Journal of Obstetric and Gynaecological Practices POGS

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Volume 1, Number 2, July-December 2023
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EDITORIAL

Sushil Chawla

Low Molecular Weight Heparin in Obstetrics

[Year:2023] [Month:July-December] [Volume:1] [Number:2] [Pages:2] [Pages No:31 - 32]

Keywords: Abruptio placentae, Antiphospholipid syndrome, Fetal growth restriction, Heparin, Intrauterine fetal death, Low molecular weight heparin, Preeclampsia, Recurrent pregnancy loss, Thrombophilias

   DOI: 10.5005/jogyp-11012-0015  |  Open Access |  How to cite  | 

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Original Article

Andri Hamonangan Sipahutar, Muara Panusunan Lubis, Muhammad Fidel Ganis Siregar, Makmur Sitepu, Henry Salim Siregar, Muhammad Rusda Harahap

Correlation of Placenta Accreta Spectrum Ultrasound Score and the International Federation of Gynecology and Obstetrics Clinical Grading in Placenta Accreta Spectrum Incidence at H. Adam Malik General Hospital, Medan

[Year:2023] [Month:July-December] [Volume:1] [Number:2] [Pages:9] [Pages No:33 - 41]

Keywords: Cesarean section, Cervical, Childbirth, Fetus, High-risk pregnancy, Maternal, Placenta, Placenta accreta, Placenta accreta spectrum, Pregnancy

   DOI: 10.5005/jogyp-11012-0013  |  Open Access |  How to cite  | 

Abstract

Background: Placenta accreta spectrum (PAS) is a general term used to describe the clinical condition when part of the placenta, or the entire placenta, invades the uterine wall making it difficult to separate. One of the methods to grade this disorder is the International Federation of Gynecology and Obstetrics (FIGO) grading system which helps in determining the nature and severity of PAS disorders. The PAS ultrasound grading was performed via transvaginal and transabdominal ultrasonography (in all cases) according to the guidelines for ultrasonographic (USG) detection of PAS using the following USG signs, loss of clear zone, placenta lacunae, bladder wall disorders, uterovesical hypervascularity, and increased vascularity of the parametrial region. Aim and objective: To determine the relationship between PAS ultrasound score and FIGO clinical grading on the incidence of PAS disorders at H. Adam Malik General Hospital, Medan, Indonesia. Materials and methods: Patient identity and secondary data were obtained from medical records. The PAS ultrasound score data was taken from transabdominal ultrasonography and transvaginal ultrasonography records. The FIGO clinical grading data collection was based on operative field findings. Some sections of the uterus and placenta were submitted to the anatomical pathology laboratory for histopathological examination to assess the involvement of the placenta invading the uterine wall. Finally, the correlation between the FIGO grading and PAS ultrasound score was calculated using SPSS software. Results: The results showed that there was a significant relationship between the length of operation (p = 0.042; p > 0.05); curettage history (p = 0.231; p > 0.05); the amount of bleeding (p = 0.16; p > 0.05); gestational age at delivery (p = 0.384; p > 0.05); upper arm circumference (UAC) (all) (p = 0.295; p > 0.05); parity (p = 0.133; p > 0.05); and history of placenta accreta (p = 0.761; p > 0.05) with PAS score. There was a significant relationship between the amount of bleeding and arterial ligation with a value of p = 0.011 (p < 0.05) where the majority of patients who underwent ligation experienced bleeding of 2000−3000 cc compared to those who did not undergo the ligation procedure with bleeding below 2000 cc. The FIGO score frequency distribution was 17 people (34.7%) at stage I; 14 people (28.6%) at stage II; 9 people (18.4%) at stage IIIa; 6 people (12.2%) at stage IIIb; and 3 people (6.1%) were at stage IIIc. On the contrary, for PAS score found 7 people (14.3%) at stage 0; 22 people (44.9%) at stage I; 16 people (32.7%) at stage II; and 4 people (8.2%) at stage III. The Kolmogorov–Smirnov normality test showed that the PAS score and FIGO score data were not normally distributed (p < 0.05). After conducting the Chi-square test to assess the relationship between the FIGO score and the PAS score, a p-value of 0.000 was found; this value indicates that there is a significant relationship between the PAS score and the FIGO score (p < 0.001). Based on the presence of USG signs of impaired PAS, 57.9% [95% confidence interval (CI): 51.6–64.0%; 150/259] of women were classified as PAS 0, 15.1% (95% CI: 11, 2–19.9; 39/259) as PAS 1, 6.2% (95% CI: 3.8–9.8; 16/259) as PAS 2, and 20.8% (95% CI: 18, 2–26.4; 54/259) as PAS 3. Conclusion: In this study, it was found that there was a significant relationship between PAS score and FIGO clinical grading in the incidence of PAS abnormalities.

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Original Article

V Dinesh Ram, N Chandan, Mahalakshmi, Jayashree Srinivasan, J Damodharan

Impact of Oocytes with Mild and Heavy Debris in Perivitelline Space on Blastocyst Quality

[Year:2023] [Month:July-December] [Volume:1] [Number:2] [Pages:7] [Pages No:42 - 48]

Keywords: Human menopausal gonadotropin, Perivitelline space, Zona pellucida

   DOI: 10.5005/jogyp-11012-0014  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of this study is to compare the blastocyst quality of oocytes with mild and heavy debris in perivitelline space (DPVS). Objective: To investigate the rate of blastocyst development of oocytes with mild DPVS and to investigate the rate of blastocyst development of oocytes with heavy DPVS, then to compare the rate of blastocyst development of oocytes with mild and heavy DPVS and to identify ideal blastocyst for transfer. Study population: Patients who have undergone controlled ovarian stimulation for the intracytoplasmic sperm injection (ICSI) cycle from March 2023 to May 2023 ARC International Fertility and Research Centre. Study groups: Two groups were considered—oocytes with mild debris or granularity in perivitelline space (PVS) and oocytes with heavy debris or granularity in PVS. Results: This study from March 2023 to May 2023 was done at ARC International Fertility and Research Centre. Patients undergoing the Antagonist protocol for the ICSI cycle were considered. Around 371 M2 oocytes were analyzed, in that 203 had mild debris or granularity in PVS and 168 had heavy debris or granularity in PVS. In oocytes with mild debris or granularity in PVS, their fertilization rate, cleavage rate, and frozen blastocyst rate are 88, 81, and 47%, respectively. In oocytes with heavy debris or granularity in PVS their fertilization rate, cleavage rate, and frozen blastocyst rate are 76, 59, and 15%, respectively. Oocytes with heavy debris or granularity in PVS have compromised blastocyst quality compared with mild debris or granularity in PVS. Conclusion: In this study, we conclude that debris or granularity in PVS can be considered an indicator of oocyte competence. This can help in identifying a cohort of oocytes with a lower chance of forming viable embryos. This helps in reducing the culture of supernumerary embryos. We suggest that when the patients enroll for donor oocytes, oocytes without heavy debris or granularity in PVS should be used because heavy granularity in PVS has compromised blastocyst conversion. Further studies are needed with a large sample size to get a conclusion.

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Original Article

Jayashree Babu, Chandan Nagaraj, Mahalakshmi Saravanan, Nidhi Sharma

Comparison of Effects of Stimulation Days on Oocyte Morphology and Day 5 Blastocyst Rate in ICSI Cycle

[Year:2023] [Month:July-December] [Volume:1] [Number:2] [Pages:5] [Pages No:49 - 53]

Keywords: Anti-müllerian hormone, Controlled ovarian stimulation, Gonadotropin, Oocyte maturation

   DOI: 10.5005/jogyp-11012-0016  |  Open Access |  How to cite  | 

Abstract

Aim: To compare and identify the effect of normal and prolonged stimulation on oocyte morphology and day 5 blastocyst rate in intracytoplasmic sperm injection (ICSI) cycle in normal reserve patients. Materials and methodology: A comparative study where two groups were considered—patients undergoing controlled ovarian stimulation for ICSI cycle with anti-müllerian hormone (AMH) 2–4 ng/mL with stimulation days of 10 and 11, and patients undergoing controlled ovarian stimulation for ICSI cycle with AMH 2–4 ng/mL with stimulation days of 12, 13, and 14 between March 2023 and May 2023. The mean AMH value was 2.91 ng/mL. The mean age of the patients in normal stimulation was 31.25 years and in prolonged stimulation was 33.11 years. Around 34 patients (403 oocytes) were analyzed in normal stimulation and 32 patients (303 oocytes) were analyzed in prolonged stimulation. Type of trigger, gonadotropin used, and the dosage were not considered. Result: The oocyte maturation rate, fertilization rate, cleavage rate, day 3 good embryo rate, and day 5 blastocyst rate of normal stimulation are 76, 82, 76, 61, and 39%, respectively. The oocytes with single, double, and multiple defects of normal stimulation are 23, 55, and 22%, respectively. The oocyte maturation rate, fertilization rate, cleavage rate, day 3 good embryo rate, and day 5 blastocyst rate of prolonged stimulation are 76, 84, 76, 64, and 30%, respectively. The oocytes with single, double, and multiple defects of normal stimulation are 6, 41, and 77%, respectively. The p-value for the oocyte maturation rate was 0.032535731 and the p-value for day 5 blastocyst rate was 0.003925882. Conclusion: Prolonged stimulation is associated with oocyte maturation rate, oocyte morphology, and day 5 blastocyst rate.

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Original Article

Umme Ruman, Mahjabin Naz, Mir Masudur Rhaman, Ratu Rumana Binte Rahman

Hypertensive Disorders in Pregnancy – Gestosis Scoring can Predict the Launching of a Deadly Missile—Preeclampsia

[Year:2023] [Month:July-December] [Volume:1] [Number:2] [Pages:4] [Pages No:54 - 57]

Keywords: Diagnosis, Gestosis, Preeclampsia, Prediction

   DOI: 10.5005/jogyp-11012-0019  |  Open Access |  How to cite  | 

Abstract

Introduction: The hypertensive disorders in pregnancy (HDP) – gestosis score is a risk scoring system for developing preeclampsia (PE). It has a range of scores from 1 to 3. A pregnant woman is marked as “at risk for preeclampsia” if her overall score is 3 or higher. She is then managed accordingly. Aims: To predict PE, we assessed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the HDP–gestosis score. Materials and methods: A prospective research based on a hospital done for a duration of 1 year. Ninety-four pregnant women after 20 weeks of pregnancy were evaluated for the development of PE based on collected information on the patient's age, gravida, obstetric history, menstrual cycle regularity, polycystic ovarian disease history, length of the marriage, parity, prior medical and surgical intervention, prior/current medications, and family history. Gestosis score was determined and grouped into the following three risk categories: Mild (score of 1), moderate (score of 2), and high risk (score of 3 or more). Data were entered into Microsoft Excel 2007 and analyzed in statistical package for the social sciences (SPSS) software, version 2007 (IBM Corp., New York, USA). Results: The mean age, gestational age and body mass index (BMI) of the women were 24.34 ± 4.1 years, 13.7 ± 1.7 weeks, and 21.45 ± 1.9 kg/m2, respectively. The gestosis score was 2 in 46.8% (n = 44) of the participants, 1 in 30.9% (n = 29), and ≥3 in 22.3% (n = 21) of the women. Preeclampsia developed in 23.4% (n = 22) of participants. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of HDP–gestosis score ≥3 for predicting PE were 86.36, 97.22, 90.84, 95.89, and 94.68%, respectively. Conclusion: Gestosis score is a useful clinical marker for PE development that enables patients to receive quick care, reducing the burden of developing PE.

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CASE REPORT

Romman Fatima, Jakkula Srikanth, Afra Fatima

Small Round Cell Tumor/Primary Neuroendocrine Tumor Vagina

[Year:2023] [Month:July-December] [Volume:1] [Number:2] [Pages:3] [Pages No:58 - 60]

Keywords: Case report, Gynecological cancer, Menopause, Vaginal

   DOI: 10.5005/jogyp-11012-0017  |  Open Access |  How to cite  | 

Abstract

Background: Primary neuroendocrine tumors are neural crest cells in origin composed of solid sheets of undifferentiated small round cells that stain for CD99, S100 protein, neuron-specific enolase, and vimentin. Neuroendocrine tumors are also referred to as amine precursor uptake and decarboxylation (APUD) tumors because these cells often show amine precursors like levodopa and 5-hydroxytryptophan uptake and their subsequent decarboxylation to produce amines such as serotonin and catecholamines. Neuroendocrine tumors can be classified according to their anatomical (Novel Treatment of Small-Cell Neuroendocrine of the Vagina, n.d.) and by their levels of differentiation. They are graded histologically into GX-indeterminate; G1 – having a mitotic count below 2; G2 – mitotic count between 2 and 20; and G3 – mitotic count greater than 20. The Ki67 index can also be used for grading the tumors where grade 1 corresponds to 3%, grade 2 corresponds to between 3 and 20%, and grade 3 corresponds to above 20%. Since these tumors secrete metabolites, that can be used as biomarkers; new markers are extensively studied besides those mentioned above like truncated heat shock protein 70, high levels of CDX2 a homeobox gene end product that plays a vital role in intestinal differentiation, and protein 55 which belongs to the chromogranin family. Several other methods are available to diagnose small tumors that are missed on CT scans, such as octreoscan, somatostatin receptor scintigraphy indium-111 scan, and even more accurate gallium-68-DOTATOC (Primary Small Cell Neuroendocrine Carcinoma of Vagina: A Rare Case Report, n.d.) scan. These tumors have an incidence of about 2.5–5 per 1,000 cases; one such case of genitourinary neuroendocrine tumor is described in this article.

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LETTER TO EDITOR

Anuradha Choudhary, Aditya Narayan Choudhary

The Transformative Role of Artificial Intelligence in Training Obstetrics and Gynecology Residents

[Year:2023] [Month:July-December] [Volume:1] [Number:2] [Pages:2] [Pages No:61 - 62]

Keywords: Artificial intelligence, Artificial intelligence in healthcare, Gynecology, Obstetrics, Resident training

   DOI: 10.5005/jogyp-11012-0012  |  Open Access |  How to cite  | 

118

Quiz

Rajesh Kumar Mishra

Quiz

[Year:2023] [Month:July-December] [Volume:1] [Number:2] [Pages:1] [Pages No:63 - 63]

   DOI: 10.5005/jogyp-11012-0020  |  Open Access |  How to cite  | 

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