time from the rupture of membranes to the time of delivery. RESULTS: There was a significant inverse relation between the periods of gestation and latency interval, and positive correlation between anterior MT (p value 0.047), LUS thickness (p value 0.000), and latency interval implicating that the thicker the myometrium at admission in cases of PPROM the longer the latency period. CONCLUSION: MT appears a promising tool for obstetricians for predicting latency in cases of PPROM and guiding the management.

Amoebic cervicitis mimicking posterior wall fibroid: a rare presentation.

Amoebiasis of the uterine cervix is an extremely rare entity, and presentation as fibroid uterus has not been reported, to the best of our knowledge in our extensive search of the English literature. It can clinically simulate cervical malignancy by virtue of surface papillomatous and overall ulcerated and necrotic appearance. We present a case of amoebic infection of the cervix in a 45-year-old female which was suspected to be a posterior wall fibroid with degeneration until a histopathological examination of the surgical specimen revealed the presence of Entamoeba histolytica trophozoites. The patient recovered after surgery and antiamoebic therapy.

Primary choriocarcinoma metastasizing to skeletal muscles, presenting as an abdominal wall mass: A rare presentation.

Choriocarcinoma is a highly malignant tumor of the trophoblastic origin. Most cases are present within 1 year of antecedent pregnancy. We present an extremely rare case of choriocarcinoma of the anterior abdominal muscle in a 41-year-old female who presented as mass in anterior abdominal wall 4 months after undergoing a total abdominal hysterectomy with bilateral salpingo oophorectomy for a diagnosis of fibroid uterus. Laparotomy done for the mass revealed it to be an extraperitoneal mass within the rectus muscle that on histopathological examination was confirmed to be primary choriocarcinoma. Computed tomography scan revealed pulmonary metastases and patient was given combination chemotherapy to which she responded well.