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Bamba C, Rohilla M, Kumari A, Kaur A, Srivastava P. Influence of forkhead box protein 3 gene polymorphisms in recurrent pregnancy loss: A meta-analysis. Placenta 2024; 146:79-88. [PMID: 38198891 DOI: 10.1016/j.placenta.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Treg cells play an important role in development of tolerance in maternal immune system against the semi-allogenic embryo. Human forkhead box protein 3 (FOXP3) gene, is the major transcription factor responsible for the regulation of Treg function during pregnancy. Single nucleotide polymorphisms (SNPs) of FOXP3 gene have been reported as a risk factor for Recurrent Pregnancy Loss (RPL), however, results from previous studies are inconsistent. METHODOLOGY We have collected data from different studies to investigate the overall association of FOXP3 SNPs with risk of RPL. PubMed, Google Scholar, Elsevier, and Cochrane databases were searched to identify eligible studies. Odds Ratio (OR) and 95 % Confidence Interval (CI), calculated via fixed effect or random effect models, were used to evaluate strength of association. This meta-analysis included 11 studies (1383 RPL cases and 1413 controls) of 6 SNPs: rs3761548 A/C, rs2232365 A/G, rs2294021 T/C, 2280883 T/C, rs5902434del/ATT and rs141704699C/T, with ≥2 studies per SNPs and at least 1 significant result. RESULTS We observed that FOXP3 polymorphism was predominantly present in Asian women with history of RPL. rs2232365 A/G, rs3761548 A/C, rs2294021 T/C, rs2280883 T/C and rs5902434del/ATT polymorphisms were significantly associated with risk of RPL in Indian population. Further, among the most commonly seen polymorphism, rs3761548 A/C was significantly associated with risk of RPL in women from Kazakhstan, China and Gaza, Palestine; rs2232365 A/G in populations of Kazakhstan, Egypt, Iran and Gaza, Palestine. Results of this study indicates that FOXP3 polymorphism is significantly associated with risk of RPL, especially in Asians.
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Affiliation(s)
- Chitra Bamba
- Genetic Metabolic Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India
| | - Minakshi Rohilla
- Department of Obstetric & Gynaecology, Post Graduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India
| | - Anu Kumari
- Genetic Metabolic Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India
| | - Anupriya Kaur
- Genetic Metabolic Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India
| | - Priyanka Srivastava
- Genetic Metabolic Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Sector-12, Chandigarh, 160012, India.
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Datta P, Garg P, Rattan D, Bagga R, Rohilla M, Khurana S, Sehgal R. Comparison of B1 and RE 529 gene targets by real time PCR and LAMP assay for diagnosis of toxoplasmosis in pregnant females. Indian J Med Microbiol 2024; 47:100481. [PMID: 37924678 DOI: 10.1016/j.ijmmb.2023.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE The aim of this study is to accurately diagnose the presence of toxoplasmosis in pregnant women. In this study we evaluated two gene targets B1 and RE-529 using two different molecular methods i.e., real-time PCR and LAMP. PROCEDURE A total of 150 blood samples were collected from pregnant women attending the PGIMER outpatient clinic. The serum and Buffy layer were extracted and various serological (ELISA) and molecular tests (qPCR and LAMP) targeting B1 and RE-529 were carried out. FINDING Out of 150 patients, 32 were seropositive. Amongst which for the RE-529 gene, 18 were LAMP positive and 16 were qPCR positive, while for the B1 gene, 14 were LAMP positive and 13 were qPCR positive. CONCLUSIONS Molecular methods were more sensitive than serological tests to diagnose congenital toxoplasmosis in antenatal females. Few seronegative patients were reported positive using molecular methods. In addition, LAMP targeting the RE-529 gene is more sensitive than qPCR, and LAMP targets the B1 gene.
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Affiliation(s)
- Priya Datta
- Department of Medical Parasitology, PGIMER, Chandigarh, 160012, India.
| | - Puja Garg
- Department of Medical Parasitology, PGIMER, Chandigarh, 160012, India.
| | - Divya Rattan
- Department of Medical Parasitology, PGIMER, Chandigarh, 160012, India.
| | - Rashmi Bagga
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, 160012, India.
| | - Minakshi Rohilla
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, 160012, India.
| | - Sumeeta Khurana
- Department of Medical Parasitology, PGIMER, Chandigarh, 160012, India.
| | - Rakesh Sehgal
- Department of Medical Parasitology, PGIMER, Chandigarh, 160012, India.
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Yadav B, Soni R, Biswal M, Suri V, Rohilla M. Clinical profile and outcomes of Scrub typhus in pregnant women presenting to a tertiary care hospital of North India. J OBSTET GYNAECOL 2023; 43:2141617. [PMID: 36428288 DOI: 10.1080/01443615.2022.2141617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Scrub typhus, caused by Orientia tsutsugamushi, is a re-emerging endemic zoonosis in the Asia Pacific region. It is a febrile condition ranging in severity from mild to severe, with fatality rates as high as 30%. The present study aims towards analysing the clinical profile and pregnancy outcomes in 27 cases of scrub typhus admitted to a tertiary care centre in North India. The medical records of 27 pregnant women who had scrub typhus were analysed. The IgM ELISA was used to look for IgM antibodies to Orientia tsutsugamushi in the patient's serum sample. An optical density of more than or equal to 0.468 was considered as positive. Majority of the pregnant females delivered healthy and live babies. However, poor foetal outcomes were observed in four (14.8%) cases with intrauterine deaths occurring in two (7.4%) cases and still birth in one (3.7%) case, while one (3.7%) patient had spontaneous abortion. Maternal mortality was reported in one patient (3.7%) due to a delay in diagnosis. In endemic settings, a strong index of suspicion for scrub typhus is necessary in pregnant females presenting with fever. The key to reducing morbidity in both the mother and foetus is early diagnosis and treatment.Impact StatementWhat is already known on this subject? Scrub typhus is a febrile condition ranging in severity from mild to severe, with 30% mortality in untreated patients.What do the results of this study add? Majority of the pregnant females delivered healthy and live babies. However, poor foetal outcomes were observed in four (14.8%) cases with intrauterine deaths occurring in two (7.4%) cases and still birth in one (3.7%) case, while one (3.7%) patient had spontaneous abortion. Maternal mortality was reported in one patient (3.7%) due to a delay in diagnosis.What are the implications of these findings for clinical practice and/or further research? In endemic settings, a strong index of suspicion for scrub typhus is necessary for pregnant females presenting with fever. The key to reducing morbidity in both the mother and foetus is early diagnosis and treatment.
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Affiliation(s)
- Bhavana Yadav
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Ranu Soni
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics & Gynecology, PGIMER, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics & Gynecology, PGIMER, Chandigarh, India
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Kulshreshtha S, Siwatch S, Aggarwal N, Rohilla M, Grover S. Mental health issues in antenatal women with prior adverse pregnancy outcomes: Unmasking the mental anguish of rainbow pregnancy. Indian J Med Res 2023; 158:190-196. [PMID: 37787261 PMCID: PMC10645033 DOI: 10.4103/ijmr.ijmr_1241_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Indexed: 10/04/2023] Open
Abstract
Background & objectives Mental health issues in pregnancy have adverse implications on the quality of life, however still they go unevaluated and underreported. Women with previous history of abortions or stillbirth may have a higher risk of experiencing mental health problems. The present investigation was aimed to study the prevalence of depression, anxiety, stress and domestic violence in antenatal women with prior pregnancy losses and the need for interventions to treat the same. Methods One hundred pregnant women with a history of prior pregnancy losses (group 1) and 100 women without obstetrical losses (group 2) were enrolled in this cross-sectional study carried out in a tertiary care hospital in India. Women were screened for depression, anxiety, stress and domestic violence using various questionnaires: EPDS (Edinburgh postnatal depression scale), PRAQ-2 (pregnancy-related anxiety questionnaire-revised 2), GAD 7 (generalized anxiety disorder-7) and PSS (perceived stress scale). Results The prevalence of depression (EPDS scale) and pregnancy specific anxiety (PRAQ-2 scale) was significantly higher in group 1 than in group 2 (27 vs. 10%, P=0.008; and 15 vs. 6%, P=0.03). The prevalence of general anxiety (GAD 7 scale) and stress (PSS), however, was high and comparable in both the groups (33 vs. 29%, P=0.44; and 33 vs. 27%; P=0.35 respectively). Recurrent abortions was found to be an independent risk factor for depression [adjusted odds ratio=26.45; OR=28]. In group 1, 31 per cent required counselling in the psychiatry department and nine per cent required medication. Interpretation & conclusion Mental health issues, especially depression, are prevalent in antenatal women with previous losses. Unrecognised and untreated, there is a need for counselling and developing screening protocols at India's societal and institutional levels.
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Affiliation(s)
- Shatakshi Kulshreshtha
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sujata Siwatch
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Neelam Aggarwal
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Srivastava P, Bamba C, Chopra S, Rohilla M, Chaudhry C, Kaur A, Panigrahi I, Mandal K. Identification of genetic alterations in couples and their products of conceptions from recurrent pregnancy loss in North Indian population. Front Genet 2023; 14:1155211. [PMID: 37260775 PMCID: PMC10227573 DOI: 10.3389/fgene.2023.1155211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Abstract
Background: Recurrent pregnancy loss (RPL) is one of the most common pregnancy-related complications, which can be stressful and emotionally draining for a couple. Genetic alterations, which are responsible for RPL, can be present in either of the three genomes: mother, father, or their fetuses. In addition, environmental factors interacting with these three genomes can affect germline cells. With this aim, the present study was conducted to understand the underlying etiology of RPL using Next-generation sequencing (NGS; couple exome and TRIO exomes) in combination with cytogenetic tests [karyotyping and chromosomal microarray (CMA)]. Material & Methods: In present study we recruited 61 couples with RPL (history of ≥ 2 abortions) and 31 products of conceptions (POCs). For all couples karyotyping was done at the time of recruitment, followed by collection of POC samples and parental blood samples. Before processing POC samples for CMA, they were checked for maternal cell contamination (MCC) by QF-PCR. In POC samples with no pathogenic variant, TRIO exome sequencing was done. Further, in case of unavailability of POC sample, couple exome sequencing was done for RPL couples. Results: In six individuals out of 61 couples (5%), abnormality in karyotypes was detected. Among 116 normal karyotypes, there were 11 heteromorphisms (9.5%), for which the couples had to be counselled and reassured. Out of the 31 POCs, 10 were excluded because of MCC (around 30%) and one had major aneuploidy. CMA in POCs identified pathogenic copy number variations (CNVs) in 25% of cases (5/20) and variant of unknown significance (VUS) in 20% of cases (4/20). Autosomal trisomy was the most frequent chromosomal abnormality diagnosed. NGS was performed to establish single-gene causes of RPL. Couple exome sequencing was performed in 20 couples, and 14 were found to be carriers for autosomal recessive conditions. A total of 50 potential disease-causing variants in 40 genes were identified in 33 of 40 individuals (82.5%). Putative causative variants were identified in 37.5% of the TRIO cases (3/8). Mutations in few important genes (SRP54, ERBB4, NEB, ALMS, ALAD, MTHFR, F5, and APOE), which are involved in vital pathways, early embryonic development, and fetal demise, were identified in the POCs. Conclusion: It enhances our understanding of prenatal phenotypes of many Mendelian disorders. These mutated genes may play an auxiliary role in the development of treatment strategies for RPL. There was no correlation of the number of abortions with etiological yield of any technique to detect the cause of RPL. This study shows the utilization of combination of techniques in improving our understanding of the cause of early embryonic lethality in humans.
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Affiliation(s)
- Priyanka Srivastava
- Genetic Metabolic Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chitra Bamba
- Genetic Metabolic Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Seema Chopra
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chakshu Chaudhry
- Genetic Metabolic Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupriya Kaur
- Genetic Metabolic Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Inusha Panigrahi
- Genetic Metabolic Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kausik Mandal
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Bhagat N, Singla R, Rohilla M, Arora A, Suri V. Usage of postpartum intrauterine contraceptive device (postpartum-IUD) after an increase in the institutional delivery rate in India: time to re-visit the effect of timing of counselling on its acceptance. EUR J CONTRACEP REPR 2023; 28:132-140. [PMID: 36971318 DOI: 10.1080/13625187.2023.2187249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE While increase in institutional deliveries brings an opportunity to counsel women for postpartum family planning (PPFP), its uptake remains low. Reasons for poor acceptance of postpartum intrauterine contraceptive device (postpartum-IUD), and its relation with the timing of counselling need to be investigated. METHODS Women attending the antenatal clinic, reporting in labour, and within 48 h of delivery respectively were invited to participate. Eligible women were asked about awareness and choice for PPFP. After counselling, acceptance for PPFP was compared with the baseline. Acceptance and continuation of postpartum-IUD were compared between women counselled in the antenatal, intrapartum, and postpartum periods. RESULTS Only 23% of 360 women were aware of postpartum-IUD. After counselling, acceptance for PPFP increased from 14% to 97% and for postpartum-IUD, from 0.5% to 33.9%. Acceptance of postpartum-IUD among women counselled in the antenatal, intrapartum and postpartum period was 45%, 35% and 21.7% respectively. Acceptance was higher among the antenatal-counselling group than the postpartum-counselling group (OR 0.45; CI 0.22-0.94; p = 0.03). CONCLUSION Counselling, irrespective of its timing, improves acceptance for PPFP. Acceptance and continuation of postpartum-IUD are higher following counselling in antenatal period. All eligible women should be counselled irrespective of 'when' they approach the facility.
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Singla R, Suri V, Veeramalla S, Shafiq N, Rohilla M, Kalra J. Ensuring Compliance with Surgical Antimicrobial Prophylaxis Policy in High-Volume Resource-Limited Settings: Integrated Measures from Inception to Audit. J Gynecol Surg 2023. [DOI: 10.1089/gyn.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Affiliation(s)
- Rimpi Singla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Snigdha Veeramalla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaswinder Kalra
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Siwatch S, Rohilla M, Singh T, Jain V. Vaginal tuberculosis presenting as amenorrhea and hematometra post delivery. Trop Doct 2023; 53:313-314. [PMID: 36600677 DOI: 10.1177/00494755221148765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sujata Siwatch
- Associate Professor, Department of Obstetrics and Gynaecology, 29751PGIMER, Chandigarh, India
| | - Minakshi Rohilla
- Professor, Department of Obstetrics and Gynaecology, 29751PGIMER, Chandigarh, India
| | - Tulika Singh
- Additional Professor, Department of Radiodiagnosis & Imaging, 29751PGIMER, Chandigarh, India
| | - Vanita Jain
- Professor, Department of Obstetrics and Gynaecology, 29751PGIMER, Chandigarh, India
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Sharma B, Rohilla M, Suri V, Jain V, Prasad GRV, Kalra J, Pandey N. Obstetric Teleconsultation by Using Mobile Phone Technology in COVID Pandemic. Indian J Community Med 2023; 48:190-195. [PMID: 37082410 PMCID: PMC10112758 DOI: 10.4103/ijcm.ijcm_552_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/21/2022] [Indexed: 02/10/2023] Open
Abstract
Introduction Obstetrics teleconsultation is a new concept to enable health-care services in the COVID pandemic by limiting in-person visits. This study describes the methodology of mobile-based teleconsultation, preliminary findings, and the experience of the obstetricians. Material and Methods The data of pregnant women who got registered for teleconsultation in early phase of COVID pandemic lockdown were reviewed and analyzed. A qualitative analysis was performed to assess the experience of obstetricians (consultants, senior residents, and junior residents) via an online electronic survey. Results The majority of obstetrics teleconsultations were for routine antenatal care (75%) and fetal medicine consultation (12.3%). Out of 187 women, 29.9% were advised to continue antenatal care at local hospitals, whereas 33.6% were asked to follow up via teleconsultation. Most of the obstetricians (73.68%) felt that they were able to satisfy the pregnant women and rated the teleconsultation satisfactory. Conclusion Obstetrics telemedicine found to be beneficial for providing routine antenatal care services via reducing physical visits and overcrowding in outpatient departments, promoting antenatal care at local hospitals, and making specialized (maternal-fetal medicine) care accessible even during COVID-19 pandemic.
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Affiliation(s)
- Bharti Sharma
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - GRV Prasad
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasvinder Kalra
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navin Pandey
- Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Brar R, Rohilla M, Parashar A, Jain V. Pregnancy and Vaginal Childbirth Followed by Reconstructive Vulval Surgery in a Woman with Giant and Isolated Vulval Elephantiasis. Oman Med J 2023. [DOI: 10.5001/omj.2024.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Iyengar K, Gupta M, Pal S, Kaur K, Singla N, Verma M, Dhiman A, Singla R, Rohilla M, Suri V, Aggarwal N, Singh T, Goel P, Goel NK, Pant R, Gaur KL, Gehlot H, Bhati I, Verma M, Agarwal S, Acharya R, Singh K, Chauhan M, Rastogi R, Bedi R, Pancholi P, Nayak B, Modi B, Nakum K, Trivedi A, Aggarwal S, Patel S. Baseline Assessment of Evidence-Based Intrapartum Care Practices in Medical Schools in 3 States in India: A Mixed-Methods Study. Glob Health Sci Pract 2022; 10:e2100590. [PMID: 35487543 PMCID: PMC9053154 DOI: 10.9745/ghsp-d-21-00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Implementation research with pre- and post-comparison was planned to improve the quality of evidence-based intrapartum care services in Indian medical schools. We present the baseline study results to assess the status of adherence to intrapartum evidence-based practices (IP-EBP) in study schools in 3 states in India and the perception of the faculty. METHODS A concurrent mixed-methods approach was used to conduct the baseline assessment in 9 medical schools in Rajasthan, Gujarat, and Union Territory from October 2018 to June 2019. IP-EBP among pregnant women in uncomplicated first (n=135), second (n=120), and third stage (n=120) of labor were observed using a predesigned, pretested checklist quantitatively. We conducted in-depth interviews with 33 obstetrics and gynecology faculty to understand their perceptions of intrapartum practices. Quantitative data were analyzed using SPSS (version 22). COM-B (Capability, Opportunity, and Motivation Behavior) model was used to understand the behaviors, and thematic analysis was done for the qualitative data. FINDINGS Unindicated augmentation of labor was done in 64.4%, fundal pressure applied in 50.8%, episiotomy done in 58.3%, and delivery in lithotomy position was performed in 86.7% of women in labor. CONCLUSIONS Intrapartum practices that are not recommended were routinely practiced in the study medical schools due to a lack of staff awareness of evidence-based practices and incorrect beliefs about their impact.
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Affiliation(s)
| | - Madhu Gupta
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Swarnika Pal
- Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Kiranjit Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neena Singla
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madhur Verma
- All India Institute Medical Science, Bathinda, Punjab, India
| | - Anchal Dhiman
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rimpi Singla
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Minakshi Rohilla
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neelam Aggarwal
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tarundeep Singh
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Poonam Goel
- Government Medical College and Hospital, Chandigarh, India
| | - N K Goel
- Government Medical College and Hospital, Chandigarh, India
| | - Reena Pant
- Swai Maan Singh Medical College, Jaipur, Rajasthan, India
| | | | - Hanslata Gehlot
- Dr. Sampurnanand Medical College and Hospital, Jodhpur, Rajasthan, India
| | - Indra Bhati
- Dr. Sampurnanand Medical College and Hospital, Jodhpur, Rajasthan, India
| | - Manoj Verma
- Dr. Sampurnanand Medical College and Hospital, Jodhpur, Rajasthan, India
| | - Sudesh Agarwal
- Sardar Patel Medical College and PBM Hospital, Bikaner Rajasthan, India
| | - Rekha Acharya
- Sardar Patel Medical College and PBM Hospital, Bikaner Rajasthan, India
| | - Keerti Singh
- Rabindranath Tagore Medical College and Hospital, Udaipur, Rajasthan, India
| | - Madhubala Chauhan
- Rabindranath Tagore Medical College and Hospital, Udaipur, Rajasthan, India
| | - Radha Rastogi
- Rabindranath Tagore Medical College and Hospital, Udaipur, Rajasthan, India
| | - Renu Bedi
- Jawaharlal Nehru Medical College and Hospital, Ajmer Rajasthan, India
| | - Poornima Pancholi
- Jawaharlal Nehru Medical College and Hospital, Ajmer Rajasthan, India
| | - Bipin Nayak
- GMERS Medical College and Hospital, Gandhinagar, Gujarat, India
| | - Bhavesh Modi
- GMERS Medical College and Hospital, Gandhinagar, Gujarat, India
| | - Kanaklata Nakum
- Government Medical College and Hospital, Bhavnagar, Gujarat, India
| | - Atul Trivedi
- Government Medical College and Hospital, Bhavnagar, Gujarat, India
| | | | - Sangita Patel
- Government Medical College and Hospital, Baroda, Gujarat, India
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Sarkar A, Rohilla M, Kumari S. Concurrence of glucose-6-phosphate dehydrogenase deficiency in pregnancy. J OBSTET GYNAECOL 2022; 42:747-750. [DOI: 10.1080/01443615.2021.2024157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Avir Sarkar
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
| | - Snigdha Kumari
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India
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Luwang AL, Saha PK, Rohilla M, Sikka P, Saha L, Gautam V. Chlorhexidine-alcohol versus povidone-iodine as preoperative skin antisepsis for prevention of surgical site infection in cesarean delivery-a pilot randomized control trial. Trials 2021; 22:540. [PMID: 34404473 PMCID: PMC8369632 DOI: 10.1186/s13063-021-05490-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives To compare the efficacy of chlorhexidine–alcohol and povidone–iodine as preoperative antiseptic skin preparation for prevention of surgical site infection (SSI) after cesarean delivery (CD). Materials and methods A total of 311 eligible women who underwent CS were recruited in the study after fulfilling all the eligibility and exclusion criteria. Patients were randomized into two groups (153 in chlorhexidine–alcohol group and 158 in povidone–iodine group) by a computer-generated randomization table. Patients were followed for a period of 30 days in postoperative period to monitor for SSI. Results The rate of SSI in the chlorhexidine–alcohol group is 5.4% and that of the povidone–iodine group is 8.6%. E. coli, K. pneumoniae, and Acinetobacter baumannii were the most common organisms isolated. E. coli was found in 9.5% of the total SSI cases. Conclusions The study found that the patients who received chlorhexidine–alcohol as skin antiseptic had less chance of developing SSI than those who received povidone–iodine; however, it did not reach a statistical significance. Trial registration Clinical Trials Registry of India CTRI/2018/05/014294. Registered on May 31, 2018
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Affiliation(s)
- Athokpam Lenin Luwang
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
| | - Pradip Kumar Saha
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India.
| | - Minakshi Rohilla
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
| | - Lekha Saha
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
| | - Vikas Gautam
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Pin 160012, India
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Nagabhushana P, Kumari S, Rohilla M, Srinivasan R, Arora A, Rastogi P. Discordant immunohistochemistry in an unusual MLH1 gene variant in a case of Lynch syndrome. Gynecol Oncol Rep 2021; 37:100854. [PMID: 34504932 PMCID: PMC8416636 DOI: 10.1016/j.gore.2021.100854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023] Open
Abstract
Immunohistochemistry for mismatch repair proteins and microsatellite instability testing are recommended screening methods for Lynch syndrome. They have a good sensitivity and specificity, allowing for directed genetic testing and diagnosis. We report a case of Lynch syndrome with retained MMR protein expression who later showed an MLH1 gene variant on genetic testing (Next Generation Sequencing) requested because of the clinical presentation of metachronous colonic and endometrial carcinoma. This report makes the case for strong clinical suspicion and directed genetic testing despite initial screen negative results.
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Affiliation(s)
| | - Snigdha Kumari
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Aashima Arora
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
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Abstract
PURPOSE This study aimed to highlight the clinical features, diagnosis, and different modalities of the treatment of cesarean scar pregnancy (CSP). METHODS This study was done in the tertiary referral hospital of India for one year. A total of 11 cases were enrolled prospectively. In each case, the diagnostic ultrasonography and measurement of baseline beta-human chorionic gonadotropin (β-HCG) levels were done. The treatment was given based on the hemodynamic status of the patient and desire for future fertility. Various treatment modalities used were medical, surgical, or interventional digital subtraction angiography to control hemorrhage. Also, in some cases, ultrasound-guided methotrexate was injected into the scar ectopic. Medically treated cases were followed up until their β-HCG levels became normal. RESULTS Out of 11 patients, six had a history of two cesarean sections in the past, four patients had a history of one cesarean section and one patient with a previous three low segments cesarean section (LSCS). Seven out of 11 patients underwent medical management with either methotrexate with potassium chloride (KCl) or methotrexate alone. The success of the medical management was monitored by serial β- HCG values. The mean time for the resolution of these 10 patients was 86.7 ± 53.6 days. Three patients underwent emergency uterine artery embolization due to uncontrolled bleeding and one patient required laparotomy. CONCLUSION CSP is a life-threatening condition that can be diagnosed with the help of transvaginal ultrasonography. The treatment, however, depends on the hemodynamic status of the patient and desire for future fertility. Well-defined diagnostic criteria coupled with structured management and follow-up protocol can help in treating this challenging form of ectopic pregnancy.
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Affiliation(s)
- Neha Agarwal
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND.,Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, IND
| | - Shalini Gainder
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Seema Chopra
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Minakshi Rohilla
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Grv Prasad
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Vanita Jain
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
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Rohilla M, Wadhwa V, Purushothaman R, Vilanilam G, Lewis P, Wong K. Abstract No. 97 Pediatric interventional radiology workforce in North America: a descriptive analysis of demographics, educational backgrounds, and scholarly activities. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Kaur J, Sarkar A, Rohilla M. Physical examination-indicated cerclage in twin pregnancy: a randomized controlled trial. Am J Obstet Gynecol 2021; 224:131-132. [PMID: 32950477 DOI: 10.1016/j.ajog.2020.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
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18
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Siwatch S, Rohilla M, Singh A, Ahuja C, Jain K, Jain V. Pregnancy in a Persistent Vegetative State: A Management Dilemma. Case Report, Literature Review and Ethical Concerns. J Obstet Gynaecol India 2020; 70:310-313. [PMID: 32764853 DOI: 10.1007/s13224-019-01274-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Sujata Siwatch
- Department of Obstetrics & Gynecology, PGIMER, Sector-12, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics & Gynecology, PGIMER, Sector-12, Chandigarh, India
| | | | - Chirag Ahuja
- Department of Radiology, PGIMER, Chandigarh, India
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics & Gynecology, PGIMER, Sector-12, Chandigarh, India
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Affiliation(s)
- Sujata Siwatch
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Minakshi Rohilla
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalini Gainder
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G R V Prasad
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Rohilla M, Muthyala T, Rohilla M, Radhika S. APET in the background of endometrioma in an elderly infertile woman - a rare case. J OBSTET GYNAECOL 2019; 40:880-882. [PMID: 31368390 DOI: 10.1080/01443615.2019.1629401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Minakshi Rohilla
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.,Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tanuja Muthyala
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.,All India Institute Of Medical Sciences, Mangalagiri, India
| | - Manish Rohilla
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.,Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Srinivasan Radhika
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.,Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Mishra N, Pradhan K, Sahoo GD, Rohilla M, Meena M. Can hsCRP be the sole investigation for predicting the severity and outcome in women with pre-eclampsia presenting late in pregnancy? Trop J Obstet Gynaecol 2019. [DOI: 10.4103/tjog.tjog_66_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Muthyala T, Siwatch S, Gainder S, Rohilla M, Jain V, Gupta P. Cystadenofibroma of Ovary- A Rare Cause of Postmenopausal Bleeding. J Clin Diagn Res 2019. [DOI: 10.7860/jcdr/2019/42399.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rajwanshi A, Rohilla M, Singh P. Trans-oral fine needle aspiration cytology in cervical (C1 and C2) vertebral lesions: a novel diagnostic approach. Cytopathology 2016; 28:31-34. [PMID: 27489015 DOI: 10.1111/cyt.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fine needle aspiration (FNA) cytology is a relatively non-invasive method for diagnosing both superficial and deep-seated neoplastic and non-neoplastic lesions. In this study, we evaluated the diagnostic utility of trans-oral FNA in cervical (C1 and C2) vertebral and paravertebral lesions. MATERIAL AND METHODS Eighteen FNA cases of cervical vertebral and paravertebral lesions performed by a trans-oral route without any image-guidance between 1995 and 2014 were retrieved from the archives of the cytology department at PGIMER, Chandigarh and reviewed. RESULTS Out of 18 cases, a definite diagnosis was given in 15 cases (83.3%). The commonest diagnosis seen was granulomatous inflammation consistent with tuberculosis (33.3%). CONCLUSION Trans-oral FNA is a quick, inexpensive and relatively safe outpatient procedure for sampling C1 and C2 vertebral and paravertebral lesions, which are clinically and radiologically difficult to approach. It helps in the early diagnosis and management of these patients.
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Affiliation(s)
- A Rajwanshi
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - M Rohilla
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Singh
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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25
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Rohilla M, Rai R, Yanamandra U, Chaudhary N, Malhotra P, Varma N, Jain V, Prasad GRV, Kalra J, Varma SC. Obstetric Complications and Management in Chronic Myeloid Leukemia. Indian J Hematol Blood Transfus 2016; 32:62-6. [PMID: 26855508 PMCID: PMC4733674 DOI: 10.1007/s12288-015-0519-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022] Open
Abstract
Chronic myeloid leukaemia (CML) is amongst the most common haematological malignancies encountered in adults. The younger age of onset and increased incidence of CML in Indians leads to higher chances of encountering it in pregnancy. Pregnancy in CML is a complex situation as first line therapy with tyrosine kinase inhibitors (TKI), is fraught with multiple fetal safety issues. The fetal aspects have been elucidated in literature, but there is scarcity of information on the obstetric outcome per se in presence of CML, excluding the influence of TKI. Obstetric outcomes of 5 pregnancies in four patients with CML are being reported. Literature on interplay of CML and bleeding or thrombotic manifestations is reviewed. The major complications encountered were antepartum (APH) and postpartum haemorrhage (PPH), preterm labour, intrauterine growth retardation and intrauterine fetal death. Patients in the reproductive age group with diagnosis of CML should be carefully counseled regarding the effect of disease and TKI on the maternal-fetal health. Bleeding complications, particularly APH and PPH may be encountered in CML patients. Close coordination of the obstetrician, haematologist, and neonatologist is required in managing these cases successfully. The need for absolute contraception till the remission of disease needs to be emphasized for further pregnancies.
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Affiliation(s)
- Minakshi Rohilla
- />Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
| | - Rakhi Rai
- />Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
| | - Uday Yanamandra
- />Department of Hematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
| | - Neelam Chaudhary
- />Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
| | - Pankaj Malhotra
- />Department of Hematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
| | - Neelam Varma
- />Department of Hematology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
| | - Vanita Jain
- />Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
| | - G. R. V. Prasad
- />Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
| | - Jasvinder Kalra
- />Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
| | - Subhash C. Varma
- />Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh (U.T.), India
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Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcomes, and the oral glucose tolerance test (OGTT) is the recommended test for its diagnosis. We evaluated the role of glycated hemoglobin (HbA1c) in screening and diagnosis of GDM and its correlation with adverse pregnancy outcomes. SUBJECTS AND METHODS In this prospective observational study, OGTT and HbA1c were performed in 500 antenatal women between 24 and 28 weeks of gestation; the pregnant women were followed up thereafter. Repeat OGTT and HbA1c were done in women with GDM at 6 weeks postpartum. RESULTS Among the 500 women, 45 were diagnosed with GDM, for an incidence of 9%. The mean HbA1c level in women with GDM was 6.2 ± 0.6%, whereas it was 5.4 ± 0.5% in those with normoglycemia. Women with GDM had a higher incidence of pregnancy-related complications compared with normoglycemic women. An HbA1c cutoff of 5.3% had a sensitivity of 95.6% and a specificity of 51.6% for the diagnosis of GDM and would have avoided OGTT in approximately half of antenatal women, while missing 5% of the women. However, those with an abnormal HbA1c will require a confirmatory OGTT, as 50% of normoglycemic women would be misclassified as having GDM by this approach. On repeat testing postpartum, two of 45 women (4.4%) had overt diabetes mellitus, whereas five (11.1%) had impaired glucose tolerance. CONCLUSIONS Although HbA1c cannot replace OGTT in the diagnosis of GDM, it can be used as a screening test, avoiding OGTT in approximately 50% of women, if a cutoff of 5.3% is used.
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Affiliation(s)
- Srmshtty Soumya
- 1 Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Minakshi Rohilla
- 1 Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Seema Chopra
- 1 Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Sourabh Dutta
- 3 Department of Neonatology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Anil Bhansali
- 2 Department of Endocrinology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Girish Parthan
- 2 Department of Endocrinology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Pinaki Dutta
- 2 Department of Endocrinology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
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Abstract
Scrub typhus, an acute febrile illness caused by Rickettsia and transmitted by mites, is a re-emerging endemic zoonosis in the Asia Pacific region. It is an uncommon entity and very few cases of this disease in pregnant women have been reported. We present a series of six such cases collected over 1 year with poor feto-maternal outcome in 50%.
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Affiliation(s)
- Monika Meena
- MD, senior resident, Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Minakshi Rohilla
- MD, additional Professor, Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Vanita Jain
- MD, Professor, Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Jaswinder Kalra
- MD, Professor, Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Grv Prasad
- MD, Professor, Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
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Rohilla M, Singh P, Kaur J, Jain V, Gupta N, Prasad G. Individualistic approach to the management of complete hydatidiform mole with coexisting live fetus. Eur J Obstet Gynecol Reprod Biol 2015; 191:39-42. [DOI: 10.1016/j.ejogrb.2015.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/10/2015] [Accepted: 05/19/2015] [Indexed: 11/26/2022]
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Rohilla M, Kalpdev A, Jain V. Identification and treatment of intra-abdominal fetal skeletal remains: A consequence of illicit and unsafe abortion. EUR J CONTRACEP REPR 2015; 20:236-40. [PMID: 25697232 DOI: 10.3109/13625187.2015.1009030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The safety of abortions has always been a matter of concern for women's health. Unsafe abortion is one of the most neglected health-care problems in developing countries due to lack of awareness of the legal issues and limited access to authorised services often leading the women to poor quality of abortion in unsafe settings through untrained health personnel. CASE REPORT Two rare cases of second trimester unsafe abortions are reported here in which women presented after several weeks with well-preserved remains of fetal skeleton in their abdomen along with complicated multiple visceral injuries. Both these second trimester abortions were performed by untrained village abortionists for sex selection and unwanted pregnancy in an unmarried adolescent girl. The management in the unmarried girl was further complicated due to undisclosed history of abortion. CONCLUSION These reports of unsafe abortion highlight the need for clinicians to have a high index of suspicion for an undisclosed abortion when treating any morbid woman of reproductive age with a bizarre abdominal clinical picture.
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Affiliation(s)
- Minakshi Rohilla
- Department of Obstetrics & Gynaecology, Postgraduate Institute of Medical Education & Research (PGIMER) , Chandigarh , India
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Rohilla M, Aggarwal N, Singh P, Jain V. Evisceration as fetal destructive operation: an art revisited. Arch Gynecol Obstet 2014; 291:701-3. [PMID: 25149171 DOI: 10.1007/s00404-014-3428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/12/2014] [Indexed: 11/25/2022]
Abstract
Fetal destructive operation is a vanishing art today. In an era of increasing cesarean deliveries it has become a historic event. Incidence of destructive operation has varied from various Indian hospitals 0.09-0.28%. Evisceration is one of the rarest of all destructive operations, performed in cases of cephalopelvic disproportion with large fetal abdominal or thoracic tumors and fetal malformations, which are incompatible with life. Less than 50 cases of fetal evisceration have been reported in the literature so far. We are presenting a case of gross fetal abdominal malformation in a multigravida woman, which necessitated internal podalic version followed by evisceration and breech extraction.
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Affiliation(s)
- Minakshi Rohilla
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh (U.T.), 160012, India,
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Rohilla M, Singh P, Kaur J, Prasad GRV, Jain V, Lal A. Uterine necrosis and lumbosacral-plexopathy following pelvic vessel embolization for postpartum haemorrhage: report of two cases and review of literature. Arch Gynecol Obstet 2014; 290:819-23. [PMID: 24947325 DOI: 10.1007/s00404-014-3310-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 06/02/2014] [Indexed: 12/01/2022]
Abstract
We are reporting two cases of uterine necrosis and lumbosacral-plexopathy in patients, who underwent pelvic vessel embolization (PVE) following postpartum hemorrhage. Embolization was performed with gelfoam slurry, polyvinyl alcohol (PVA) particles and coil in one patient and with gelfoam slurry only, in second patient. Both patients had lower limbs weakness and had persistent fever in the postembolization period. Nerve conduction study in both were suggestive of common peroneal and tibial neuropathy. An ultrasonography and computed tomography of abdomen and pelvis revealed bulky uterus with no identifiable endometrium and multiple air foci in subendometrial region suggestive of uterine necrosis, confirmed later by histology of expelled uterine mass. Lumbosacral ischemia resulting in paraparesis and uterine necrosis presenting as longstanding fever after embolization are extremely rare but overwhelming complications of embolization. Only 19 cases of uterine necrosis and <10 cases of lumbosacral plexopathy have been reported in the literature. The overall effectiveness of PVE is high in treatment of obstetric hemorrhage with low complication rate and highly selective PVE may further prevent these complication. To the best of our knowledge the co-existing uterine necrosis and lumbosacral plexopathy secondry to PVE has not been described prevoiusly in patients with postpartum hemorrhage. Both patients recovered with conservative management.
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Affiliation(s)
- Minakshi Rohilla
- Department of Obstetrics and gynecology, PGIMER, Chandigarh, 160012, UT, India,
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Lata K, Dutta P, Sridhar S, Rohilla M, Srinivasan A, Prashad GRV, Shah VN, Bhansali A. Thyroid autoimmunity and obstetric outcomes in women with recurrent miscarriage: a case-control study. Endocr Connect 2013; 2:118-24. [PMID: 23802061 PMCID: PMC3691574 DOI: 10.1530/ec-13-0012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/02/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Thyroid antibody positivity during pregnancy has been associated with adverse outcomes including miscarriage and preterm delivery. The aim of the study is to evaluate the obstetric outcome in pregnant women with recurrent miscarriage and their response to levothyroxine (l-T4) therapy. STUDY DESIGN AND METHODS All pregnant and non-pregnant women between 21 and 35 years of age with a history of two or more consecutive miscarriages were included in the study. A third group comprising 100 pregnant women without a history of miscarriage were taken as healthy controls. Thyroid autoimmunity, prevalence of subclinical hypothyroidism and maternal and foetal complications were analysed in all the groups with appropriate statistical methods. RESULTS The mean age of the patients included in the study was 27.0±3.1 years. Of 100 pregnant patients with previous recurrent miscarriage, thyroid autoimmunity (thyroid peroxidase antibody (TPOAb(+)) >34 U/ml) was found in 31% of the cases. The incidence of subclinical hypothyroidism was higher in TPOAb(+) group than in TPOAb(-) group (52 vs 16%; P=0.0002). There was no difference in the prevalence of miscarriage or obstetric outcomes between recurrent miscarriage and healthy pregnant women group irrespective of TPO status. CONCLUSIONS The prevalence of thyroid autoimmunity was higher in pregnant women with a history of recurrent abortion compared with healthy pregnant control population. Following l-T4 treatment, there was no difference in prevalence of miscarriage between hypothyroid and euthyroid individuals in TPOAb(+) women.
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Affiliation(s)
- Kusum Lata
- Departments of Obstetrics and GynecologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Pinaki Dutta
- Department of EndocrinologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Subbiah Sridhar
- Department of EndocrinologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Minakshi Rohilla
- Departments of Obstetrics and GynecologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Anand Srinivasan
- Department of PharmacologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - G R V Prashad
- Departments of Obstetrics and GynecologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Viral N Shah
- Department of EndocrinologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Anil Bhansali
- Department of EndocrinologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
- Correspondence should be addressed to A Bhansali
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Abstract
A 23-year-old primigravida presented to the labour ward at 37 weeks gestation referred with intrauterine growth restriction, oligohydramnios and placentomegaly. Differential diagnoses of placentomegaly were considered. Her antenatal blood screening tests were normal. There were no fetal malformations. However, triple screen and fetal karyotype were not done as patient presented late in pregnancy. The patient soon went into spontaneous labour and delivered a girl weighing 2.15 kg with a normal Apgar score. The cord was long and twisted; placenta was bulky, 1.7 kg, with prominent grape-like vesicles involving whole placenta with a rim of normal placenta at the periphery. Microscopy showed some areas of multiple villi with marked hydropic changes and myxoid degeneration, preserved vasculature and no trophoblastic proliferation. Placental mesenchymal dysplasia was thus diagnosed. The baby had no evidence of Beckwith-Wiedemann syndrome. The child is now 3 years old with normal development and is doing well.
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Rohilla M, Chopra S, Aggrawal N, Suri V, Rajvanshi A, Acharya G. Diagnostic dilemma of adnexal mass in a postmenopausal woman. J OBSTET GYNAECOL 2012; 32:315-6. [DOI: 10.3109/01443615.2011.645919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rohilla M, Raveendran A, Dhaliwal LK, Chopra S. Response to comments on: Rohilla M, Raveendran A, Dhaliwal LK, Chopra S. 2010. Severe anaemia in pregnancy: a tertiary hospital experience from northern India. Journal of Obstetrics and Gynaecology 30:694–696. J OBSTET GYNAECOL 2011. [DOI: 10.3109/01443615.2011.591951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. It is one of the most prevalent types of odontogenic cysts associated with erupted, developing, or impacted tooth, particularly the mandibular third molars, the other teeth that are commonly affected are maxillary canines. The present case report is unique as it enclosed three permanent maxillary teeth: the central incisor, lateral incisor, and canine that had to be extracted during surgical enucleation of the cyst.
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Affiliation(s)
- M Rohilla
- Department of Pedodontics, Government Dental College, Rohtak, India.
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Abstract
Anaemia is a major health problem among woman of reproductive age group, particularly in developing countries. We undertook this study to determine the maternal and perinatal outcome in patients with severe anaemia in pregnancy, with a haemoglobin concentration of < 7 g/dl. The in-hospital data were analysed for 12 months between January 2007 and December 2007 and 2.15% (n = 96) of women were found to have severe anaemia. Out of these, 18.75% had pre-term premature rupture of membranes and 5.12% of all deliveries were pre-term. Hypertensive diseases of pregnancy were seen in 17.7%; abruption in 3.12% and 9.37% had congestive cardiac failure. Postpartum haemorrhage was seen in 25.5% of the patients and 8.33% had puerperal pyrexia. Fetal distress was seen in 26% of and 33.33% had small for gestational age neonates; there were 16.66% stillbirths and 4.16% neonatal deaths. Of the 96 severely anaemic women, six died after admission. Our study shows that efforts must be taken towards safe motherhood and spreading awareness about the various consequences of anaemia, which is usually preventable with early correction.
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Affiliation(s)
- M Rohilla
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gupta K, Nada R, Joshi K, Rohilla M, Walia R. Can Ascending Infection from Bladder Serve as the Portal of Entry for Primary Renal Zygomycosis? Mycopathologia 2010; 170:357-60. [DOI: 10.1007/s11046-010-9329-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
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Rohilla M, Pandit IK, Srivastava N. Why the carioprotective potential of luting cements crucial? J Indian Soc Pedod Prev Dent 2009; 27:219-23. [PMID: 19915272 DOI: 10.4103/0970-4388.57656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Space maintainers make good oral hygiene difficult, modify the oral environment, and increase the chances of enamel demineralization. Demineralization can be prevented or reduced by improving patient oral hygiene or by using topical fluorides. However these methods depend on patient compliance and, therefore, are not very reliable. Thus, caries prevention in banding might be enhanced by using fluoride-releasing cements. The aim of the study was to comparatively evaluate the carioprotective potential of various luting media used for band cementation in permanent as well as deciduous molars. In this study, 100 molars were taken, which were banded and stored in artificial saliva for 1 month after which the teeth were debanded. An area of 2 x 2 mm was spared and the teeth were coated with nail varnish. The coated teeth were dipped in artificial caries solution in one month followed by 1-day immersion in methylene blue dye, after which the samples were sectioned through the window. The depth of dye penetration was measured and the results were statistically analyzed. Minimum dye penetration was observed with glass ionomer, which could be due to the fluoride release from the cement, whereas the control group showed the maximum, probably due to direct contact with the artificial caries solution.
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Affiliation(s)
- M Rohilla
- Government Dental College, Rohtak, India.
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Rohilla M, Chopra S, Suri V, Aggarwal N, Vermani N. Acardiac-acephalus twins: a report of 2 cases and review of literature. Medscape J Med 2008; 10:200. [PMID: 18924652 PMCID: PMC2562047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Acardiac twinning, a rare congenital anomaly of monozygotic twin pregnancy, often results from abnormal placental vascular anastomoses. This leads to twin reversal arterial perfusion with complex pathophysiology. Current information on early recognition and treatment for salvation of the normal twin is based on individual case reports in the literature. We report 2 cases of acardiac-acephalus twins and briefly review the relevant literature.
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Affiliation(s)
- Minakshi Rohilla
- Department of Obstetrics & Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Rohilla M, Saldanha K, Waseem M. Early versus delayed surgical treatment of open tibial fractures: effect on the rates of infection and need of secondary surgical procedures to promote bone union. Injury 2006; 37:85-6; author reply 86-7. [PMID: 16384557 DOI: 10.1016/j.injury.2005.06.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 06/21/2005] [Indexed: 02/02/2023]
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Rohilla M. Sweeping of membranes in formal induction of labour. BJOG 2003; 110:711; author reply 711. [PMID: 12842069 DOI: 10.1046/j.1471-0528.2003.20371.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rohilla M. Gestational diabetes mellitus and glucose tolerance test: value of the values. Am J Obstet Gynecol 2002; 187:1424; author reply 1424-5. [PMID: 12439542 DOI: 10.1067/mob.2002.128514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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