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Papers by Aparajita D'souza
CHRISMED Journal of Health and Research, 2015
The risk of renal arteriovenous malformations (AVMs) must be kept in mind as a cause as sudden he... more The risk of renal arteriovenous malformations (AVMs) must be kept in mind as a cause as sudden hematuria in patients with previous renal injury. Treatment of renal AVMs has evolved from nephrectomy to angioembolization, as it allows good control bleeding while preserving maximum renal function and appears to be the first treatment of choice. Hence, angioembolization facilities must be available in centers dealing with renal trauma.
The Journal of Obstetrics and Gynecology of India, Jan 7, 2023
Background COVID-19 pandemic led to an alarming rise in sickness absenteeism among the radiologis... more Background COVID-19 pandemic led to an alarming rise in sickness absenteeism among the radiologists. Anticipating a continued shortage of experienced radiologists in future COVID waves, it is essential to train the medical professionals in basic skills related to ultrasonography to enable them to perform basic Obstetrics and Gynecology (OG) scans safely in emergencies. Virtual reality simulation training is an alternative to conventional ultrasound training. Methods A cross-sectional study was conducted during 8-day-long workshop to identify the trainees' basic, after training knowledge and skills in OG ultrasound and to document their perceptions of the training. Statistical analysis was done using descriptive statistics (percentages and mean standard deviations) and paired t test for comparisons. Results A total of 80 health care professionals underwent ultrasound simulation training. It was found that the post-test score in the knowledge domain, instrument handling, basic gynecological skills, and first-trimester antenatal ultrasound skills in the practical domain was significantly higher than the pre-test score (P-value < 0.0001). Out of 80 participants, 45 (56.25%) agreed that ultrasound simulation is an ideal method of teaching and training basic OG skills to the novice. Sixty-six out of 80 (82.5%) felt that the principles of handling a human mannequin are the same as those of real patients. Forty-eight participants out of 80 (60.0%) felt that ultrasound simulation can be used as an ideal tool for self-assessment of health care professionals. Conclusion The study showed that ultrasound-based simulation can provide a realistic setting for training and assessment of novices in learning basic skills.
Objective: To determine the frequency, causes and outcome of liver disease in pregnant women STUD... more Objective: To determine the frequency, causes and outcome of liver disease in pregnant women STUDY DESIGN: This retrospective cohort study was conducted in the Department of Obstetrics and Gynecology, in a tertiary hospital in Punjab between January 2014 and December 2014. Medical records of all pregnant patients who were admitted to our department with pre-existing liver disease or those suspected to have liver dysfunction on the basis of clinical and /or laboratory data were reviewed and analyzed statistically. RESULT: During the study period, there were 1528 deliveries in the hospital and 51 pregnant women were diagnosed to have liver disorders giving an overall incidence of 3.3%. Cholestasis of pregnancy was the commonest cause accounting for 54.9% of cases, followed by hypertensive disorders/HELLP (21.6%) and viral hepatitis (19.6%). Hepatitis E infection was most common cause for viral hepatitis (11.8%). DIC (33.3%) was most common maternal complication. There was one maternal...
Background: Preterm premature rupture of the membranes (PPROM) is a known dreaded complication of... more Background: Preterm premature rupture of the membranes (PPROM) is a known dreaded complication of pregnancy as it is associated with significant perinatal complications. The objective of our study was to bring forward the incidence and feto-maternal outcome in pregnancies with PPROM in Indian scenario. Methods: This retrospective cohort study was conducted in the Department of Obstetrics and Gynecology, in a tertiary hospital in Punjab between January 2014 and December 2014. Medical records of all pregnant patients who were admitted to our department with PPROM on the basis of clinical and /or laboratory data were reviewed. These 75 women were divided into two groups according to gestation age (GA), Group 1- early PPROM (24- 33 6/7 weeks of GA) (n=38) and Group 2- late PPROM (34-36 6/7 weeks of GA) (n=37). A multivariate analysis was used to find the association between PPROM and perinatal outcome. Results: During the study period, there were 1528 deliveries in the hospital and 75 p...
Benign metastasising leiomyomatosis is a rare condition affecting women in the reproductive age-g... more Benign metastasising leiomyomatosis is a rare condition affecting women in the reproductive age-group with a history of uterine fibroids, who have undergone treatment by myomectomy or hysterectomy. It is characterised by development of multiple, indolent, smooth muscle tumours outside the uterus, most commonly in the lungs, and manifests several years after the uterine surgery. We describe the case of a young woman, who had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy for multiple fibroids and a right ovarian cyst. After 5 years of being on oestrogen replacement therapy, she was detected to have benign metastasising leiomyoma, for which an additional laparotomy was performed. At laparotomy, removal of the pelvic mass was associated with several complications. The metastatic lesions in the lung responded well to progestogens (megestrol acetate) alone as evidenced by regression of the lesions detected at follow-up after 6 months and 1 year.
World Journal of Laparoscopic Surgery with DVD, 2017
Introduction: Osseous metaplasia of endometrium is a rare disorder characterized by the presence ... more Introduction: Osseous metaplasia of endometrium is a rare disorder characterized by the presence of mature or immature bone in the endometrium. The rarity of the case and high probability of missing out, which may lead to delay in appropriate treatment, makes this case of interest. Case report: A 37-year-old lady, married for 10 years P2L2 with previous two lower-segment cesarean section, presented to the gynecology outpatient department with complaints of secondary infertility for past 7 years, irregular menstrual cycles, dysmenorrhea, and dyspareunia. Her general examination and bimanual exploration were normal. On ultrasonography, an echogenic foci was seen casting posterior acoustic shadow. On diagnostic laparohysteroscopy, multiple small coral-like white plaques-bony spicules were seen. They were removed using hysteroscopic forceps and submitted for histopathological study. A histological diagnosis of osseous metaplasia of endometrium was made. She is on follow-up for infertility treatment. Conclusion: Endometrial ossification is a rare finding, which can be misdiagnosed and requires higher degree of suspicion to diagnose the condition properly. Hysteroscopy has been shown to be effective in the diagnosis and treatment of cases of osseous metaplasia of the endometrium associated with infertility.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2015
The roll-over test was first described by Grant et al. It is based on the observation that signif... more The roll-over test was first described by Grant et al. It is based on the observation that significant supine hypertension is present for a period of 8 to 10 weeks prior to the onset of preeclampsia. The results of the roll-over test were highly variable among different investigations and there was poor reproducibility even in the same patient.
Journal of Research in Medical Education & Ethics
Hong Kong Medical Journal Xianggang Yi Xue Za Zhi Hong Kong Academy of Medicine, Apr 1, 2012
Benign metastasising leiomyomatosis is a rare condition affecting women in the reproductive age-g... more Benign metastasising leiomyomatosis is a rare condition affecting women in the reproductive age-group with a history of uterine fibroids, who have undergone treatment by myomectomy or hysterectomy. It is characterised by development of multiple, indolent, smooth muscle tumours outside the uterus, most commonly in the lungs, and manifests several years after the uterine surgery. We describe the case of a young woman, who had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy for multiple fibroids and a right ovarian cyst. After 5 years of being on oestrogen replacement therapy, she was detected to have benign metastasising leiomyoma, for which an additional laparotomy was performed. At laparotomy, removal of the pelvic mass was associated with several complications. The metastatic lesions in the lung responded well to progestogens (megestrol acetate) alone as evidenced by regression of the lesions detected at follow-up after 6 months and 1 year.
Obstetrics & Gynecology, 1997
OBJECTIVE: To compare the efficacy and safety of two prostaglandin derivatives, misoprostol and d... more OBJECTIVE: To compare the efficacy and safety of two prostaglandin derivatives, misoprostol and dinoprostone, for ripening the cervix and inducing labor in women with an unfavorable cervix. METHODS: One hundred fifty-five women admitted for induction of ...
International Journal of Research in Medical Sciences, 2015
A stillbirth is defined as the birth of a dead fetus that has reached 20 weeks of gestation or mo... more A stillbirth is defined as the birth of a dead fetus that has reached 20 weeks of gestation or more, or has a birth weight of 500 g or more but for international comparisons 28 weeks is more common as the lower limit of gestational age. 1,2 The rates of stillbirth remain highest in developing countries but are likely underestimated due to poor access to obstetric care and limited recordkeeping. 3 Stillbirth rates range from 3.1/1,000 births in developed countries to 28.3 in developing countries. 4 The wide range of stillbirth statistics may act as an indicator of the quality of the country's medical system. It also reflects the quality of antenatal care and obstetric management during labor and childbirth. 5,6 A stillbirth is emotionally devastating for the patients and the clinicians and many of these are preventable. Most often, the cause of the stillbirth cannot be identified. The known aetiologies are fetal (e.g. congenital malformations, infections); placental (e.g. insufficiency, abruption); or maternal (e.g. infections, diabetes mellitus). 7,8 There is a need for research on stillbirths and its associated risk factors as many countries lack data on this. 7
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2015
Background: Preterm Prelabour Rupture of Membranes (PPROM) is a leading cause of maternal and neo... more Background: Preterm Prelabour Rupture of Membranes (PPROM) is a leading cause of maternal and neonatal morbidity and mortality. The objective of our study was to bring forward the association between genitourinary infections and PPROM in Indian scenario. Methods: This retrospective case-control study was conducted in the Department of Obstetrics and Gynecology, in a tertiary referral teaching hospital in Punjab. A total of 150 women were evaluated for genitourinary infections and their association with PPROM. Cases group 1 (n=75) included pregnant females with diagnosis of PPROM based on history and vaginal examination. Control group 2 (n=75) included pregnant women admitted to labour room at 37 completed weeks of gestation or more and with no history of PPROM. The control group was matched to case group with respect to age and parity. Case to control ratio was taken as 1:1. A multivariate analysis was used to find the association between PPROM and genitourinary infections. Microsoft Excel and the Statistical Package for the Social Sciences (SPSS), Version 21 were used for data analysis. A P value of <0.05 was determined to be statistically significant. Results: In our study genitourinary infections were seen in 16 women in Case Group 1 (21.3%), compared to 7 women in Control Group (9.3%). Genitourinary infections were associated significantly with PPROM (p 0.02) (odds ratio [OR], 2.618; 95% Confidence interval [CI], 1.021-7.239). Conclusions: Screening for genitourinary infections should be considered especially in high risk cases. Early recognition and prompt treatment of genitourinary infections is the key to optimize the maternal and fetal outcome in PPROM.
CHRISMED Journal of Health and Research, 2015
The risk of renal arteriovenous malformations (AVMs) must be kept in mind as a cause as sudden he... more The risk of renal arteriovenous malformations (AVMs) must be kept in mind as a cause as sudden hematuria in patients with previous renal injury. Treatment of renal AVMs has evolved from nephrectomy to angioembolization, as it allows good control bleeding while preserving maximum renal function and appears to be the first treatment of choice. Hence, angioembolization facilities must be available in centers dealing with renal trauma.
The Journal of Obstetrics and Gynecology of India, Jan 7, 2023
Background COVID-19 pandemic led to an alarming rise in sickness absenteeism among the radiologis... more Background COVID-19 pandemic led to an alarming rise in sickness absenteeism among the radiologists. Anticipating a continued shortage of experienced radiologists in future COVID waves, it is essential to train the medical professionals in basic skills related to ultrasonography to enable them to perform basic Obstetrics and Gynecology (OG) scans safely in emergencies. Virtual reality simulation training is an alternative to conventional ultrasound training. Methods A cross-sectional study was conducted during 8-day-long workshop to identify the trainees' basic, after training knowledge and skills in OG ultrasound and to document their perceptions of the training. Statistical analysis was done using descriptive statistics (percentages and mean standard deviations) and paired t test for comparisons. Results A total of 80 health care professionals underwent ultrasound simulation training. It was found that the post-test score in the knowledge domain, instrument handling, basic gynecological skills, and first-trimester antenatal ultrasound skills in the practical domain was significantly higher than the pre-test score (P-value < 0.0001). Out of 80 participants, 45 (56.25%) agreed that ultrasound simulation is an ideal method of teaching and training basic OG skills to the novice. Sixty-six out of 80 (82.5%) felt that the principles of handling a human mannequin are the same as those of real patients. Forty-eight participants out of 80 (60.0%) felt that ultrasound simulation can be used as an ideal tool for self-assessment of health care professionals. Conclusion The study showed that ultrasound-based simulation can provide a realistic setting for training and assessment of novices in learning basic skills.
Objective: To determine the frequency, causes and outcome of liver disease in pregnant women STUD... more Objective: To determine the frequency, causes and outcome of liver disease in pregnant women STUDY DESIGN: This retrospective cohort study was conducted in the Department of Obstetrics and Gynecology, in a tertiary hospital in Punjab between January 2014 and December 2014. Medical records of all pregnant patients who were admitted to our department with pre-existing liver disease or those suspected to have liver dysfunction on the basis of clinical and /or laboratory data were reviewed and analyzed statistically. RESULT: During the study period, there were 1528 deliveries in the hospital and 51 pregnant women were diagnosed to have liver disorders giving an overall incidence of 3.3%. Cholestasis of pregnancy was the commonest cause accounting for 54.9% of cases, followed by hypertensive disorders/HELLP (21.6%) and viral hepatitis (19.6%). Hepatitis E infection was most common cause for viral hepatitis (11.8%). DIC (33.3%) was most common maternal complication. There was one maternal...
Background: Preterm premature rupture of the membranes (PPROM) is a known dreaded complication of... more Background: Preterm premature rupture of the membranes (PPROM) is a known dreaded complication of pregnancy as it is associated with significant perinatal complications. The objective of our study was to bring forward the incidence and feto-maternal outcome in pregnancies with PPROM in Indian scenario. Methods: This retrospective cohort study was conducted in the Department of Obstetrics and Gynecology, in a tertiary hospital in Punjab between January 2014 and December 2014. Medical records of all pregnant patients who were admitted to our department with PPROM on the basis of clinical and /or laboratory data were reviewed. These 75 women were divided into two groups according to gestation age (GA), Group 1- early PPROM (24- 33 6/7 weeks of GA) (n=38) and Group 2- late PPROM (34-36 6/7 weeks of GA) (n=37). A multivariate analysis was used to find the association between PPROM and perinatal outcome. Results: During the study period, there were 1528 deliveries in the hospital and 75 p...
Benign metastasising leiomyomatosis is a rare condition affecting women in the reproductive age-g... more Benign metastasising leiomyomatosis is a rare condition affecting women in the reproductive age-group with a history of uterine fibroids, who have undergone treatment by myomectomy or hysterectomy. It is characterised by development of multiple, indolent, smooth muscle tumours outside the uterus, most commonly in the lungs, and manifests several years after the uterine surgery. We describe the case of a young woman, who had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy for multiple fibroids and a right ovarian cyst. After 5 years of being on oestrogen replacement therapy, she was detected to have benign metastasising leiomyoma, for which an additional laparotomy was performed. At laparotomy, removal of the pelvic mass was associated with several complications. The metastatic lesions in the lung responded well to progestogens (megestrol acetate) alone as evidenced by regression of the lesions detected at follow-up after 6 months and 1 year.
World Journal of Laparoscopic Surgery with DVD, 2017
Introduction: Osseous metaplasia of endometrium is a rare disorder characterized by the presence ... more Introduction: Osseous metaplasia of endometrium is a rare disorder characterized by the presence of mature or immature bone in the endometrium. The rarity of the case and high probability of missing out, which may lead to delay in appropriate treatment, makes this case of interest. Case report: A 37-year-old lady, married for 10 years P2L2 with previous two lower-segment cesarean section, presented to the gynecology outpatient department with complaints of secondary infertility for past 7 years, irregular menstrual cycles, dysmenorrhea, and dyspareunia. Her general examination and bimanual exploration were normal. On ultrasonography, an echogenic foci was seen casting posterior acoustic shadow. On diagnostic laparohysteroscopy, multiple small coral-like white plaques-bony spicules were seen. They were removed using hysteroscopic forceps and submitted for histopathological study. A histological diagnosis of osseous metaplasia of endometrium was made. She is on follow-up for infertility treatment. Conclusion: Endometrial ossification is a rare finding, which can be misdiagnosed and requires higher degree of suspicion to diagnose the condition properly. Hysteroscopy has been shown to be effective in the diagnosis and treatment of cases of osseous metaplasia of the endometrium associated with infertility.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2015
The roll-over test was first described by Grant et al. It is based on the observation that signif... more The roll-over test was first described by Grant et al. It is based on the observation that significant supine hypertension is present for a period of 8 to 10 weeks prior to the onset of preeclampsia. The results of the roll-over test were highly variable among different investigations and there was poor reproducibility even in the same patient.
Journal of Research in Medical Education & Ethics
Hong Kong Medical Journal Xianggang Yi Xue Za Zhi Hong Kong Academy of Medicine, Apr 1, 2012
Benign metastasising leiomyomatosis is a rare condition affecting women in the reproductive age-g... more Benign metastasising leiomyomatosis is a rare condition affecting women in the reproductive age-group with a history of uterine fibroids, who have undergone treatment by myomectomy or hysterectomy. It is characterised by development of multiple, indolent, smooth muscle tumours outside the uterus, most commonly in the lungs, and manifests several years after the uterine surgery. We describe the case of a young woman, who had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy for multiple fibroids and a right ovarian cyst. After 5 years of being on oestrogen replacement therapy, she was detected to have benign metastasising leiomyoma, for which an additional laparotomy was performed. At laparotomy, removal of the pelvic mass was associated with several complications. The metastatic lesions in the lung responded well to progestogens (megestrol acetate) alone as evidenced by regression of the lesions detected at follow-up after 6 months and 1 year.
Obstetrics & Gynecology, 1997
OBJECTIVE: To compare the efficacy and safety of two prostaglandin derivatives, misoprostol and d... more OBJECTIVE: To compare the efficacy and safety of two prostaglandin derivatives, misoprostol and dinoprostone, for ripening the cervix and inducing labor in women with an unfavorable cervix. METHODS: One hundred fifty-five women admitted for induction of ...
International Journal of Research in Medical Sciences, 2015
A stillbirth is defined as the birth of a dead fetus that has reached 20 weeks of gestation or mo... more A stillbirth is defined as the birth of a dead fetus that has reached 20 weeks of gestation or more, or has a birth weight of 500 g or more but for international comparisons 28 weeks is more common as the lower limit of gestational age. 1,2 The rates of stillbirth remain highest in developing countries but are likely underestimated due to poor access to obstetric care and limited recordkeeping. 3 Stillbirth rates range from 3.1/1,000 births in developed countries to 28.3 in developing countries. 4 The wide range of stillbirth statistics may act as an indicator of the quality of the country's medical system. It also reflects the quality of antenatal care and obstetric management during labor and childbirth. 5,6 A stillbirth is emotionally devastating for the patients and the clinicians and many of these are preventable. Most often, the cause of the stillbirth cannot be identified. The known aetiologies are fetal (e.g. congenital malformations, infections); placental (e.g. insufficiency, abruption); or maternal (e.g. infections, diabetes mellitus). 7,8 There is a need for research on stillbirths and its associated risk factors as many countries lack data on this. 7
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2015
Background: Preterm Prelabour Rupture of Membranes (PPROM) is a leading cause of maternal and neo... more Background: Preterm Prelabour Rupture of Membranes (PPROM) is a leading cause of maternal and neonatal morbidity and mortality. The objective of our study was to bring forward the association between genitourinary infections and PPROM in Indian scenario. Methods: This retrospective case-control study was conducted in the Department of Obstetrics and Gynecology, in a tertiary referral teaching hospital in Punjab. A total of 150 women were evaluated for genitourinary infections and their association with PPROM. Cases group 1 (n=75) included pregnant females with diagnosis of PPROM based on history and vaginal examination. Control group 2 (n=75) included pregnant women admitted to labour room at 37 completed weeks of gestation or more and with no history of PPROM. The control group was matched to case group with respect to age and parity. Case to control ratio was taken as 1:1. A multivariate analysis was used to find the association between PPROM and genitourinary infections. Microsoft Excel and the Statistical Package for the Social Sciences (SPSS), Version 21 were used for data analysis. A P value of <0.05 was determined to be statistically significant. Results: In our study genitourinary infections were seen in 16 women in Case Group 1 (21.3%), compared to 7 women in Control Group (9.3%). Genitourinary infections were associated significantly with PPROM (p 0.02) (odds ratio [OR], 2.618; 95% Confidence interval [CI], 1.021-7.239). Conclusions: Screening for genitourinary infections should be considered especially in high risk cases. Early recognition and prompt treatment of genitourinary infections is the key to optimize the maternal and fetal outcome in PPROM.