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OBJECTIVE To study the changes in the rates of perinatal mortality, birth asphyxia, and caesarean sections in relation to interventions implemented over the past 18 years, in a tertiary centre in South India. DESIGN Retrospective study. SETTING Labour and maternity unit of a tertiary centre in South India. POPULATION OR SAMPLE Women who gave birth between 2000 and 2018. METHODS Information from perinatal audits, chart reviews, and data retrieved from the electronic database were used. Interventions implemented during this time period were audits and training, obstetric re-organisation, and minor changes in staffing and infrastructure. MAIN OUTCOME MEASURES Main outcome measures were perinatal mortality rate, birth asphyxia rate, and caesarean section rate. RESULTS Perinatal mortality rate decreased from 44 per 1000 births in 2000 to 16.4 per 1000 births in 2018 (P

Introduction: Wound Dehiscence (WD) following Vaginal Delivery (VD) or Cesarean Delivery (CD) causes considerable discomfort to the woman, leading to significant physical, emotional and financial burden. The rate of Perineal Wound Dehiscence (PWD) is relatively low and more common with instrumental delivery. However, there is minimal information on the incidence and risk factors causing WD, especially for PWD. Aim: To assess the incidence and risk factors of peripartum wound dehiscence. Materials and Methods: This retrospective study was conducted in a large tertiary care centre where there were 14759 deliveries. 4671 women had caesarean deliveries and 10,088 women had the vaginal delivery. There were 86 cases (0.8%) of WD in the VD group and 95 (2%) in the CD group. These cases were compared with twice as many controls. Results: Induction of Labour (IOL) and BMI >30 kg/m2 were more common in cases compared to controls in the CD group. However, on multivariate analysis, this association was not seen. IOL, meconium stained liquor (MSAF), instrumental delivery and use of episiotomy was more common among cases than controls in the VD group. IOL did not show up as an independent risk factor on multivariate analysis. Conclusion: An association between IOL, primigravidae, instrumental delivery and MSAF was seen with peripartum WD.

Female ageing “Geripause” is receiving much attention from the health care community due to worldwide increase in proportion of elderly population as a result of improved health services and awareness. Pelvic floor disorder such as urinary incontinence, faecal incontinence and pelvic organ prolapse disproportionately affect geriatric population and undermines the quality of life. Surgery remains an important and effective therapeutic option for many women with pelvic floor disorders. Operative outcome can be adversely affected in elderly because of physiologic changes associated with aging and the increased number of comorbidities. To present date there is limited information on morbidity and mortality following urogynaecology surgery in geriatric patients. A retrospective analysis was performed on all patients of age more than 60 years old who underwent urogynaecologic surgery in urogynaecology unit from January 2011 to December 2014. Total 551 patients of all age underwent pelvic reconstructive surgery and Out of 121 patients were of age more than 60 years. Overall in our series 66% patients had one or more than one risk factors and 23% of patients had one or more than one perioperative complications. Intraoperative and postoperative complications rate was 4.9% and 18.1% respectively. Elderly women can undergo urogynecologic surgery with an acceptable rate of complications and should not be excluded from interventions that may improve their quality of life.

Actinomycosis is a chronic, suppurative, granulomatous disease which is typically seen in the cervicofacial and thoracic regions and less commonly abdominopelvic (10-20%). It is caused by an anaerobic, filamentous gram positive bacterium which is a normal commensal of the oropharynx, gastrointestinal tract and genital tract. Pelvic actinomycosis is almost always associated with the current or prior use of an intrauterine contraceptive device. Clinical diagnosis is difficult owing to the close resemblance to an ovarian tumour. Definitive diagnosis is usually made only after histopathological correlation. Reported here is a patient with pelvic actinomycosis unrelated to the use of an intrauterine contraceptive device. This patient presented with clinical features suggestive of chronic pelvic inflammatory disease with a possible benign ovarian tumour. Operative findings were consistent with pelvic inflammatory disease. The typical histopathological features of the Splendor Hoeppli phenomenon with sulphur granules and isolation of the actinomyces organism (which is rare) revealed the diagnosis of actinomycosis of the fallopian tubes. Pelvic actinomycosis is a rare condition and seldom described in the absence of an intrauterine device. High dose, long term antibiotic therapy is the key to successful resolution with surgery reserved for refractory cases. This patient showed good clinical and radiological response.

Background: Hysterectomy is the most common gynecological surgery performed. There are few studies evaluating hysterectomy as a risk factor for urinary incontinence. If hysterectomy is found to be a risk factor for developing urinary incontinence, women undergoing hysterectomy can be well informed prior to the procedure regarding the same. The objective of the present study was to study the prevalence of urinary incontinence in post-menopausal women and its relationship to hysterectomy. To evaluate the association of metabolic syndrome, to urinary incontinence.Methods: This study was a prospective cohort study done in Christian Medical College and Hospital, Vellore, Tamil Nadu between December 2016- December 2017. Postmenopausal women both with natural and surgical menopause, were enrolled into the study after an informed consent. The UDI-6 questionnaire was used to assess urinary incontinence. The categorical variables were presented using frequencies and percentages. The comparison of categorical variables was done using Fisher's exact test. The odds ratio and confidence interval were calculated for the prevalence. P value < 0.05 was considered to be statistically significant.Results: A total of 600 women were enrolled into the study with 300 women having attained natural menopause and 300 women with a surgical menopause. The prevalence of urinary incontinence among these post-menopausal women was 46.24%. The prevalence of urinary incontinence amongst the women with natural menopause was 47.3% and amongst the women with surgical menopause was 45% (p = 0.566). Women with metabolic syndrome suffered from urinary incontinence more than their counterparts without metabolic syndrome (55.8% vs. 36%, p

Improvement in survival rates of cancer patients has lead to a shift in focus toward fertility issues, especially in young survivors. Male fertility preservation is well established. Embryo cryopreservation remains most successful female fertility preservation option. Other female fertility preservation procedures like oocyte/ovarian tissue cryopreservation either have limited efficacy or in experimental stages. We have highlighted not uncommon clinical scenarios where the fertility preservation option was exercised. There is an urgent need to spread awareness among clinicians and patients regarding the various available fertility preservation measures. Timely referral will help in improving the quality of life of cancer survivors.

Background: Pelvic organ prolapses (POP) is a common problem in women. The prevalence of POP increase with age. The true prevalence and risk factor for developing hydroureteronephrosis (HUN) in women with pelvic organ prolapse is still unclear due to lack of prospective studies on sufficiently large cohorts. This prospective study was done to study the prevalence of HUN in women with POP and to identify the risk factors for developing HUN.Methods: In this prospective observational study 219 patients were recruited for surgical repair for pelvic organ prolapse for 2 years. Preoperatively, all patients had transabdominal scan to assess the uterus, adnexa and to look for Hydroureteronephrosis (HUN). Women with presence of HUN were followed postoperatively look for the resolution of HUN.Results: The prevalence of bilateral HUN was 6.85%. The mean age of women with HUN ranged from 51-69 years. Diabetes and hypertension were significant risk factor for development of HUN (OR 4.70, 95% CI -1.59-13.88 and OR 3.72, 95% CI- 1.23-11.1 respectively). There was a statistically significant correlation between chronic kidney disease and HUN. (OR 1 with 95%: CI 9.49-30.42). The correlation between stage of pelvic organ prolapse and HUN was not statistically significant (p = 0.062). There was a statistically significant correlation between the duration (2years -15 years) of POP to HUN. (OR 0.233, 95%0.13-0.419). Patients were followed up post operatively for resolution of HUN. HUN resolved in 9 women (60%) and persisted in 6 (40%).Conclusions: The prevalence of bilateral HUN in women with pelvic organ prolapse was 6.8%. Presence of hypertension, diabetes and chronic kidney disease was a risk factor for HUN. HUN resolved in 60% of women after pelvic reconstructive surgery.

Background: The objectives of the study were to identify the causes of premature ovarian insufficiency (POI) and to assess the severity of menopausal symptoms as well as the impact on cardiovascular health in these patients.Methods: Authors did a cross sectional case control study with 100 cases and 100 age matched controls. Women 4months and FSH >25mIU/ml were identified with POI. Women

Background: As the average life expectancy of women extends 20-30 years after menopause, the medical impacts of changes leading to metabolic syndrome on postmenopausal women are significant. The menopausal state has been noted to be an independent risk factor for the occurrence of metabolic syndrome. This study was conducted to look at the prevalence of metabolic syndrome in postmenopausal women.Methods: A prospective cross sectional study was done and postmenopausal women were assessed for metabolic syndrome using the International Diabetes Federation Criteria.Results: The prevalence of metabolic syndrome was found to be 64%. Women with metabolic syndrome had a higher systolic blood pressure and larger waist circumference, however did not differ in terms of diabetes and dyslipidemia. There was no significant difference with regards to frequency and severity of menopausal symptoms between women with and without metabolic syndrome.Conclusions: The increased prevalence of metabolic syndrome in postmenopausal women may be directly due to ovarian insufficiency and indirectly due to metabolic consequences of central fat redistribution with estrogen deficiency.

Background: Primary objective of this work was to study the prevalence of voiding and defecatory dysfunction in women with pelvic organ prolapse and correlate the stage and compartment of prolapse with voiding and defecatory dysfunction. The secondary objective was to correlate stage of prolapse with flow rate and post void residue and to study the voiding dysfunction in pelvic organ prolapse.Methods: A prospective observational cohort study in 120 post-menopausal women scheduled for vaginal hysterectomy pelvic floor repair. Short form of pelvic floor distress inventory (PFDI-20) and International prostate symptom questionnaire I-PSS score for Lower urinary tract symptoms (LUTS)was employed.Results: The prevalence of voiding dysfunction in this study was 78% and defecatory dysfunction was 77%. Higher stage of prolapse had significant correlation with voiding dysfunction. (P value was 0.028). Women with posterior compartment defect had more voiding dysfunction with the significant P value (p value was 0.04). Pre-operative voiding dysfunction resolved post operatively in 86%, the p

Background: Pelvic organ prolapse (POP) has a significant impact on quality of life. Post-operative voiding dysfunction is seen in 2.5 to 24% of patients following pelvic reconstructive surgery. Risk factors like age of the patient, size of the genital hiatus and stage of prolapse are known to be associated with early post-operative voiding disorders.Methods: This is a prospective cohort study done in Christian Medical College, Vellore over one year. Patients with stage II to IV pelvic organ prolapse who underwent pelvic reconstructive surgery were observed post operatively for covert and overt urinary retention. Inability to void accompanied by pain and discomfort is defined as overt retention. Early post-operative urinary retention (POUR) is retention of urine in the first 72 hours postoperatively. Covert retention is defined as a non-painful bladder with chronic high post void residue. Chi- square test or Fisher’s exact test was used to assess the association between the clinical predictors and early post-operative urinary retention in univariate analysis.Results: In this study, 75 patients were recruited. Nine patients had POUR. Among the patients who had post-operative urinary retention, 77.78% had stage III pelvic organ prolapse (n=7). P value was 0.042. The prevalence of early POUR after pelvic reconstructive surgery was 12.85 % (n=9). A 55.55% had covert retention (n=5) and 44.44% patients had overt retention (n=4).Conclusions: The prevalence of early POUR after pelvic reconstructive surgery was 12.85%. Stage of the prolapse was an independent predictor for early postoperative urinary retention.

Puerperal infection is a common complication of labour. It occurs universally and is usually responsive to first line antibiotics. However, resistance to first line antibiotics and even second line antibiotics is becoming more wide spread. We report a case of puerperal infection caused by carbapenem resistant organisms leading to prolonged fever and hospitalisation. A 28-year-old primigravida, following caesarean section done elsewhere, for elevated blood pressure presented with high grade fever. The patient was treated with antibiotic to which she failed to respond. She underwent laparotomy twice and only improved after Colistin was combined with Meropenam, based on urine and pus culture reports.

Background: Women spend one third of their life in menopause. The age related anatomical and physiological changes predispose them to MetS and lower urinary tract symptoms (LUTS). The aim was to study the prevalence of metabolic syndrome (MetS) and lower urinary tract symptoms in postmenopausal women attending menopause clinic, to study the correlation of LUTS and body composition among women with MetS.Methods: 154 post-menopausal women who attended menopause clinic at the Christian Medical College Hospital Vellore, were recruited. MetS was diagnosed using IDF criteria. LUTS were assessed BFLUTS questionnaires. Blood was taken to assess serum fasting glucose and lipid profile. DEXA was performed to assess the whole-body composition.Results: Of 154 postmenopausal women, 64% had MetS and 43% of women had a total LUTS score > 5. 90% of women had filling symptoms,57% had incontinence,17% had voiding symptoms,14 % had quality of life issues and 6 % had sexual symptoms. However, there was no statistical significant difference between two groups in correlating the variables of MetS with LUTS (P >0.05). The percentage of total body fat by DEXA scan was significantly greater (P=0.006) in women with MetS (37.32±5.04) when compared to the women without MetS (34.629±3.65).Conclusions: Prevalence of MetS among the study population was 64 %. LUTS were observed in 43% of the patients. There was no significant difference in LUTS in women with MetS and without Mets. However, there was a significant difference in body composition among women with and without MetS.

Objective To compare 25 μg of vaginal misoprostol with a Foley catheter for induction of labor (IOL) for fetal growth restriction. Methods A randomized controlled trial was conducted in a tertiary center in South India. Women with fetal growth restriction (n = 100) were randomized to be induced with three doses of vaginal misoprostol (25 μg) every 6 hours or with an intracervical Foley catheter, inserted 12 hours before rupture of membranes, and oxytocin if needed. The primary outcome was uterine tachysystole with fetal cardiotocography abnormalities. Secondary outcomes pertained to effectiveness, complications, and patient satisfaction. Results One woman in the misoprostol group and none in the Foley catheter group had uterine tachysystole. The duration of labor from IOL to delivery was similar in both groups ( P = 0.416). More women in the misoprostol group had a vaginal delivery within 12 hours (26.1% versus 5.6%; P = 0.005). Women induced with misoprostol were less likely to deliver by lower-segment cesarean delivery (15.2% versus 29.6%; P = 0.168) and to require oxytocin augmentation (60.9% versus 85.2%; P = 0.007). Complications were few in both group. Conclusion Few women had uterine tachysystole with cardiotocography abnormalities. Vaginal misoprostol at 25 μg was more effective than a Foley catheter for IOL in fetal growth restriction. Clinical Trials Registry India: CTRI/2014/02/004411 .