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Sharma JB, Dharmendra S, Rapaka G, Singh UB, Kriplani A, Kumar S, Dash NR, Nayyer R. Comparative study on complications and difficulties in laparoscopy in female genital tuberculosis cases versus non-tuberculosis cases. J Minim Access Surg 2024; 20:207-215. [PMID: 37357491 PMCID: PMC11095795 DOI: 10.4103/jmas.jmas_3_23] [Citation(s) in RCA: 1] [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: 01/05/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Female genital tuberculosis (FGTB) is an important type of extrapulmonary tuberculosis (TB) associated with morbidity especially infertility in developing countries. Laparoscopy may be difficult and hazardous in FGTB. The aim of the study was to observe the difficulties and complications of laparoscopy in FGTB cases. MATERIALS AND METHODS It was a prospective study over 12 years' period on 412 cases of diagnostic laparoscopy performed on FGTB cases with infertility. All patients underwent history taking and clinical examination and endometrial sampling for acid-fast bacilli (AFB) microscopy, culture, polymerase chain reaction (PCR), gene Xpert (last 212 cases) and histopathological evidence of epithelioid granuloma. Another 412 cases of diagnostic laparoscopy in the absence of FGTB performed during same time were taken as controls from the pool of non-TB cases. Various difficulties and complications were noted in both groups and statistical analysis was done. RESULTS Mean age, parity, body mass index and duration of infertility were 26.8 versus 25.4 years, 0.32 versus 0.28, 23.15 versus 25.28 Kg/m 2 and 4.15 versus 5.12 years, respectively. Primary and secondary infertility was seen in 78.6% and 20.38% of cases in the study group and 74.75% and 25.24% in the control group, respectively. Endometrial biopsy showed AFB microscopy in 5.3%, culture in 6.3%, epithelioid granuloma in 15.77% and on peritoneal biopsy granuloma in 6.55%, positive PCR in 368 (89.32%) and positive gene Xpert in 38 out of 212 (17.92%, out of last 212 cases). Definite findings of FGTB were seen in 171 (41.50%) cases. Probable findings of FGTB were seen in 241 (58.49%) cases. Various complications were difficulty in the creation of pneumoperitoneum or insertion of trocar and cannula in 16.74% and 13.10% of cases as compared to 1.94% and 1.69% in the control group. Excessive bleeding was seen in 5.09% versus 0.97% cases, respectively. Various injuries observed were bowel injury in 1.69% versus 0.24% cases (small bowel in 1.21% vs. 0.24%, large bowel in 0.48% vs. 0.1%), while bladder injury was seen in 0.97% versus 0.24% cases, subacute intestinal obstruction was seen in 5.8% versus 0.72% cases respectively while flare up of TB was seen in 5.09% versus 0% in cases and controls, respectively. Wound infection was seen in 8.48% versus 1.25% cases, respectively. INTERPRETATION AND CONCLUSION FGTB is associated with increased complications and difficulties as compared to laparoscopy in other cases.
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Affiliation(s)
| | - Sona Dharmendra
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Gawri Rapaka
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | | | - Alka Kriplani
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - N. R. Dash
- Department of GI Surgery, AIIMS, New Delhi, India
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Jain N, Sharma S, Kriplani I, Kriplani A. A Foreign Body (Broken Karman's Cannula Tip No. 8) in Uterus: Nightmare for an Obstetrician. J Obstet Gynaecol India 2024; 74:94-95. [PMID: 38434122 PMCID: PMC10902244 DOI: 10.1007/s13224-023-01908-y] [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] [Received: 10/05/2023] [Accepted: 11/06/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
- Namita Jain
- Obstetrics and Gynecology Department, Paras Hospital, Gurugram, 122002 India
| | - Seema Sharma
- Obstetrics and Gynecology Department, Paras Hospital, Gurugram, 122002 India
| | - Isha Kriplani
- Obstetrics and Gynecology Department, Paras Hospital, Gurugram, 122002 India
| | - Alka Kriplani
- Obstetrics and Gynecology Department, Paras Hospital, Gurugram, 122002 India
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Sodhi M, Gupta P, Kriplani I, Kriplani A. Laparoscopic Cerclage in a Case of Unicornuate Uterus with Cervical Insufficiency and Previous Failed Mc Donald Cerclage with a Successful Outcome: A Case Report. J Obstet Gynaecol India 2023; 73:268-270. [PMID: 38143987 PMCID: PMC10746642 DOI: 10.1007/s13224-023-01798-0] [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: 08/07/2022] [Accepted: 06/16/2023] [Indexed: 12/26/2023] Open
Abstract
In this report, we describe a 28-year-old woman, with unicornuate uterus and multiple mid-trimester losses, with two failed Mc Donald's cerclage. She presented to us as a case of recurrent pregnancy losses with history suggestive of cervical incompetence and on detailed investigation was found to be ANA and anti-cardiolipin antibody positive and Rh negative. We performed an interval laparoscopic cervical cerclage for her and were able to successfully deliver her at 35 + 3 weeks with a healthy baby by caesarean section after previous five pregnancy losses and two failed Mc Donald's cerclage. Cervical cerclage can be used as an effective method of preventing abortions in unicornuate uterus pregnancy, while laparoscopic cerclage would be a better choice for patients with cervical incompetence with previous failed Mc Donald's cerclage. The possibility of uterine rupture for these high-risk patients should be kept in mind and decision to deliver at appropriate period of gestation so as to avoid uterine rupture and prematurity should be taken.
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Affiliation(s)
- Manpreet Sodhi
- Consultant Obstetrics and Gynecology and ART, Paras Hospita, Gurugram, India
| | - Prachi Gupta
- Associate Consultant, Obstetrics and Gynecology and ART, Paras Hospital, Gurugram, India
| | - Isha Kriplani
- Associate Consultant, Obstetrics and Gynecology and ART, Paras Hospital, Gurugram, India
| | - Alka Kriplani
- Director and Head, Minimally Invasive Gynecology, Obstetrics and ART Paras Hospital, Gurugram, India
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Kachhawa G, Kaundal A, Kulshrestha V, Sethi D, Kriplani A, Sreeniwas V, Agarwal N. Awareness Regarding Medicolegal Aspects of Medical Services Among Reproductive Age Women: A Population-Based Cross-Sectional Study. Cureus 2023; 15:e49360. [PMID: 38143698 PMCID: PMC10749207 DOI: 10.7759/cureus.49360] [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] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
INTRODUCTION The government has implemented various laws to regulate medical practice and improve the quality of health care services. This study evaluated the general population's awareness of various medicolegal aspects related to the medical profession. Methods: A cross-sectional study was conducted. Knowledge of laws and ethics related to medical practice was assessed based on a well-structured questionnaire including 25 items. Women were categorized based on their score into low (below 50th percentile), medium (50th -75th percentile), and high (above 75th percentile) awareness. Results: A total of 334 women were recruited. The mean age of the women in the study was 30.29±6.58 SD years; most women were between 20-30 (56.28%). Most women were graduates (33.23%), followed by postgraduates (29.04%). The majority of women were unemployed (housewives: 64.67%, students: 4.49%), followed by skilled workers (22.75%), semi-professional, and professionals (8.08%). High awareness about the various medicolegal aspects was seen in 25.1% of women, while 29.04% had medium awareness and 45.80% had low awareness. It was also seen that the women with higher education(p=0.002) and those employed (0.001) had better knowledge. Further, graduate housewives had better awareness than non-graduate housewives. Conclusion: Education and self-independence significantly affected awareness of medicolegal issues among our women. Assuring the right to education and empowering women with self-independence will go a long way in ensuring active participation in medical decision-making.
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Affiliation(s)
- Garima Kachhawa
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
| | - Asmita Kaundal
- Obstetrics and Gynaecology, AIl India Institute of Medical Sciences, Bilaspur, IND
| | - Vidushi Kulshrestha
- Obstetrics and Gynaecology, AIl India Institute of Medical Sciences, New Delhi, IND
| | - Divya Sethi
- Biostatistics, All India Institute of Medical Sciences, New Delhi, IND
| | - Alka Kriplani
- Obstetrics and Gynecology, Paras Hospitals, Gurgaon, IND
| | - V Sreeniwas
- Biostatistics, All India Institute of Medical Sciences, New Delhi, IND
| | - Nutan Agarwal
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, IND
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Kriplani I, Kriplani A, Sharma S, Sodhi M, Jain N. Laparoscopic Management of Disseminated Peritoneal Leiomyomatosis. J Minim Invasive Gynecol 2023; 30:443-444. [PMID: 36934877 DOI: 10.1016/j.jmig.2023.03.006] [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: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
STUDY OBJECTIVE To show laparoscopic management of disseminated peritoneal leiomyomatosis (DPL). DESIGN Stepwise demonstration of the technique with narrated video footage. SETTING DPL is characterized by dissemination and proliferation of peritoneal and subperitoneal lesions primarily originating from smooth muscle cells [1]. Generally considered benign, cases of malignant transformation to leiomyosarcoma have been reported [2,3]. Iatrogenic DPL occurs because of unconfined morcellation resulting in small fragments of myoma that may implant on any organ and start deriving blood supply from it or may be pulled into port site while withdrawing laparoscopic cannulas [4]. It is estimated that the overall incidence of DPL after laparoscopic uncontained morcellation was 0.12% to 0.95% [5]. Mainstay of treatment is surgical resection of myomas and regular follow-up with imaging. A 28-year-old unmarried girl presented with complain of lump abdomen increasing in size for 1 year. She also complained of a 15 kg weight loss in the last 1 year; 4 years ago, patient had undergone laparoscopic myomectomy with unconfined morcellation for a 10 × 8 cm cervical myoma. Presently her menses were regular with a 28-day cycle and 3 to 4 days' average flow. Magnetic resonance imaging showed multiple nodular lesions of varying sizes in relation to small bowel, colon, uterus, and anterior abdominal wall suggestive of DPL. Bilateral ovaries were normal. Tumor markers were as follows: CA 125 23.2 (<35) U/mL Carcinoembryonic antigen 1.67 (<8) ng/mL CA 19-9 47 (<37) U/mL Lactate dehydrogenase 809 (180-360) IU/L Alpha-fetoprotein 2.03 (<10) ng/mL Beta human chorionic gonadotropin 1.2(<2) mIU/mL Tru-cut biopsy was done elsewhere to rule out peritoneal carcinomatosis in view of raised CA 19-9 and lactate dehydrogenase, history of weight loss, and imaging showing multiple abdominal masses. Histopathological examination showed leiomyomatosis and immunohistochemistry for smooth muscle actin, desmin, and vimentin were positive. INTERVENTIONS On laparoscopy the abdominal cavity was found studded with multiple leiomyomas of varying sizes deriving blood supply from ilium, transverse, descending and sigmoid colon, rectum, left tube, left ovary, pouch of Douglas, bilateral uterosacrals, uterovesical fold, and anterior abdominal wall. Large blood vessels were seen traversing between the descending and sigmoid colon and the myomas. Principles of surgery were as follows: 1. Complete removal of myomas 2. Cauterization of blood vessels feeding the parasitic myomas to minimize blood loss 3. Disscetion abutting the myoma to prevent injury to adjacent viscera. A total of 26 myomas were removed. All the myomas were retrieved by morcellation in a bag. Histopathology confirmed the diagnosis of diffuse peritoneal leiomyomatosis. Follow-up ultrasound at 6 months showed no recurrence of leiomyomatosis. CONCLUSION Proper mapping of lesions and surgery for complete removal of all masses is the mainstay of treatment. Contained morcellation in bag should be the norm to prevent iatrogenic DPL. Regular follow-up with imaging is required to rule out recurrence.
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Affiliation(s)
- Isha Kriplani
- Department of Obstetrics and Gynecology, Paras Hospital Gurugram, Haryana, India (all authors).
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, Paras Hospital Gurugram, Haryana, India (all authors)
| | - Seema Sharma
- Department of Obstetrics and Gynecology, Paras Hospital Gurugram, Haryana, India (all authors)
| | - Manpreet Sodhi
- Department of Obstetrics and Gynecology, Paras Hospital Gurugram, Haryana, India (all authors)
| | - Namita Jain
- Department of Obstetrics and Gynecology, Paras Hospital Gurugram, Haryana, India (all authors)
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Bhatla N, Sehgal R, Konar H, Vivekanand A, Kriplani A, Vanamail P, Purandare CN. A 5-year comparative study of efficacy and acceptability of three different sizes of TCu380Ag and TCu380A intrauterine devices. Int J Gynaecol Obstet 2023; 161:784-793. [PMID: 36652393 DOI: 10.1002/ijgo.14651] [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: 10/06/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The intrauterine contraceptive device TCu380Ag when compared with TCu380A at 1 year of use had better acceptability and continuation rates. OBJECTIVES To study the continuation rate, efficacy, and acceptability of TCu380Ag in three sizes versus TCu380A at 5 years of use. METHODS A total of 600 women opting for intrauterine contraceptive devices were randomized equally into two groups. Group 1 received the TCu380Ag device (Normal, Maxi, and Mini for uterocervical length 7-8.5 cm, 8-9 cm, and 6-7.5 cm, respectively) and Group 2 received the TCu380A device. Follow-up was performed at 5 years to assess efficacy, acceptability, and continuation. Frequency data comparisons was performed across categories using χ2 /Fisher exact test. RESULTS At 5 years of use, Kaplan-Meier survival analysis showed that TCu380Ag compared with TCu380A had a higher continuation rate (45% vs. 35%, P = 0.010) with 100% efficacy each. TCu380Ag had fewer side effects, including heavy menstrual bleeding (16.6% vs. 34.1%, P < 0.001), abdomen pain (12.1% vs. 23.0%, P = 0.001), and expulsions (4.4% vs. 8.7%, P < 0.050), and fewer discontinuations attributable to contraceptive side effects (42.7% vs. 56.9%, P = 0.012). The mini TCu380Ag had the highest continuation rates and least menstrual irregularity (P < 0.050). CONCLUSIONS The TCu380Ag device in three sizes is an alternative to TCu380A for women desiring 5 years of contraception with equal efficacy, better continuation, and acceptability. The mini size is preferred for women with a uterocervical length of 6 to 7.5 cm.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohini Sehgal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Hiralal Konar
- Calcutta National Medical College & Hospital, Kolkata, India
| | | | - Alka Kriplani
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - C N Purandare
- FIGO, Indian College of Obstetricians and Gynaecologists, Purandare Hospital, Mumbai, India
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Panwar A, Lata K, Kriplani I, Sharma S, Kriplani A. Role of Laparoscopic Transillumination Guidance During Hysteroscopic Metroplasty in Simplifying Surgical Management of Type II Robert's Uterus. J Obstet Gynaecol India 2022; 72:421-424. [PMID: 36457422 PMCID: PMC9701275 DOI: 10.1007/s13224-021-01609-4] [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: 05/27/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022] Open
Abstract
Robert's uterus is a rare variant of septate uterus with an asymmetrical septum which divides the uterine cavity into a noncommunicating hemiuterus causing hematometra and other communicating hemiuterus with a single cervix and a normal fundal contour (U2bC3V4 ESHRE classification). It is a cause of severe dysmenorrhea in young girls. However, there is a type of Robert uterus (Type II) which does not have collection in the blind cavity and causes symptoms later, similar to our case. We describe a case of hysteroscopic septum resection (metroplasty) with laparoscopic guidance by transillumination in a case of Type II Robert's uterus in a 25-year-old nulliparous woman. Thick muscular septum posed a surgical challenge which was supplemented by astutely utilizing laparoscopic transillumination.
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Affiliation(s)
- Akshita Panwar
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Kusum Lata
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences New Delhi, Room No 3076, Third floor, New Delhi, India
| | - Isha Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Seema Sharma
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Alka Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
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Lata K, Panwar A, Kriplani I, Sharma S, Kriplani A. Endometrial Vascular Dystrophy and Isthmocele: Hysteroscopic Visual Enigma. J Obstet Gynaecol India 2022; 72:412-414. [PMID: 36457450 PMCID: PMC9701282 DOI: 10.1007/s13224-021-01595-7] [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] [Received: 08/10/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Kusum Lata
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Akshita Panwar
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Isha Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Seema Sharma
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Alka Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
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Kriplani I, Srivastava V, Bhardwaj K, Jain N, Kriplani A. Laparoscopic Management of Partial Molar Caesarean Scar Ectopic Pregnancy. J Minim Invasive Gynecol 2022; 29:1221-1223. [PMID: 36007836 DOI: 10.1016/j.jmig.2022.08.008] [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: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE To demonstrate laparoscopic management of a molar scar ectopic pregnancy. DESIGN Stepwise demonstration of the technique with narrated video footage. SETTING Cesarean scar ectopic pregnancy and molar pregnancy are 2 separate extremely rare pathologies with an incidence range from 1/1800 to 1/2500 of all pregnancies for the former [1,2]. The concurrence of both cesarean scar ectopic and molar pregnancy is furthermore exceptionally rare, and there are only 8 reported cases of cesarean scar molar pregnancy in literature till date [3]. There is a high risk of uterine rupture, uncontrolled hemorrhage, hysterectomy, and significant maternal morbidity owing to thin myometrium and fibrous scar after cesarean section [4,5]. Knowledge and awareness about this clinical condition aid in early diagnosis and reduced morbidity. Here, we present a rare case of cesarean scar ectopic pregnancy that was operated for failed medical management and diagnosed to be molar scar ectopic pregnancy intraoperatively. INTERVENTIONS Total laparoscopic approach to molar scar ectopic pregnancy excision involved the following steps, strategies to minimize blood loss, and complete enucleation of tissue: (1) Hysteroscopy to localize the scar ectopic and its type and size (2) Bladder dissection to expose scar (3) Intramyometrial injection of vasopressin (4) Use of harmonic scalpel to delineate the gestational sac (5) Complete evacuation of products of conception (6) Excision of scar tissue (7) Uterine repair in 2 layers CONCLUSION: There are only 8 reported cases of cesarean scar molar pregnancy in literature till date, and all patients had at least 2 previous uterine curettages with abnormally increased β-hCG levels. The clinical manifestations were varied, the most common symptom being vaginal bleeding for a period >1 month, including our case [3]. Considering the limitations of ultrasound, magnetic resonance imaging, and serum hCG levels in the differential diagnosis of molar cesarean scar pregnancy from normal cesarean scar pregnancy, postoperative specimen should be sent for histologic examination [6]. As seen in our case, the possibility of molar pregnancy at cesarean scar ectopic site should be kept in mind in cases with rising β-hCG levels despite continuous medical interventions, which was being medically managed for 3 months. Our case is the first to be successfully managed with laparoscopic surgery as the previously reported cases were managed with suction evacuation, chemotherapy, laparotomy, or hysterectomy [3].
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Affiliation(s)
- Isha Kriplani
- Department of Obstetrics and Gynaecology, Paras Hospital, Gurugram, Haryana, India (all authors)..
| | - Vartika Srivastava
- Department of Obstetrics and Gynaecology, Paras Hospital, Gurugram, Haryana, India (all authors)
| | - Kusum Bhardwaj
- Department of Obstetrics and Gynaecology, Paras Hospital, Gurugram, Haryana, India (all authors)
| | - Namita Jain
- Department of Obstetrics and Gynaecology, Paras Hospital, Gurugram, Haryana, India (all authors)
| | - Alka Kriplani
- Department of Obstetrics and Gynaecology, Paras Hospital, Gurugram, Haryana, India (all authors)
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Yadav V, Sharma JB, Kriplani A, Bhatla N, Kachhawa G, Mahey R, Kumari R. Obstetrics outcome in pulmonary tuberculosis. Indian J Tuberc 2022; 69:305-310. [PMID: 35760479 DOI: 10.1016/j.ijtb.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/20/2020] [Revised: 11/20/2020] [Accepted: 12/23/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND To evaluate the maternal and perinatal outcome in pulmonary tuberculosis cases as compared to low risk pregnancies in a tertiary referral hospital. METHODS A total of 15 cases of pulmonary tuberculosis over a period of two years who delivered in our unit was studied in the retrospective study. The maternal and perinatal outcome in them was compared with 191 low risk pregnancies who delivered at the same time in the hospital after taking into account inclusion and exclusion criteria. RESULTS The mean age and mean parity was 25.73 ± 2.85 and 28.75 ± 3.11, 2.1 and 1.9 in the 2 groups. Symptoms of pulmonary tuberculosis were cough (100%), chest pain (80%), expectoration (100%), hemoptysis (33.3%), fever (93.33%), anorexia (86.66%) and loss of weight (80%). Symptoms in study patients were significantly more common in study patients. The presence of associated medical problems was similar in the 2 groups. The prevalence of oligoamnios, gestational diabetes mellitus, antepartum hemorrhage and intrahepatic cholestasis was similar in the 2 groups. Prevalence of preterm labor was 53.33% in study group which was significantly higher than in controls (8.9%). Risk of premature rupture of membrane was also significantly higher in the study groups (53.33%) as compared to control groups (8.9%). Mean gestational age was also significantly lower (36.2 weeks) in study group as compared to 38.6 weeks in control group. The incidence of cesarean delivery was similar in the 2 groups (26.66% vs 28.79%). The mean birth weights was 2308.6 gm in the study group as compared to 2707.56 gm in control group. Fetal growth restrictions and Respiratory distress syndrome in babies was significantly higher in study group than in control group. Low APGAR score (<8) was also higher (33.3%) in study group as compared to control group (2.61%). CONCLUSION Pulmonary tuberculosis during pregnancy is associated with increased perinatal morbidity, low birth weight, poor APGAR and increased respiratory distress rates.
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Affiliation(s)
- Vikas Yadav
- Department of Obstetrics and Gynecology, SMS&R, G. NOIDA, UP, India
| | - J B Sharma
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India.
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
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Agarwal N, Mahey R, Kulshrestha V, Kriplani A, Saraya A, Sachdev V. Serum Bile Acids in Intrahepatic Cholestasis of Pregnancy (ICP), Versus Pregnant and Nonpregnant Controls in Asian Indian Women and a Proposed Scoring to Optimize Management in ICP. J Obstet Gynaecol India 2022; 72:218-224. [DOI: 10.1007/s13224-021-01501-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/15/2021] [Indexed: 01/17/2023] Open
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Jain N, Kriplani I, Sharma S, Hanumantaiya S, Kriplani A. Urinary retention unveiling deeply embedded multiple leiomyomas in women with Mayer–Rokitansky–Kuster–Hauser syndrome and its successful laparoscopic management: a case-report and literature review. J Surg Case Rep 2022; 2022:rjac291. [PMID: 35721263 PMCID: PMC9202637 DOI: 10.1093/jscr/rjac291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
Abstract
Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is the second most common cause of primary amenorrhea with an incidence of 1:4000–5000 women. It is characterized by aplasia or hypoplasia of the uterus and the upper two-thirds of the vagina with normal ovaries and tubes and a normal secondary sexual characteristics. The occurrence of leiomyoma is common but it is rare to have leiomyoma in uterine remnant in MRKH syndrome. Although few cases of MRKH syndrome with leiomyoma have been reported in the literature, none presented with urinary retention. Here, we report a case of 28-year-old women who presented with urinary retention that unmasked deeply embedded huge fibroids in pelvis arising from a rudimentary uterine horns and its safe management via laparoscopic approach.
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Affiliation(s)
- Namita Jain
- Obstetrics and Gynecology Department, Paras Hospital , Gurugram 122002 , India
| | - Isha Kriplani
- Obstetrics and Gynecology Department, Paras Hospital , Gurugram 122002 , India
| | - Seema Sharma
- Obstetrics and Gynecology Department, Paras Hospital , Gurugram 122002 , India
| | - Shaily Hanumantaiya
- Obstetrics and Gynecology Department, Paras Hospital , Gurugram 122002 , India
| | - Alka Kriplani
- Obstetrics and Gynecology Department, Paras Hospital , Gurugram 122002 , India
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Lata K, Davis AA, Sehrawat V, Panwar A, Kriplani I, Kriplani A. Universal Laparoscopic Approach with Emphasis on Ovarian Preservation and Use of Indigenous Bags for Spillage Free Removal of Dermoid Cysts: Update on Technique. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0170] [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: 11/12/2022] Open
Affiliation(s)
- Kusum Lata
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Delhi, New Delhi, India
| | - Amenda Ann Davis
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
| | - Vandana Sehrawat
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
| | - Akshita Panwar
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
| | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Delhi, New Delhi, India
| | - Alka Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
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Chawla A, Kriplani A, Pandit S, Choudhary A. Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR) and Lymphocyte-Monocyte Ratio (LMR) in predicting Systemic Inflammatory Response Syndrome (SIRS) and sepsis after Percutaneous Nephrolithotomy (PNL). Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00135-x] [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: 11/29/2022]
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Sharma JB, Singh UB, Kriplani A, Kumar S, Roy KK, Kumari A, Dharmendra S. Hysteroscopic observations in 348 consecutive cases of female genital tuberculosis: A prospective study. Indian J Tuberc 2022; 69:48-57. [PMID: 35074151 DOI: 10.1016/j.ijtb.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/20/2020] [Revised: 12/29/2020] [Accepted: 02/19/2021] [Indexed: 06/14/2023]
Abstract
STUDY OBJECTIVE To evaluate the hysteroscopic findings in female genital tuberculosis. DESIGN It was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB). SETTING It was a prospective cross-sectional study in a tertiary referral centre. PATIENTS A total of 348 patients with infertility with FGTB on various tests. INTERVENTION A total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings. MEASUREMENTS AND MAIN RESULTS The mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m2 and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation. CONCLUSION Hysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.
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Affiliation(s)
| | | | - Alka Kriplani
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Kallol Kumar Roy
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Anukriti Kumari
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Sona Dharmendra
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
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Gambhir M, Gamanagatti S, Sharma R, Manchanda S, Hemachandran N, Kriplani A, Dadhwal V, Malhotra N, Sharma JB. Uterine artery Embolization: Interventional Radiologist's Perspective in Management of Uncontrolled Obstetric Hemorrhage. J Obstet Gynaecol India 2021; 72:126-133. [PMID: 35928089 PMCID: PMC9343483 DOI: 10.1007/s13224-021-01567-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose To study the efficacy and safety of uterine artery embolization in treatment of obstetric hemorrhage. Methods This ethically approved prospective study was conducted between November 2017 and October 2019, and written informed consent was obtained from all patients. Consecutive patients presenting with uncontrolled obstetric hemorrhage were evaluated. Fifty-three patients with uncontrolled bleeding underwent uterine artery embolization (UAE) and were followed up. Results Spectrum of patients encountered in this study was arteriovenous malformations (AVMs) (n = 25), retained products of conception (RPOC) (n = 16), RPOC with secondary AVMs (n = 5), ectopic pregnancy (n = 5) and iatrogenic trauma to cervix or vagina (n = 2). A total of 57 UAE procedures were performed in these 53 patients as repeat sessions were required in four patients. Most common embolic agent used was polyvinyl alcohol (PVA) particles with gelfoam followed by cyanoacrylate glue as second most common agent. Technical success was achieved in 57 (100%) of 57 UAE procedures. Primary clinical success was achieved in 49 (92%) of 53 patients and secondary clinical success in 52 (98%) patients. Clinical failure was observed in one patient who underwent hysterectomy. Conclusion Uterine artery embolization is a safe and effective procedure in the management of uncontrolled obstetric hemorrhage.
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Lata K, Davis AA, Panwar A, Kriplani I, Kriplani A. Laparoscopic Management of Post-cesarean Uterovesical Abscess: A New Approach to an Old Problem. J Obstet Gynaecol India 2021; 71:313-317. [PMID: 34408352 DOI: 10.1007/s13224-020-01396-4] [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] [Received: 05/29/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kusum Lata
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Room No. 3076, Third floor, New Delhi, India
| | - Amenda Ann Davis
- Department of Minimal Invasive Gynecology, Paras Hospitals, Gurgaon, India
| | - Akshita Panwar
- Department of Minimal Invasive Gynecology, Paras Hospitals, Gurgaon, India
| | - Isha Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Room No. 3076, Third floor, New Delhi, India
| | - Alka Kriplani
- Department of Minimal Invasive Gynecology, Paras Hospitals, Gurgaon, India
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Gupta M, Kachhawa G, Kumari R, Kriplani A. Pregnancy with Klippel-Trenaunay syndrome. Natl Med J India 2021; 33:86-88. [PMID: 33753636 DOI: 10.4103/0970-258x.310985] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder characterized by the presence of vascular naevi, varicose veins and soft tissue or bone hypertrophy affecting one or more extremities. Due to the rarity of the syndrome, there is limited literature regarding the current practice in the management of pregnancy complicated with KTS. Successful management of pregnancy with KTS is a challenge for clinicians as pregnancy exacerbates the already increased risk of thrombosis and haemorrhage associated with this syndrome. We report a patient with KTS with previous poor obstetric history managed with favourable maternal and foetal outcomes.
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Affiliation(s)
- Monica Gupta
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
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Panwar A, Lata K, Sharma S, Kriplani I, Kriplani A, Tomar SS. Non-Mesh Sacrocolpopexy as a Supplementary Procedure to Abdominal Radical Hysterectomy in Carcinoma Cervix Ib2 Coexisting with Procidentia. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0071] [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: 11/13/2022] Open
Affiliation(s)
- Akshita Panwar
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
- Gynaecology Outpatient Department, Paras Hospitals, Gurugram, Haryana, India
| | - Kusum Lata
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
| | - Seema Sharma
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
| | - Isha Kriplani
- Department of Reproductive Medicine, Fortis La Femme, New Delhi, India
| | - Alka Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
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Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Jensen LN, Giordano D, Cecatti JG, Aleem HA, Talegawkar SA, Benachi A, Diemert A, Kitoto AT, Thinkhamrop J, Lumbiganon P, Tabor A, Kriplani A, Perez RG, Hecher K, Hanson MA, Gülmezoglu AM, Platt LD. Correction: The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. PLoS Med 2021; 18:e1003526. [PMID: 33411728 PMCID: PMC7790295 DOI: 10.1371/journal.pmed.1003526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1002220.].
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Lata K, Davis AA, Panwar A, Kriplani I, Kriplani A. An Unusual Case of Post-Cesarean Amenorrhea Due to Posterior Cervicoperitoneal Fistula: Biologic Plausibility and Laparoscopic Management. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0037] [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: 11/12/2022] Open
Affiliation(s)
- Kusum Lata
- Paras Hospitals, Gurgaon, Haryana, India
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22
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Panwar A, Kriplani A, Lata K, Kriplani I, Sharma S, Tomar SS. Laparoscopic Management of Interstitial Ectopic Pregnancy Coexistent with a Fibroid: A Cause or a Chance? J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Akshita Panwar
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
| | - Alka Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
| | - Kusum Lata
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
| | - Isha Kriplani
- Department of Reproductive Medicine, Fortis La Femme, New Delhi, Delhi, India
| | - Seema Sharma
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, Haryana, India
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23
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Panwar A, Davis AA, Lata K, Sharma S, Kriplani A. Laparoscopic Management of Accessory Cavitated Uterine Mass: A Report of Two Cases and Review of Literature. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Akshita Panwar
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
| | - Amenda Ann Davis
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
| | - Kusum Lata
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
| | - Seema Sharma
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, Paras Hospitals, Gurgaon, India
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24
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Amaresh M, Hegde P, Chawla A, de la Rosette JJMCH, Laguna MP, Kriplani A. Safety and efficacy of superior calyceal access versus inferior calyceal access for pelvic and/or lower calyceal renal calculi- a prospective observational comparative study. World J Urol 2020; 39:2155-2161. [PMID: 32865690 PMCID: PMC8216999 DOI: 10.1007/s00345-020-03409-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To compare efficacy and safety between superior calyceal access and inferior calyceal access for pelvic and/or lower calyceal renal stones. Methods Consecutive patients presenting with Pelvic and/or inferior calyceal renal calculi were allocated to the superior calyceal access (group 1) or inferior calyceal access (group 2) treatment arm. Allocation of treatment access was based on the surgeon’s preference. Variables studied included stone free rate, operating time, intraoperative and postoperative complications. Statistical analysis was executed using SPSS, Version 16.0. The statistical significance was evaluated at 5% level of significance (p value < 0.05). Results Between July 2018 and February 2019, 63 patients were included in each group. The percutaneous inserted guidewire entered the ureter in 92% in group1 and 74.6% in group 2 (p = 0.034). Stone fragments migrated to the middle calyx in 3.2% in group1 and 9.5% in group 2 (p = 0.033). A second puncture was required in one patient in group 1 and in 5 patients in group 2 (p = 0.04). The operative duration (minutes) was 13.46 ± 1.09 in the group 1 while 16.58 ± 1.44 in the group 2 (p = 0.002). Thoracic complications (hydropneumothorax) occurred to 2 patients in superior calyceal access group managed with intercostal tube drainage (p = 0.243).Post operatively blood transfusion was required in two patients in group 2 (p = 0.169). Angioembolization was done in one patient among the inferior calyceal access approach (p = 0.683). Complete stone clearance assessed at 3 months was 96.8% in group 1 and 85.7% in group 2 (p = 0.046). Conclusions Superior calyceal access is a safe and most efficacious in terms of achieving complete stone clearance rate with reduced operative time, minimal blood loss, less need for a second puncture and auxiliary procedures at minimal complications. Study registration Clinical trials registry – INDIA; CTRI/2018/07/014,687.
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Affiliation(s)
- M Amaresh
- Department of Urology, Kasturba Medical College, Manipal, Karnataka, India
| | - P Hegde
- Department of Urology, Kasturba Medical College, Manipal, Karnataka, India
| | - A Chawla
- Department of Urology, Kasturba Medical College, Manipal, Karnataka, India.
| | | | - M P Laguna
- Department of Urology, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - A Kriplani
- Department of Urology, Kasturba Medical College, Manipal, Karnataka, India
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Jaiswal U, Yadav RK, Bhat MA, Kriplani A, Roy KK, Netam RK. Cytokine and growth factor profile in endometriosis: a multiplex analysis of peritoneal fluid to assess diagnostic utility. Gynecol Endocrinol 2020; 36:718-722. [PMID: 31958023 DOI: 10.1080/09513590.2020.1712695] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We aimed to assay cytokines and growth factors in peritoneal fluid samples from women with and without endometriosis to understand the inflammatory milieu, and assess their potential diagnostic utility. This cross-sectional study conducted at a tertiary care hospital included 54 women, aged 20-45 years, with regular menstrual history and undergoing diagnostic/therapeutic laparoscopy for infertility and/or pain. Peritoneal fluid samples were collected after insertion of trocar & laparoscope but prior to other surgical intervention. A multiplex immunoassay of 27 cytokines and growth factors was performed. The concentration of FGF2 and CSF3 were significantly lower in women with endometriosis than without endometriosis (p = .043 and .003, respectively). The levels of CCL2 and IL1RN were significantly higher in moderate-severe than in minimal-mild endometriosis (p = .038 and .043, respectively). Phase-specific comparison revealed that in proliferative phase, the levels of CSF2 and CSF3 were lower in women with endometriosis than without the disease (p = .047 and .013, respectively). The ROC curve analysis provided a cutoff value 0.78 and 0.76 for FGF2 and CSF3, respectively. Cytokines and growth factors such as FGF2, CSF3, CSF2, CCL2 and IL1RN seem to contribute to the pathogenesis of endometriosis and may have a potential utility for the diagnosis of endometriosis.
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Affiliation(s)
- Urja Jaiswal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Muzaffer Ahmed Bhat
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Kallol Kumar Roy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritesh Kumar Netam
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Background Cesarean scar ectopic pregnancies are increasing in frequency, due to rise in cesarean deliveries. They should be managed early in pregnancy, preferably by surgical excision, failing which they may rupture, or later develop into morbidly adherent placenta. Methods This is a series of five cases described to explain the instrumentations and techniques in the laparoscopic excision of cesarean scar ectopic pregnancies. Written consent was taken from the patients. Results All five patients underwent successful laparoscopic excision. Follow-up period was uneventful. Conclusion Laparoscopic excision of cesarean scar ectopic is a technically demanding procedure, but with excellent results. All gynecologists should be familiar with this technique due to the increasing incidence of cesarean scar ectopic gestations.
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Affiliation(s)
- Kusum Lata
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Amenda Ann Davis
- Department of Obstetrics, Gynaecology, and ART, Paras Hospitals, Gurgaon, India
| | - Akshita Panwar
- Department of Obstetrics, Gynaecology, and ART, Paras Hospitals, Gurgaon, India
| | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sharma
- Department of Obstetrics, Gynaecology, and ART, Paras Hospitals, Gurgaon, India
| | - Alka Kriplani
- Department of Obstetrics, Gynaecology, and ART, Paras Hospitals, Gurgaon, India
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Garg P, Yadav K, Jaryal AK, Kachhawa G, Kriplani A, Deepak KK. Sequential analysis of heart rate variability, blood pressure variability and baroreflex sensitivity in healthy pregnancy. Clin Auton Res 2020; 30:433-439. [PMID: 31981003 DOI: 10.1007/s10286-020-00667-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 11/06/2019] [Accepted: 01/14/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this study was to demonstrate the temporal profile of changes in heart rate variability (HRV), blood pressure variability (BPV), and cardiac baroreflex sensitivity (BRS) during the course of a healthy pregnancy. MATERIALS AND METHODS This was a longitudinal study during which autonomic variability parameters (HRV, BPV, BRS) were assessed in 66 pregnant women at 11-13, 20-22 and 30-32 weeks of gestation. A lead II electrocardiogram tracing and beat-to-beat blood pressure were recorded with the subject breathing spontaneously in the supine position. Changes in the parameters were analyzed using repeated measures analysis of variance. RESULTS Overall HRV (SDNN; standard deviation of all NN intervals) was found to decrease significantly over the course of pregnancy (p < 0.05). Similarly, indices which represent the parasympathetic component of these variables (SDSD [standard deviation of differences between adjacent NN intervals]; pNN50 [NN50 count {number of pairs of adjacent NN intervals differing by more than 50 ms} divided by the total number of all NN intervals]; high-frequency [HF] power) were also found to decrease significantly from the first to third trimester of pregnancy (p < 0.05). Low-frequency (LF) power increased over the course of pregnancy (p < 0.05). The LF/HF ratio increased significantly from first to third trimester of pregnancy (median: 0.66 [first trimester] vs.1.02 [second] vs. 0.91 [third]; p < 0.05) Overall BPV increased during the course of pregnancy, with a significant rise in the HF component of BPV and a significant fall in the LF component of BPV with advancing gestation (p < 0.05). BRS decreased over the course of pregnancy (median: 16.31, interquartile range [IQR] 11.04-23.13 [first trimester] vs. 11.42, IQR 8.54-19.52 [second] vs. 8.84, IQR 7.15-12.45 [third] ms/mmHg; p < 0.05). CONCLUSION Pregnancy is associated with decreased vagal and increased sympathetic modulation of cardiac autonomic tone with advancing gestation, together with increased BPV. The reduction in cardiac BRS may play a role in increasing BPV and decreasing HRV over the course of pregnancy.
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Affiliation(s)
- Priyanka Garg
- Department of Physiology, Government Allopathic Medical College, Banda, UP, India
| | - Kavita Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Kishore Kumar Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Davis AA, Lata K, Panwar A, Kriplani A. Unexpected rupture of an expectantly managed tubal ectopic pregnancy: a reminder for enhanced diligence. BMJ Case Rep 2019; 12:e230876. [PMID: 31888919 PMCID: PMC6936481 DOI: 10.1136/bcr-2019-230876] [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] [Accepted: 12/16/2019] [Indexed: 11/03/2022] Open
Abstract
Expectant management of tubal ectopic pregnancies is a feasible and possibly preferable method of management in asymptomatic women with low serum β-human chorionic gonadotropin (hCG). This involves serial monitoring of β-hCG until negative, after which it is deemed as spontaneously resolved ectopic pregnancy. We describe a case of tubal ectopic pregnancy which was expectantly managed with an initial β-hCG of 585 mIU/mL until undetectable. This patient presented with ruptured ectopic pregnancy 8 weeks after the original diagnosis, at the level of 5 mIU/mL. This highlights the importance of close monitoring in the expectant management of tubal ectopic pregnancies, with the incorporation of imaging, even when serial β-hCG shows a persistently reducing trend.
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Affiliation(s)
- Amenda Ann Davis
- Obstetrics and Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
| | - Kusum Lata
- Obstetrics and Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
| | - Akshita Panwar
- Obstetrics and Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
| | - Alka Kriplani
- Obstetrics and Gynaecology, Paras Hospitals, Gurgaon, Haryana, India
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Bansal K, Kharbanda OP, Sharma JB, Sood M, Priya H, Kriplani A. Effectiveness of an integrated perinatal oral health assessment and promotion program on the knowledge in Indian pregnant women. J Indian Soc Pedod Prev Dent 2019; 37:383-391. [PMID: 31710014 DOI: 10.4103/jisppd.jisppd_201_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Oral health during pregnancy plays a crucial role in the overall health and well-being of pregnant women. Evidence shows that most young children acquire cariogenic organisms from their mothers. Poor maternal knowledge about oral diseases combined with inappropriate feeding can lead to severe caries among young children. The aim of study was to assess the oral health status of pregnant women and to evaluate the gain in their knowledge after educational session in an antenatal setting. MATERIALS AND METHODS It is a pre- and post-intervention study carried out on the pregnant women (n = 198) attending an antenatal clinic in a tertiary care hospital. A specially designed semi-structured 14-point questionnaire was used to assess the pre- and post-knowledge and attitude to the oral health. Each participant was educated for self and infant oral care with the help of a specially prepared colored printed booklet. Kruskal-Wallis test was used to explore the associations between the age, education and socioeconomic class and knowledge; Wilcoxon signed-rank test was used to compare pre- and post-knowledge score. RESULTS Median preoral health knowledge-attitude score was found to be 4 (0-8) and was found to be associated with the level of education (P = 0.014) and socioeconomic class (0.019). There was a significant improvement in the median postknowledge score to 7 (2-10) (P < 0.001) following oral health educational session in all categories. CONCLUSIONS An integrated preventive oral health checkup and educational program to pregnant women can benefit the dental health of the women and children. Prenatal care workers can be involved to disseminate the oral health awareness to pregnant women during antenatal visits.
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Affiliation(s)
- Kalpana Bansal
- Department of Pedodontics and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Om P Kharbanda
- Department of Orthodontics and Dento-Facial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - J B Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Harsh Priya
- Department of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Garg P, Jaryal AK, Kachhawa G, Kriplani A, Deepak KK. Sequential profile of endothelial functions and arterial stiffness in preeclampsia during the course of pregnancy. Pregnancy Hypertens 2019; 18:88-95. [DOI: 10.1016/j.preghy.2019.09.013] [Citation(s) in RCA: 7] [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: 02/18/2019] [Revised: 07/31/2019] [Accepted: 09/22/2019] [Indexed: 11/15/2022]
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Kriplani A, Dalal V, Kachhawa G, Mahey R, Yadav V, Kriplani I. Minimally Invasive Endoscopic Approach for Management of OHVIRA Syndrome. J Obstet Gynaecol India 2019; 69:350-355. [PMID: 31391743 DOI: 10.1007/s13224-019-01240-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/06/2018] [Accepted: 05/12/2019] [Indexed: 11/25/2022] Open
Abstract
Background Herlyn-Werner-Wunderlich syndrome is an uncommon entity characterized by uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis (also called OHVIRA syndrome). Due to rarity and varied presentations, often correct diagnosis is missed out during work up, leading to management problems. We describe our dependence on detailed preoperative work up and minimally invasive endoscopic approach in management of the eight patients of OHVIRA syndrome. Methods In this retrospective case series study, eight patients of OHVIRA syndrome were managed from January 2012 to March 2018 with the help of improved imaging facility and diagnostic work up. Precise diagnosis helped in adopting minimally invasive approach in management. Patients were reviewed, focusing on presentation, radiologic findings and surgical management. Results Median age at diagnosis was 19 years (range 13-41 years). Abdominal pain and dysmenorrhea were the main presenting complaint. All patients except one had associated ipsilateral renal agenesis. Surgical excision of the obstructed hemivaginal septum and hematometra drainage was the main treatment. In seven patients, vaginoscopic resection of vaginal septum was done with resectoscope except one 41-year-old patient, where resection of vaginal septum was performed laparoscopically along with hysterectomy. Conclusion Vaginoscopic resection of obstructed hemivaginal septum is an effective method. Management has shifted to minimally invasive approach due to improved imaging, precise preoperative diagnosis and proper understanding of the disease.
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Affiliation(s)
| | | | - Garima Kachhawa
- 3Obstetrics and Gynaecology Department, AIIMS, New Delhi, India
| | - Reeta Mahey
- 3Obstetrics and Gynaecology Department, AIIMS, New Delhi, India
| | - Vikas Yadav
- 3Obstetrics and Gynaecology Department, AIIMS, New Delhi, India
| | - Isha Kriplani
- 3Obstetrics and Gynaecology Department, AIIMS, New Delhi, India
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Agrawal A, Mahey R, Kachhawa G, Khadgawat R, Vanamail P, Kriplani A. Comparison of metformin plus myoinositol vs metformin alone in PCOS women undergoing ovulation induction cycles: randomized controlled trial. Gynecol Endocrinol 2019; 35:511-514. [PMID: 30614289 DOI: 10.1080/09513590.2018.1549656] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Indexed: 10/27/2022] Open
Abstract
The present study was planned to evaluate the benefit of synergetic effect of Metformin plus Myo-inositol versus Metformin alone in infertile polycystic ovarian syndrome (PCOS) women undergoing ovulation induction. One hundred and twenty infertile PCOS women were randomized: Group I (n = 60) received Metformin (500 mg) plus Myoinositol(600 mg) three times a day; Group II received Metformin 500 mg three times a day. Subjects were advised to try for spontaneous conception. Those who did not conceive after 3 months, were given three cycles of ovulation induction + intrauterine insemination. Hormonal and biochemical profile parameters were done at baseline and after 3 months of therapy. Primary outcome measure was live birth rate. Secondary outcomes were improvement in menstrual cycle, hormonal and biochemical parameters, spontaneous conception, abortions, multiple pregnancy, and ovarian hyperstimulation syndrome. Baseline demographic, hormonal and biochemical parameters were comparable in two groups. There was a significant improvement in menstrual cycles (cycle length and bleeding days) in Group I as compared to Group II. The improvement in biochemical and hormonal parameters were comparable in the two groups after 3 months. Live birth rate was significantly higher in the Group I as compared to Group II [55% (33/60); 26.67% (16/60); p = .002]. The study concluded significantly higher live birth rate in women receiving the combination as compared to metformin alone.
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Affiliation(s)
- Anisha Agrawal
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
| | - Reeta Mahey
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
| | - Garima Kachhawa
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
| | - Rajesh Khadgawat
- b Department of Endocrnoligy , All India Institute of Medical Sciences , New Delhi , India
| | - Perumal Vanamail
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
| | - Alka Kriplani
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
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Kumari R, Vaishya V, Khanna G, Chauhan M, Sharma JB, Kriplani A. Tuberculosis of the cervix: An uncommon cause of vaginal discharge in a post-menopausal woman. Natl Med J India 2019; 31:149-150. [PMID: 31044761 DOI: 10.4103/0970-258x.255757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Discharge per vaginum is a common symptom of a variety of gynaecological diseases. Among post-menopausal women, atrophic vaginitis, cervicitis and cervical carcinoma are common causes of this symptom. We present a 64-year-old woman who had foul-smelling discharge per vaginum for the past 1 year. Per speculum examination revealed an unhealthy-looking cervix and white discharge. On bi-manual examination, the cervix was flush with the vagina. There was no obvious growth felt, the exact uterine size could not be ascertained and the finger was stained with thick discharge. A biopsy of the cervix showed epithelioid cell granulomas and a diagnosis of tuberculosis was made. The patient responded to antitubercular therapy. Tuberculosis of the cervix may be a rare cause of foul- smelling discharge per vaginum in post-menopausal women but there should be a high index of suspicion of this condition, especially in areas where tuberculosis is common. We report this post-menopausal woman owing to the rarity of tuberculosis of the cervix mimicking a gynaecological malignancy.
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Affiliation(s)
- Rajesh Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vandana Vaishya
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Gaurav Khanna
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Mukul Chauhan
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Kriplani A, Sehgal R, Konar H, Vivekanand A, Vanamail P, Purandare CN. A 1-year comparison of TCu380Ag versus TCu380A intrauterine contraceptive devices in India. Int J Gynaecol Obstet 2019; 145:268-277. [PMID: 30919459 DOI: 10.1002/ijgo.12809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/17/2018] [Revised: 11/30/2018] [Accepted: 03/22/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare TCu380Ag and TCu380A intrauterine contraceptive devices after 1 year of use. METHODS A prospective randomized controlled trial was conducted among healthy married women aged 20-35 years who attended the family planning clinics of three tertiary centers in India between August 1, 2015, to March 31, 2018. The TCu380Ag group (n=300) received one of three sizes of this device depending on uterocervical length: maxi (8.0-9.0 cm), normal (7.0-8.5 cm), or mini (6.0-7.5 cm). The remaining 300 participants received TCu380A. Follow-up was conducted at 3-monthly intervals to assess continuation rate, acceptability, efficacy, adverse effects, and complications. RESULTS The TCu380Ag group had a higher continuation rate than the TCu380A group at 1 year (84.0% vs 75.8%; P=0.01), with an efficacy of 99.6% versus 100.0% (P>0.05). Overall estimated continuation rates were 94.5% (95% confidence interval [CI] 91.7%-96.4%) and 88.4% (95% CI 83.2%-91.5%), respectively (P=0.026). Use of TCu380Ag was associated with fewer adverse effects (heavy menstrual bleeding, abdominal pain, or expulsion) when compared with TCu380A (P>0.05 for all comparisons). Discontinuation rates owing to adverse effects were 6.59% for TCu380Ag versus 13.26% for TCu380A (P=0.01). CONCLUSIONS Varying sizes of TCu380Ag could provide an alternative to TCu380A.
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Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohini Sehgal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Hiralal Konar
- Department of Obstetrics and Gynaecology, Calcutta National Medical College and Hospital, Kolkata, India
| | - Achanta Vivekanand
- Department of Obstetrics and Gynecology, Prathima Institute of Medical Sciences, Karimnagar, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Chittaranjan N Purandare
- Department of Obstetrics and Gynaecology, Indian College of Obstetricians and Gynaecologists, Purandare Hospital, Mumbai, India
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Jose A, Mahey R, Sharma JB, Bhatla N, Saxena R, Kalaivani M, Kriplani A. Comparison of ferric Carboxymaltose and iron sucrose complex for treatment of iron deficiency anemia in pregnancy- randomised controlled trial. BMC Pregnancy Childbirth 2019; 19:54. [PMID: 30717690 PMCID: PMC6360702 DOI: 10.1186/s12884-019-2200-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/23/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of intravenous Ferric Carboxymaltose. (FCM) in comparison with intravenous Iron sucrose complex (ISC) for treatment of iron deficiency anemia in pregnancy. METHODS A randomized clinical trial was conducted from (January 2016-August 2017). at a tertiary hospital. Pregnant women diagnosed with moderate to severe iron deficiency anaemia were screened for the study. One hundred patients were randomized to receive either intravenous FCM or ISC. Primary outcome was rise in hemoglobin (Hb) from baseline after 12 weeks. Secondary outcomes were change in RBC indices, serum iron studies, improvement in fatigue scores, number of visits and perinatal outcome. RESULTS Mean rise in Hb at 12 weeks was significantly higher in FCM group (29 g/L vs 22 g/L; p value < 0.01). FCM was associated with greater improvement in fatigue scores. Number of visits were significantly less in FCM group. No serious adverse events were noted in either group. CONCLUSION Treatment with FCM resulted in rapid replenishment of iron stores in pregnant women with significantly higher Hb rise over a 12 week period. The convenient dosing with lesser number of total doses to complete the treatment will lead to better compliance in community setting. CLINICAL TRIAL REGISTRATION ( WWW.CTRI.NIC.IN ): CTRI/2015/09/006224. Registered on 21/07/2017 (Trial registered retrospectively).
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Affiliation(s)
- Ambily Jose
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Kriplani A, Dalal V, Mahey R, Kachhawa G, Thariani K, Kriplani I, Vanamail P, Sharma JB. Long-Term Outcome of Laparoscopic Sacrohysteropexy for Uterovaginal Prolapse in Young Women. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Venus Dalal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Karishma Thariani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Yadav V, Malhotra N, Mahey R, Singh N, Kriplani A. Ovarian Sensitivity Index (OSI): Validating the Use of a Marker for Ovarian Responsiveness in IVF. J Reprod Infertil 2019; 20:83-88. [PMID: 31058052 PMCID: PMC6486569] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In this study, an attempt was made to validate the use of OSI as a measure of ovarian response during IVF treatment and to correlate OSI with age and BMI and other measures of ovarian response such as AMH, antral follicle count (AFC), total dose of administered gonadotrophins, and duration of stimulation. METHODS This study was a retrospective comparative cohort one. The study included a total of 2150 women who underwent the first IVF cycle between January 2008 and December 2017 at our center using long-agonist protocol. Patients were divided into four subgroups according to the circulating AMH level: below the 25th percentile (AMH 0.25-1.1 ng/ml, subgroup A), between 25th and 50th percentiles (AMH 1.2-1.6 ng/ml, subgroup B), between the 50th and 75th percentiles (AMH1.7-2.6 ng/ml, subgroup C), and above the 75th percentile (AMH 2.7-8.5 ng/ml, subgroup D). Qualitative data were analyzed by Chi-square or Fisher's exact test. The p<0.05 was considered statistically significant. RESULTS The four subgroups formed on the basis of the AMH level did not significantly differ for age, BMI and infertility duration. OSI was significantly correlated to age (r=0.167; p=0.001), and has negative correlation with AFC (r=-0.236, p=0.001) and AMH levels (r=-0.123, p=0.001). Multiple linear regression analysis was done on OSI with other independent variables such as age, BMI, AFC, AMH. Analysis showed that approximately 8% variation in the value of OSI can be attributed to these variables with the highest correlation with antral follicle count. CONCLUSION The present study showed that OSI appears to be a highly reliable index of ovarian responsiveness to recombinant FSH and can be useful to estimate the FSH dose.
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Affiliation(s)
| | - Neena Malhotra
- Corresponding Author: Neena Malhotra, Department of Obstetrics and Gynecology, AIIMS, Ansari nagar, Delhi 110029, India, E-mail:
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Abstract
Background: Empty follicle syndrome (EFS) is a condition in which no oocytes are retrieved from normally growing ovarian follicles after ovarian stimulation. It is a rare and frustrating condition of obscure etiology. Objective: The objective of this study was to estimate the incidence of EFS and study factors related to it. Design: This was a retrospective study. Setting: This study was conducted in hospital-based research center. Methods: In 1968 in vitro fertilization cycles from January 2010 to August 2016 were studied. Agonist, antagonist, and miniflare protocols were used for the stimulation. Results: The incidence of EFS is 2.38% (47/1968 cycles). Antagonist protocol group (76.59%, n = 36) had highest incidence of EFS (6.69%). Literature on EFS depicts decreased ovarian reserve (DOR) as the main cause, but only 4.25% of patients had DOR in our study. Interestingly, polycystic ovary syndrome and unexplained infertility were found in 31.9% of the cases. Serum anti-Müllerian hormone (AMH) levels (mean ± standard deviation [SD]) were 4.47 ± 3.54 ng/ml, and antral follicle count (AFC) was 15.30 ± 8.07 (mean ± SD) emphasizing that diminished ovarian reserve is not the main factor for EFS. All patients (n = 95) who underwent ovum pickup on day when any patient had EFS were taken as control. Patients with EFS were compared with controls. A statistically significant difference was not observed in serum AMH (P = 0.38) and AFC (P = 0.52). Conclusion: EFS is an uncommon event. Antagonist cycles have higher chances of empty follicle at ovum pickup. Looking at the profile of patients in this study, we conclude that EFS is not a manifestation of DOR.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Venus Dalal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanamail Perumal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Yadav V, Sharma JB, Kachhawa G, Kulshrestha V, Mahey R, Kumari R, Kriplani A. Obstetrical and perinatal outcome in pregnant women with extrapulmonary tuberculosis. Indian J Tuberc 2018; 66:158-162. [PMID: 30797275 DOI: 10.1016/j.ijtb.2018.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
Tuberculosis (TB) is a major health problem and a leading cause of illness and death from infectious disease. Tuberculosis in pregnancy has been associated with increased risks of prematurity and small for gestational age (SGA)infants.The present study is aimed to examine obstetrical and perinatal outcomes among women who had extra-pulmonary tuberculosis. MATERIAL AND METHODS It was retrospective study involving patient who presented with extra pulmonary tuberculosis over a period of ten years (2008-2017)was reviewed. Diagnosed women were compared with controls in the ratio of six controls for each case. Data included age, parity and complications in the antenatal, intrapartum and postpartum periods. The mean birth weights of infant and the frequency of small for gestation age, neonatal depression and still births were used for perinatal outcome. RESULTS During the period of study 30 pregnant women were booked for extra -pulmonary TB. 22/30(73.3%) were diagnosed having extra pulmonary -TB prior to pregnancy and were taking ATT (anti-tubercular therapy) during the pregnancy, in 8/30(26.6%) it was diagnosed during pregnancy. Age, parity were similar in two groups. There was significantly increased incidence of oligoamnios and preterm rupture of membrane (P = 0.001). Mean gestation age of delivery in TB cases was 36.15 ± 1.8 weeks as compared to37.5 ± 0.5 weeks in low risk patients (P = 0.001). The mean birth weight of the infants of mother with extra pulmonary TB was 2324.26 ± 379.5 grams and 2712.3 ± 635.7 for control group(P = 0.001). CONCLUSION This study emphasize on the need for early diagnosis and treatment of tuberculosis preferably before pregnancy, regular medical follow up and good perinatal care.
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Affiliation(s)
- Vikas Yadav
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - J B Sharma
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India.
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | | | - Reeta Mahey
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
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Goel T, Sharma J, Mahey R, Kachhawa G, Kriplani I, Kriplani A. Effect of Anti Tubercular Treatment on Laparoscopic Obstetrics and gynecology department at a hospital and Hysteroscopic Findings in Infertile Women with Genital Tuberculosis. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.695] [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: 11/29/2022]
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Mahey R, Gupta M, Kandpal S, Malhotra N, Vanamail P, Singh N, Kriplani A. Fertility awareness and knowledge among Indian women attending an infertility clinic: a cross-sectional study. BMC Womens Health 2018; 18:177. [PMID: 30373587 PMCID: PMC6206860 DOI: 10.1186/s12905-018-0669-y] [Citation(s) in RCA: 17] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022]
Abstract
Background To evaluate fertility knowledge and awareness among infertile women attending an Indian assisted fertility clinic and their understanding of the menstrual cycle, how age affects fertility and need for assisted fertility treatment. Methods A cross sectional study was conducted including 205 women seeking fertility treatment at an assisted reproductive unit between March 2017 to August 2017. Patients were interviewed with the help of structured questionnaire by a fertility counsellor. The previous studies were reviewed and a questionnaire was made according to our patient profile and sociodemographic characteristics. Knowledge and awareness was stratified according to socioeconomic status (SES). Results Most women (59%) were aged between 20 to 30 years indicating concern about their fertility and need for evaluation. More than half (63%) women were from the middle socio-economic strata. Knowledge about fertility and reproduction was low: 85% were not aware of the ovulatory period in the menstrual cycle, only 8% considered age more than 35 years as the most significant risk factor for infertility and most were unaware of when to seek treatment for infertility after trying for pregnancy. Less than half of women understood the need for assisted fertility treatment and donor oocytes in advanced age. Conclusions Most Indian women across different SES are unaware of the effect of age on fertility. Targeted educational interventions are needed to improve knowledge regarding ideal age of fertility, factors affecting fertility potential and fertility options available for sub-fertile couples. Fertility counselling and information should be provided to young people at every contact with health care professionals.
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Affiliation(s)
- Reeta Mahey
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monica Gupta
- Department of Obstetrics & Gynecology, Fellow Reproductive Medicine, All India Institute of Medical Sciences, Room no3076, Third Floor, Teaching Block, Ansari Nagar-, New Delhi, 110029, India.
| | - Shobha Kandpal
- Department of Obstetrics & Gynecology, Medical Social Service Officer, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Garg P, Jaryal AK, Kachhawa G, Deepak KK, Kriplani A. Estimation of asymmetric dimethylarginine (ADMA), placental growth factor (PLGF) and pentraxin 3 (PTX 3) in women with preeclampsia. Pregnancy Hypertens 2018; 14:245-251. [DOI: 10.1016/j.preghy.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/06/2018] [Accepted: 03/09/2018] [Indexed: 11/15/2022]
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Sharma JB, Yadav V, Mishra S, Kriplani A, Bhatla N, Kachhawa G, Kumari R, Toshayan V. Comparative study on maternal and fetal outcome in pregnant women with rheumatic heart disease and severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. Indian Heart J 2018; 70:685-689. [PMID: 30392507 PMCID: PMC6204450 DOI: 10.1016/j.ihj.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Mitral stenosis due to rheumatic heart disease is a common problem in India causing significant morbidity and mortality. We have compared the maternal and fetal outcome of women with severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. METHODS A total of 24 women of severe rheumatic mitral stenosis who underwent balloon mitral valvotomy before pregnancy (14 women, group 1) or during pregnancy (10 women, group 2) were included in the retrospective descriptive analysis. RESULTS The mean age was 25.5±3.6 yrs in group 1 and 25.7±3.5 yrs in group 2. There was no difference in characteristics -primigravidas, time since diagnosis from pregnancy, NYHA (New York Heart Association) class and associated medical problems in the two groups. There was significant difference in cardiac events during pregnancy in the two groups. New York Heart Association class deterioration was observed in only 3(21.4% women in group 1) as compared to all (10; 100% women) in group 2(p<0.001). The incidence of arrhythmias and atrial fibrillation was not different in two groups. Obstetric events were similar in the two groups. Mode of delivery and caesarean section rate was also similar in the two groups. There was no significant difference in mean birth weights (2399.75±601.8gm vs. 2641.70±580.6gm),rate of fetal growth restriction, still birth and congenital malformation rates in the two groups. CONCLUSION Percutaneous mitral valvotomy for patients with severe mitral stenosis can be safely performed during pregnancy and has equivalent maternal and fetal outcomes as that performed before pregnancy.
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Affiliation(s)
- J B Sharma
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India.
| | - Vikas Yadav
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - S Mishra
- Department of Cardiology, AIIMS, New Delhi, India
| | - A Kriplani
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Varnit Toshayan
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
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Karthik SDS, Kriplani A, Kachhawa G, Khadgawat R, Aggarwal N, Bhatla N. Comparison of Two Regimens of Gonadotropin-releasing Hormone Antagonists in Clomiphene-gonadotropin Induced Controlled Ovulation and Intrauterine Insemination Cycles: Randomized Controlled Study. J Hum Reprod Sci 2018; 11:148-154. [PMID: 30158811 PMCID: PMC6094528 DOI: 10.4103/jhrs.jhrs_92_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 12/04/2022] Open
Abstract
Context: Gonadotropin-releasing hormone (GnRH) antagonists in fixed or flexible regimens are used for prevention of premature luteinizing hormone (LH) surge, however, data comparing these regimens in stimulated intrauterine insemination (IUI) cycles are lacking. Aims: The aim of this study is to evaluate the effectiveness of GnRH antagonists in fixed and flexible regimens on the rate of premature luteinization (PL) and ovulation rate in sequential clomiphene-gonadotropin controlled ovulation–IUI cycles. Settings and Design: This study was conducted at tertiary care center; this was randomized controlled study. Materials and Methods: A total of 45 infertile women randomized into three groups of 15 each received clomiphene citrate + human menopausal gonadotrophin. GnRH antagonist was added according to fixed (n = 15) and flexible (n = 15) protocol. No antagonist in control group (n = 15). PL was defined as LH level ≥10 mIU/ml and progesterone level ≥1.0 ng/ml. Statistical Analysis: Mean values compared using the Student's t-test or one-way analysis of variance. Categorical variables distribution tested using either Pearson's Chi-square or Fisher's exact test as appropriate. Results: Of a total of 45 women, 58% (n = 26) presented with primary and 42% (n = 19) secondary infertility with mean age of 30.8 ± 3.43 years and BMI 26.57 ± 3.22 kg/m2. Fixed regimen (3.7%) showed most reduction in PL compared to flexible (15.38%, P = 0.33) or control (36.67%, P = 0.004). On human chorionic gonadotropin day, mean LH (P = 0.002) and progesterone (P = 0.079) levels in fixed, flexible, and control groups were as follows: 5.04 ± 5.47 mIU/ml, 3.95 ± 4.16 mIU/ml, 9.57 ± 7.91 mIU/ml, and 0.409 ± 0.320 ng/ml, 0.579 ± 0.727 ng/ml, and 1.033 ± 1.022 ng/ml, respectively. Ovulation (P = 0.813) and pregnancy rates (P = 0.99) were 88.9%, 84.6%, and 90% and 22.2%, 19.23%, and 10% in fixed, flexible, and control groups, respectively. Conclusions: Addition of antagonist in any regimen appears to lower PL rates and improve pregnancy rates in controlled ovarian stimulation and IUI cycles.
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Affiliation(s)
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Clinical Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nutan Aggarwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Kriplani A, Goyal M, Kachhawa G, Mahey R, Kulshrestha V. Etiology and management of primary amenorrhoea: A study of 102 cases at tertiary centre. Taiwan J Obstet Gynecol 2018; 56:761-764. [PMID: 29241916 DOI: 10.1016/j.tjog.2017.10.010] [Citation(s) in RCA: 6] [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] [Accepted: 06/28/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To determine the prevalence of etiologic causes of primary amenorrhea in Indian population. MATERIALS AND METHODS A retrospective study was performed using 102 complete medical records of women with primary amenorrhea who attended the Gynaecologic Endocrinology Clinic, Department of Obstetrics and Gynaecology, AIIMS, New Delhi from September 2012 to September 2015. Cases were analysed according to clinical profile, development of secondary sexual characteristics, physical examination, pelvic and rectal examination, X-ray of chest and lumbo-sacral spine, hormone profile, pelvic USG, MRI, and cytogenetic study including karyotype. RESULTS The three most common causes of primary amenorrhea were Mullerian anomalies (47%), gonadal dysgenesis (20.5%), and hypogonadotropic hypogonadism (14.7%) in the present study. There were 3 cases of Turner syndrome (45,XO), 5 cases of Swyer's syndrome (46,XY) and 2 cases of Androgen insensitivity syndrome (46,XY). One case had pituitary macroadenoma and eight cases (7.8%) were of genital tuberculosis. CONCLUSIONS The present study has currently been the largest case series of primary amenorrhea from North India. Mullerian anomaly is the most prevalent etiological factor leading to amenorrhoea followed by gonadal dysgenesis in our study. Racial, genetic and environmental factors could play role in the cause of primary amenorrhea.
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Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Manu Goyal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Basni Industrial Area, Jodhpur 342005, India.
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Kriplani A, Mahey R, Kachhawa G, Kriplani I, Goel T, Kalaivani M. Cesarean Myomectomy: Experience at a Tertiary-Care Center. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0135] [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: 11/12/2022] Open
Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Tuhina Goel
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Statistics, All India Institute of Medical Sciences, New Delhi, India
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Srivastava S, Mahey R, Kachhawa G, Bhatla N, Upadhyay AD, Kriplani A. Comparison of intramyometrial vasopressin plus rectal misoprostol with intramyometrial vasopressin alone to decrease blood loss during laparoscopic myomectomy: Randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2018; 228:279-283. [PMID: 30056355 DOI: 10.1016/j.ejogrb.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/17/2018] [Revised: 05/28/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of intramyometrial vasopressin plus rectal misoprostol with intramyometrial vasopressin alone to reduce blood loss during laparoscopic myomectomy. STUDY DESIGN A randomized, single-blind, controlled trial was conducted at All India Institute of Medical Sciences, New Delhi, India. Sixty women with symptomatic leiomyoma scheduled for laparoscopic myomectomy were recruited for the study. Thirty women received intramyometrial vasopressin plus rectal misoprostol (30 min before procedure) (Group I) and 30 women received intramyometrial vasopressin alone (Group II) during laparoscopic myomectomy. The primary outcome measure was intra-operative blood loss during surgery. Secondary outcome measures included decrease in postoperative haemoglobin, ease of enucleation of myomas, duration of surgery, need for additional haemostatic measures or blood transfusion, intra- and postoperative morbidity, and duration of hospital stay. RESULTS The baseline demographic features and characteristics of leiomyomas were comparable in both groups. The mean (±standard deviation) blood loss in Group I was 139 ± 96.7 ml, which was significantly less than that for Group II (206 ± 101.2 ml) (p = 0.008). The mean postoperative haemoglobin was 11.6 ± 1.3 g/dl in Group I and 10.0 ± 1.2 g/dl in Group II (p = 0.001). Although blood loss was not clinically significant in either group, the decrease in haemoglobin was significantly higher in Group II. The mean score for ease of enucleation (surgeon-rated measure) was significantly lower in Group I (2.6 ± 1.1) compared with Group II (3.4 ± 1.1) (p = 0.029). Intra- and postoperative vital signs, duration of surgery, need for blood transfusion and postoperative morbidity were comparable in both groups. CONCLUSIONS The addition of rectal misoprostol to intramyometrial vasopressin led to a significant reduction in blood loss and decreased the postoperative drop in haemoglobin. The combination also improved the ease of enucleation of myomas.
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Affiliation(s)
- Sonal Srivastava
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Makwana T, Takkar B, Venkatesh P, Sharma JB, Gupta Y, Chawla R, Vohra R, Kriplani A, Tandon N. Prevalence, progression, and outcomes of diabetic retinopathy during pregnancy in Indian scenario. Indian J Ophthalmol 2018; 66:541-546. [PMID: 29582816 PMCID: PMC5892058 DOI: 10.4103/ijo.ijo_1062_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 01/22/2023] Open
Abstract
Purpose The objective of this study is to evaluate pattern of diabetic retinopathy (DR) during pregnancy in females with pregestational diabetes mellitus (DM). Methods This is an ambispective observational cohort study conducted at an Indian tertiary care centre. A total of 50 pregnant females with pregestational DM were included while those with gestational DM were excluded from the study. Ocular examination (inclusive of fundus photography) was conducted and systemic parameters (inclusive of Glycated hemoglobin) were assessed during each of the 3 trimesters and 3 months postpartum. The prevalence and progression of DR during pregnancy in the study cohort were the main outcome measures. Results Three of the 50 patients had type 1 DM while 47 had type II DM. All the patients with type I DM were insulin dependent while 19 patients with type II DM were insulin dependent. Overall prevalence of DR was 8% (4/50); 2 cases had nonproliferative DR (NPDR), and 2 had proliferative DR (PDR). During the study period, worsening was seen in both the patients with PDR and one required vitrectomy. Mean visual acuity in patients with PDR decreased from 0.77 logMAR units at presentation to 1.23 logMAR at final follow-up. There was no change in the mean visual acuity of patients with NPDR. None of the patients with NPDR converted to PDR. There was no new onset DR in the patients without DR at presentation. Assessment of risk factors for DR revealed significantly higher duration of DM (14 ± 6.32 years vs. 3.43 ± 1.43 years, P = 0.0008). The median age was also higher in the DR patients (31 years vs. 29 years, P = 0.32). Conclusion No new onset cases were seen during the course of pregnancy and no conversion from NPDR to PDR was seen; however, a worsening of the two PDR cases was observed. No cases of DR were seen in noninsulin-dependent DM. None of the four participants with DR showed a spontaneous resolution of DR postpartum. Patients with PDR and long-standing DM require careful observation during pregnancy. A registry of diabetic mothers should be set up for development of guidelines for managing such cases.
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Affiliation(s)
- Tarjani Makwana
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
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Bhatla N, Nene BM, Joshi S, Esmy PO, Poli URR, Joshi G, Verma Y, Zomawia E, Pimple S, Prabhu PR, Basu P, Muwonge R, Hingmire S, Sauvaget C, Lucas E, Pawlita M, Gheit T, Jayant K, Malvi SG, Siddiqi M, Michel A, Butt J, Sankaran S, Kannan TPRA, Varghese R, Divate U, Willhauck-Fleckenstein M, Waterboer T, Müller M, Sehr P, Kriplani A, Mishra G, Jadhav R, Thorat R, Tommasino M, Pillai MR, Sankaranarayanan R. Are two doses of human papillomavirus vaccine sufficient for girls aged 15-18 years? Results from a cohort study in India. Papillomavirus Res 2018; 5:163-171. [PMID: 29578097 PMCID: PMC6047463 DOI: 10.1016/j.pvr.2018.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 01/08/2023]
Abstract
Extending two-dose recommendations of HPV vaccine to girls between 15 and 18 years will reduce program cost and improve compliance. Immunogenicity and vaccine targeted HPV infection outcomes were compared between 1795 girls aged 15-18 years receiving two (1-180 days) and 1515 girls of same age receiving three (1-60-180 days) doses. Immunogenicity outcomes in 15-18 year old two-dose recipients were also compared with the 10-14 year old three-dose (N = 2833) and two-dose (N = 3184) recipients. The 15-18 year old two-dose recipients had non-inferior L1-binding antibody titres at seven months against vaccine-targeted HPV types compared to three-dose recipients at 15-18 years and three-dose recipients at 10-14 years of age. Neutralizing antibody titres at 18 months in 15-18 year old two-dose recipients were non-inferior to same age three-dose recipients for all except HPV 18. The titres were inferior to those in the 10-14 year old three-dose recipients for all targeted types. Frequency of incident infections from vaccine-targeted HPV types in the 15-18 year old two-dose recipients was similar to the three dose recipients. None of the girls receiving two or three doses had persistent infection from vaccine-targeted types. These findings support that two doses of HPV vaccine can be extended to girls aged 15-18 years.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhagwan M Nene
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi District, Solapur, Maharashtra 413401, India
| | - Smita Joshi
- Jehangir Clinical Development Centre, Jehangir Hospital Premises, Pune 411001, India
| | - Pulikottil O Esmy
- Christian Fellowship Community Health Centre, Ambillikai (near Oddanchathram), Dindigul District, Tamil Nadu 624612, India
| | - Usha Rani Reddy Poli
- MNJ Institute of Oncology & Regional Cancer Center, Red Hills, Lakadikapul, Hyderabad, Andhra Pradesh 500004, India
| | - Geeta Joshi
- Gujarat Cancer & Research Institute (GCRI), M.P. Shah Cancer Hospital, Civil Hospital Campus, Asarwa, Ahmedabad 380016, India
| | - Yogesh Verma
- Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim 737101, Sikkim, India
| | | | - Sharmila Pimple
- Department of Preventive Oncology, Tata Memorial Center, Tata Memorial Hospital & Cancer Research Inst, Parel, Mumbai 400012, India
| | - Priya R Prabhu
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram, 695014 Kerala, India
| | - Partha Basu
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, 50 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Richard Muwonge
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, 50 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Sanjay Hingmire
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi District, Solapur, Maharashtra 413401, India
| | - Catherine Sauvaget
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, 50 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Eric Lucas
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, 50 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Michael Pawlita
- Infection, inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany
| | - Tarik Gheit
- Section of Infections and Cancer Biology, International Agency for Research on Cancer, Lyon, France
| | - Kasturi Jayant
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi District, Solapur, Maharashtra 413401, India
| | - Sylla G Malvi
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi District, Solapur, Maharashtra 413401, India
| | - Maqsood Siddiqi
- Cancer Foundation of India, Kolkata, West Bengal 700039, India
| | - Angelika Michel
- Infection, inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany
| | - Julia Butt
- Infection, inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany
| | - Subha Sankaran
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram, 695014 Kerala, India
| | | | - Rintu Varghese
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram, 695014 Kerala, India
| | - Uma Divate
- Jehangir Clinical Development Centre, Jehangir Hospital Premises, Pune 411001, India
| | - Martina Willhauck-Fleckenstein
- Infection, inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany
| | - Tim Waterboer
- Infection, inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany
| | - Martin Müller
- Infection, inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany
| | - Peter Sehr
- EMBL-DKFZ Chemical Biology Core Facility, European Molecular Biology Laboratory, D-69117 Heidelberg, Germany
| | - Alka Kriplani
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Gauravi Mishra
- Department of Preventive Oncology, Tata Memorial Center, Tata Memorial Hospital & Cancer Research Inst, Parel, Mumbai 400012, India
| | - Radhika Jadhav
- Jehangir Clinical Development Centre, Jehangir Hospital Premises, Pune 411001, India
| | - Ranjit Thorat
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi District, Solapur, Maharashtra 413401, India
| | - Massimo Tommasino
- Section of Infections and Cancer Biology, International Agency for Research on Cancer, Lyon, France
| | - M Radhakrishna Pillai
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram, 695014 Kerala, India
| | - Rengaswamy Sankaranarayanan
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, 50 cours Albert Thomas, 69372 Lyon Cedex 08, France.
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Kriplani A, Karthik SDS, Kriplani I, Kachhawa G. Laparoscopic Peritoneal Vaginoplasty for Mayer–Rokitansky–Küster–Hauser Syndrome: An Experience at a Tertiary Care Center. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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