Department Of Gynecology Research Articles

Impact of Physical Exercise to Reduce the Risk of Gestational Hypertension, A Role of Leptin and Adiponectin

Objective: To investigate the effect of exercise on the blood pressure of new-onset hypertension and non-hypertensive pregnant women and to determine the serum leptin and adiponectin levels and their response to exercise. Methodology: This quasi-experimental cross-over study was conducted at the Department of Gynaecology and Obstetrics, Hayatabad Medical Complex Peshawar. Samples were processed and analyzed at Khyber Girls Medical College Peshawar from January 2022 to April 2022. A total of 140 pregnant females were recruited for this study through convenience sampling. Out of this total, 70 were normotensive for the control group and 70 were hypertensive (gestational hypertensive). All participants were included after taking an informed consent. Results: In normotensive pregnant women, mean systolic and diastolic blood pressure remained normal, and no hypertension developed. In gestational hypertensive women, 70% responded significantly to physical exercise. Post-exercise, Group A saw decreases in systolic BP , diastolic BP , and leptin levels, with an increase in adiponectin. Group B exhibited more pronounced changes by decreased systolic BP, diastolic BP, leptin, and increased adiponectin. Conclusions: We observed that recommended physical exercise during pregnancy is safe and beneficial for maternal health in pregnancy. Physical exercise significantly reduced the progression of GH and brought the serum leptin and adiponectin levels toward normal range. Therefore, physical activity should be encouraged in every healthy woman after addressing potential barriers to exercise during pregnancy. Keywords: Gestational hypertension, Exercise, Leptin, Adiponectin

Association Between Serum Uric Acid and Pregnancy Outcomes: A Study in Chinese Women

ABSTRACT Objective The study aims to explore the relationship between serum uric acid (UA) levels in the first trimester and pregnancy outcomes. Methods The clinical data of 1381 pregnant women who delivered in the Department of Obstetrics and Gynecology of Beijing Chao-Yang Hospital from June 2021 to July 2022 were collected. All patients were categorized into four groups (Q1-Q4) according to quartiles of UA, using the first quartile of UA as the reference group. Logistic regression analysis was used to observe the correlation between UA and pregnancy outcomes. Restricted cubic spline (RCS) was drawn to observe the dose-response relationship between UA and pregnancy outcomes. Results The numbers of GDM patients in Q1-Q4 were 40 (11.70%), 46 (13.49%), 60 (17.29%) and 83 (23.65%), respectively (p < 0.001). Logistic regression analysis showed that higher quartiles of UA were significantly associated with an increased prevalence of gestational diabetes mellitus (GDM). After adjusting for confounding factors (maternal age, prepregnancy BMI, gestational weight gain, and gestational age), compared with the lowest quartile of UA, the highest quartile of UA had 2.06 times odds of GDM (OR, 2.06; 95% CI, 1.34, 3.18; p = 0.001) in Q4. RCS suggested that the risk of GDM increased slowly until UA levels reached 219.43 µmol/L and then began to increase rapidly afterward (overall p = 0.0037). Conclusions Increased uric acid concentrations in the first trimester are associated with an increased risk of GDM and gestational hypertension.

Evaluation of efficacy of mentzer index for screening of beta - Thalassemia trait in antenatal women

People with thalassemia trait should be distinguished from those who have anemia due to iron deficiency since they typically have mild microcytic hypochromic anemia and are mostly asymptomatic. : To evaluate efficacy of Mentzer index for screening Beta- Thalassemia trait in pregnant women.From January 2023 to October 2023, the observational study was carried out in the Department of Gynecology &amp; Obstetrics at Sri Guru Ram Das Charitable Hospital Amritsar. The study comprised 130 pregnant women with anemia. To assess microcytic hypochromic anemia, tests like complete blood count (CBC), peripheral blood smears, iron studies, and hemoglobin electrophoresis were performed. Mentzer Index (MI) was computed, and its specificity and sensitivity assessed. Of the 130 patients, 112 had Mentzer Index greater than 13 and 18 had Mentzer Index less than 13 but only 12 out of these18 had beta thal-trait according to HPLC. There were total 15 females having beta thal-trait as per HPLC, however 3 of the 15 had Mentzer &amp;#62;13. Conserding Beta thal-trait, the Mentzer Index's sensitivity and specificity were 80% and 95.65% in this study, and 95.33% and 86.96% for IDA. Mentzer Index (MI) is a helpful tool to distinguish iron deficiency from thalassemia trait as its specificity and sensitivity is high as electrophoresis in diagnosis. In situations with limited resources, this proves to be advantageous in terms of cost-effectiveness.

To evaluate the reliability of Urea and Creatinine values in vaginal wash fluid for the diagnosis of PROM

Background &amp; Methods: The aim of the study is to evaluate the reliability of urea and creatinine values in vaginal wash fluid for the diagnosis of PROM. Study performed on pregnant women in the third trimester between 28 and 37 weeks of gestation with history of possible leakage of amniotic fluid at tending in the department of Obstetrics and Gynaecology. Results: Total 50 subjects were recruited. Group 1 is PROM confirmed 25 subjects . Group 2 were controls and in each group 25 subjects were allotted. The comparison of co-morbidity between study groups in vaginal wash fluid to diagnosis the high rupture of membrane. Around 24% of subjects had co-morbidity in PROM confirmed category. Conclusion: In PROM confirmed subject urea level was 9.99 ± 4.16 and in controls it was around 4.12 ± 2.65. This shows that both PROM confirmed and suspected subjects had increased urea level than the control group. Thus urea and creatinine levels in vaginal wash fluid serves as an excellent diagnostic marker in diagnosing premature rupture of membrane. In conclusion, our study demonstrated that the measurement of vaginal fluid urea and creatinine is a simple and reliable test for diagnosis of PROM.

Enhanced recovery after surgery (ERAS) a multimodal perioperative care pathway in cesarean deliveries

Enhanced Recovery After Surgery (ERAS) is an evidence based perioperative program applied for early recovery of patients after surgery to reduce the postoperative surgical stress and hasten early physiological and functional recovery. The present study is focused on application of ERAS protocol in the branch of obstetrics following cesarean sections.The primary objective is to compare the efficacy between post-operative recommendations of ERAS protocols and traditional post-operative care in cesarean sections. A total of 300 patients were included in this study from November 2020 to October 2022 from the inpatient department of Obstetrics and Gynaecology of Pradyumna Bal Memorial hospital, KIMS, Bhubaneswar. Out of 300 patients, 150 were in ERAS group and 150 were in control (conventional) group. The median Length of stay (LOS) of ERAS and control group were 3 and 5 days respectively (p&amp;#60;0.01). The median patient satisfaction score on Likert scale was 4 and 3 for ERAS and control group respectively (p&amp;#60;0.01).The application of ERAS in post-operative period after cesarean has showed significant results in decreasing length of stay and better patient satisfaction score.

Menstrual challenges in puberty: Investigating menorrhagia in adolescent girls

Menorrhagia, defined as excessive or prolonged menstrual bleeding, poses a significant challenge during this developmental stage, potentially impacting the health and well-being of adolescent girls. Despite its prevalence, comprehensive studies on menorrhagia in this specific demographic are scarce. This study aims to address this gap by investigating the underlying causes and treatment outcomes of puberty menorrhagia.A six-month observational study involving 50 adolescent girls presenting with menorrhagia was conducted at the Department of Obstetrics and Gynecology in a tertiary care center. The study utilized consecutive enumerative sampling and included a thorough investigation of participants, collecting data on demographic profiles, symptom severity, anemia levels, diagnoses, therapy requirements, and responses to conservative management. Baseline investigations encompassed a range of tests, including pregnancy exclusion, complete blood count, coagulation profile, and hormonal assays.The study cohort of 50 participants revealed varying characteristics: 24% were under 14 years, 34% were between 14-16 years, and 42% were aged 17-19 years. BMI distribution showed 14% below 18.5, 76% between 18.5 and 25, and 10% exceeding 25. Symptom duration included 20% reporting less than 6 months, 34% between 6-12 months, and 46% over 12 months. Etiology analysis indicated 60% with ovulatory dysfunction. Hemoglobin level analysis illustrated the prevalence and severity of anemia. Diverse treatments, including hormonal and non-hormonal interventions, were administered.This study provides insights into the causes of puberty menorrhagia, emphasizing the need for a holistic treatment. Future research should delve deeper into identified associations and clinical variants to enhance our understanding and guide effective interventions. Management should be directed to the cause.

Rights-based reproductive services in medical schools in Rajasthan, Gujarat and Chandigarh, India: baseline findings of mixed-methods implementation research.

There is a need to assess and strengthen reproductive rights-based family planning and abortion services in Indian medical schools that play a key role in medical education and service delivery. This study presents the findings of baseline assessment across nine schools in two states and one union territory with objective to assess, identify the gaps and improve the status of reproductive rights and evidence-based family planning and abortion services in Indian medical schools. A convergent parallel mixed methods study was conducted in nine medical schools in Rajasthan, Gujarat, and Chandigarh a Union territory in India from October 2018 to June 2019. In-depth interviews with 33 faculty from the Department of Obstetrics and Gynaecology were conducted. The COM-B (Capability, Opportunity, and Motivation) model of behaviours was used to qualitatively identify barriers and facilitators of reproductive rights-based family planning and abortion services. Reproductive health services provided to 104 women for family planning and abortion were observed quantitatively using a pre-tested checklist. Providers' preference bias in recommending contraceptive methods to specific clients (wherein sterilisation was offered to women with two or more children and IUCD to women with one child) was observed as barrier to reproductive rights. The facilitators of rights based reproductive services included well-informed faculty regarding providing dignified and respectful care. Barriers included infrastructure gaps, high workload, insufficient human resources affecting privacy, and lower awareness and decision-making power of clients. Family planning counselling using the cafeteria approach was offered in 69.4% of cases, 31.6% of women seeking abortion services were offered counselling on both family planning and abortion. Sterilisation or IUD insertion was a pre-condition in 36.8% of women requesting an abortion. Right-based reproductive services around family planning counselling and abortion services were delivered partially despite the medical schools' trained faculty, mainly due to provider bias, high workload, and less autonomy and lower awareness of reproductive rights among women.

Pain and Fertility Outcomes in Patients Undergoing Cyst Excision Versus Cyst Aspiration in Moderate to Severe Endometriosis: A Case Series

Background: Endometriosis and ovarian cysts are prevalent gynecological disorders characterized by the presence of abnormal tissue growth in the pelvic cavity. Objective: To document the pain and fertility outcomes in patients undergoing cyst excision versus cyst aspiration in moderate to severe endometriosis presenting to a tertiary healthcare facility. Methods: This was a case series conducted in the Department of Obstetrics and Gynecology, Vinayaka Missions Medical College &amp; Hospital, Vinayaka Missions Research Foundation (VMRF, Deemed to be University), Karaikal, Puducherry, India between June 2021 and May 2023 (n=14). Results: The study included 14 patients, divided evenly with 7 undergoing cyst excision and 7 undergoing cyst aspiration. Before surgery, both groups had comparable baseline characteristics in terms of age, symptom severity, and the nature of the ovarian cysts. After surgery, patients who underwent cyst excision showed a higher rate of pain relief compared to those who underwent cyst aspiration (61% versus 26%, respectively). In terms of fertility outcomes, 55% of patients in the cyst excision group achieved improved clinical pregnancy outcomes after surgery, whereas 35% of those in the cyst aspiration group had comparable results. Conclusion: Cyst excision appears to be associated with superior pain relief and faster recovery compared to cyst aspiration in patients with endometriosis or ovarian cysts.

Abstract A065: Estimation of HPV16-induced cervical cancer cells in routine Thin-prep cytology samples of cancer patients

Abstract Persistent infection with human papillomavirus has been implicated in the etiology of cervical cancer and sustained expression of its E7 oncoprotein has been rendered suggestive of malignant transformation. However, there are limited E7 protein-based detection assays. This might be due to paucity of data on steady-state expression level of E7 protein and the number of HPV-induced cervical cancer cells in routine Thin-prep cytology samples. So, the objective of the present study was to identify and estimate HPV16-induced cervical cancer cells in cytology samples of cancer patients, with the goal to generate a quantitative immunological method in the cytological diagnosis of cervical lesions. We collected 25 Thin-prep cytology samples of cervical cancer patients (PAP test confirmed) from Obstetrics and Gynecology department, AIIMS, New Delhi. Samples were conditioned to enrich cellular components and were then quantified using hemocytometer for total cell count, PAP staining for cancerous cell count and immunofluorescence using HPV16 E7 antibody for HPV16-induced cancerous cell count. The method devised efficiently found an average number of 7 × 103 cells/ ml to be E7 positive, out of total 27 x 104 cells/ ml. Although PAP test detected 71 x 103 cells/ ml to be abnormal or cancerous, only 10% of them were found to be HPV16 transformed, suggesting HPV E7 as the primary marker for detecting transformed cells and thereby, identifying patients at-risk and prompting a better prognosis. This simple and efficient method deduced allows optimizing the number of HPV16-induced cervical cancer cells from cytology samples which directly correlates to the amount of HPV-16 major oncoprotein- E7 expression, and the disease severity. Citation Format: Srishty Raman, Pranay Tanwar, Neerja Bhatla, Subhash Chandra Yadav. Estimation of HPV16-induced cervical cancer cells in routine Thin-prep cytology samples of cancer patients [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A065.

INFLUENCE OF UROGENEITRAL INFECTION IN PREGNANT WOMEN ON THE UTERINE – FETOPLACENTARY COMPLEX

As reported by the World Health Organization (WHO), approximately 20 % of pregnant women globally are aff ected by an infection of the lower genital tract. Urogenital infection can result in complications during the onset and progression of pregnancy, as well as the postpartum period. These complications include placental dysfunction, premature birth, low birth weight, premature rupture of the fetal membranes, and postpartum endometritis. A marker of normal placental function is α2-fertility microglobulin (AFMG), the determination of which will refl ect the presence or absence of a uterine- fetoplacental complex violation during urogenital infection in pregnant women.The aim of the study is to reveal the infl uence of urogenital infection on the dysfunction of the uterine – fetoplacental complex in pregnant women.Materials and methods. A total of 75 pregnant women were examined, divided into two groups: the main group (MG) and the comparison group (CG). The MG consisted of 55 pregnant women, of whom 35 underwent local sanitation of the urogenital infection according to the identifi ed pathogen (Subgroup A) and 20 refused this procedure (Subgroup B). The CG consisted of 20 pregnant women without urogenital infection, as determined by bacterioscopic, bacteriological, and polymerase chain reaction (PCR) examinations. All pregnant women underwent determination of AFMG in blood serum via immunoenzymatic methodology. The statistical analysis was conducted using the MedStat software (serial number MS00019). The study was performed in accordance with the provisions of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of PFMU for all women who participated in this study. Statistical processing was performed using the MedStat program (serial number MS00019). The work is a part of the initiative research work of the Department of Obstetrics and Gynecology No. 1 of Poltava State Medical University «Pathogenetic role of endothelial dysfunction and genetic features in pathology during pregnancy and gynecological diseases» (state registration No. 0117U005253, term of implementation 2017-2023).Research results. The results of the study demonstrated that pregnant women with a urogenital infection had a history of chronic pyelonephritis 5.5 times more frequently (p = 0.03) and salpingo- oophoritis 10.2 times more frequently (p &lt; 0.001), which may be a source of latent infection. The most prevalent infectious agents among pregnant women were: The most prevalent microorganisms were Ureaplasma urealyticum (21.4 %), Candida fungi (19.04 %), Gardnerella vaginalis (11.9 %), and Toxoplasma gondii (11.9 %). The level of AFMG in pregnant women with urogenital infection was observed to be 4.3 times lower than in pregnant women with CG (p &lt; 0.001). The remediation of an infection of the lower genital tract during pregnancy has been observed to increase AFMG production by a factor of four (p &lt; 0.001). The level of AFMG in pregnant women of CG was 2.2 times higher than in pregnant womenof Subgroup A (p &lt; 0.004).Conclusions. It was demonstrated that urogenital infection in pregnant women has a considerable impact on the dysfunction of the utero- fetoplacental complex. It was also shown that local sanitation of the lower genital tract in these women, based on the identified pathogen, has a benefi cial eff ect on the placenta’s functioning. However, this approach does not fully address the issue of protein synthesis impairment.

CESAREAN SECTION IN UKRAINE AND THE UNITED KINGDOM: SIMILARITIES AND DIFFERENCES

The aim of the study was to conduct a comparative analysis of cesarean sections in Ukraine and the United Kingdom in order to improve the quality of medical care and optimize outcomes for both mother and newborn.Materials and methods. To achieve this goal, we analyzed the unifi ed clinical protocol «Caesarean section» of the Ministry of Health of Ukraine dated January 5, 2022 and the UK NICE GUIDELINE «Caesarean birth» in the latest version dated September 6, 2023. The work was performed in accordance with the research plan of the Department of Obstetrics and Gynecology #2 of KhNMU: «Optimization of diagnostics, treatment of diseases of the reproductive system and pregnancy complications in women with extragenital pathology» (state registration number 0121U11923).Results. A comparative study of cesarean section protocols in Ukraine and the United Kingdom provided important insights into the current state of obstetric practice in both countries. Signifi cant diversity in CS protocols in Ukraine and the UK was noted. This is particularly true for both clinical aspects and aspects related to organizational and sociocultural factors. A signifi cant infl uence of social and cultural factors in the UK on the frequency of CR was found. The diff erence between the Ukrainian medical system and the NHS in the UK is mainly in the control of narcotic analgesics, the duration of the postoperative period, and the consideration of the woman’s preference for the method of delivery is quite controversial.Conclusions. Negative statistics reveal that the increase in the frequency of CS is typical not only for the UK, but also for Ukraine, although in Ukraine the explanation for this situation is the increase in the frequency of obstetric and extragenital pathology during martial law, and in the UK it is the woman’s choice. Understanding the diff erences between countries in their approaches to CS will help improve the quality of medical care and optimize outcomes for both mother and newborn. Understanding the differences between countries in their approaches to CS will help to improve the quality of medical careand optimize outcomes for both mother and newborn.

Iron Sucrose versus Ferric Carboxymaltose: Effectiveness in Treatment of Postpartum Anaemia following Caesarian Section

Background: Postpartum anemia is a leading cause of maternal mortality and morbidity throughout the world, particularly in developing countries.The most common causes of postpartum anemia are antepartum iron deficiency anemia and blood loss during childbirth. Treatment of anemia with ferric carboxymaltose during labor can considerably reduce maternal and newborn morbidity. The aim of the study is to compare the effectiveness of iron sucrose and ferric carboxymaltose in the treatment of postpartum anaemia following caesarian section. Materials and methods: A comparative cross-sectional study was carried out among the 234 outdoor patients of the Department of Obstetrics and Gynecology at Sheikh Hasina Medical College Hospital, Tangail during the period from July 2017 to June 2020. Results: The pre-transfusion mean of hemoglobin level was 8.9±0.5 gm/dl and the post-transfusion mean of hemoglobin level was 10.4±0.4 gm/dl in group A. The pre-transfusion mean of hemoglobin level was 8.7±0.7 gm/dl and the post-transfusion mean of hemoglobin level was 11.0±0.4 gm/dl in group B. The mean of increased hemoglobin level was 1.5±0.4 gm/dl and 2.3±0.5 gm/dl respectively in both groups. The pre-transfusion mean of ferritin level was 46.3±16.1 ng/mL and the post-transfusion mean of ferritin level was 171.5±25.8 ng/mLin group A. The pre-transfusion level was 46.5±16.2 ng/mL and the post-transfusion mean ferritin level was ±24.9 ng/mLin group B. The mean of increased ferritin level was 125.2±22.2 ng/mL and 149.0± 20.5 ng/mL respectively in both groups. These differences were statistically significant within the study groups (p&lt;0.05). Conclusions: The study revealed that serum ferritin levels increased significantly in the FCC group than ISC group. Ferric carboxymaltose are more effective and safe for the treatment of iron deficiency anemia in postpartum patients. IAHS Medical Journal Vol 7(1), June 2024; 8-12

OPTIMIZING THE DELIVERY METHOD FOR EXTREMELY PREMATURE BIRTHS

The contemporary classifi cation of premature birth is predicated on the condition of the newborn, encompassing the severity of respiratory disorders, morpho- functional immaturity, prognosis for survival, and long-term consequences. In accordance with these criteria, newborns with a gestational age of up to 28 weeks are classifi ed as extremely premature, given the inherently challenging nature of their weaning process. This article presents the dynamics of early neonatal mortality and lethality indicators in cases of vaginal and abdominal delivery. This article presents an analysis of contemporary global trends in the selection of delivery methods for premature births and extremely premature pregnancies.The aim of the study. To propose a modifi ed approach to the choice of delivery method in pregnant women in the gestational period of 24-28 weeks.Research materials and methods. The analysis was conducted on 350 cases of extremely premature singleton births (within 24-28 weeks) that occurred at the Perinatal Center of Kyiv between 2019 and 2023. A comparison of the early neonatal mortality rate of newborns with a gestational age of 24-28 weeks was conducted, stratifi ed by the method of delivery. The relative risk of mortality during the fi rst seven days and throughout the fi rst year of life, contingent on the method of delivery, was calculated. Furthermore, the frequency of the most common complications of the neonatal period in newborns with extremely low body weight was analyzed, and the relative risk of their development was calculated depending on the method of delivery. The Foster- Stewart test was employed to substantiate the statistical reliability of the obtained results. The two average indicators are then compared with one another using the Student’s test. A value of ≤0.05 indicates statistically signifi cant changes in the indicator’s dynamics. The research was carried out within the framework of the implementation of scientifi c topics of the Department of Obstetrics and Gynecology No. 1 of the Bogomolets National Medical University: Research work «Preservation and restoration of women’s reproductive health in conditions of rapid medical and social changes» implementation period 01.01.2023-12.2024. Research results and their discussion. An analysis of the dynamics of early neonatal mortality in the category of 24-28 gestationalweeks from 2019 to 2023 was conducted, identifying several factors. These included the active implementation of intranatal magnesium therapy and improvements in the quality of neonatal care at the technical level. As evidenced by the data, the rate of early neonatal mortality in very early premature births reached 43.3 % in 2019, declining to 25.5 % by 2022. In the 2019-2020 period, 50 % of neonatal deaths occurring within the fi rst seven days were infants born by caesarean section. The ratio of vaginal births to births by caesarean section in gestational periods up to 28 weeks is approximately 2:1. In addition to the observed reduction in the rate of early neonatal mortality, a two-fold decrease was noted in the rate among children born by caesarean section. The mortality rate of extremely premature infants, despite a gradual decline, remains relatively high, at approximately 34.2 % in 2023. Our fi ndings, based on the expansion of indications for caesarean section rather than its routine use in preterm birth, indicate that the relative risk of neonatal death before seven days for vaginal delivery compared with caesarean section, calculated with a 95 % confi dence interval, was 2.65. Similarly, the calculated riskof mortality during the fi rst year of life is 1.34. With regard to intraventricular hemorrhage, the relative risk was 3.12, indicating that the route of delivery in this cohort of newborns exerts an infl uence on the frequency of the complication. The risk of hemorrhagic syndrome is 0.97, which does not provide suffi cient evidence to suggest that it can be prevented by selecting an abdominal delivery. The proportion of abdominal deliveries at the Perinatal Center has remained relatively stable since the expansion of indications for premature births, with a slight increase from 14.2 % in 2019 to 15.2 % in 2023. This was accomplished through a logical and evidence- based approach to caesarean section in full-term pregnancies.Conclusions. 1.From 2019 to 2023, a notable decline was observed in the incidence of early neonatal mortality (from 43.3 to 23.6 %) and child mortality (from 61.3 % to 34.2 %) among newborns with a gestational age of up to 28 weeks. 2. The incidence of early neonatal mortality up to 28 weeks is lower among newborns delivered by caesarean section than among those delivered vaginally. 3. The optimization of perinatal indicators is contingent upon an individualized approach to the selection of a delivery method for pregnant women with premature rupture of the membranes up to 28 weeks.

Prognostic Value of Serum D-dimer in Predicting Outcomes in COVID-19 Positive Pregnant Women

Background: Combined effects of pregnancy induced hypercoagulability and SARS-CoV-2 infection place pregnant women with COVID-19 disease at high risk of severe outcome. COVID-19 severity has also been associated with serum D-dimer, a biomarker reflecting coagulation and fibrin degradation, in general populations. Despite its prognostic value in pregnant women, the prognostic value of this finding particularly in maternal outcomes remains less understood. The aim of this study was to determine whether elevated serum D-dimer levels in pregnant COVID-19 positive women are of prognostic significance for severe maternal outcomes. Methods: This retrospective observational study included 62 third trimester COVID 19 positive pregnant women admitted to the Department of Obstetrics and Gynecology, BSMMU, Dhaka from March 2019 to February 2020. Serum D-dimer were measured at admission and day 7, 14. D-dimer levels were related to clinical outcomes and statistically evaluated using chi square tests and logistic regression at p &lt; 0.05. Results: Significantly associated with higher risk of severe outcomes, all of which included ICU admission, respiratory complications and adverse pregnancy events is elevated D-dimer levels (≥1.5 mg/L). In logistic regression analysis, patients with D-dimer levels of ≥1.5 mg/L had 3.5-fold greater odds of severe outcomes (OR 3.486; 95% CI, 1.184 to 10.263; p = 0.023). D-dimer had a sensitivity of 64.29%, 67.55% specificity in predicting severe outcomes. Conclusion: Serum D-dimer is valuable prognostic marker of disease severity in pregnant COVID-19 positive women and may be used for early risk assessment and clinical decision making. Routine measurement may help identify early high risk cases in order to improve maternal outcomes.

Patient awareness, knowledge, and acceptability of antenatal perineal massage: A single-center cross-sectional study from Saudi Arabia.

This study assessed the knowledge, awareness, and acceptability of antenatal perineal massage (APM) among pregnant women in Saudi Arabia. This cross-sectional study included 240 pregnant women who met the predefined inclusion criteria and attended the Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, from 1 October to 31 December 2023. Participants answered seven knowledge questions, classified as having good knowledge if they answered ≥4 correctly and poor knowledge if <4 were correct. Most women (46.25%) reported it was their first encounter with APM. Common sources of information included the internet (39.58%), physicians/midwives (7.92%), and friends/family (3.75%). Nearly half (47.5%) had heard of APM, but only 8.75% had practiced it, and 3.75% attended related classes. Only 17.5% knew that APM could be performed by the woman or her partner, while 25.83% knew it should start at 34 weeks, and 17.92% recognized the recommended duration of 5 to 10 minutes daily. Additionally, 22.5%, 15.83%, and 35.42% acknowledged APM's benefits for labor duration, anal sphincter dysfunction, and perineal injuries, respectively. The average knowledge score was 1.39±1.84, with 84.17% classified as having poor knowledge. No significant differences were found between knowledge levels (p>0.05). Low acceptability was noted, with only 58% of patients and 37% of their partners willing to engage in APM. No significant differences in acceptability were found between poor and good knowledge groups (p>0.05). The study revealed low awareness, poor knowledge, and weak acceptability of APM among pregnant patients. Targeted education for patients and healthcare providers could enhance knowledge and improve maternal-fetal health outcomes.

Relationship between exposure to air pollutants in the first trimester and spontaneous abortion in pregnant women in the river valley city.

Purpose The relationship between exposure doses of 2.5-micrometer Particulate Matter (PM2.5), Inhalable particles (PM10), Sulfur Dioxide (SO2), Nitrogen Dioxide (NO2) and Ozone (O3) in the first trimester and spontaneous abortion of pregnant women was evaluated by global average method and nearest monitoring station method, respectively. Method Retrospective analysis of the clinical data of pregnant women with spontaneous abortion and full-term pregnant women in the Department of Obstetrics and Gynecology of two third-class hospitals in a valley city in Northwest China. According to the age factor, the eligible pregnant women were matched at a ratio of 1 : 4. The global average method and the nearest monitoring station method were used to evaluate the exposure of pollutants. The rank-sum test and conditional logistic regression were used to analyze the correlation between air pollutants and spontaneous abortion. Results Although the global average method and the nearest monitoring station method are slightly different in the assessment of exposure dose, they do not affect the correlation evaluation with spontaneous abortion. The exposure of pregnant women to PM2.5(OR1 = 1.156, OR2 = 1.036), SO2 (OR1 = 1.432, OR2 = 1.429) and NO2 (OR1 = 1.121, OR2 = 1.159) in the first trimester is related to the occurrence of spontaneous abortion.(OR1: the global average method, OR2: the nearest monitoring station method) Conclusion The exposure of PM2.5, SO2 and NO2 in the first trimester in valley cities is associated with the occurrence of spontaneous abortion in pregnant women.

Triple Negative Breast Cancer: Experience of the Obstetrics and Gynecology Department 2 Over A Period of 3 Years about 105 Cases at the Hassan II University Hospital in Fes

Introduction: Breast cancer is the second leading cause of death worldwide and the leading cancer in women. It is both the most common and the leading cause of death in women from cancer, thus posing a real public health problem. It presents tumor heterogeneity on the histological and molecular levels, explaining the diversity of presentations, responses to treatments, and prognosis. Triple-negative breast cancer is defined by the absence of expression of hormone receptors: estrogen receptors (ER), progesterone receptors (PR) and by the absence of overexpression or amplification of genes encoding HER2 receptors (Human epidermal growth factor receptor 2) and representing only a minority of breast cancers (10-20%). The therapeutic choices for this type of breast cancer are limited because patients do not benefit from hormonal therapy or targeted therapies, which poses a real problem in therapeutic management. Our objective is to describe the epidemiological, clinical, anatomo-pathological characteristics, as well as the evolutionary profile after adequate management of triple-negative breast cancer through the analysis of a series of cases of triple-negative breast cancer collected at the gynecology-obstetrics department 2 at the Hassan II University Hospital in Fez. Method: This is a retrospective study of a series of triple negative breast cancer cases collected in the gynecology-obstetrics department II at the Hassan II University Hospital in Fez during the period between January 2020 and December 2023. Inclusion criteria: Histologically confirmed triple negative infiltrating breast cancer treated in the gynecology-obstetrics department 2 of the Hassan II University Hospital in Fez. IHC = ER = 0% RP = 0% HER2 negative Exclusion criteria: male sex and presence of distant metastases. Results: On the epidemio-clinical level: a peak in frequency between 31 and 42 years old, and 45.7% of patients still in genital activity. On the anatomo-pathological level: ...

Efficacy and safety evaluation of a novel hemostatic gelatin matrix for intraoperative hemostasis: a prospective, randomized controlled trial

Borayflo Haemostatic matrix is a new absorbable hemostatic gelatin matrix which can be used for intraoperative assisted hemostasis. In a prospective, multicenter, non-inferiority, randomized controlled trial, a total of 354 subjects were recruited from the departments of hepatobiliary surgery, obstetrics and gynaecology and orthopaedics of 4 hospitals and randomly allocated to test group (Borayflo Haemostatic matrix) or control group (Surgiflo Haemostatic matrix) in a 1:1 ratio. In the modified intention-to-treat population, 163 (93.14%) of 175 subjects in the test group versus 167 (94.89%) of 176 subjects in the control group successfully achieved hemostasis within 5 min (P > 0.05). Non-inferiority for effective rates of hemostasis at 5 min to Surgiflo Haemostatic matrix was shown in the study (treatment difference: -1.74% [95%CI, -6.70–3.22%] for modified intention-to-treat population). In terms of efficacy and safety, the new hemostatic gelatin matrix (Borayflo Haemostatic matrix) is equivalent to Surgiflo Haemostatic matrix. There was no significant difference in the incidence of AEs or SAEs between the test and control groups(P > 0.05). In addition, Borayflo Haemostatic matrix is a domestically produced haemostatic gelatin product, an advantage that will reduce the cost of surgical haemostasis for Chinese patients.

An in vitro investigation into the cytotoxic impact of antigen-presenting dendritic cell-tumor infiltrating lymphocytes on ovarian cancer cells

ObjectiveThe objective of this study is to develop a novel therapeutic approach for the treatment of ovarian cancer while investigating the role of tumor-infiltrating lymphocytes (TILs) in the context of ovarian cancer therapy. The primary aim is to establish a technical procedure for the isolation of tumor cells, lymphocytes, and dendritic cells (DCs) derived from ovarian cancer tissues or ascites. Subsequently, the focus lies on the generation of dendritic cell-tumor infiltrating lymphocytes (DC-TILs) exhibiting specific cytotoxic capabilities aimed at targeted therapeutic interventions. The cytotoxic impact of DC-TIL interactions on tumor cells was investigated through in vitro experimentation. This research aims to provide fundamental experimental insights for the future clinical advancement of TIL therapy in ovarian cancer.MethodsThe experimental samples included fresh surgical specimens and ascites specimens procured from three patients (ranging in age from 32 to 75), sourced from the Department of Gynecology at the Third Bethune Hospital of Jilin University. TILs were extracted through in vitro isolation from solid tumor tissues, while primary tumor cells and DCs were obtained from ascites specimens. Tumor-specific antigens derived from patient tumor cells were utilized to stimulate the maturation of DCs. TILs were subsequently co-cultured with antigen-stimulated DC cells. Subsequently, TILs with specific killing effects were obtained, and the cytotoxic impact of DC-TILs on tumor cells was detected in vitro.Results(1) TILs were successfully obtained through expansion from the tumor tissue of a patient diagnosed with ovarian cancer. (2) DCs were successfully induced from ascites cells harvested from patients diagnosed with ovarian cancer. (3) TILs significantly enhanced the cytotoxicity of tumor cells following DC stimulation.ConclusionTILs have the capacity to augment the cytotoxicity directed towards tumor cells following DC stimulation.

PRESCRIPTION AUDIT AT A TERTIARY CARE HOSPITAL – A CROSS-SECTIONAL STUDY

Objective: The aim of this study was to analyze prescribing practices at Silchar Medical College and Hospital (SMCH) through a cross-sectional audit of 600 outpatient prescriptions, adhering to the National Health Mission Prescription Audit Guidelines 2021. Methods: The audit examined prescriptions of patients who visited the Outpatient department (OPD) of Department of General Medicine, Surgery, Orthopedics, Gynecology and Obstetrics, Pulmonary Medicine, Pediatrics, Dermatology, and Psychiatry. The audit evaluated key aspects such as the completeness of patient information, legibility of prescriptions, documentation of clinical details, and adherence to standard treatment guidelines (STG). Results: The prescription audit at SMCH revealed high compliance with essential criteria such as OPD registration and patient gender documentation. However, gaps were identified in areas such as allergy status documentation (0%), legible handwriting (75.7%), and follow-up advice (16.9%). In addition, adherence to STG was observed in 75% of prescriptions, with a concerning finding that there was a lack of facility’s Antibiotic Policy. Conclusion: The study underscores the importance of complete and accurate prescription documentation to ensure patient safety and effective treatment.