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Research Journal of Obstetrics and Gynecology
eISSN: 2077-222X
pISSN: 1994-7925

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Research Article
Robson Ten Group Classification System for Analysis of Cesarean Sections in an Indian Hospital
Arpita Y. Reddy, Anita Dalal and Romana Khursheed
Background and Aim: Cesarean section (CS) is the most commonly performed life-saving procedure. However, CS is associated with its own risks for maternal and perinatal morbidity and mortality in present as well as subsequent pregnancies. There is increase in cesarean section rates globally. Cesarean section audits are an important tool to understand and make recommendations for a possible reduction in cesarean delivery rates. Hence, the current study analyzed leading groups contributing to high cesarean section rates at a teaching hospital, by using Robson’s Ten Group Classification System (RTGCS). Materials and Methods: The present study was conducted in the Department of Obstetrics and Gynecology at teaching hospital attached to KLE Academy of Higher Education’s Jawaharlal Nehru Medical College, Belagavi, Karnataka, India. All the pregnant women who delivered ‘between’ January, 2016 to December, 2016 in the labour wards were included in the study and classified according to Robson’s Ten Group Classification System (RTGCS). Results: A total of 6236 women were delivered. Out of which 3454 (55.38%) women delivered vaginally and 2782 (44.61%) women delivered through cesarean section. In this study, Group 5 was the largest contributor to the cesarean section rate 18.6% whereas, group 1 was second highest (8.1%). Group 1 (31.9%) and 3 (21.4%) contributed to most of the obstetric populations. However, Group 6, 7, 8 and 9 contribution to overall cesarean section rate was 1.7, 1.2, 1.4 and 0.5%, respectively. Group 10 also contributing significantly to cesarean section rate (4.4%). Conclusion: The study revealed that Group 1, 2 and 5 contributed to high cesarean section rate. Thus, changing the norms for non-progress of labour and fetal distress, training and encouraging obstetricians to perform versions when not contraindicated could reduce the cesarean section rate. Trial of Labour after Cesarean (TOLAC) should be offered to women with previous CS after proper patient selection and counseling the pregnant women regarding its risks and benefits.
Research Article
Relationships of Malondialdehid and Sflt-1 with Maternal and Neonatal Outcome in Preeclampsia: An Observational Analytic Study
Ariadi , Yusrawati and Joserizal Serudji
Background and Objective: Increased Malondialdehyde (MDA) will cause endothelial damage and dysfunction. Soluble fms-like tyrosine kinase-1 (sFlt1) is known increase in amniotic fluid in preeclamptic patients. This study was aimed to determine the relationship between MDA and sFlt1 with maternal and neonatal outcome in preeclampsia. Materials and Methods: This was an observational analytic study with cross sectional study design. The sample size was 35 samples of pregnant women with preeclampsia. Sampling was done by consecutive sampling, from obstetrician’s practice at RSUP. Dr. M. Djamil Padang, RSI. Ibnu Sina Padang and RSU. BMC Padang. After maternal and neonatal examination and measurements MDA and sFlt1 levels of cubital venous blood by using Enzyme-Linked Immunosorbent Assay (ELISA) method, Pearson correlation was performed to assess the relationship between variables for normally distributed data and Spearman’s correlation for abnormal distribution data with significance level p<0.05. Result: This study found MDA associations with maternal and neonatal outcomes were systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), infant weight, infant length, apgar score I and apgar score II which obtained p<0.001, r = 0.587, p = 0.011, r = 0.356, p<0.001, r = 0.497, p = 0.005, r = 0.393, p = 0.001, r = 0.448, p = 0.063, r = 0.265 and p = 0.020, r = 0.328. The relationship of sFlt1 with maternal and neonatal outcome found p = 0.984, r = 0.003, p = 0.783, r = 0.040, p = 0.758, r = 0.045, p = 0.471, r = 0.104, p = 0.292, r = 0.152, p = 0.639, r = 0.068 and p = 0.707, r = 0.055. Conclusion:There was relationship between MDA with maternal and neonatal outcomes except for apgar score in the first minute. There was no relationship between sFlt1 with materal and neonatal outcome.
Research Article
Effect of Synbiotic on Interleukin 10 and Tumor Necrosis Factor-α Serum Level in Pregnant Women with Bacterial Vaginosis
Natami Dewi Ratih, Aditya Zulfikar, St. Maisuri T. Chalid, Fatmawati Madya, Sharvianty Arifuddin and Nasrum Massi
Background and Objective: Bacterial Vaginosis (BV) is the bacterial infection commonly found in women within reproductive age with 19-24(%) of availability. The aim of this study is to determine the effect of synbiotic on IL-10 and TNF-α serum level in pregnant women with bacterial vaginosis. Materials and Methods: This study was followed by 44 pregnant women with bacterial vaginosis diagnosed by Amsel criteria and the inclusion and exclusion criteria. Sample group consists of 22 women who receive synbiotic and standard treatment and the control group consists of 22 women who receive placebo and standard treatment. Results: All women are followed up for 2 weeks after treatment is started. The change of mean difference of IL-10 before and after treatment in sample group is -321.38±625.71 and in control group is -182.65±473.16. The data are analyzed using Mann-Whitney test with p-value 0.302. This study shows significantly elevated of IL-10 serum level in both groups after treatment. Although in the sample group indicates more elevated of IL-10 serum level after treatment, this difference is not significant between both groups. The change of mean difference of TNF-α before and after treatment in sample group is 100.37±119.57 and in control group is 80.16±134.81. The data are analyzed using Mann-Whitney test with p-value 0.189. Conclusion: This study shows the significant derivation of TNF-α serum level in both groups after treatment. Although in the sample group indicates more derivation of TNF-α serum level after treatment, this difference is not significant in both groups.
Research Article
Subclinical Hypothyroidism Effect on Interpretation of Nuchal Translucency Early in Pregnancy
Fatin n Shallal Farha, Ban Hadi Hameed and Miami Abdul Hassan Ali
Background and Objectives: Subclinical and overt hypothyroidism represent major health problems with an increasing prevalence and a potential serious impact on mother health. It affects the measurement of nuchal translucency to the degree that forced the obstetricians to re-evaluate it as a single screening test for aneuploidies and encouraged them toward the use of other maternal serum markers early in pregnancy. To clarify the effect of subclinical hypothyroidism on the interpretation of nuchal Translucency in early pregnancy. Materials and Methods: A prospective comparative case control study was conducted at the out patients clinic of the Obstetrical Department at Al-Yarmouk Teaching Hospital from the 1st of September 2016 to the 1st of September 2018. About 140 pregnant women were enrolled in the study; 100 of them were apparently healthy pregnant women in their first trimester (11-13+6 weeks) assigned as a control group and the other 40 were pregnant women of the same gestational age diagnosed as having subclinical hypothyroidism after thyroid function screening of 500 pregnant women who attended this tertiary hospital and were assigned as patient group. Ultrasound measurement of the crown ramp length and nuchal translucency had been done for all participants. The data from both groups were statistically analyzed and compared. Results: Forty patients had subclinical hypothyroidism from a total of 500 women screened (8%). The mean measurement of nuchal translucency was significantly higher in the patient group compared to control group (2.92±0.96 versus 2.45±0.62 mm, respectively) and there was a significant positive linear correlation between nuchal translucency (NT) and thyroid stimulating hormone (TSH) level. All those with abnormally raised nuchal translucency delivered healthy fetuses. Conclusion: Subclinical hypothyroidism might affect the interpretation of nuchal translucency and reduce its significance as a screening test in that population.
Research Article
Hypertriglyceridemia and Waist Phenotype as Markers in the Prediction of Gestational Diabetes in Iraqi Women
Faris Anwer Rasheed, Raghad Hasan Mshattat, Ulfat Mohammad Alnakkash and Saad Abdulrahman Hussain
Background and Objective: Abdominal visceral adiposity in early pregnancy can be considered as an indicator of the risk of impaired glucose tolerance in later pregnancy. Accordingly, the "hypertriglyceridemic waist" phenotype can be utilized as a clinical marker of visceral obesity. The present study aimed to assess the association between the hypertriglyceridemic- waist phenotype in early pregnancy and glucose intolerance in later pregnancy. Materials and Methods: A case-control study was carried out at AL-Elweyia Maternity Teaching Hospital for one year from 1st of January, 2012 to the 1st of January, 2013. A 100 pregnant women were enrolled in this study. The women were allocated according to the waist girth equal to or greater than 85 cm and less than 85 cm. Plasma triglycerides and waist girth were measured at 11-14 weeks of gestation for all groups. Blood glucose was measured following a 75 g oral glucose tolerance test performed at 24-28 weeks of gestation. Results: A waist girth greater than 85 cm and a triglyceride level > 1.7 mmol L1 in the first trimester was associated with an increased risk of 2 h glucose > 7.8 mmol L1 following the 75 g oral glucose tolerance test (OR 7.75, p = 0.0003). This risk remains significant, even after the sample was controlled for maternal age and fasting glucose in the first trimester. Conclusion: Measurement of waist girth and plasma triglycerides levels (hyper-triglyceridemic-waist phenotype) during the early pregnancy may be useful as an early screening for the risk of gestational diabetes.
Research Article
Screening of Urinary Incontinence in Female Dancers-A Cross Sectional Study
Arati Mahishale, Rafat Khalid Hussain Jamadar, Rajendra Bapusaheb Nerli and Shridhar Chandrakant Ghagane
Background and Objective: Urinary Incontinence (UI) is involuntary loss of urine which lead to withdrawal from activities and is considered as a barrier for life-long participation in various activities. Hence, study aimed to know the incidence of urinary incontinence in female dancers to that of non-dancers of same age group in Belagavi city. The study also aimed to find the correlation between the type of dance, intensity of dance and BMI of dancers to that of urinary incontinence. Materials and Methods: An open ended sample of female dancers, practicing various dance forms at recreational, competitive center and physiotherapy department with age ranging from 18-25 years were screened for UI for duration of six months. Results: Overall, 124 females were screened out of which 62 subjects were dancers and 62 were non dancers (age matched control) and 14 female dancers (22.5%) reported urine loss while participating in their various dance forms. Hip hop had highest incidence about 50% incontinence followed with Bharatnatyam 28% with p<0.0015. The BMI of dancers with respect to dance was evaluated and p<0.001. Urinary incontinence according to training period in 1-5 years, 6-10 years and >11 years training period groups was 18.18, 27.59 and 18.18% with p<0.0002, respectively and suggested that urinary incontinence increases with respect to training period. Conclusion: The study concluded that 22.5% of female dancers experienced urinary incontinence, BMI and training period of dancers showed to have positive correlation with urinary incontinence.
Research Article
Serum Irisin, Level and Validity in Gestational Diabetes Mellitus in Iraqi Women: A Pilot Study
Fadia Jasim Alizzi and Hind Abdul Khaliq Showman
Background and Objective: Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy and associated with increase rates of maternal and perinatal problems. Irisin is a novel adipomyokin which plays a role in carbohydrate and fat metabolism, insulin response and inflammatory response. To assess serum level of irisin, cut off level and its correlation with different anthropometric and biochemical parameter in pregnant women with GDM. Materials and Methods: case control study conducted at AL-Yarmouk teaching hospital/Al-Mustansiriyah medical college in the period from April, 2017-April, 2018. One hundred pregnant women with comparable age, gestational age and body mass index were enrolled, 50 pregnant women with GDM (study group) and 50 normal pregnant women (control group). Serum irisin level was measured by enzyme-linked immunosorbent assay kit at 24-28 weeks of pregnancy and assessed in correlation with BMI, Hb A1c, fasting insulin and Oral Glucose Tolerance Test (OGTT). Results: Serum Irisin level was significantly lower in gestational diabetic women in comparison with healthy pregnant women (1.6±0.4 vs. 2.6±0.7 μg L1) with p-value <0.001.It was independently low in correlation with BMI, serum insulin and OGTT. The cutoff value of serum Irisin in determining gestational diabetes was 2.145 μg L1 with overall 87.0% accuracy. Conclusion: Serum irisin was significantly and independently low in women with GDM. Its cutoff level may be used as biochemical marker in the diagnosis and screening of GDM.
Review Article
Effect of Cadmium on Female Reproduction and Treatment Options
Olaolu Tomilola Debby
Cadmium is a toxic heavy metal that has no known advantageous role to humans. It poses a major public health issue to living organisms and it particularly has detrimental effects on the reproductive system of females. This review was aimed at highlighting the effects of cadmium on the reproductive system of females and the remedy options available. Heavy metals are a heterogenous group of elements that form amphoteric oxides and metalloids, transition element and rare earth metals which are grouped into lanthanides and actinides. They are naturally found in the earth crust but their accumulation in the atmosphere is increased as a result of natural and human activities. Cadmium is mostly used in industrial procedures like mining, plastic stabilizers, pigment production, nickel-cadmium battery production, refining of copper, zinc and lead ores. Humans are exposed to cadmium by direct exposure and inhalation through cigarette smoking or ingestion of contaminated food or water. Some effects of cadmium on female reproduction includes alteration of steroidogenesis, delay in puberty and/or menarche, pregnancy loss, disorders of the menstrual cycle and reproductive hormones and premature birth and reduced birth weights. There were no specific therapies directed at treating only the reproductive effect of cadmium poisoning in humans, however, cadmium poisoning has been remedied with orthodox medicines, the use of metal chelators which can be taken orally or administered intravenously. In addition, antioxidants supplementations and the use of plants are being explored and have displayed some therapeutic roles against the detrimental effects of cadmium on living organisms.

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