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Scientific research in obstetrics and gynecology: changes in the trends over three decades

Gamal a kassem.

Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

The aim of this work was to assess scientific research of master’s and doctoral theses and essays in the Department of Obstetrics and Gynecology, Zagazig University, Egypt.

Materials and methods

All master’s and doctoral theses and essays since the foundation of Department of Obstetrics and Gynecology, Zagazig University, Egypt, in 1975 till end of 2012 were reviewed.

A total of 703 theses and essays were reviewed. The important topics in the specialty of obstetrics and gynecology were covered and updated. Infertility, in vitro fertilization–embryo transfer (IVF-ET) and related techniques, and polycystic ovarian disease were the most common gynecologic topics (27.2%), followed by gynecologic oncology (18.5%). Preeclampsia was the most common obstetrics topic (18.8%), followed by issues of high-risk pregnancy, fetal growth restriction, and fetal well-being (11.6%). The number of researches that allow the candidates to learn skills was 183 and it was increased from 4.4% of all research in the period 1979–1988 to 33.2% in period 1989–2000 then slightly decreased to 31.2% in period 2001–2012. Ultrasonography was on the top and was present in 99 out of 183 (54.1%) followed by laparoscopy (30, 16.4%), hysteroscopy (25, 13.7%), IVF-ET and related techniques (16, 8.7%) and colposcopy (13, 7.1%) researches. Multi-disciplinary research was decreased by 61.7% in the period 2001–2012. Researches in academic fields were abandoned and in some clinically important areas like preeclampsia were decreased.

Scientific research of master’s and doctoral theses and essays was comprehensive, updated, and had some autonomy independent of plans. Research which enable the candidate to learn skills were increased on the expense of academic, clinical and multidisciplinary research. It could be recommended that plans for scientific research should be flexible and should leave a space for local departmental views. Proper training of residents during their rotation in these subspecialties may help to revive the lost interest in clinically important areas.

Introduction

Active participation or submission of a scientific research is an essential step in residency or scholarship programs. 1 Studies have noted that research improves analytical and communication skills of the candidates as well as lifelong learning. 2 It was also observed that residents interested in research and publications have greater academic success. 3 , 4

According to the rules of Supreme Council of Universities, Egypt, submitting a scientific research in the form of a thesis or an essay is one of the requirements to gain a master’s or doctoral degree. Selection of the topic of the research is related to many factors such as availability of cases, instruments, subspecialty, and personal view of the supervising professor. The interest of the candidate is also important. In 2013, discussions started within the faculty to develop a plan for scientific research for the next 5 years. There was a need to review all research to get an impression about previous work. The aim of this study was to assess scientific research of theses and essays accepted in the Department of Obstetrics and Gynecology, Zagazig University, since its foundation in 1975 till end of 2012.

This retrospective observational study was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt, from January to March 2013.

All accepted theses and essays since the foundation of the department in 1975 till end of 2012 were reviewed. The review included title of research, year of acceptance, and supervision from another department. Methodology and skills that the candidate should learn, such as ultrasonography, endoscopy, in vitro fertilization–embryo transfer (IVF-ET), and colposcopy, were checked. Assessment also included the influence of establishment of new specialized units on scientific research. For the sake of convenience, the term “research” will be used to refer to essays and theses in this study.

The Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, was founded in 1975 as a small department under the supervision of Ain-Shams University (the mother university). Then the department became separate and also grew larger. There was an increase in the number of beds, the number of undergraduate and postgraduate candidates, staff, and subsequently the number of research activities. The formation of specialized units of laparoscopy, hysteroscopy, IVF-ET, and ultrasound started in the first half of the 1990s. Colposcopy was present since 1980. A Gynecologic Oncology Unit was founded officially in the first half of 2000s. We have no gynecologic urology unit, although there are some preparations for it.

One of the requirements for a master’s degree is to submit either a thesis or an essay. An essay is review article. For a doctoral degree, a thesis should be submitted. Each thesis or essay should have a supervising committee comprising a professor, assistant professor or lecturer(s), a system similar to mentorship. 5 If part of the work will be done in another department, a supervisor from that department will also be part of the committee. According to rules in the university, supervision from another department is recommended, but is not obligatory. Candidates are encouraged to gain training and supervision from national and international experts in the field of the research.

The study was approved by the Obstetrics and Gynecology Council of the faculty. Data were represented as mean and standard deviation.

A total of 703 theses and essays were reviewed. There were 575 (81.8%) and 128 (18.2%) theses and essays, respectively. The first thesis accepted was in 1977. Because the overall study included 36 years, this period was classified into three parts, each part comprising 12 years ( Figure 1 ). The number of topics in gynecology and obstetrics were 367 and 336, respectively ( Tables 1 and ​ and2). 2 ). Infertility was the most common topic in gynecology. Topics were updated from basic investigations like hysterosalpingography to different techniques of artificial insemination (AI) and IVF-ET. Research also evaluated different parameters of ovarian reserve and its relation to the outcome of IVF. As regards to polycystic ovarian disease (PCOD), research included diagnostic, biochemical, ultrasonographic criteria, and role of insulin sensitizers. Research in gynecologic oncology included recent aspects of diagnosis and treatment of different gynecologic tumors. Role of laparoscopy in characterization of adnexal masses, management of large ovarian cysts, hysterectomy, and pelvic lymphadenectomy in early cancer cervix are examples. Research also covered new tumor markers like human epididymis protein 4. The relation between human papilloma virus and genital tract malignancy was also studied. Ultrasound and color Doppler were used to predict depth of myometrial invasion in cancer endometrium.

Number of research that contain skills in relation to total research in obstetrics and gynecology over 36 years in Zagazig University (N=703).

Gynecological topics involved in theses and essays in relation to year of acceptance (N=367)

Abbreviations: IVF-ET, in vitro fertilization–embryo transfer; PCOD, polycystic ovarian disease; HRT, hormone replacement therapy.

Obstetrical topics involved in the theses and essays in relation to the year of acceptance (N=336)

Abbreviations: FGR, fetal growth restriction; RPL, recurrent pregnancy loss; PROM, prelabor rupture of membranes; CS, cesarean section; VBAC, vaginal birth after cesarean; IOL, induction of labor; APH, antepartum hemorrhage.

Preeclampsia was the first topic in obstetrics, and research included prediction, pathogenesis, clinical criteria, and laboratory investigations. Use of ultrasound and color Doppler was extensive.

Theses including skills were 183, which represented 31.8% of theses and 26% of all research. As shown in Figure 1 , the numbers increased from 8 of 163 (4.4%) in the period 1979–1989 to 91 of 274 (33.2%) in the period 1989–2000, and then slightly decreased to 84 of 266 (31.2%) in the period 2001–2012. Ultrasonography was the most common topic (99 theses, 54.1%) followed by laparoscopy (30, 16.4%), hysteroscopy (25, 13.7%), AI, IVF-ET, and related techniques (16, 8.7%), and lastly colposcopy (13 theses, 7.1%) ( Figure 2 ). Ultrasonography and color Doppler research included prediction, pathogenesis of preeclampsia as well as prediction, diagnosis, and monitoring of fetal growth restrictions. In preterm labor, ultrasonography was used in the prediction of preterm labor by measuring cervical length. Theses also included diagnostic criteria of placenta accreta. In abnormal uterine bleeding, ultrasound was used in evaluation of uterine cavity. In addition hydrosonography was also used in comparison to hysteroscopy. Techniques involved transabdominal, transvaginal, and transperineal examinations.

Number of theses that contain skills in obstetrics and gynecology over 36 years in Zagazig University (N=183).

Abbreviations: AI, artificial insemination; IVF-ET, in vitro fertilization–embryo transfer.

Research in laparoscopy included infertility, ovarian drilling for PCOD, and different techniques of laparoscopic hysterectomy. In hysteroscopy, theses included comparison between hysteroscopy and hysterosalpingography, as well as comparison between CO 2 and normal saline as distending medium. Hysteroscopy also used before and after failed IVF-ET. Operative hysteroscopy included monopolar and bipolar resectoscopic surgery. Research also included salpingoscopy and fallopian tube catheterizations.

Supervisions from another department in our faculty were present in 297 theses ( Table 3 ). Supervision from other universities (national experts) was noted in 10 theses, and international experts in 7 theses. The total supervisions beyond our department were present in 314 cases, which represent 54.7% of theses ( Tables 3 – 5 ).

Supervision from other departments (same university) (N=297)

Supervision from outside Egypt (international experts), (N=7)

Abbreviations: CIN, cervical intraepithelial neoplasia; HPV, human papilloma virus; IVF-ET, in vitro fertilization–embryo transfer.

This study shows that scientific research included in theses and essays for the master’s and doctoral degrees was comprehensive. Important topics in the specialty of obstetrics and gynecology were covered. Infertility was the most common topic in gynecology, followed by gynecologic oncology. Both topics represented about half of all theses and essays in gynecology. Preeclampsia was the most common obstetrics topic (18.8%), followed by issues of high-risk pregnancy, fetal growth restriction, and fetal well-being (11.6%). The study also shows that scientific research was updated. This was more evident regarding infertility research. We observed that not only the number of researches in infertility was steadily increased but also the topics were updated. Issues of AI, IVF-ET and related techniques, ovarian reserve, and role of endoscopy were covered. Recent research areas on PCOD were also studied. Actually, infertility became a well-established subspecialty mainly due to marked advancement in IVF-ET and related techniques in last three decades. 6 , 7

We observed that there was a marked increase in the number of researches after establishment of specialized units of ultrasonography, endoscopy and IVF-ET ( Figure 1 ). This was more evident for research using ultrasound. As shown in Figure 2 , theses including ultrasound jumped from five in the period 1977–1988 to 49 in the period 1989–2000. Actually, advances in technology have expanded the field of obstetrics and gynecology and made training and developing skills in different subspecialties a great challenge. 8 , 9 It seems that candidates preferred scientific research that enabled them to gain skills, and ultrasonography represented the first choice. Ultrasonography is relatively easy to learn, with great application in clinical practice. 10 Similar increase, but to a lesser extent, occurred in research in field of laparoscopy and hysteroscopy. The least number of researches were observed in the field of colposcopy. This could be explained by the absence of any national program for screening of cervical cancer. Actually, cervical cancer is not a great health problem in Egypt. 11 Similar findings were observed regarding research in gynecologic oncology which was increased by 1.5 times in the last 12 years with the establishment of the Gynecologic Oncology Unit.

Multidisciplinary collaboration in research is important. It improves research quality, increases research output, and also improves the communication skills of the researchers. 12 , 13 In the present study, more than half of the theses had supervision from another department, either academic or clinical. However, as shown in Table 3 , there was a reduction in the number of supervisions from 141 to 45 (61.7%) in the last 12 years. This may be explained by a decreased interest in academic research such as anatomy, physiology, and experimental work. The interest in ultrasound, laparoscopy, and hysteroscopy is clear, even though research in some clinically important areas like preeclampsia was also decreased ( Tables 1 and ​ and2). 2 ). Therefore, proper training of residents during their rotation in these subspecialties may help to revive the lost interest in clinically important areas.

The strength of this study is that it reviewed all master and doctoral theses and essays conducted through 36 years. This long period makes the results about changes in trends in research reliable and makes study beneficial for planning of scientific research and training of residents in obstetrics and gynecology. However, the study did not include other research published by staff members for promotion to the posts of professors. Actually, some staff members research are based on these master and doctoral theses. Therefore the study is typically concerned with research done by masters and doctoral candidates but still represents the scientific research in obstetrics and gynecology.

In conclusion, scientific research of master’s and doctoral theses and essays was comprehensive, updated, and had some autonomy independent of plans. Research which enable the candidate to learn skills were increased on the expense of academic, clinical and multidisciplinary research. It could be recommended that plans for scientific research should be flexible and should leave a space for local departmental views. Proper training of residents during their rotation in these subspecialties may help to revive the lost interest in clinically important areas.

Supervision from another university (national experts) (N=10)

Abbreviation: IVF-ET, in vitro fertilization–embryo transfer.

Acknowledgments

The author thanks Professor Mohammed M Al-bakry, ex-Head of Department of Obstetrics and Gynecology, and Professor Monqez Motea, Vice Dean and Head of Scientific Research Council, Faculty of Medicine, Zagazig University, for their great support and encouragement. The author also thanks Dr Reem Abbas, Professor in Community Medicine, for her advice regarding the statistics used for the study.

The author reports no conflict of interest in this work.

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A List of the Best Dissertation Topics in Obstetrics and Gynecology

Before students can graduate, they may have to create a dissertation on gynecology and obstetrics. In addition to requiring a significant amount of research, this research paper will necessitate hours of time spent writing and proofreading. To get started on the essay, students need to pick a topic. The best topics are completely original and contain an interesting subject. If the student truly cares about their topic, they will find it easier to research and write the paper. For some dissertation ideas, read through the following list.

Topic Ideas for Obstetrics and Gynecology

• Effectiveness of Cloposcopic Cervical Screenings
• Do Patients With frequent Miscarriages Have Higher Anticardiolip Antibodies?
• Acute Liver Failure During Pregnancy: Different Prognostic Techniques and Medical Treatments
• Prevalence of Thyroid Disorders in Obstetrics Patients
• Comparison of the Efficacy of Different Techniques for Estimating Fetal Weight Throughout Pregnancy
• Techniques for Managing Hypertension During Pregnancy
• Dealing With Insulin Resistance Among Women Who Have Polycystic Ovarian Syndrome
• How Does Vitamin D Supplementation During Pregnancy Change the Outcomes for Mother and Child?
• Gestational Diabetes and Medical Interventions
• Hepatitis-B in Pregnant Women and Their Neonatal Outcome: Do Vaccines Effectively Reduce Transmission?
• Gestational Weight Gain's Effect on Delivery and Neonatal Health
• Are Lowered Blood Platelet Counts an Indication of Hypertension Among Pregnant Women?
• Study of Human Chimeras and Their Pregnancy Outcomes
• Techniques for Treating Malignant Ovarian Tumors During Pregnancy
• Dynsfunctional Uterine Bleeding: The Efficacy of an Ultrasound Diagnosis
• What Enzymes Are Linked to Gestational Diabetes?
• Can Ultrasounds be Used as a Pelvimetric Tool?
• The Efficacy of Hormone Therapy in Early Menopause
• Comparative Study for Different Preventive Methods for Postpartum Hemorrhage
• Neonatal Outcome of Third Trimester Confinement Versus Non-Confinement
• High Risk Pregnancies and the Implications of Color Doppler
• Will an Amnio-Infusion Reduce Fetal Distress in Cases of Thick Meconoium Amniotic Fluid?
• What are the Predictors for Pregnancy-Induced Hypertension?
• Uterine Bleeding: Is Bleeding Due to Histopathological Differences in the Endometrium?
• Physical Activity Levels and Perinatal Mortality Rates
• Comparative Study of Cesarean Sections in the United States and the United Kingdom
• The Implications of Different Volumes of Amniotic Fluid in Predicting Perinatal Outcomes
• Does the Consumption of Sugar-Sweetened Beverages in Childhood Change the Age of Menarchy?
• Study of Maternal Health Services Available in Rural Peru
• Boosting Fertility Rates in Women With Polycystic Ovarian Syndrome
• Comparison of Neonatal and Maternal Outcomes for Hospital Deliveries Versus Midwifery Deliveries
• Comparison of Side Effects of Different Contraceptive Methods
• Management of Ovarian Cancer in HNPCC Carrier Families

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• Parveen S, Rengaraj S, Chaturvedula L. Factors associated with the outcome of TOLAC after one previous caesarean section: a retrospective cohort study. Journal of Obstetrics and Gynaecology. 2022 Apr 3; 42(3):430-6.
• Natarajan T, Rengaraj S, Chaturvedula L, Wyawahare M. Predictors of adverse maternal outcome in jaundiced pregnant women identified as having pregnancy-specific liver disease (P-sLD). Journal of Obstetrics and Gynaecology. 2022 Jan 20:1-7

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The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.

PRENATAL OBSTETRICS

Pregnancy outcome among individuals with obesity and low gestational weight gain (May 2024)

For individuals with obesity, increasing evidence suggests that gestational weight gain (GWG) below standard recommendations (5 kg) is safe and may result in a more favorable pregnancy outcome. In an observational study including over 11,000 pregnancies with class I obesity, 3000 with class II obesity, and 900 with class III obesity, GWG below 5 kg was not associated with an increased risk of the composite adverse outcome in those with class I or II obesity and was associated with a 20 percent risk reduction in those with class III obesity [ 1 ]. These findings suggest that GWG recommendations should be revised downward for individuals with obesity, particularly those with class III obesity. We do not advise pregnant people with obesity and GWG below 5 kg to increase weight gain if the fetus is growing appropriately on ultrasound examination. (See "Gestational weight gain", section on 'Approach to weight gain below IOM recommendations' .)

Fetal endoscopic tracheal occlusion for managing congenital diaphragmatic hernia (May 2024)

Emerging data support use of fetal endoscopic tracheal occlusion (FETO) for management of isolated, moderate-to-severe, left-sided congenital diaphragmatic hernia (CDH). In a study of such patients in the North American Fetal Therapy Network (NAFTNet) FETO Consortium, FETO was associated with higher survival at six months of age compared with expectant management (70 versus 58 percent), although the difference was not statistically significant [ 2 ]. FETO was also associated with a higher rate of preterm prelabor rupture of membranes (PPROM), earlier gestational age at delivery, and lower birth weight. Among patients with severe CDH, FETO was associated with fewer days of extracorporeal membrane oxygenation (9 versus 17 days). These data suggest that FETO may improve survival and can help decrease pediatric morbidity, despite a higher risk of PPROM. (See "Congenital diaphragmatic hernia: Prenatal issues", section on 'Outcome of FETO' .)

Reducing alcohol use during pregnancy (May 2024)

Clinicians caring for pregnant persons are advised to routinely educate and counsel about the harms of alcohol use during pregnancy. A meta-analysis of three trials reported more pregnant patients continuously abstained from alcohol consumption after receiving psychosocial interventions compared with usual care (69 versus 51 percent) [ 3 ]. We encourage clinicians caring for pregnant individuals to offer access to psychosocial interventions (eg, information sessions, self-help groups, cognitive behavioral therapy) in addition to routinely educating them about the dangers of alcohol use during pregnancy. (See "Alcohol intake and pregnancy", section on 'Management of screen-positive pregnant persons' .)

Acetaminophen use in pregnancy not associated with adverse neurodevelopment in offspring (April 2024)

Although older studies raised concerns about a possible adverse association between in utero exposure to acetaminophen and neurodevelopment, more recent studies with a lower risk of bias have not reported an association. In a population-based study in which acetaminophen use was prospectively recorded, siblings with any in utero exposure had no increased risk for attention deficit hyperactivity disorder, autism spectrum disorder, or intellectual disability at age 10 years compared with their unexposed siblings [ 4 ]. Although an association cannot be definitively excluded, these data are reassuring when a short course of acetaminophen is desirable to manage pain or fever during pregnancy. (See "Prenatal care: Patient education, health promotion, and safety of commonly used drugs", section on 'Acetaminophen' .)

Congenital anomaly risk with methadone or buprenorphine exposure (April 2024)

Data regarding the teratogenic risk of medications for opioid use disorder (MOUD) are limited. In a population-based study comparing over 9500 pregnancies exposed to buprenorphine in the first trimester with nearly 3900 methadone-exposed pregnancies, buprenorphine use was associated with a lower overall risk of congenital anomalies (5 versus 6 percent) [ 5 ]. Although the analysis adjusted for multiple potential confounding factors, unmeasured confounders may explain some of the observed associations. We base the choice of buprenorphine versus methadone for MOUD on other factors ( table 1 ). (See "Opioid use disorder: Pharmacotherapy with methadone and buprenorphine during pregnancy", section on 'Risk of structural anomalies' .)

Maternal sepsis risk with membrane rupture before 23 weeks of gestation (April 2024)

Chorioamnionitis can be a cause or a consequence of preterm prelabor rupture of membranes (PPROM), especially before 24 weeks of gestation. Development of maternal sepsis is a major concern in these pregnancies. In a prospective study of 364 patients with PPROM between 16 weeks 0 days and 22 weeks 6 days, maternal sepsis developed in 10 percent of patients with singleton pregnancies who chose to undergo pregnancy termination soon after diagnosis of PPROM and in 13 percent of those who initially chose to continue the pregnancy [ 6 ]. Two patients died. These findings underscore the importance of close maternal monitoring, early diagnosis of chorioamnionitis, timely fetal extraction, and appropriate antibiotic treatment in patients with PPROM. (See "Prelabor rupture of membranes before and at the limit of viability", section on 'Maternal sepsis and death' .)

Perinatal depression and mortality (March 2024)

Perinatal depression is associated with an increased risk of death. An analysis of a national register from Sweden compared outcomes among individuals with and without a diagnosis of depression during pregnancy or postpartum, matched by age and year of delivery [ 7 ]. After controlling for potential confounding factors, all-cause mortality was greater in those with perinatal depression over 18 years of follow-up; the increased risk was largely driven by suicide. These results confirm previous data on the risks of perinatal depression and support our practice of screening for depression during pregnancy and postpartum. Services to ensure follow-up for diagnosis and treatment should accompany screening efforts. (See "Unipolar major depression during pregnancy: Epidemiology, clinical features, assessment, and diagnosis", section on 'All cause' .)

Noninsulin antidiabetic medications and pregnancy (February 2024)

Noninsulin antidiabetic medications such as glucagon-like peptide 1 (GLP-1) agonists, sodium-glucose cotransporter 2 (SGLT-2) inhibitors, and dipeptidyl peptidase 4 (DPP-4) inhibitors are commonly used in nonpregnant individuals but avoided in pregnancy because of lack of safety data in humans and harms observed in animal studies. However, in a multinational population-based cohort study including nearly 2000 individuals with preconception/first trimester exposure to these medications, the frequency of congenital anomalies was not increased compared with insulin [ 8 ]. A limitation of the study is that it did not adjust for potential differences in A1C, diabetes severity, or diabetes duration, which could obscure true effects on risk for congenital anomalies. We continue to avoid use of GLP-1 agonists, SGLT-2 inhibitors, and DPP-4 inhibitors in females planning to conceive and in pregnancy. (See "Pregestational (preexisting) diabetes: Preconception counseling, evaluation, and management", section on 'Patients on preconception noninsulin antihyperglycemic agents' .)

Updates to the United States perinatal HIV clinical guidelines (February 2024)

The United States Department of Health and Human Services has released updates to the perinatal HIV clinical guidelines [ 9 ]. Ritonavir-boosted darunavir is now a preferred agent only for treatment-naïve pregnant individuals who have used cabotegravir-based pre-exposure prophylaxis, because of the concern for integrase inhibitor-resistant mutations; for other pregnant individuals, it is now an alternative rather than preferred agent. Additionally, bictegravir, which was previously not recommended for initial therapy in pregnant individuals, is now an alternative agent based on new pharmacokinetic data that support its use during pregnancy. Our approach to treating HIV during pregnancy is consistent with these updated guidelines. (See "Antiretroviral selection and management in pregnant individuals with HIV in resource-rich settings", section on 'Selecting the third drug' .)

Combined use of metformin and insulin for treating diabetes in pregnancy (February 2024)

In patients with type 2 diabetes, insulin is the mainstay for managing hyperglycemia in pregnancy. The addition of metformin improves maternal glucose control and reduces the chances of a large for gestational age newborn, but a prior randomized trial reported an increased risk for birth of a small for gestational age (SGA) infant. A recent randomized trial comparing use of insulin alone with insulin plus metformin in nearly 800 adult pregnant patients with either preexisting type 2 diabetes or diabetes diagnosed in early pregnancy confirmed the previously reported benefits but found that both treatment groups had low and similar rates of SGA [ 10 ]. The discordancy in SGA risk needs to be explored further, as metformin cotreatment would be undesirable if this risk is real. (See "Pregestational (preexisting) diabetes mellitus: Antenatal glycemic control", section on 'Metformin' .)

Fetoplacental GDF15 linked to nausea and vomiting of pregnancy (February 2024)

Almost all pregnant people experience nausea with or without vomiting in early pregnancy; however, the pathogenesis of the disorder has been unclear. Previous studies have shown that GDF15 is expressed in a wide variety of cells, with the highest expression in placental trophoblast, and that its protein (GDF15) appears to regulate appetite. A recent study confirmed the fetoplacental unit as a major source of GDF15 and also found that higher GDF15 levels correlated with more severe nausea and vomiting of pregnancy [ 11 ]. In the future, drugs targeting the production or action of GDF15 are a potential novel pathway for treating nausea and vomiting of pregnancy, if safety and efficacy are established. (See "Nausea and vomiting of pregnancy: Clinical findings and evaluation", section on 'Pathogenesis' .)

Use of cerebroplacental ratio at term does not reduce perinatal mortality (February 2024)

Cerebral blood flow may increase in chronically hypoxemic fetuses to compensate for the decrease in available oxygen and can be assessed by the cerebroplacental ratio (CPR; middle cerebral artery pulsatility index divided by the umbilical artery pulsatility index). However, increasing evidence indicates that use of the CPR does not reduce perinatal mortality in low-risk pregnancies. In a randomized trial comparing fetal growth assessment plus revealed versus concealed CPR in over 11,000 low-risk pregnancies at term, knowledge of CPR combined with a recommendation for delivery if the CPR was <5th percentile did not reduce perinatal mortality compared with usual care (concealed group) [ 12 ]. We do not perform umbilical artery Doppler surveillance, including the CPR, in low-risk pregnancies. (See "Doppler ultrasound of the umbilical artery for fetal surveillance in singleton pregnancies", section on 'Low-risk and unselected pregnancies' .)

Low- versus high-dose calcium supplements and risk of preeclampsia (January 2024)

In populations with low baseline dietary calcium intake, the World Health Organization recommends 1500 to 2000 mg/day calcium supplementation for pregnant individuals to reduce their risk of developing preeclampsia. However, a recent randomized trial that evaluated low (500 mg) versus high (1500 mg) calcium supplementation in over 20,000 nulliparous pregnant people residing in two countries with low dietary calcium intake found low and similar rates of preeclampsia in both groups [ 13 ]. These findings suggest that a 500 mg supplement is sufficient for preeclampsia prophylaxis in these populations. For pregnant adults in the United States, we prescribe 1000 mg/day calcium supplementation, which is the recommended daily allowance to support maternal calcium demands without bone resorption. (See "Preeclampsia: Prevention", section on 'Calcium supplementation when baseline dietary calcium intake is low' .)

Respectful maternity care (January 2024)

Respectful maternity care is variably defined but broadly involves both absence of disrespectful conduct and promotion of respectful conduct toward pregnant individuals. A systematic review found that validated tools to measure respectful maternity care were available, but the optimal tool was unclear and high quality studies were lacking on the effectiveness of respectful maternity care for improving any maternal or infant health outcome [ 14 ]. Respectful maternal care is a basic human right, but how to best implement and monitor it and assess outcomes requires further study. (See "Prenatal care: Initial assessment", section on 'Effectiveness' .)

Outcome of a multifaceted intervention in patients with a prior cesarean birth (January 2024)

Patients with a pregnancy after a previous cesarean birth must choose between a trial of labor (TOLAC) and a planned repeat cesarean. The optimal care of such patients is unclear. In a multicenter, cluster-randomized trial including over 20,000 patients with one prior cesarean birth, a multifaceted intervention (patient decision support, use of a calculator to assess chances of a vaginal birth after cesarean [VBAC], sonographic measurement of myometrial thickness, clinician training in best intrapartum practices during TOLAC) reduced perinatal and major maternal morbidity composite outcomes compared with usual care [ 15 ]. VBAC and uterine rupture rates were similar for both groups. Further study is needed to identify the most useful component(s) of the intervention for reducing morbidity. (See "Choosing the route of delivery after cesarean birth", section on 'Person-centered decision-making model' .)

Serial amnioinfusions for bilateral renal agenesis (January 2024)

Bilateral renal agenesis (BRA) is incompatible with extrauterine life because prolonged oligohydramnios results in pulmonary hypoplasia, leading to postnatal respiratory failure. A prospective study (RAFT) assessed use of serial amnioinfusions to treat 18 cases of BRA diagnosed at <26 weeks of gestation [ 16 ]. Of the 17 live births, 14 survived ≥14 days and had placement of dialysis access, but only 6 survived to hospital discharge. Of the 4 children alive at 9 to 24 months of age, 3 had experienced a stroke and none had undergone transplant. These findings show that serial amnioinfusions for BRA mitigates pulmonary hypoplasia and increases short-term survival and access to dialysis; however, long-term outcome remains poor with no survival to transplantation. Serial amnioinfusions remain investigational and should be offered only as institutional review board-approved research. (See "Renal agenesis: Prenatal diagnosis", section on 'Investigative role of therapeutic amnioinfusion' .)

Prenatal genetic testing for monogenic diabetes due to glucokinase deficiency (December 2023)

In pregnant individuals with monogenic diabetes due to glucokinase (GCK) deficiency, management depends on the fetal genotype. If the fetus inherits the maternal GCK variant, maternal hyperglycemia will not cause fetal hyperinsulinemia and excessive growth, and maternal hyperglycemia does not require treatment. However, if the fetus does not inherit the pathogenic variant, maternal insulin therapy is indicated to prevent excessive fetal growth. Fetal ultrasound has been used to predict fetal genotype but has limited diagnostic utility. In a cohort of 38 pregnant individuals with GCK deficiency, fetal genetic testing using cell-free DNA in maternal blood had higher sensitivity (100 versus 53 percent) and specificity (96 versus 61 percent) for prenatal diagnosis of GCK deficiency compared with ultrasound measurement of fetal abdominal circumference [ 17 ]. When available, noninvasive prenatal genotyping should be used to guide management of GCK deficiency during pregnancy. (See "Classification of diabetes mellitus and genetic diabetic syndromes", section on 'Glucokinase' .)

INTRAPARTUM AND POSTPARTUM OBSTETRICS

Updates on congenital fibrinogen disorders (April 2024)

Congenital fibrinogen disorders are rare and remain underdiagnosed. New publications address the clinical manifestations of these disorders and provide obstetric guidance:

● A new report from the Rare Bleeding Disorders database described 123 patients with afibrinogenemia, hypofibrinogenemia, and dysfibrinogenemia and characterized bleeding and thrombotic manifestations [ 18 ]. (See "Disorders of fibrinogen", section on 'Clinical manifestations' .)

● New guidelines from the International Society on Thrombosis and Hemostasis (ISTH) provide target fibrinogen levels and advice for managing postpartum bleeding and thromboprophylaxis in individuals with congenital fibrin disorders [ 19 ]. (See "Disorders of fibrinogen", section on 'Conception and pregnancy' .)

A high index of suspicion for these disorders and multidisciplinary management are required.

Intrauterine postpartum hemorrhage control devices for managing postpartum hemorrhage (February 2024)

Intrauterine balloon tamponade and vacuum-induced uterine compression are the most common devices used for intrauterine postpartum hemorrhage (PPH) control in patients with atony, but it is unclear which device is superior as few comparative studies have been performed. In a retrospective study including nearly 380 patients with PPH, quantitative blood loss after placement, rate of blood transfusion, and discharge hematocrit were similar for both devices [ 20 ]. Based on these and other data, in the setting of ongoing uterine bleeding, rapid use of one of these devices is likely to be more important than the choice of device when both devices are available. (See "Postpartum hemorrhage: Use of an intrauterine hemorrhage-control device", section on 'Choice of method' .)

Labor epidural analgesia and risk of emergency delivery (December 2023)

It is well established that contemporary neuraxial labor analgesia does not increase the overall risk of cesarean or instrument-assisted vaginal delivery. However, a new retrospective database study of over 600,000 deliveries in the Netherlands reported that epidural labor analgesia was associated with an increased risk of emergency delivery (cesarean or instrument-assisted vaginal) compared with alternative analgesia (13 versus 7 percent) [ 21 ]. Because of potential confounders and lack of detail on epidural and obstetric management, we consider these data insufficient to avoid neuraxial analgesia or change the practice of early labor epidural placement to reduce the potential need for general anesthesia in patients at high risk for cesarean delivery. (See "Adverse effects of neuraxial analgesia and anesthesia for obstetrics", section on 'Effects on the progress and outcome of labor' .)

Delayed cord clamping in preterm births (December 2023)

Increasing evidence supports delaying cord clamping in preterm births. In an individual participant data meta-analysis of randomized trials of delayed versus immediate cord clamping at births <37 weeks (over 3200 infants), delaying cord clamping for >30 seconds reduced infant death before discharge (6 versus 8 percent) [ 22 ]. In a companion network meta-analysis evaluating the optimal duration of delay, a long delay (≥120 seconds) significantly reduced death before discharge compared with immediate clamping; reductions also occurred with delays of 15 to <120 seconds but were not statistically significant [ 23 ]. For preterm births that do not require resuscitation, we recommend delayed rather than immediate cord clamping. We delay cord clamping for at least 30 to 60 seconds as approximately 75 percent of blood available for placenta-to-fetus transfusion is transfused in the first minute after birth. (See "Labor and delivery: Management of the normal third stage after vaginal birth", section on 'Preterm infants' .)

OFFICE GYNECOLOGY

Pivmecillinam for acute simple cystitis (May 2024)

In 2024, the US Food and Drug Administration approved a beta-lactam antibiotic, pivmecillinam , for treatment of acute simple cystitis in female adults [ 24 ]. Pivmecillinam is one of our preferred options for treatment of cystitis and has long been used in certain European countries because it is less likely than other agents to select for resistant isolates. It also retains activity against many extended-spectrum beta-lactamase-producing organisms. The recommended dose and formulation vary by region, and data do not clearly demonstrate better clinical outcomes with one versus the other. For empiric therapy, we would generally use 185 mg pivmecillinam base (equivalent to 200 mg pivmecillinam hydrochloride) orally three times daily for three to seven days, which is the dose recommended in the United States. (See "Acute simple cystitis in adult and adolescent females", section on 'First-line antimicrobial options' .)

Same-day contraceptive start and pregnancy risk (May 2024)

Individuals who desire contraception often want to start the method on the same day as their office visit, but the risk of pregnancy for those >7 days from the onset of their last menstrual period has been a concern. However, in a prospective study of over 3500 individuals seeking hormonal contraception, first-cycle unintended pregnancy rates were low for both those with same-day starts >7 days from the onset of menses and those who waited to start the method within 7 days of onset of menses (0.4 and 0.1 percent, respectively), even though approximately 20 percent of same-day start participants had at least one episode of unprotected intercourse within the prior 14 days [ 25 ]. For individuals who prefer a same-day start and understand the potential need for follow-up pregnancy testing, hormonal contraceptives (any method) may be started on the same day as the visit with low overall pregnancy risk. (See "Contraception: Counseling and selection", section on 'Starting a method' .)

Infertility and autism spectrum disorder (December 2023)

Patients with infertility often ask about the impact of the disorder and its treatment on risk of autism spectrum disorder (ASD) in offspring. In a large population-based cohort study comparing ASD risk among children whose parents had subfertility (an infertility consultation without treatment), infertility treatment, or neither (unassisted conception), children in the subfertility and infertility treatment groups had a small increased risk of ASD compared with unassisted conception but the absolute risk was low (2.5 to 2.7 per 1000 person-years versus 1.9 per 1000 person-years with unassisted conception) [ 26 ]. The increased risk was similar in the subfertile and infertility treatment groups, suggesting that infertility treatment was not a major risk factor. Obstetrical and neonatal factors (eg, preterm birth) appeared to mediate a sizeable proportion of the increased risk for ASD. (See "Assisted reproductive technology: Infant and child outcomes", section on 'Confounders' .)

Macular changes related to pentosan polysulfate sodium (November 2023)

Macular eye disease has been reported in patients who have taken pentosan polysulfate sodium (PPS), which is used for the treatment of interstitial cystitis. In a prospective cohort study of 26 eyes with PPS maculopathy and >3000 g cumulative PPS exposure, progression of macular changes continued 13 to 30 months after drug cessation [ 27 ]. Median visual acuity decreased slightly; most patients reported progression of symptoms, including difficulty in low-light environments and blurry vision. These results indicate that PPS maculopathy progresses despite drug discontinuation, underscoring the importance of regular screening for maculopathy in patients with current or prior PPS exposure. (See "Interstitial cystitis/bladder pain syndrome: Management", section on 'Pentosan polysulfate sodium as alternative' .)

GYNECOLOGIC SURGERY

Risk of unplanned hysterectomy at time of myomectomy (February 2024)

Myomectomy is an option for patients with bothersome fibroid symptoms (eg, bleeding, bulk); however, data are limited regarding the risk of unplanned hysterectomy at the time of myomectomy. In a retrospective study of the American College of Surgeons' National Surgical Quality Improvement Program database from 2010 to 2021 including over 13,000 patients undergoing myomectomy, the risk of unplanned hysterectomy was higher in those undergoing laparoscopic myomectomy compared with an open abdominal or hysteroscopic approach (7.1, 3.2, and 1.9 percent respectively) [ 28 ]. While much lower risks have been reported (<0.4 percent), and expert surgeons at high-volume centers may have fewer conversions to hysterectomy, this study highlights the importance of discussing the risk of unplanned hysterectomy during the informed consent process. (See "Uterine fibroids (leiomyomas): Laparoscopic myomectomy and other laparoscopic treatments", section on 'Unplanned hysterectomy' and "Uterine fibroids (leiomyomas): Open abdominal myomectomy procedure", section on 'Unplanned hysterectomy' and "Uterine fibroids (leiomyomas): Hysteroscopic myomectomy", section on 'Unplanned hysterectomy' .)

Risk of subsequent hysterectomy after endometrial ablation (January 2024)

Endometrial ablation is an alternative to hysterectomy in selected premenopausal patients with heavy menstrual bleeding. Most ablations are performed using a non-resectoscopic technique; however, the long-term efficacy of this approach is unclear. In a meta-analysis of 53 studies including over 48,000 patients managed with non-resectoscopic endometrial ablation (NREA), the rates of subsequent hysterectomy were 4 percent at 12 months, 8 to 12 percent at 18 to 60 months, and 21 percent at 120 months [ 29 ]. Hysterectomy rates were similar for the different NREA devices (eg, thermal balloon, microwave, radiofrequency). These findings are useful for counseling patients about the long-term risk for hysterectomy after NREA. (See "Endometrial ablation: Non-resectoscopic techniques", section on 'Efficacy' .)

Pregnancy and childbirth after urinary incontinence surgery (January 2024)

Patients with stress urinary incontinence (SUI) have historically been advised to delay midurethral sling (MUS) surgery until after childbearing because of concerns for worsening SUI symptoms following delivery. In a meta-analysis of patients with MUS surgery who were followed for a mean of nearly 10 years, similar low SUI recurrence and reoperation rates were reported for the 381 patients with and the 860 patients without subsequent childbirth [ 30 ]. Birth route did not affect the findings. Although the total number of recurrences and reoperations was small, this study adds to the body of evidence suggesting that subsequent childbirth does not worsen SUI outcomes for patients who have undergone MUS. (See "Surgical management of stress urinary incontinence in females: Retropubic midurethral slings", section on 'Subsequent pregnancy' .)

GYNECOLOGIC ONCOLOGY

Updated vulvar carcinoma staging system (May 2024)

An updated version of the American Joint Committee on Cancer tumor, node, metastasis staging for vulvar carcinoma has been published ( table 2 ) [ 31 ]. This version is now in alignment with the 2021 International Federation of Gynecology and Obstetrics vulvar carcinoma staging system. Both systems are used worldwide to stage patients with squamous and basal cell carcinomas, adenocarcinomas, and carcinomas arising from the Bartholin gland. (See "Squamous cell carcinoma of the vulva: Staging and surgical treatment", section on 'Staging system' .)

Types of hysterectomy in patients with stage IB1 cervical cancer (March 2024)

Patients with stage IB1 cervical cancer (ie, >5 mm depth of stromal invasion and ≤2 cm in greatest dimension) are typically treated with radical hysterectomy; however, less extensive surgery is being evaluated. In a randomized trial including over 640 patients with stage IB1 cervical cancer, radical hysterectomy and simple hysterectomy plus lymph node assessment resulted in similar rates of recurrence at three years (2.2 and 2.5 percent, respectively) [ 32 ]. Although the study has limitations, including a short follow-up period, simple hysterectomy with lymph node assessment may be an acceptable alternative to radical hysterectomy in patients with IB1 cervical cancer. (See "Management of early-stage cervical cancer", section on 'Type of surgery' .)

Increasing incidence of cervical and uterine corpus cancer in the United States (February 2024)

In January 2024, the American Cancer Society published their annual report of cancer statistics in the United States [ 33 ]. Notable trends in regard to gynecologic cancers include a 1.7 percent increase in the annual incidence of cervical cancer from 2012 to 2019 in individuals aged 30 to 44 years, after decades of decline. Cancer of the uterine corpus (all ages) continued to increase by approximately 1 percent annually and was the only cancer in the report in which survival decreased. These and other data emphasize the continued importance of both early detection and prevention (eg, for cervical cancer: human papillomavirus vaccination and screening for precursor lesions; for endometrial cancer: achieving and maintaining a normal body mass index). (See "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis", section on 'Incidence and mortality' and "Endometrial carcinoma: Epidemiology, risk factors, and prevention", section on 'Epidemiology' and "Endometrial carcinoma: Clinical features, diagnosis, prognosis, and screening", section on 'Prognosis' .)

• Johansson K, Bodnar LM, Abrams B, Hutcheon JA. Safety of low weight gain or weight loss in pregnancies with class 1, 2, and 3 obesity: a population-based cohort study. Lancet 2024.
• Bergh E, Baschat AA, Cortes MS, et al. Fetoscopic Endoluminal Tracheal Occlusion for Severe, Left-Sided Congenital Diaphragmatic Hernia: The North American Fetal Therapy Network Fetoscopic Endoluminal Tracheal Occlusion Consortium Experience. Obstet Gynecol 2024; 143:440.
• Minozzi S, Ambrosi L, Saulle R, et al. Psychosocial and medication interventions to stop or reduce alcohol consumption during pregnancy. Cochrane Database Syst Rev 2024; 4:CD015042.
• Ahlqvist VH, Sjöqvist H, Dalman C, et al. Acetaminophen Use During Pregnancy and Children's Risk of Autism, ADHD, and Intellectual Disability. JAMA 2024; 331:1205.
• Suarez EA, Bateman BT, Straub L, et al. First Trimester Use of Buprenorphine or Methadone and the Risk of Congenital Malformations. JAMA Intern Med 2024; 184:242.
• Goodfellow L, Care A, Curran C, et al. Preterm prelabour rupture of membranes before 23 weeks' gestation: prospective observational study. BMJ Med 2024; 3:e000729.
• Hagatulah N, Bränn E, Oberg AS, et al. Perinatal depression and risk of mortality: nationwide, register based study in Sweden. BMJ 2024; 384:e075462.
• Cesta CE, Rotem R, Bateman BT, et al. Safety of GLP-1 Receptor Agonists and Other Second-Line Antidiabetics in Early Pregnancy. JAMA Intern Med 2024; 184:144.
• Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States. https://clinicalinfo.hiv.gov/en/guidelines/perinatal/whats-new-guidelines (Accessed on February 08, 2023).
• Boggess KA, Valint A, Refuerzo JS, et al. Metformin Plus Insulin for Preexisting Diabetes or Gestational Diabetes in Early Pregnancy: The MOMPOD Randomized Clinical Trial. JAMA 2023; 330:2182.
• Fejzo M, Rocha N, Cimino I, et al. GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature 2024; 625:760.
• Rial-Crestelo M, Lubusky M, Parra-Cordero M, et al. Term planned delivery based on fetal growth assessment with or without the cerebroplacental ratio in low-risk pregnancies (RATIO37): an international, multicentre, open-label, randomised controlled trial. Lancet 2024; 403:545.
• Dwarkanath P, Muhihi A, Sudfeld CR, et al. Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy. N Engl J Med 2024; 390:143.
• Cantor AG, Jungbauer RM, Skelly AC, et al. Respectful Maternity Care : A Systematic Review. Ann Intern Med 2024; 177:50.
• Chaillet N, Mâsse B, Grobman WA, et al. Perinatal morbidity among women with a previous caesarean delivery (PRISMA trial): a cluster-randomised trial. Lancet 2024; 403:44.
• Miller JL, Baschat AA, Rosner M, et al. Neonatal Survival After Serial Amnioinfusions for Bilateral Renal Agenesis: The Renal Anhydramnios Fetal Therapy Trial. JAMA 2023; 330:2096.
• Hughes AE, Houghton JAL, Bunce B, et al. Bringing precision medicine to the management of pregnancy in women with glucokinase-MODY: a study of diagnostic accuracy and feasibility of non-invasive prenatal testing. Diabetologia 2023; 66:1997.
• Mohsenian S, Palla R, Menegatti M, et al. Congenital fibrinogen disorders: a retrospective clinical and genetic analysis of the Prospective Rare Bleeding Disorders Database. Blood Adv 2024; 8:1392.
• Casini A, Abdul Kadir R, Abdelwahab M, et al. Management of pregnancy and delivery in congenital fibrinogen disorders: communication from the ISTH SSC Subcommittee on Factor XIII and Fibrinogen. J Thromb Haemost 2024; 22:1516.
• Shields LE, Foster M, Klein C, et al. 68 Prospective multicenter trial comparing balloon versus suction hemorrhage control devices for postpartum hemorrhage. Am J Obstet Gynecol 2024; 230:S51.
• Damhuis SE, Groen H, Thilaganathan B, et al. Effect of intrapartum epidural analgesia on rate of emergency delivery for presumed fetal compromise: nationwide registry-based cohort study. Ultrasound Obstet Gynecol 2023; 62:668.
• Seidler AL, Aberoumand M, Hunter KE, et al. Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: a systematic review and individual participant data meta-analysis. Lancet 2023; 402:2209.
• Seidler AL, Libesman S, Hunter KE, et al. Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: a systematic review and network meta-analysis with individual participant data. Lancet 2023; 402:2223.
• Pivya (pivmecillinam) tablets. US Food and Drug Administration (FDA) approved product information. Revised April 2024. US Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/216483s000lbl.pdf (Accessed on May 22, 2024).
• Torres E, Carter G, Gero A, et al. Frequency of same-day contraceptive initiation, recent unprotected intercourse, and pregnancy risk: a prospective cohort study of multiple contraceptive methods. Am J Obstet Gynecol 2024; 230:661.e1.
• Velez MP, Dayan N, Shellenberger J, et al. Infertility and Risk of Autism Spectrum Disorder in Children. JAMA Netw Open 2023; 6:e2343954.
• Somisetty S, Santina A, Au A, et al. Progression of Pentosan Polysulfate Sodium Maculopathy in a Prospective Cohort. Am J Ophthalmol 2023; 255:57.
• Coyne K, Purdy MP, Bews KA, et al. Risk of hysterectomy at the time of myomectomy: an underestimated surgical risk. Fertil Steril 2024; 121:107.
• Oderkerk TJ, Beelen P, Bukkems ALA, et al. Risk of Hysterectomy After Endometrial Ablation: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:51.
• Nahshon C, Abramov Y, Kugelman N, et al. The effect of subsequent pregnancy and childbirth on stress urinary incontinence recurrence following midurethral sling procedure: a meta-analysis. Am J Obstet Gynecol 2024; 230:308.
• Olawaiye AB, Hagemann I, Bhoshale P, et al. AJCC Cancer Staging System, Version 9: Vulva, 9th ed, American College of Surgeons, 2023.
• Plante M, Kwon JS, Ferguson S, et al. Simple versus Radical Hysterectomy in Women with Low-Risk Cervical Cancer. N Engl J Med 2024; 390:819.
• Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024; 74:12.

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Sunday 12 July 2015

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1 The Maternal and Foetal outcome in premature rupture of membranes.

2.      Coagulation disorder in abruptio placentae and maternal and fetal outcome.

3.      Study of Incidental HPV infection in PAP smear.

4.      Doppler USG OBS and mean arterial pressure studies at 19-24 weeks and their outcome in pregnancy related to PIH.

5.      Carcinoma of Cervix and its Management.

6.      Pregnancy induced Hypertension : a prospective study of Fetomaternal outcome and its corelation to USG Doppler study and Histopathological changes of placenta.

7.      Ectopic Pregnancy : Diagnosis & Management.

8.      A prospective study of etiology, investigations, management and pregnancy outcome in Ist trimester abortions and its correlation with TORCH infection.

9.      Safe simple and method of termination of early pregnancy MVA syringe.

10.  A Study of ovarian malignancies; with special reference to management protocols.

11.  Clinical and Sonographic correlation of IUGR.

12.  To study Maternal & Neonatal outcome in vaginal birth after Caesarean section (VBAC) Vs Elective lower segment Caesarean section in patients with previous lower segment Caesarean section due to non recurrent cause.

13.  Seroprevalence of Rubella virus in Preconceptional and Infertile women.

14.  Comparative study of efficacy of Valethamate Bromide and Drotaverine in normal labor.

15.  Cord blood nucleated red blood cell count- A marker of foetal Asphyxia.

16.  Hysterectomy morbidity and mortality.

17.  Comparative study of the Effect of different parenteral Iron preparation in pregnant anaemic women.

18.  Nuchal cord & perinatal outcome.

19.  Modified extraperitoneal Cesarean section -A study of 30 cases

20.  Comparative analysis between PGE1 and PGE2 analogues for medical induction of labour.

21.  Correlation of Pelvic findings, Ultrasound with Doppler and Tumor Marker (CA125) with Histopathological nature of ovarian tumors in women of 40 to 60 years of age.

22.  Maternal and Perinatal outcome in Placenta Previa.

23.  Effect of Progestrone in Management of Threatened preterm labour.

24.  To Study the Effect of Omega 3 fatty acids on Pregnancy outcome.

25.  Combined use of Serum Inhibin and CA 125 assays as Tumour Marker For Ovarian Cancer.

26.  To Study the Correlation between Maternal Body Mass Index & Obstetric outcome.

27.  To Study incidence of immediate postoperative complications of obstetrical and Gynaecological surgery.

28.  Screening for preeclampsia and fetal growth restriction by uterine artery doppler at 11-14 weeks Gestation.

29.  A study of Trans Obturator sling surgery in Management of Stress Urinary incontinence.

30.  A study of correlation between maternal body mass index in pregnancy and its perinatal outcome.

31.  Study of Multiple Pregnancy.

32.  Role of Intrapartum fetal monitoring in predicting perinatal outcome.

33.  Ultrasound evaluation of congenital anomalies in at risk Pregnacies.

34.  Study of Perinatal Mortality.

35.  Clinico-Microbiological Correlation of White Per Vaginal Discharge.

36.  Placental Localisation by Ultrasound & its role in prediction of Pregnancy induced Hypertension.

37.  Walking Epidural for painless labour.

38.  Comparative Study of Various Methods of Fetal Weight Estimation at Term Pregnancy.

39.  Comparison Study of various Oxytocics in management of third stage of labour.

40.  Study of Socio-Demographic factors contributing to Eclampsia and their correlation with perinatal and Maternal outcome.

41.  Control study on birth defects and risk factors at tertiary care centre.

42.  Prospective clinical study of cases of Abruptio Placentae.

43.  Study of safety & efficacy of low dose magnesium sulphate (MgSo4) regimen in controlling convulsion in Eclampsia.

44.  Clinical study of PPH in rural population.

45.  Effect of Maternal Haemoglobin % on Birth Weight and Apgar Score of baby.

46.  Correlation of Clinical Features and Hormonal assays in Women having Polysistic Ovaries on Ultrasonography.

47.  Intravenous Versus Oral Iron for Treatment of Anaemia in Pregnancy.

48.  Borderline AFI in Last Trimester and Perinatal Outcome.

49.  Extra-Amniotic Normal saline Instillation in 2nd trimester abortion.

50.  A Study of Fetal outcome in Twin pregnancy at Government medical college , Nagpur.

51.  Syndromic Diagnosis in RTI/STI among women of reproductive age group.

52.  An Observational (Longitudinal) study of Amniotic Fluid index & perinatal (Fetal)outcome.

53.  Prevalence & clinico pathological profile of endometriosis in Perimenopausal Women.

54.  Perinatal outcome in cases of Term & Preterm Prelabour rupture of membranes with special reference to Body mass index, Hemoglobin status, Amniotic fluid index, Cervical score & Cervical and Vaginal colonization.

55.  Study of Incidence of Hypothyroidism in Neonates.

56.  Emergency Contraception – Public Awareness.

57.  To study the effect of per-rectal Buscopan suppository (10 mg)on duration of active stage of labour, from ‘3’ cms – cervical dilatation to delivery of baby.

58.  To compare the effects of intravaginal prostaglandin E1 and intracervical prostraglandin E2 for prelabour ripening of unfavourable uterine cervix in nulliparous women.

59.  To study the efficacy of prophylactic IV methyl- Ergometrine, IM Prostaglanding -F2α, and oral prostaglandin -E1 in prevention of postpartum haemorrhage.

60.  Complications and outcome in teenage pregnancy.

61.  Study of risk factors and outcome in cases with postpartum hemorrhage.

62.  Pregnancy outcomes in the in vitro fertilization conceived polycystic ovary syndrome patients: a retrospective study

63.  The study of maternal factors and perinatal outcome in meconium-stained liquor in full term pregnancies.

64.  A retrospective study on postmenopausal bleeding-causes and its diagnosis using transvaginal ultrasound and hysteroscopy.

65.  A study of effect of vitamin D supplementation in vitamin D deficient females having polycystic ovarian syndrome.

66.  Study of sublingual misoprostol versus interavaginal misoprostol in induction of labor.

67.   Maternal and perinatal outcome in cases of oligohydramnios.

68.  The role of dignostic hystero-laparoscopy in the evaluation of infertility and the diagnostic accuracy of hysterosalpingography in early detection of causes of infertility over hystoero-laparoscopy.

69.  The study of maternal factors and perinatal outcome in Gestational Diabetes Mellitus

70.  Ultrasound evaluation of cause of vaginal bleeding in first trimester of pregnancy.

71.  Evaluation of factors leading to blood transfusion in antenatal & postnatal patients.

72.  A prospective study to assess compliance safety and expulsion rate of CU-T 380 A in immediate post partum period.

73.  A prospective comparative study to evaluate the efficacy and acceptability of intravenous iron sucrose and oral ferrous fumarate for the prevention of iron deficiency anemia during pregnancy.

74.  Early neonatal outcome in meconium stained amniotic fluid in uncomplicated pregnancies.

75.  Prostaglandin E1 in prevention of post partum bleeding: route of administration.

76.  Prospective study to evaluate the safety,efficacy and acceptance of intra-venous iron sucrose complex in pregnant women with iron deficiency anaemia.

77.  Non stress test as an admission test to assess the outcome of high risk pregnancy.

78.  Study of indications of caesarean section and related maternal and fetal complications in teaching institute.

79.  Study of maternal and neonatak outcome in cases of abruptio placenta.

80.  Combination of foley bulb and vaginal misoproostol compared with vaginal misoprostol alone for cervical ripening and labor induction.

81.  Prevalence of gestational diabetes mellitus with its maternal and fetal outcome.

82.  Study of obstetric and fetal outcome of post caesarean section pregnancy at tertiary health care centre.

83.  Study of complications of medical termination of pregnancy in first trimester.

84.  A clinical study of ectopic pregnancy.

85.   Prevalence of bacterial vaginosis in pregnancy after 20 weeks of gestation.

86.   Prospective study of ultrasound imaging of ovaries with its clinical implication and management.

87.  Role of encirclage operation in primigrivida patient with short cervical length.

88.  Umbilical cord coiling index and perinatal outcome.

89.  Relationship of the findings of colour doppler and non-stress test with the perinatal outcome among the cases of intra-uterine growth restriction.

90.  The role of external pelvimetry and maternal height in the prediction of mode of delivery among nulliparous women.

91.  A clinical study to correlate perinatal outcome of newborns with intrapartum diagnosis of fetal distress.

92.  A comparative study of clinicosurgical outcome between total abdominal hysterectomy and vaginal hysterectomy in non proplapse and non oncological uterine conditions.

93.  Comparison of sperm vitality of fresh semen before and after sperm preparation using two different methods in subfertile

94.  Asthenozoospermic males attending the infertility OPD at a tertiary care centre.

95.  Prospective study of socio demographic characteristics,maternal disorders & foetal risk factors responsible for early and late stillbirth in a rural tertiary care hospital.

96.  A clinico -pathological study of women with complex and/or atypical endometrial hyperplasia and endometrial carcinoma with special refernce to risk factors including lifestyle diseases and polycystic ovarian syndrome.

97.   Foetal and maternal outcome in eclampsia.

98.   Study of non-descent vaginal hysterectomy.         

99. Evaluation of high risk mothers by a screening system and its co-relation with perinatal outcome.

100. Study of maternal and neonatak outcome in cases of post partum hemorrhage.

Disclaimer!

There are many methods of sample size determination. It is one of the first hurdle when someone starts writing a thesis. I have tried to give simplest way of determination of sample size. You need to show the method to your PG teacher before you include this method in your thesis. First confirm from your PG teacher and then only proceed.

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