Bangladesh Journal of Obstetrics & Gynaecology <p>The Official Journal of the Obstetrical and Gynaecological Society of Bangladesh. Full text articles available.</p> Obstetrical & Gynaecological Society of Bangladesh en-US Bangladesh Journal of Obstetrics & Gynaecology 1018-4287 Prenatal Diagnosis <p>Abstract not available</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 61-62</p> Rashida Begum ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 61 62 10.3329/bjog.v31i2.34211 Chorionic Villus Sampling (CVS) for Prenatal Diagnosis of Genetic Disorders in Bangladesh <p><strong>Objective(s): </strong>The aim of the study was to identify safety and outcome of trans abdominal Chorionic Villus Sampling (CVS) for prenatal diagnosis of genetic disorders.</p><p><strong>Materials and methods: </strong>This is a retrospective analytical study on women who had undergone trans abdominal CVS. All CVS were done at Fetal medicine centre, Family Foundation, Green Road, Dhaka, from June 2013 to December 2016. A total of 286 couples, who were referred for prenatal diagnosis of various genetic disorders were studied. Trans abdominal CVS was done under local anesthesia and real-time ultrasound guidance. A 18G/88mm Spinal Needle (B Braun, Germany) was used. All CVS were performed with the “2 operators” technique. The needle was introduced trans abdominally into the placenta in its longitudinal direction. Once the needle was adequately placed, the chorionic villi were aspirated with a to and fro jiggling movement of the aspiration needle and a suction force was applied through a syringe. Results were recorded and analyzed for descriptive statistics.</p><p><strong>Results: </strong>A total of 286 CVSs were performed as outdoor basis. The most common indication was detecting Beta-thalassaemia (82.5%). Other indications were for diagnosis of aneuploidy (9.7%), Hemophilia (3.1%), Spinal muscular atrophy (SMA) (2.4%), Duchenne Muscular Dystrophy (DMD) (2%). Most procedures were done between 11 and 13 weeks (range 11- 14 weeks). Most aspirations (95.1%) were easy; however, in 4.8% cases the aspiration was difficult due to a variety of factors. The overall success rate was 100%. Minor complications like placental hematoma and pervaginal (P/V) bleeding occurred in 2% and 1.3% respectively, which were subsided by conservative management. The procedure related miscarriage within three weeks not occurred in any cases.</p><p><strong>Conclusion: </strong>Trans abdominal CVS under real-time sonography is a useful outdoor procedure for prenatal diagnosis in early pregnancy without significant risk to the mother and the fetus.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 63-69</p> Rezaul Karim Kazal Saima Akhtar Chowdhury Tabassum Parveen Hasna Hena Pervin Farah Noor Nasreen Akhter ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 63 69 10.3329/bjog.v31i2.34212 Efficacy and Safety of Para Cervical Block in Manual Vacuum Aspiration (MVA) - in Low Resource Setting <p><strong>Objective (s): </strong>To determine the safety and effectiveness of para-cervical block for cervical dilatation and uterine evacuation by MVA.</p><p><strong>Materials and methods: </strong>This descriptive (cross-sectional) study was conducted in a low resource set-up at Homna, Upzilla Health Complex Comilla between January 2016 and June 2016. Forty five patients of 1<sup>st </sup>trimester incomplete abortion of 12 weeks gestation were the target population for manual vacuum aspiration (MVA) for this study. All patients received para cervical block before MVA procedure. Three minutes after application of block, suction and evacuation of uterus was done. Perioperative oral analgesic (Ibuprofen) and anxiolytic (diazepam) were used 30 minutes before procedure in all patients. Before the procedure, all the women were asked to evaluate the level of pain on a visual analog scale ranged from 0-10. Thirty minutes after the procedure, the patient was asked to describe the pain that she had been feeling during MVA by using the same visual analog scale. Visual analog scale was described by: no pain (0 points), slight pain (1-3 points), moderate pain (4-6 points) and severe pain (7-10 points). Patients were followed up for 7 days and were evaluated for complications before leaving the facility and on the 7th day after procedure. A routine USG of lower abdomen was done on 7<sup>th</sup> post-evacuation day in all patients, which revealed completeness of the procedure. Informed consent was taken from all the patients.</p><p><strong>Results: </strong>All were first trimester incomplete abortion cases. MVA was performed with para cervical block. Para cervical block reduced pain sensation on cervical dilatation. According to VAS 30 (66.67%) patients had mild pain, 3(6.67%) patients had moderate pain and 12(26.67%) patients had no pain during the procedure. Six (13.33%) patients had mild pain and others had no pain after the procedure. There was no severe pain before or after the procedure. Thirty (75.56%) patients discharged before 4 hours and 11 (24.44%) patients discharged after 4 hours of the procedure. No patients had any complications like pervaginal bleeding, infection or retention of product. The cost was minimum and patient’s satisfaction was high.</p><p><strong>Conclusion: </strong>Paracevical block is effective in reducing pain sensation during MVA with a reasonable cost of the procedure.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 70-74</p> Nafisa Jesmin ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 70 74 10.3329/bjog.v31i2.34213 Association of Serum C-reactive Protein in Preeclampsia and its Effect on Fetal Birth Weight – A Case Control Study <p><strong>Objective(s): </strong>The aim of this study was to evaluate the association of serum C-reactive protein (CRP) in preeclampsia (PE) and its effect on fetal birth weight.</p><p><strong>Materials and methods: </strong>This case control study was conducted in Chittagong Medical College Hospital, Bangladesh, from July 2013 to June 2014. Study population was pregnant women of third trimester with preeclampsia (case group) and normal blood pressure (control group). The maternal serum C-reactive protein (CRP) levels were measured by immune turbidometric assay between 32 weeks to term. The women were divided into three groups: mild PE, severe PE (according to ACOG criteria) and normal healthy group. The value of CRP and its correlation with birth weight was compared between groups.</p><p><strong>Results: </strong>One hundred and fifty (150) pregnant women were analyzed. Among them 50 were case and 100 control. There was no difference between age of the patients of both groups. The mean systolic blood pressure was 148.40 ± 12.35 mm Hg in case and 122.15 ± 6.44 mmHg in control group. The mean diastolic blood pressure was 100.00 ± 9.74 mmHg in case and 74.05 ± 5.97 mmHg for the control. The systolic and diastolic blood pressure was significantly higher in preeclamptic group (P &lt; 0.000). C-reactive protein was 10.28 ± 7.25 mg/ mL in mild PE and 10.94 ± 6.32 mg/mL in severe PE and 3.45 ± 1.71 mg/mL in normotensive group, which was significantly higher in case than control group (P = 0.000). Preeclamptic women delivered at a significantly shorter gestational age than normal pregnant women. Mean gestational age during delivery for the case group and control group was 39.02 ± 1.6 and 39.58 ± 0.8 weeks respectively. Mean birth weight in PE (2.52 ± 0.42 kg) was significantly lower than normal pregnancies (2.88 ± 0.29 kg). The sensitivity and specificity of CRP were 68% and 98% respectively. Multiple regression analysis showed that there is a strong association between CRP levels and PE and birth weight.</p><p><strong>Conclusion: </strong>This small study showed that in case group CRP was raised in 68% cases which is much higher in comparison to healthy control group where CRP was high only in 2% cases. High CRP has association with low birth weight. Therefore, CRP may be used as cost effective investigation to identify the risk of preeclampsia and its effect on fetal birth weight.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 75-80</p> Shahanaj Sharmin Shahanara Chy Diadrul Alam Nasreen Banu Fahmida Rashid Shanjida Kabir ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 75 80 10.3329/bjog.v31i2.34214 The Impact of Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia on Female Sexual Function <p><strong>Objective(s): </strong>Aim of the study was to find out the impact of LEEP (Loop Electrosurgical Excision) on overall sexual function in women with CIN.</p><p><strong>Materials and methods: </strong>This cross sectional study was performed at colposcopy clinic of Dhaka Medical College and Hospital from January 2016 to June 2016. Forty six women with CIN who underwent LEEP at least 6 months before were included in this study by purposive sampling. Face to face interview was taken with a preformed questionnaire on pre procedural sexual function and post-procedural sexual function.</p><p><strong>Results: </strong>Mean age of the women was 32.32 ±4.44 years (range 25 to 40 year). Time of resumption of sexual intercourse was 6.2 weeks on average. There was no change in coital frequency. About nine percent of women complaint of dyspareunia and vaginal dryness, 6.52% complaint of dissatisfaction to sexual intercourse, 10.87% felt lower abdominal pain after coitus and 13.1 % women felt decrease in sexual desire.</p><p><strong>Conclusion: </strong>LEEP for the treatment of cervical intraepithelial neoplasia doesn’t significantly affect women’s sexuality, when compared with sexual function before performing LEEP. Possible adverse effects may overcome by psychological counseling and healthy and hygienic life style.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 81-85</p> Mohammed Mizanur Rahman Raunak Jahan Jannatul Ferdous Ferdousi Islam ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 81 85 10.3329/bjog.v31i2.34215 Thyroid status and Treatment Response of Hypothyroid Infertile Women in Tertiary Care Center of Bangladesh <p><strong>Objective(s): </strong>Aim of this study was to find out the prevalence of hypothyroidism in infertile women as well as to assess their response to treatment.</p><p><strong>Materials and methods: </strong>This descriptive study was conducted in Infertility unit of Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, a tertiary care centre from January 2014 to December 2014. Four hundred women who visited infertility clinic of the department for fertility treatment were the target population for this study. Routine investigations such as CBC, Blood sugar 2 hours postparandial or GTT, TSH and Prolactin was done. Subclinical hypothyroidism was diagnosed when there was increased TSH and normal FT<sub>4</sub>. Hypothyroid patients were given Levothyroxin depending upon TSH levels and continued until end of the study. Patients were followed up for six months even if pregnancy was attained.</p><p><strong>Results: </strong>Out of 400 women 55% were primary and 45% were secondary subfertility. Mean duration of infertility was 4.5 ± 1.2 years. Ninety two (23%) patients were hypothyroid. Among them 66 (16.5%) were subclinical hypothyroid and 26 (6.5%) were frank hypothyroid. The mean TSH levels were 7.34 ± 2.13 ìIU/ml, and the mean PRL levels were 52.46 ± 11.17 ng/ml. Out of 92 infertile women diagnosed as hypothyroidism 75 (81.52%) women conceived after treatment with drugs for hypothyroidism (dose depending upon severity of hypothyroidism, i.e. TSH levels). More than 90% women had regular ovulation for consecutive three cycles after initiation of treatment.</p><p><strong>Conclusion: </strong>The normal TSH levels are the pre-requisite for fertilization. The decision to initiate thyroid replacement therapy in both clinical and subclinical hypothyroidism at early stage is justified in infertile women.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 86-89<em></em></p> Farzana Deeba Parveen Fatima Jesmine Banu Shakeela Ishrat Nurjahan Begum Shaheen Ara Anwary ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 86 89 10.3329/bjog.v31i2.34216 Outcome of Abdominal Sacrocolpopexy for Post Hysterectomy Vaginal Vault Prolapse <p><strong>Objective (s): </strong>The aim of this study was to explore the outcome of abdominal sacrocolpopexy for the correction of post hysterectomy vaginal vault prolapse.</p><p><strong>Materials and Methods: </strong>This prospective study was done over the period of five years from 2011 to 2015 where twenty patients of vault prolapse were subjected to abdominal sacrocolpopexy. Procedure was completed by securing the vaginal apex to the anterior longitudinal ligament of sacrum using synthetic mesh. Intra and postoperative complications and patients’ satisfaction was assessed.</p><p><strong>Results: </strong>No post-operative serious complications were reported during follow up period. The vaginal vault was well supported in all patients with no recurrent vault prolapse. One patient had mild asymptomatic rectocele. No mesh complication was found during the follow up period.</p><p><strong>Conclusion: </strong>The abdominal sacrocolpopexy achieves excellent correction of post hysterectomy vaginal vault prolapse with minimal morbidity.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 90-93<em></em></p> Liza Chowdhury Nurun Nahar Khanam Junnu Rayen Janna ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 90 93 10.3329/bjog.v31i2.34217 Updates in Cervical Cancer Prevention <p>Cervical cancer is a totally preventable cancer in females. There is continuous effort ongoing to overcome the existing deficiencies in the screening and vaccination programme. The goal is to improve the situation so that maximum reduction in the incidence and mortality of cervical cancer can be achieved.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 94-96<em></em></p> Farhat Hussain ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 94 96 10.3329/bjog.v31i2.34218 Unilateral Absence of Ovary and Fallopian Tube: 3 Rare Case Reports <p>Here we reported three cases of unilateral tubal and ovarian absence, along with laparoscopic images and images during ceasarean section in Anwer Khan Modern Medical College. Three patients with primary infertility of 6-8 years duration were reported as non-visualization of right adnexal structures on transvaginal ultrasound and hysterosalpingography. Absence of right adnexal structures of varying degree were detected during laparoscopy. Subsequent evaluation of renal system with Intravenous Pyelography were done. Ipsilateral absence of the fallopian tube and ovary without any other system anomalies were detected. Vascular accidents, Congenital defects or torsion could be the possible etiologic factors. Laparoscopy is a feasible option as a diagnostic tool for these cases.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 97-100<em></em></p> Maruf Siddiqui Nusrat Ghafoor Fahmida Naznine Chowdhury Ayesha Siddiqua TA Chowdhury ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 97 100 10.3329/bjog.v31i2.34219 A Rare Shape of Placenta; Placenta Bipartite, Bilobata, Dimidiate, Duplex: A Rare Case Report <p>Placenta bipartite is a rare variation of placental morphology. The estimated incidence is up to 2-8 % of pregnancy. There is no distinct racial, ethnic or geographical prediction observed. The diagnosis of an anomalous placenta is important for patient management at the time of delivery. Specifically, the bilobed placenta can be associated with first-trimester bleeding, polyhydramnios, abruption, and retained placenta. Careful attention to the cord insertion is also required for optimal fetal management. We report a case of a 24 years multi gravida with previous history of 2 C/S who had regular antenatal checkup and her pregnancy was uneventful till 36 wks. Her early USG at 16 weeks showed low lying placenta little away from the internal os of cervix. She was advised to take complete bed rest, avoid journey and coitus. Couple was warned about pervaginal bleeding, which may occur any time and also advised to ready at least four blood donors. Her 2<sup>nd</sup> USG scan at 26wks showed placenta bipartite and insertion of cord over the internal os of cervix. Patient was treated conservatively and dose of inj. Oradexon was completed at 32wks for lung maturation. At 36 weeks, patient perceived less foetal movement and then emergency LUCS with BLTL was done. Baby was well and her postpartum period was uneventful.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 101-103<em></em></p> Pratima Rani Biswas Gautom Kumar Paul Mina Chowdhury Md Selim ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 101 103 10.3329/bjog.v31i2.34220 Tubal Hydatidiform Mole: A Case Report <p>The incidence of ectopic pregnancy is 20 per 1,000 pregnancies. Hydatidiform mole occurs in 1 per 1,000 pregnancies. Thus, the incidence of the ectopic molar gestation is very rare. We report a case of tubal molar pregnancy diagnosed at the systematic histology examination of an ectopic pregnancy. A 22 years old second gravida presented with five weeks amenorrhea, severe lower abdominal pain and mild vaginal bleeding for one day; and excessive sweating and restlessness for 6 hours. On clinical examination, she had severe anaemia, pulse was 120 per minute and blood pressure was 80/60 mm hg. The gynecological examination was difficult because of lower abdominal pain and tenderness. She was diagnosed as a case of ruptured tubal pregnancy with shock. Pelvic ultrasound revealed an irregular echogenic mass in the left adnexa. She was resuscitated and emergency laparotomy was done: it revealed a left-sided ruptured ampullary ectopic pregnancy. Left salpingectomy was performed. The systematic histologic test identified an ectopic molar pregnancy. The patient was followed with weekly quantitative B-hCG titers until three successive B-hCG levels were negative. It is important that clinicians routinely send for histological examination of tubal specimens in ectopic pregnancy in order to diagnose cases of ectopic molar gestations early and provide appropriate post treatment follow up.</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 104-106<em></em></p> Ferdousi Begum Setara Kasem Shahnaz Begum Amina Zannat Farhana Rahman Rafida Moslemin Khan AUM Muhsin ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 104 106 10.3329/bjog.v31i2.34221 Abstracts Vol.31(2) <p>Abstract not available</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 107-110<em></em></p> Saleha Begum Chowdhury ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 107 110 10.3329/bjog.v31i2.34222 Society News Vol.31(2) <p>Abstract not available</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 111<em></em></p> Farhana Dewan ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 111 111 10.3329/bjog.v31i2.34223 International News Vol.31(2) <p>Abstract not available</p><p>Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 112-113<em></em></p> Saleha Begum Chowdhury ##submission.copyrightStatement## 2017-10-12 2017-10-12 31 2 112 113 10.3329/bjog.v31i2.34224