Bangladesh Journal of Obstetrics & Gynaecology

Abstracts Vol. 37(2)

Saria Tasnim — Mon, 06 Nov 2023 00:00:00 +0000

Abstract not available

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 165-169

Society News Vol. 37(2)

Saria Tasnim — Mon, 06 Nov 2023 00:00:00 +0000

Abstract not available

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 170

International News Vol. 37(2)

Saria Tasnim — Mon, 06 Nov 2023 00:00:00 +0000

Abstract not available

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 171

Obituary Vol. 37(2)

Saria Tasnim — Mon, 06 Nov 2023 00:00:00 +0000

Abstract not available

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 172

BJOG yearly CME program Vol. 37(2)

Saria Tasnim — Mon, 06 Nov 2023 00:00:00 +0000

Abstract not available

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 173

Sacrospinous ligament fixation

Iffat Ara — Mon, 06 Nov 2023 00:00:00 +0000

Abstract not available

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 88-89

Scar Ectopic: Diagnostic and Management Challenge

Joysree Saha, Priyanka Podder — Mon, 06 Nov 2023 00:00:00 +0000

Scar ectopic pregnancy is the rarest form of ectopic pregnancy and has been increasingly diagnosed all over the world. Usually when a blastocyst implants on the fibrous tissue of the previous Caesarean scar is called scar ectopic. This type of abnormal implantation of embryo can occur following hysterotomy, dilatation and curettage ,abnormal placentation surgery on uterus like myomectomy ,hysteroscopy and manual removal of placenta. The incidence is increased due to increase in number of Caesarean deliveries. Trans vaginal Sonography helps in early diagnosis. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility. Excision of trophoblastic tissues using laparotomy or laparoscopy, systemically administered methotrexate, and more recently uterine artery embolization are the treatment options for scar ectopic. When TVS is inconclusive, MRI can be recommended.

We are reporting here a case of first trimester caesarean scar pregnancy with viable fetus in the process of rupture, where uterine repair could be done to preserve the future fertility.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 154-156

Morbidly Adherent Placenta at Upper Segment of Uterus- A Case Report

Nadira Sultana, Arifa Akter Zahan Shoma, Khairul Alam — Mon, 06 Nov 2023 00:00:00 +0000

Background: Morbidly adherent placenta (MAP) is a spectrum of disorder which describes adherence of all or part of the placenta to the uterine wall or surrounding organs. It is one of the most devastating complication of pregnancy. It occurs when there is abnormally firm attachment of placental villi to the uterine wall with the absence of normal intervening decidua basalis and nitabuch’s layer. MAP is often asymptomatic antenatally and the diagnosis is only established after unsuccessful attempt to remove of the placenta at delivery. A majority of morbidly adherent placenta are diagnosed during the third stage of labour or during caesarean section which results in adverse consequences including exsanguinating haemorrhage . It is one of the most common cause of obstetric hysterectomy. Accurate prenatal diagnosis is critical to reduce the risk of maternal morbidity and mortality.

Aim: To report the case of a morbid adherent placenta at upper segment of uterus with conservation of uterus following reconstructive surgery.

Case Presentation: A 24 years old 3rd gravid women with morbid adherent placenta at upper segment was treated by segmental resection and reconstructive surgery. Her post- operative period was uneventful.

Conclusion: Antenatal diagnosis of morbidly adherent placenta, multi-disciplinary team with surgical expertise and facilities for blood transfusion can reduce maternal mortality and morbidity. This rare morbid attachment of placenta at upper segment is one of the example.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 157-161

Successful Pregnancy Outcome in end-stage Renal Disease (ESRD) Patient : A Case Report

Mon, 06 Nov 2023 00:00:00 +0000

Pregnancy in women with chronic kidney disease (CKD) has always been considered as a challenging event both for the mother and the fetus . Outcomes of pregnancy in patients with End stage renal disease ( ESRD ) have long been considered to be extremely poor and challenges are harder in ESRD patients undergoing maintenance hemodialysis( MHD) . The cases of successful full term pregnancy occurring in an ESRD patient are still very few in whole world even after the evolutionary improvement of medical care. Development of well established multidisciplinary center make it possible to bring a successful pregnancy outcome among ESRD patients who are on going MHD. Patients with CKD are usually amenorrheic and fertility is markedly reduced . Women with chronic kidney disease, who get pregnant have poor pregnancy outcome in term of fetus and mother. Here we report a case of 34 years old lady, mother of two children , housewife presented in Bangladesh Specialized Hospital with a diagnosis 3 rd G 29 weeks of pregnancy with ESRD (on maintenance hemodialysis) with Hypertension. She was treated conservatively with joint consultation with Consultant Obstetrician, Nephrologist and Pediatrician. Her elective Lower uterine segment Cesarean section (LUCS) was done at her 35 weeks of pregnancy due to fetal distress with previous history of 2 LUCS. Both the mother and baby were healthy while discharge from hospital.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 162-164

Complications during Vaginal Sacrospinous Fixation along with McCall Culdoplasty in Stage III and IV POP

Bilkis Begum, Bilkis Begum, Rowshan Ara Begum — Mon, 06 Nov 2023 00:00:00 +0000

In Bangladesh, about half a million women are suffering from stage III or IV pelvic organ prolapse (POP). With traditional surgical methods, there is a chance of recurrence, especially of apical prolapse. Sacrospinous fixation (SSF) along with MacCall Culdoplasty during vaginal hysterectomy can reduce this recurrence rate enormously. This study was designed to identify, manage as well as to prevent per-/post-operative complications during SSF. The study period was from August 2017 to December 2021 at Kumudini Women’s Medical College and Hospital, Bangladesh. Total 335 stage III and IV utero-vaginal prolapse cases were included in this study. The surgeries performed were vaginal hysterectomy followed by modified McCall Culdoplasty and right-sided vaginal sacrospinous ligament fixation (SSF) along with anterior and posterior fascial closure and perineorrhaphy. A standard data collection sheet was used to record the information. Per-operatively, main complications were hemorrhage (3.57%) due to vessel injury and rectal injury (0.90%). The immediate early postoperative complication was buttock pain (24%). Of these, in 97.53% cases, pain subsided within 6 weeks with analgesic and counselling. Only one patient had recurrence of apical prolapse within 1st week of operation. It should be concluded that with proper knowledge of anatomy and careful surgical technique, most of the complications can be avoided.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 90-97

Engaging National Professional Society to Combat Postpartum Hemorrhage Using Bundle Approach - A FIGO-SAFOG-OGSB-MGH Project: Experience of Implementation in Bangladesh

Mon, 06 Nov 2023 00:00:00 +0000

Objective: To reduce the incidence and death due to post-partum Hemorrhage (PPH) and capacity building of health service providers by using PPH Emergency response using Bundle Approach.

Method: Planning and implementation of WHO formulated PPH Bundles [Active Management of Third Stage of Labour (AMTSL), First response Bundle and Refractory PPH Bundle] by Obstetrical and Gynaecological Society of Bangladesh (OGSB) in 14 different levels of public and private hospitals in Bangladesh. After discussion with International Federation of Gynaecology and Obstetrics (FIGO) and South Asian Federation of Obstetrics and Gynaecology (SAFOG) team, a Memorandum of understanding (MOU) was signed; permission from Ministry of Health and Family welfare (MOHFW) was obtained through Directorate General of Health Services (DGHS) and also from all the institutions. The project period was from November 2019 to September 2022 in a spoke-and-hub fashion. A group of master trainers and a technical advisory group were developed comprising of senior obstetricians and gynecologist of Bangladesh. Data were obtained through record keeping of the respective hospitals and Management Information System (MIS) of DGHS, monitoring was done by OGSB and Massachusetts General Hospital (MGH)-FIGO team.

Results: Consultative and planning meetings were organized among OGSB, FIGO, SAFOG and MGH: 16 master trainers, 74 trainers were produced and 740 health service providers (Doctor, Nurses, midwives) and 450 non clinical staffs were trained. All clinical and nonclinical bundles were implemented in 14 facilities in spoke-and-hub fashion. Occurrence of PPH, detection rate of PPH, filling up PPH checklist and debrief forms were improved. Data collection system, understanding about data improved a lot. Facility readiness, team work, data monitoring & supervision, network integration and leadership skills were instituted and shown excellent positive changes. Regular simulations were continued which helped old & new service providers to learn and continue proper use of the clinical and non-clinical interventions. Scale up was planned and continued.

Conclusion: PPH emergency response using bundle approach was found to be an important practical way to reduce occurrence, death and disability related to PPH. Needs for surgery has reduced also. Quality of services improved in terms of providing standard care, record keeping and reporting. Regular supervision and monitoring; data management and personal motivation are the challenges.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 98-108

Preoperative, Intraoperative and Postoperative Assessment of Pelvic Organ Prolapse by Pelvic Organ Prolapse Quantification System and Surgical Outcome

Mon, 06 Nov 2023 00:00:00 +0000

Background: Pelvic organ prolapse (POP) is a common disease of middle aged and elderly women with an incidence of 7-10% and life time risk for surgery 11 to 20%. Assessing pelvic organ prolapsed in an objective, reproducible and applicable method is essential to have successful surgical outcome. Aim of the study was preoperative, intraoperative pre and postsurgical as well as postoperative assessment of pelvic organ prolapse by POP- Q system in patients undergoing reconstructive surgery and measure optimum surgical outcome stage 0 (Q<-1), Tvl > 4 cm and Genital hiatus (3 to 3.4cm) to prevent recurrence (POP-Q stage > -1) and dyspareunia (Pb d”3 cm).

Methods : This was hospital based Prospective study done with 250 patient diagnosed as pelvic organ prolapse at OPD. Excluding 14 patients 236 had surgery in Chattagram Metropolitan Hospital during January 2010 to December 2019. POP-Q measurement was done with Valsalva before anesthesia, intraoperative after anesthesia pre and postsurgical and postoperatively in follow up visit within three months of surgery by same surgeon. All POPQ measurement were done by same surgeon using a wooden Spatula marked in cm (POP-Q popsicle stick). All measurement were recorded in grid form and preoperative & presurgical POP-Q staging was done. The result was then summarized as mean and SD for numerical variable and percentage for categorical variable.

Result : A total 236 patient had surgery, 233 had vaginal hysterectomy with Apical vaginal suspension with uterosacral ligament and sacrospinous fixation was done in 3 patients with vault prolapse. Mean age was 51 ± 5SD years (51 to 60 years 51%), 84% sexually active, low socioeconomic group (68%), multiparous 100% mean parity 4 ± 2SD (e” 6 62%), 95% had vaginal delivery with history of home delivery 89%, resuming house hold work within two weeks of delivery in 97% cases. Most were postmenopausal 96%. All intraoperative presurgical measurement except Pb and Tvl showed significant higher descent as compared to preoperative finding before anesthesia, mean difference were Aa 0.7, Ba1.6, C 1.6, Ap 0.25 Bp 1.6 D1.6 Gh. 8cm with highest descent in Ba C, D Bp. Immediate postsurgical measurement all patient showed optimum anatomical outcome (stage 0). But follow up within 3 month (10 to 90 days) 13 patient showed satisfactory anatomical outcome (stage 1 Q<-1)) with no recurrence (Q>-1) nor dyspareunia. Total vaginal length and Pb no change in measurement before and after anesthesia but Tvl reduced by 2.3 cm and Pb increased by .3cm postsurgical. Presurgical measurementof Gh increased by. 8cm but reduced to 3.5 cm postsurgical. No significant difference in postsurgical intraoperative measurements during follow up within 3 months except Gh (3.2 cm) which is narrower even with valsalva menovure.

Conclusion : POP-Q technique in assessment of Pelvic organ prolapse was anatomically site specific and is with good reproducibility and less intra and inter observer variation. Significant difference in descent alert surgeon to plan surgical technique to have optimum anatomical outcome and prevent recurrence and dysparunea.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 109-118

Psychosocial and Perceived Stress Associated with Pre-eclampsia in a Periurban Hospital

Saria Tasnim, Shahida Choudhury, Farida Yesmin, Summyia Nazmeen — Mon, 06 Nov 2023 00:00:00 +0000

Pre-eclampsia complicates about 2% of pregnancy Exact aetiology of Pre-eclampsia is not known, however a number of psychosocial factors are often found to be associated with it.

The purpose of the study was to ascertain the prevalence of psychosocial factors and perceived stress among patients with Pre-eclampsia.

This was a cross sectional study done at institute of child and mother health during July to September, 2015. Total 71 women admitted for delivery with diagnosis of Preeclampsia were interviewed in the postnatal ward within three days of delivery using a structured questionnaire. Informed consent was taken. Data analyzed using SPSS version 22.

Mean age was 23.9± 4.3 years with a range of 18-36 years, about a quarter were illiterate. Majority of them stay within extended family and mean household family member was 6.25± 1.93 about 77.5% of husbands were smokers, history of abortion was present in 21.1%. More than half of them have history of hypertension or diabetes in the family. Mean Systolic BP was 122.6±21.3 and mean diastolic BP was 83.5±14.6. About 42.2% reported that their family members were not aware of need of proper nutrition during pregnancy rather were indifferent. Ability to spend money by her was limited, sometimes by 33.8%, 28.2% if they ask for and 36.6% never have the opportunity. On recall of last one month period a significant proportion of women stated that they felt to be stressed sometimes during pregnancy.

Risk factors for Preeclampsia like family history of Hypertension and Diabetes, passive smoking, low education level was found quite prevalent among women with pre-eclampsia. Majority of women reported to experience moderate stress and prevalence of stress was more among 19-24 years age group.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 119-126

Birth defect: Findings from Obstetrics & Gynae Department of a tertiary Hospital

Irin Parveen Alam, Nusrat Jahan Eva — Mon, 06 Nov 2023 00:00:00 +0000

Objectives: To determine the frequency and types of birth defect among newborn in Sir Salimullah Medical College Hospital Study Design: Cross-sectional study.

Methods: The study was conducted in Sir Salimullah Medical College Hospital from January- December 2018. Birth defect identified previously during pregnancy on USG or defect detected at birth at Obstetrics department were included in the study. The study was conducted at Obstetrics department of SSMC MH. All births with gross congenital malformations were noted. All malformations were classified as per ICD 10 classification. The mother of the newborn with congenital malformations was interviewed consecutively using predesigned, pretested questionnaire. The variables included parents age, antenatal registration, antenatal history of drug intake, consanguinity and previous history of malformations. Statistical analysis was done using chi square test.

Results: Out of 8912 live births, congenital malformations were observed in 50 cases. The frequency of congenital malformation was 0.56%. There were 25 males and 23 females and two newborns had ambiguous genitalia. The highest congenital abnormality reported in this study was in the age group between 20-29 years, which was 31(62%), The central nervous system was the most common system involved. Among 50 neonates, 8 neonate had multiple congenital anomalies and 42 babies had isolated malformations.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 127-131

Maternal and Neonatal Risk Factors for Developing Early Onset Newborn Sepsis (EONS) in a Tertiary Care Hospital in Bangladesh

Dilara Alo, Bilkis Sultana — Mon, 06 Nov 2023 00:00:00 +0000

Background: Globally, sepsis is still one of the major causes of morbidity and mortality in neonates, in spite of recent advances in health care units.

Objective: To identify maternal and neonatal risk factors for developing early onset newborn sepsis (EONS) in a tertiary care hospital in Bangladesh.

Methods: This cross-sectional study was carried out in the Neonatology department of Mugda Medical College Hospital (MuMCH) between November 2021 to April 2022 among the neonates who had clinical features of sepsis developed within 72 hours of postnatal age. After taking informed written consent from the parents the clinical profile and risk factors (both maternal and neonatal) were noted in a preformed data collection sheet. Blood for septic screening and C/S were done to confirm the diagnosis.

Results: Majority (90.0%) newborns had maternal risk factors of sepsis whereas 6(10.0%) had not any maternal risk factors of sepsis. Mothers of majority (80.0%) newborns with sepsis had PROM>18 hours. One third had UTI/ lower abdominal pain/ fever within last 2 weeks of delivery. In more than half (56.7%) of the newborn septic cases their mothers had prolonged labour. More than half (58.2%) newborns belonged to gestational age less than 37 completed weeks. About two third (66.7%) newborns belonged to birth weight less than 2500 gm. Almost one third (30.0%) newborns had prelacteal feeding. More than two third (70.0%) newborns were given 7.1% chlorohexidin. Six (10.0%) newborns required resuscitation by bag mask at birth.

Conclusion: For newborn sepsis maternal risk factors PROM>18 hours, prolonged labour, P/ V examination more than 3 times were more common. Neonatal risk factors include prematurity, low birth weight, prelacteal feeding.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 132-138

Neurodevelopmental Disorders (NDDs) in Children: Role of Maternal Factors

Laila Areju Man Banu, FM Anamul Haque, Saria Tasnim — Mon, 06 Nov 2023 00:00:00 +0000

Neurodevelopmental disorders (NDDs) are disabilities affecting normal brain development and function. The early stages of brain development are critical, and disruption of this process results in neurodevelopmental disorders (NDDs) in children. Common neurodevelopmental disorders in children include autism spectrum disease (ASD), attention deficit hyperactivity disorder (ADHD), cerebral palsy (CP), intellectual disability (ID), epilepsy, learning disability, schizophrenia etc. Though the causes of NDDs are multifactorial, epidemiological studies have shown that a number of maternal factors such as, diabetes, hypertension, obesity, maternal immune activation, infection, diet, genetics, lifestyle etc. also influence the development of NDDs. In this review, we focus on some common NDDs in children and the mechanism by which different maternal factors may contribute to the development of NDDs. With the increasing incidence of NDDs, it is urgent to mitigate the risk and severity of these conditions through both preventive measures in pregnancy and developing treatment strategies.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 139-147

Bundle Approach in Clinical Practice: The Concept and Evidences

Ferdousi Begum, Farhana Dewan, Sameena Chowdhury — Mon, 06 Nov 2023 00:00:00 +0000

A bundle is a structured way of improving the processes of care and patient outcomes: a small, straightforward set of evidence-based practices-generally three to five-that, when performed collectively and reliably, have been proven to improve patient outcomes. Quality teams should resist the impulse to label any list of good changes a bundle. The power of a bundle comes from the body of science behind it and the method of execution: with complete consistency. It’s not that the changes in a bundle are new; these are well established best practices, but are often not performed uniformly, making treatment unreliable, at times idiosyncratic. A bundle ties the changes together into a package of interventions that people know must be followed for every patient, every single time. It resembles a list, but a bundle is more than that. A bundle has specific elements that make it unique. The changes are all necessary and all sufficient. It is a cohesive unit of steps that must all be completed to succeed. The changes are all based on randomized controlled trials, Level 1 evidence. They’ve been proven in scientific tests and are accepted, well-established. There should be no controversy involved, no debate or discussion of bundle elements. A bundle focuses on how to deliver the best care- not what the care should be. We want providers to get right to work on the how: on completing steps x, y, and z for every patient. The changes in a bundle are clearcut and straightforward; they involve all-or-nothing measurement. The evidences so far has proven the effectiveness of bundle approach in prevention and treatment of medical conditions.

Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 148-153