DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY

 

 

FACULTY
 

 

            

EDUCATION

Short Term Training

 

Elective training of three to four weeks was provided to two doctors, one from U.P. and another from Orissa and two months training in Obstetric Ultrasonography was given to another doctor from Mizoram.  Elaborate one-month endoscopy training was given to a doctor from M.P.  Also a doctor from Delhi joined as observer for one month in the department.

 

Continuing Medical Education

 

Faculty members of the department participated in and delivered 90 lectures in continuing medical education programmes, symposia and national and international conferences held during the year.

 

RESEARCH

Research Completed

 

A.     AEvaluation of transcervical endometrial cryoablation in the treatment of dysfunctional

uterine bleeding. Study included 27 women of 25-50 years age group with menorrhogic cycles unresponsive to medical treatment, who had completed their family and had benign edometrial histology.  Pre procedure evaluation was done to exclude other causes for menorrhagia.   Endometrial cryoablation was done in postmenstrual phase, on OPD basis under paracervical block with N₂O gas as refringerent.  Of  the 27 women who underwent the procedure 11 women (40.74%) attained amenorrhoea, 6 (22.22%) had oligomenorrhoea and 8 patients did not respond to treatment.  Only complication noted in the study was mild suprapubic pain for 24 hours and a vaginal discharge for 2 weeks.

 

A.                 A comparative study of the Effects of Various Modes of Hormone Replacement Therapy on Postmenopausal Health : The study included 55 postmenopausal women (28 natural and 27 surgical).  They were divided into five groups based the type of HRT they received.  Group I was given oral estrogen (1 mg/day) and medroxyprogesterone acetate (2.5 mg/day) continuously.  Group II was given transdermal estradiol patch (50 ug biweekly + oral medroxyprogesterone acetate 2.5 mg daily, group III received tibolone 2.5 mg/day continuous and group IV received vaginal cream (estriol) biweekly + medroxyprogesterone acetate 2.5 continuous and group V was control group and did not receive any hormone.  All the patients were called for follow-up at three months and six months.  Mean age at menopause in this study was 45.6 + 4.7 years and most of the patients were within 5-7 years since menopause.  The serum estradiol increased in all the treatment groups, significantly in oral group when compared to control group, which decreased.  Effects of HRT on menopausal symptoms: there was 50-60% improvement in postmenopausal symptoms when compared to control group.  There was a trend of increase in serum cholesterol in all the groups except tibolone group.  This increase could be because of continuous low dose of progesterone intake.  There was increase in HDL in all the three treatment groups, in comparison to control group.  There was increase in LDL-C in all the groups, but the increase was significant only in control group.  There was increase in VLDL-C in all the groups except oral group statistical significance.  There was a rising trend in serum triglycerides levels except in tibolone group.

 

B.                 Laparoscopic management of ectopic pregnancy : evaluation of clinical parameters and decline of serum  bhcG levels.

 

Fifteen patients of ectopic pregnancy underwent laparoscopic surgery from July 1998 through September 2000.  Average age of patients was 20.2 years.  Maximum cases presented with amenorrhoea and pain abdomen, mean jerum  -

b-hcG 4278.75 MIU/ml.  All cases underwent successful surgery laparoscopically and were uneventfully discharged on post-operative day 2.  All patients had negative serum b-hcG levels by day 21.  There were no cases of persistent ectopic pregnancy.

 

C.                 “Evaluation of cystic ovarian masses by ultrasound, color doppler, CT scan and aspiration cytology : Correlation with histology”.

A total number of 30 patients having ovarian tumour > 5cm were evaluated by clinical examination, ultrasound, color doppler, CT scan and aspiration cytology.   The correlation of each above modality with the histopathology after the surgery of ovarian tumour was evaluated.  The study concluded that  (1) Clinical evaluation was best parameter in differentiating between benign and malignant ovarian tumour, giving a sensitivity of 100% specificity of 96% and diagnostic accuracy of 96.6%.  (2) CT scan was not cost effective.  (3) Doppler study had very low sensitivity and specificity of 40% and 80% respectively and  (4) Aspiration cytology with specific findings had good diagnostic co-relation.

 

Research Continuing

 

A.                   The effect of Nitroglycerine patch in lowering the blood pressure in women with PIH.

B.                   Transvaginal sonography in first and early second trimester of pregnancy for detection of fetal kidney malformation.

C.                   Evaluation of endometrial changes in Tamoxifen treated women by transvaginal sonography, sonohysterography, hysteroscopy and endometrial aspirations and correlation with p53 expression.

D.                   Hysteroscopic transcervical bilateral proximal tubal cannulation under laparoscopic guidance.

E.                    A comparative study of daily versus intermittent iron supplementation in pregnant women.

F.                    Vulvar vestibutitis : A study of the magnitude of the problem and management outcome.

G.                   Laparoscopic unipolar versus bipolar ovarian drilling in infertile women with resistant polycystic ovarian syndrome.

H.                   Detection of feto-maternal haemorrhage following chorionic villus sampling by Kleihauer Betke and rise in Maternal Serum Alpha Feto Protein.

I.                      Uterine volume and blood flow changes in the uterus induced by GnRH analogues in cases of fibroids.

J.                     Randomised double blind placebo controlled trial of effects of Metformin on Clinical Biochemical, endocrine, radiological profile in women in PCOS.

K.                  Prediction of Perinatal asphyxia by the presence of nucleated RBC in umbilical cord blood of term newborns.

L.                    Evaluation of intrapartum fetal pulse oximetry for fetal monitoring in labour.

M.                 Evaluation of effect of transdermal introglycerin patch in preterm labour.

N.                  Uterine Artery Embolisation for treatment of symptomatic fibroids-comparative study with medical (GnRH) & surgical (hysterectomy treatment).

O.                  Effect on low density lipoprotein oxidation in post menopausal women : antioxidants versus estrogen replacement therapy.

 

 

Collaborative Research Completed

 

A.                 Prenatal diagnosis of fetal RhD group from amniotic fluid and chorionic villus tissue by polymerase chain reaction :  The knowledge of fetal RhD status is very useful in the management of pregnancies with Rh isoimmunisation.  If the father is heterozygous Rh positive, there is a 50% chance that the fetus is Rh negative.  If the fetus is diagnosed Rh negative, it will eliminate the need to monitor and treat the individual pregnancy intensively with serial ultrasound, amniocentesis or cordocentesis, maternal high dose IVIG and intrauterine fetal blood transfusion.  However, if the fetus is Rh positive intensive therapy and vigilance is indicated for a favourable outcome in these very high risk pregnancies.  In Rh-negative non-immunised pregnancies, knowledge of blood group avoids use of Anti D after invasive procedures or prophylactic Anti D (28-30 weeks), threatened abortion, antepartum haemmorhage, and external cephalic version.

 

The aim of the study was to determine the technique of determination of RhD group from amniotic fluid and chorionic villus tissue and to compare the accuracy of RhD grouping by polymerase chain reaction with serological fetal/neonatal cord blood Rh group.

 

Fetal RhD group was attempted by using Polymerase Chain Reaction from 33 amniotic fluid samples and 27 chorionic villus samples obtained by amniocentesis and chorionic villus sampling respectively.  It was correlated with fetal/neonatal cord blood type (serology) obtained by cardicentesis/cordocentesis or after delivery.

 

In Conclusion

 

1.                  Fetal RhD group could be determined by Polymerase Chain Reaction in 25/33 amniotic fluid samples.

2.                  RhD group was determined by Polymerase Chain Reaction in 27/27 Chorionic villus samples.

3.                  Fetal RhD was 96% accurate (24/25-amniotic fluid NDA) when correlated with fetal cord blood serology.

4.                  Fetal RhD group was 96.3% accurate (26/27 Chorionic Villus DNA) when correlated with fetal cord blood serology.

 

Although larger studies are needed to confirm the sensitivity and specificity of this method, the ability to determine the RhD status of the fetus in pregnancy represents a major advance in the management of pregnancy in Rh negative women.

 

 Collaborative Research Continuing

 

A.                 The study of knowledge, attitudes and practices of emergency contraception among women of reproductive age group including adolescent girls and providers(ICMR).

B.                 Phase III ICMR clinical trial of norplant I (6 capsules) contraception (ICMR).

C.                 Profile o women with polycystic ovaries (ICMR).

D.                 Clinical evaluation of antifertility effect of Pippalyadi Yoga (Phase I study).

E.                  Comparison of intrauterine insemination versus timed intercourse in super ovulated cycles with clomiphine citrate (CSIR).

F.                  Sonographic evaluation of the umbilical coiling index and its correlation with umbilical cord insertion and neonatal otucome (CSIR).

G.                 Mifepristone with three regiments of misoprostol for termination of pregnancy- early abortion (WHO).

H.                 Levonosgesrel and mifepristone in emergency contraception (WHO).

I.                    Infective etiology in infertility.  Role of mycrobacterium tuberculosis, chiamydia trachomatis mycoplasma, ureaplasma and anaerobes (MICROBIOLOGY).

 

 

POST PARTUM PROGRAMME

 

The Post Partum Programme (PPP) is a maternity centred hospital based approach to family welfare programme by providing a package of MCH and family welfare services in the vicinity of the hospital as well as in the field practice areas.  It is run as an integrated multidisciplinary exercise where the department of Obstetrics and Gynaecology coordinates with departments of Paediatrics, Community Medicine, Surgery and Anaesthesiology.

 

 

Achievement of different family planning methods, Post Partum Programme

(2000-2001)

 

        Method                                                       Achievement

CuT                                                                                                                        790

Oral Pills (13 cycles = 1 user)                                                   329 cycles

Conventional contraceptives (72 pieces = 1 user)                      60,915 pieces

Sterilisation                                                                               1238

(a)     Tubectomy                                                                         1158

(b)    Vasectomy                                                                         80

 

·        Note : Family Planning Methods Are Free Of Target

 

MATERNAL AND CHILD HEALTH (MCH) PERRFORMANCE (2000-2001)

POST PARTUM PROGRAMME

 

Pregnant Women                     

TT(Mothers) (2^nd or Booster)                           6250                1469                23.5

Iron & Folic Acid Tablets(Mothers)                  6250                21301              340.8

 

Children(0-1) Year                                          

DPT 3^rd Dose                                                   6150                1293                21.0

Polio 3^rd Dose                                                  6150                1293                21.0

BCG                                                                6150                2730                44.4

Measles                                                            6150                1364                22.2    

Vit. A. 1^st  dose                                                6150                606                  9.9

 

Children (1-2) years

DPT Booster Dose                                           6000                1050                17.5

Polio Booster Dose                                          6000                1003                16.7

Vit. A 2^nd Dose                                                6000                272                  4.5

Vit. A 3^rd Dose                                                 6000                48                    0.8

Vit. A 4^th Dose                                                  -                      14                      -

Vit. A 5^th Dose                                                  -                      40                      -

 

Children Under 5 Years                                    4500                480                  10.7

DT

 

Note : Vit. A was not available or some time in this year.

 

PATIENT CARE

Hospital Care : Facilities available in the department (including special clinic and special laboratory facilities) besides the regular gynaecology outdoor which is held everyday, the following special clinical are held.

 

1.         General antenatal clinic                          3/week                         18328

2.         High risk pregnancy clinic                      3/week                           9989

3.         Fetal medicine clinic                              1/week                            560

4.         IVF clinic                                             1/week                            110

5.         Infertility clinic                                       3/week                         8228

6.         Menopause clinic                                  2/week                            428

7.         Gynae endocrine clinic                          3/week                            629

8.         Adolescent clinic                                   1/week                              82

9.         Gynaecological cancer clinic                  2/week                            989

10.       Post natal clinic                                     3/week                            422

11.              Medical termination of                          6/week                          1268

Pregnancy clinic

12.       Family welfare clinic                              6/week                         6262

 

Operations Performed

 

Gynaecological

            Major               982

            Minor             5083

Obstetrics

            Major               1370

            Minor               3703

 

LABORATORY INVESTIGATIONS

 

Fetal Medicine

Cordocentesis                                    :           29

Chorionic villus sampling                    :           154

Aminocentesis                                    :           57

Cyst aspiration                                    :           82

Intra utero infusion                              :           52

Hysteroscopies                                   :           512

Infertility surgery                                  :           375

Plastic reconstructive surgery            :           108

High risk obstetrics                             :           841

Gynae oncology                                  :           161

Laparoscopies                                    :           1202

Interventional ultrasound                     :           9146

Non stress test                                   :           1602

Manning score                                    :           829

Urine albumin                                      :           1618

Urine sugar                                         :           1618

Blood haemogram                              :           1618

 

 

COMMUNITY SERVICES/CAMPS

 

The faculties of the department participated in community awareness programmes through public education talks in radio, phone - in programmes and panel discussions of AIR and allied, T.V. channels, teleconferencing session for PGD MCH programmes of IGNOU, community health camps, baby shows and health melas.

 

PUBLICATIONS

 

1.                  Agarwal N, Kriplani A.  Secondary infertility and dysfunctional uterine bleeding from a lippes loop placed 32 years earlier.  Int J Gynecol Obstet 69:167-168, 2000.

2.                  Agarwal N, Kriplani A, Bhatla N, Deorari AK.  Idiopathic origin of meconium peritonitis.  Indian J Pediat, 2000; 67:845-846.

3.                  Agarwal N, Sehgal R, Takkar D, Buckshee K.  Oestradiol, Transdermal matrix patch for menopausal symptoms.  Gynecol  Obstet, 2000; 2 (4):38-42.

4.                  Agarwal N, Kriplani A.  Puerperal inversion of uterus a review.  Asian J Gynecol Obstet Practice, 2000; 9 (4):36-38.

5.                  Banerjee N, Kriplani A.  Antibiotic prescribing in obstetric care.   Gynecol Obstet communications, 2000; 2:49-54.

6.                  Dadhwal V.  Bacterial vaginosis.  Gynecol Obstet Communications, 2000; 2 (5):24-28.

7.         Dadhwal V, Mittal S, Kumar S, Barua A.  Hematometra in post menarchal adolescent girls: A report of two cases.  Gynecol Obstet Invest, 2000;  50:67-69.

8.         Dadhwal V, Kochar S, Mittal S, Kumar S, Agarwal S, Arora V, Barua A.  Fetal gastrointestinal malformations.  Int J Pediat, 2000; 68(1):25-30.

9.         Deka D.  Premature rupture of membranes at term and its management.  Gynecol Obstet Today, 2000; II (V):643-646.

10.       Deka D.  Positive maternal serologic toxoplasma test result in pregnancy.    A perplexing tripidation Gynecol Obstet Today, 2000; 5 (12):718-720.

11.              Deka D.  Recurrent abruptio placenta in three cconsecutive pregnancies: successful otucome with intensive feto-maternal monitoring.  Jour gynecol Obstet of India, 2000; 50 (6):113.

12.              Deka D, Malhotra N.  Intrauterine transfusion.  Perinatology, 2000; 2 (6):303-310.

13.              Deka D, Kabra M.  Persistent non-reactive non-stress test in Down’s syndrome fetuses: A report of 2 cases.  Jour Gynecol Obstet of India , 2000; 50 (6):111.

14.              Deka D, Banerjee N, Takkar D.  Incarceration of pregnant uterus in an incisional hernia.  Int J Gynecol Obstet, 2000; 70(3):376-379.

15.              Deka D, Malhotra N, Agarwal N, Roy KK, Takkar D.  Role of ultrasonography in the early diagnosis of secondary abdominal pregnancy.  Ultrasound Int, 2000; 6 (2):72-77.

16.              Deka D, Dadhawal V, Guleria K, Gupta NP, Kinra G.  Ultrasound and MRI in the diagnosis of Pheochromocytoma in pregnancy(A case report).  Ultrasound Int, 2001; 7 (1):15-18.

17.              Garg P, Vaijyanath AM, Garg P.  Aortic stenosis: Pregnancy and labour.  J Nep Med Assoc, 2000; 39:289-290.

18.              Goswami D. Kriplani A.  Current concepts in male factor intertility and its management.  Asian J Gynecol Obstet Practice, 2000; 4 (3):10-15.

19.              Goswami D, Kriplani A.  Ovulation induction strategies for practicing gynaecologists.  Asian J Gynecol Obstet Practice, 2001; 5 (1):11-21.

20.              Kriplani A, Agarwal N, Takkar D.  Laparoscopic ovarian elichiocauting for management of polycystic ovarian disease( Abstract).  Int J Gynecol Obstet, 2000; 70 (suppl): 33.

21.              Kriplani A, Goswami D, Agarwal N, Bhatla N, Amini.  Twin pregnancy following gonadotrophin therapy in patient with Sheeshan’s syndrome.  Int J Gynecol Obstet, 2000; 71:59-63.

22.              Kumar S.  Understanding health needs of adolescents.  Gynecol Obstet Today, 2000; V(6):254-355.

23.              Kumar S, Mittal S, Dadhwal V.  Infections as aetiology of preterm labour.  Gynecol Obstet Today, 2000; V(12):715-717.

24.              Kumar S, Mittal S, Sharma MC, Kumar L.  Mixed mullerian tumor of uterus with heterologous components: A case report.  Gynecol Obstet Today, 2000; V(II):666-668.

25.              Kumar S, Suneeta PV, Vimalamma N.  Management of primary dysmenorrhoea.  Gynecol Obstet Today, 2000; V(10):620-622.

26.              Kumar L, Kumar S, Singh BP, Dawar R, Kriplani A, Bhatla N.  Malignant germ cell tumours of the ovary.  Asian Pacific Journal of cancer prevention, 2000; 1:59-64.

27.              Kumar A, Ahmed N, Chaturvedi P, Mittal S, Farooque A.  Cyclic behavious of splenic mononuclear cells (MNCs) in regulation of granulosa cell progesterone production.  Molecular & cell. Endo, 2000; 164, 253.

28.              Maheshwari M, Vijaya R, Kabra M, Arora S, Shivram S, Deka D, Kriplani A, Menon PSN.  Prenatal diagnosis of Duchene muscle dystrophy.  Natl Med J India, 2000; 13:129-131.

29.              Malhotra N, Sood M. Sexual violence-A neglected health problem in developing work.  Int J Gynecol Obstet, 2000; 71 (3):257-258.

30.              Malhotra N, Sood M.  Ovarian germ cell neoplasm in pregnancy.  European J Gynecol Obstet, 2000; 21 (4):396.

31.              Malhotra N, Sood M.  Endodermal sinus tumour in pregnancy-Gynaecologic oncology, 2000; 78 (2):265-266.

32.              Malhotra N, Dkea D.  Can Down syndrome cause persistent non-reactive non-stress test ?  Int J Gynecol Obstet, 2001; 72 (3):261-262.

33.              Malhotra N, Deka D, Takkar D, Kochar S, Goel S, Sharma MC.  Hydatiform mole with coexisting live fetus in dichorionic twin gestation.  European J Gynecol Obstet Reprod Biol, 2001; 94(2):301-303.

34.              Misra R, Grundsell H.  The Ellick evacuator: a reinvention.  Surgical Endoscopy, 2000; 15.

35.              Mittal S, Dadhwal V, Kumar S, Verma A.  A clinical profile of patients with polycystic ovarian syndrome.  Molecular Cellular Endocinology, 2000; 164:265.

36.              Mittal S, Anandalaxmi PN, Lakhpatia M.  Contraceptive knowledge and use-a survey of New Delhi women.  Gynecol Obstet Comm, 2000; 2 (6):27-31.

37.              Roy KK, Kriplani A.  How should health care workers be prevented from HIV infection?  Asian J Gynecol Obstet Practice, 2000; 4; 2:34-35.

38.              Roy KK, Kriplani A.  Antenatal fetal monitoring-a changing scenario.  Asian J Gynecol Obstet Practice, 2000; 5; 1:34-37.

39.              Roy KK, Kriplani A.  The selective oestrogen receptor modulator (SERMS) - will it replace HRT ? Asian J Gynecol Obstet Practice, 2000; 5; 2:27-29.

40.              Roy KK, Banerjee, Sinha A.  Laparoscopic removal of translocated retroperitoneal IUD.  Int J Gynecol Obstet, 2000.; 71:241-243.

41.              Roy KK, Malhotra N, Banerjee N.  Recurrent eclampsia in a  woman with chronicc pyelonephritis.  European J Gynecol Obstet and Reprod Bio, 2001; 94:307-308.

42.              Sinha A, Kriplani A.  Current concepts in treatment of fibroid.  Asian J Gynecol Obstet Practice, 2001; 5 (1):37-44.

43.              Sireesha SM, Mittal S, Kumar S, Dadhwal V, Sharma RS.  Comparitive study of efficacy of direct intrafollicular insemination (D1F1) and direct intra-peritoneal insemination (D1P1) in the treatment of infertility.  Molecular Cellular Endocrinology, 2000; 164:265.

44.              Takkar D, Roy KK, Kriplani A, Chaudhary M, Jayalaxmi TS.  Laparoscopy assisted vaginal hysterectomy with application of Nd:YAG lasers. XVI FIGO World Congress of