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.

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.

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.

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.

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.

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.

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.

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.

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.

Giant Dental Calculus: A Rare Case Report and Review.

Inadequate oral hygiene is the root cause of the initiation and establishment of the periodontal disease. Dental calculus serves as plaque retentive area, thereby contributing to gingivitis and periodontitis. The present unusual case is of a 55-year-old female patient reported to the department of periodontology with a chief complaint of hard deposit at the right maxillary and mandibular posterior region. The patient was found to have very heavy calculus deposition with respect to right maxillary and mandibular posterior teeth, and the patient was using the left side for mastication and avoiding chewing from the right side mainly due to some periodontal problem. The extraction of the hopeless teeth along with dental calculus was done. Dimensions of dental calculi at maxillary and mandibular teeth was 4 cm × 3 cm each.

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.

Prevalence of impacted third molars among orthodontic patients in different malocclusions.

OBJECTIVES: The aim of this retrospective study was to investigate the prevalence and pattern of third molar impaction and missing third molars in patients over 18 years in different anteroposterior skeletal patterns among central Indian populations. MATERIALS AND METHODS: The study reviewed 357 orthopantomograms of patients attending the Government College of Dentistry, Indore, Madhya Pradesh. Patients were evaluated to determine the prevalence of third molar impaction, angulation, and level of eruption in Class I, Class II, and Class III patients using Winter's classification to determine angulation of third molars and Pell and Gregory classification for level of impaction. RESULTS: Out of 357 patients, 187 (52.3%) were present with at least one impacted teeth. The third molar impaction was most commonly present in Class II malocclusion (60.65%). Overall, the most common angulation of impaction in both genders was the mesioangular (39%), and the most common level of impaction in both arches was Level B. In Class I, Class II and Class III malocclusion vertical angulation was the most common finding in the maxillary arch and mesioangular angulation in the mandibular arch. No significant association was observed between different types of malocclusion and third molar impaction (P > 0.4648). CONCLUSION: This study found that almost half of the adult patients above 18 years had at least one impacted third molar. The anteroposterior relationship does not have any significant role for the third molar impaction.

Patterns and prevalence of canine anomalies in orthodontic patients.

OBJECTIVE: The aim of the present study was to present detailed information regarding the impacted maxillary and mandibular canines and their patterns of presentation into the oral cavity and to evaluate the prevalence of different canine anomalies, such as ectopic canine, transmigration, transposition and agenesis of permanent canines among central Indian population. METHOD: A total of 1593 patients OPG's were thoroughly evaluated and the prevalence of different canine anomalies like impacted maxillary and mandibular canine, transmigration, transposition, agenesis and ectopic canine eruptions were evaluated. The canine angulation, vertical position in relation to occlusal surface of adjacent tooth's and the overlapping of adjacent teeth's crown by impacted canine was evaluated by tracings. RESULT: Out of 1593 subjects, 22 patients had impacted canines. The prevalence of canine impaction was1.38%, with maxillary canine impaction of 0.93%, mandibular canine impaction of 0.37%, canine agenesis 0.06%, transmigration 0.12%, canine transposition 0.18% and the ectopic canine was 5.5%. CONCLUSION: There is no gender difference in canine impaction. The prevalence of canine impaction is 1.38%.

Randomised controlled trial to study the efficacy of exercise with and without metformin on women with polycystic ovary syndrome.

OBJECTIVES: 1. To study the efficacy of exercise in improving clinical symptoms, anthropometry, glucose tolerance and laboratory profile in women with Polycystic ovarian syndrome. 2. To study the combined efficacy of exercise and metformin on above parameters in women with polycystic ovary syndrome. STUDY DESIGN: A Randomised double blinded placebo controlled trial was performed at a district hospital in New Delhi. Sixty six women were included in the study. Block randomisation was done to divide the women into two groups. Women were treated with fixed exercise schedule along with oral placebo in Group A and exercise with oral metformin in Group B. Outcomes stated in objectives were studied and statistically analysed. Quantitative variables were compared using unpaired t-test and Paired t-test within the groups across follow-ups. Qualitative variable has been compared using Chi-Square test /Fisher's exact test. RESULTS: In Group A and B significant improvement was noted in menstrual cycles, mean waist circumference, mean waist-hip ratio and body mass index. The mean weight loss was 0.78 ± 0.19 kg and 1.71 ± 0.19 kg in group A and B respectively after 3 months. The mean weight loss was 1.08 ± 0.30 kg and 1.71 ± 0.19 kg in group A and B respectively. The mean difference in modified Ferriman Gallwey score at 0, 3 and 6 months were statistically significant in both groups. On comparing group A with group B at 6 months, significant improvement was found in menstrual cycle symptoms (55.17% vs 83.33%), mean weight loss (1.08 kg vs 2.5 kg), waist circumference reduction (2.56 cm vs 4.75 cm) and change in mean waist hip ratio (0.02 vs 0.04). Significant changes were noted in OGTT and Serum testosterone level at 6 months in Group B, but not in Group A. Statistically no significant differences were found in acne, acanthosis nigricans and other biochemical parameters. CONCLUSION: Regular exercise should be recommended for the women with PCOS. It results in statistically significant improvement in menstrual cycle pattern, hirsutism, body mass index, weight, waist circumference waist-hip ratio. Addition of metformin resulted in added benefits on menstrual cycle, hirsutism, weight, body mass index, waist circumference, waist hip ratio, serum testosterone and Oral Glucose Tolerance Test (OGTT).

Association of midline discrepancy with tempromandibular joint disorder. A systematic review.

AIM: The aim is to evaluate the association between midline discrepancies and tempromandibular disorders (TMDs). METHODS: Literature search was performed by using various search engines to include human studies in English. TMDs include a wide variety of signs and symptoms such as pain in and around TMJ, jaw muscles, clicking and locking of jaws, pain during mandibular movement and restricted mandibular movements. The etiology is multifactorial, including one or several of the following factors like severe malocclusions (increased overjet, retroclination of incisors, cross bite, CR CO discrepancies etc), stress and psychological factors, structural abnormalities as possible etiology. There are controversies concerning the association between different traits of malocclusion and TMDs. The aim of the present study was to find out any association between signs and symptoms of TMDs with midline discrepancies, which represent an important trait of malocclusion. RESULT: Of the seven studies evaluated in this systematic review for investigating the association between midline discrepancy and TMD, six had moderate grade (B) of evidence. Four studies of moderate grade evidence (B) showed a significant association between the presence of midline shift and TMDs, and the remaining studies (two) had non-significant association. Only one study had a strong grade of evidence (A) and interestingly it denies the presence of midline shift to be a causative factor for TMDs. So, it can be concluded that the results are inconclusive regarding the association of midline discrepancies with TMDs. Nonetheless, this requires concrete evidence which necessitates further long term research into this aspect.