Girija NARENDRAKUMAR Wagh

• MD OBGYN, Diploma in Gynac-Endoscopy, FICOG, FICS
• Head of Faculty at Bharati Vidyapeeth Deemed University

Background Micronutrients (folate and vitamin B12) and homocysteine are key components of the one-carbon metabolism and literature on the associations of these micronutrients with the pathophysiology of gestational diabetes mellitus (GDM) is unclear. The current study aims to examine the levels of these micronutrients across pregnancy in women who...

Objective To generate longitudinal fetal growth data in an Indian population and compare it with Intergrowth-21st. Material and methods Fetal biometry data was collected in a prospective longitudinal observational study (REVAMP: Research Exploring Various Aspects and Mechanisms in Preeclampsia) from 2017 to 2022. Fetal crown-rump length (CRL) was...

Preeclampsia is characterized by impaired angiogenesis and assessment of angiogenic factors can play a crucial role in the early diagnosis of preeclampsia. The current study reports the levels of angiogenic factors longitudinally from early pregnancy in women with preeclampsia and in the subtypes of preeclampsia, to identify their role in early pre...

Preeclampsia (PE) is a pregnancy-specific disorder and a major contributor to maternal and fetal morbidity and mortality. Role of oxidative stress in early pregnancy with the pathophysiology of the disorder is unclear. The current study aims to analyse maternal levels of oxidative stress markers (MDA and protein carbonyl) longitudinally across gest...

Birth after Cesarean Section 3 Disclaimer: These recommendations for "Birth after Cesarean Section" have been developed, to be of assistance to obstetricians, gynecologists, consulting physicians, and general practitioners by providing guidance and recommendations for managing women who have had a cesarean section and are going to give birth again....

The maternal fatty acid status plays a key role in influencing pregnancy outcomes. Omega-3 fatty acids are the precursors for E-series (RvE) and D-series resolvins (RvD) and possess anti-inflammatory properties. Pregnancy complications like gestational diabetes mellitus (GDM) are associated with excess maternal inflammation. This study reports the...

Introduction: Expression of nutrient transporters in the placenta affects fetal growth. This study reports the protein expression of nutrient transporters in the syncytial membranes [microvillous membrane (MVM) and basal membrane (BM)] of normotensive control and preeclampsia placentae. Methods: Placentae were collected from fourteen normotensiv...

Preeclampsia (PE) is a pregnancy disorder that may be associated with inadequate maternal nutrition. Fatty acids are vital for placental and fetal growth. Fatty acid desaturases, key enzymes influencing the metabolism of polyunsaturated fatty acids, are reported to be associated with cardiometabolic risk. Any imbalance in the levels of omega-3 and...

Problem: C-reactive protein (CRP) is a marker for inflammation and its role as a possible biomarker for an early prediction of pre-eclampsia (PE) is unclear. The present study investigates the levels of high-sensitivity CRP (hs-CRP) longitudinally across pregnancy in women with PE and compares them to women without PE (non-PE). Method of study:...

Introduction: Earlier studies have shown higher apoptosis in the pre-term placenta as compared to term. However, the exact mechanisms triggering these are not completely understood. Studies in neuronal and non-neuronal tissues have shown that the precursor form of NGF (proNGF) triggers apoptosis through preferential activation of p75NTR and sortil...

The aim of this study was to examine serum vitamin D concentrations from early pregnancy until delivery in women who did and did not develop preeclampsia. This longitudinal study was carried out in Pune, India. A total of 1154 women with singleton pregnancies were recruited in early pregnancy from two hospitals. Blood samples were collected and sto...

The present study reports the levels of maternal serum calcium and magnesium from early pregnancy until delivery, along with cord levels, in women who developed preeclampsia (PE) and compares them with those without PE. A total of 324 pregnant women (216 non-PE and 108 PE women) were included in this retrospective case–control study of prospectivel...

Objective To determine the trimester specific gestational weight gain (GWG) in a population of pregnant women from Western India and compare it with the Intergrowth–21st international and an Indian reference (GARBH–Ini cohort—Group for Advanced Research on BirtH outcomes). Study design A prospective longitudinal observational study was undertaken...

Background: Abnormal uterine bleeding (AUB) is defined as bleeding from the uterine corpus endometrium to be precise, the bleeding is abnormal in regularity, volume, frequency, or duration. The international federation of gynecology and obstetrics (FIGO) categorized AUB based on structured medical history, laboratory tests, ultrasound, and or hyste...

Background: Exogenous progesterone is a treatment option for obstetric indications associated with reduced progesterone activity. Oral natural micronized progesterone (NMP) is effective, although it requires multiple daily doses and may cause adverse events due to its active metabolites. A sustained-release formulation of NMP (NMP-SR) has been deve...

Background: Exogenous progesterone is a treatment option for obstetric indications associated with reduced progesterone activity. Oral natural micronized progesterone (NMP) is effective, although it requires multiple daily doses and may cause adverse events due to its active metabolites. A sustained-release formulation of NMP (NMP-SR) has been dev...

Objectives To compare the proportion of postpartum depression at 6 weeks among women who had caesarean delivery and women who had vaginal delivery and to assess its association with some sociodemographic factors. Design This is a descriptive comparative study with prospective enrolment. We followed the enrolled women and assessed them for postpart...

Introduction Preeclampsia is a hypertensive disorder affecting both mother and the fetus and is a major cause of maternal and neonatal morbidity and mortality. Abnormal placentation is a common feature in preeclampsia that contributes to placental dysfunction. It is likely that increased homocysteine and oxidative stress influence apoptosis in pree...

Context: Many women have postpartum sexual dysfunction. The mode of delivery is an important determinant. Aims: To calculate the risk ratio of non-resumption of vaginal sex and dyspareunia during the postpartum period among cesarean-delivered women. Settings and design: This large multisite study was conducted in 13 selected hospitals in Pune...

Background: In India the proportion of early initiation of breastfeeding is hovering around 50% and the proportion of cesarean deliveries is increasing substantially. Objectives: To compare the prevalence of early initiation of breastfeeding (EIBF) among cesarean and vaginally delivered women in hospitals in Pune District, Maharashtra State, India...

Background: In India the proportion of early initiation of breastfeeding is hovering around 50% and the proportion of cesarean deliveries is increasing substantially. Objectives: To compare the prevalence of early initiation of breastfeeding (EIBF) among cesarean and vaginally delivered women in hospitals in Pune District, Maharashtra State, India...

Introduction: Placenta previa unpredictable obstetric emergency substantially contributing to maternal morbidity and mortality. Aim: To Determine the Maternal and Neonatal outcome associated with Placenta Previa. Materials and Methods: A Retrospective observational Hospital based study, conducted in the Department of Obstetrics and Gynecology of Bh...

Preeclampsia is a pregnancy specific disorder, leading to maternal and infant morbidity and mortality. Abnormal placentation has been reported in preeclampsia. Nutrients like vitamin D and long chain polyunsaturated fatty acids (LCPUFA) are known to play a role in placental development. In an animal model we have previously demonstrated that matern...

Objectives: The current study examines the placental and maternal lipid profile and expression of genes involved in placental lipid metabolism in women with preeclampsia. Methods: The current study includes normotensive control women (n = 40) and women with preeclampsia (n = 39). Preeclampsia women were further classified into women delivering a...

Increased vaginal discharge in pregnant women in many instances is not pathological. Vulvovaginal infections like bacterial vaginosis (BV), candidiasis or trichomoniasis can result in abnormal vaginal discharge. Bacterial Vaginosis is diagnosed more frequently in women with established preterm labor (PTL) or delivery and with preterm rupture of mem...

The biosynthesis and transport of long chain polyunsaturated fatty acids (LCPUFA) require the activity of fatty acid desaturase (FADS) enzymes, fatty acid transport proteins (FATP) and fatty acid binding proteins (FABP). In a previous study we have demonstrated region-specific changes in the LCPUFA levels in preeclampsia (PE) as compared to the nor...

Background: Timely administration of vaccines, particularly for hepatitis B birth dose within 24 hours of birth is of immense importance. It is considered as an indicator of quality of immunization programme. This study aimed to assess effect of mode of delivery and type of hospital on immunization among newborns. Methods: This large multi-site stu...

Hypertensive disorders in pregnancy (HDPs) are on the rise and significantly seen to contribute to maternal morbidity and mortality [1, 2]. Delivering these patients is an additional challenge due to the dynamic nature of the delivery process, compromised maternal fetal unit, and sensitive and hyperresponsive nature of the maternal vascular respons...

Introduction: Severe Iron Deficiency Anaemia (IDA) in pregnancy is usually treated with whole blood or Packed Cell Volume (PCV) transfusion to maintain feto-placental perfusion and replete the haemodynamic mechanisms before delivery. Administration of whole blood or PCV may not always be feasible and therefore Intravenous Iron Sucrose (IVIS) is pro...

Preeclampsia is a pregnancy complication, associated with an increased risk of maternal and neonatal morbidity and mortality. The etiology of preeclampsia is not yet fully understood, although the current literature indicates an up regulation of inflammatory mediators. Vitamin D is known to have anti-inflammatory properties and influence vascular f...

Background: Our recent study indicates differential protein levels of neurotrophins and angiogenic factors in various regions of the normotensive and preeclampsia (PE) placenta. These changes may be in a response to differential mRNA expression of neurotrophins. Methods: This study examines the mRNA levels of nerve growth factor (NGF) and brain-der...

Background: Preeclampsia is a major cause of maternal, fetal and neonatal morbidity and mortality, particularly in developing countries. Considering the burden of preeclampsia and its associated complications, it is important to understand the underlying risk factors and mechanisms involved in its etiology. There is considerable interest in the po...

Background Transversus abdominis plane (TAP) block is a fascial plane block providing postoperative analgesia after lower abdominal surgeries including Cesarean section. Conventionally, it is administered under ultrasound guidance or by blind technique. We studied a novel transperitoneal surgical TAP block for providing safe and effective analgesia...

Matrix metalloproteinases (MMPs) are involved in the extracellular matrix (ECM) remodeling during human placentation and parturition and have been shown to be associated with oxidative stress. Placental regional changes in oxygen availability and oxidative stress indices may influence regional differences in expression of MMPs. This study examines...

its a though process taking into account the changing metabolic and environmental aspects in clinical practice . Important is to be able to identify , prevent and treat diabetes and obesity before it too late

Altered placental angiogenesis is implicated in the pathophysiology of preeclampsia. We have earlier reported placental regional differences in oxidative stress markers and neurotrophins. Oxidative stress and neurotrophins are reported to regulate angiogenesis. This study aims to examine protein and mRNA levels of vascular endothelial growth factor...

Background: Preeclampsia (PE) is a hypertensive disorder during pregnancy and is one of the major causes of premature deliveries in India. Lower placental angiogenesis and increased inflammation and oxidative stress are associated with both preterm deliveries and PE. Long chain polyunsaturated fatty acids (LCPUFA) are key molecules involved in the...

Objective: To investigate the metabolic profile of milk on day 3 and at the 6th month of lactation in mothers with preeclampsia (PE) and normotensive mothers. Study design: Women with PE (n=29) and control women (n=31) were recruited for this study. Milk was collected on day 3 and at the 6th month of lactation. Proton NMR spectroscopy was used t...

Severe hypertension is a challenge in obstetric practice, and the focus of the antenatal care should be toward identifying this condition in all mothers. A thorough evaluation for systemic involvement and end-organ damage is essential to assess the extent of the disease. Hypertensive urgency and crisis are distinct entities. Severe preeclampsia is...

Background: A very large number of fatty acids play wide range of physiological roles in cellular growth and function in placental as well as fetal growth. However, docosahexaenoic acid (DHA), in addition to its critical role in cellular membranes, is known to act as a ligand for several nuclear receptors and regulates the activity of transcriptio...

Preeclampsia (PE) is a pregnancy-specific disorder, defined as new onset of maternal hypertension and proteinuria after 20 weeks of gestation. Our earlier study has shown increased maternal oxidative stress at delivery to be associated with poor birth outcome in PE. However, these results were observed when the pathology had progressed and may have...

Maternal nutrition, especially LCPUFA, is an important factor in determining fetal growth and development. Our earlier cross sectional study reports lower docosahexanoic acid (DHA) levels at the time of delivery in mothers delivering low birth weight (LBW) babies. This study was undertaken to examine the role of the maternal omega-3 and omega-6 fat...

Frequency of consumption of foods rich in omega-3 fatty acids at three time points during pregnancy. NBW–Normal birth weight; LBW–Low birth weight; n—Number of subjects; p—Significance; T1 = 16th–20th week; T2 = 26th–30th week; T3 = at delivery. (DOCX)

The present prospective study examines proportions of maternal erythrocyte fatty acids across gestation and their association with cord erythrocyte fatty acids in normotensive control (NC) and preeclamptic pregnancies. We hypothesize that maternal fatty acid status in early pregnancy influences fetal fatty acid stores in preeclampsia. 137 NC women...

Objective: The present prospective study examines the levels of maternal plasma folate, vitamin B12 and homocysteine in normotensive control (NC) women and women with preeclampsia (PE) from early pregnancy till delivery. Methods: The present study includes 126 NC and 62 PE women. Maternal blood was collected at 3 time points during pregnancy (T1...

Long chain polyunsaturated fatty acids (LCPUFAs) are biologically active fatty acids which regulate placental angiogenesis, inflammation, and oxidative stress. Abnormalities in these aspects have been associated with preeclampsia (PE). Further, placenta has a heterogeneous structure with differential vascularization across different regions. We the...

Preeclampsia is characterized by hypertension and proteinuria. Improper development of the placenta due to altered angiogenesis is the main culprit in PE. Nerve growth factor (NGF) is an angiogenic factor which is expressed and localized in the placenta. Our earlier cross sectional study has shown altered NGF levels at delivery in women with PE. Ho...

Background: Long chain polyunsaturated fatty acids (LCPUFAs) are biologically active fatty acids which regulate placental angiogenesis, inflammation, and oxidative stress. Abnormalities in these aspects have been associated with preeclampsia (PE). Further, placenta has a heterogeneous structure with differential vascularization across different re...

To examine placental malondialdehyde (MDA), catalase, and glutathione peroxidase (GPx) levels in four placental regions among women with and without pre-eclampsia. A cross-sectional study was conducted among women aged 18-35years with a singleton pregnancy in Pune, India, between May 3, 2013, and June 16, 2014. Three groups were enrolled: normotens...

Maternal long chain polyunsaturated fatty acids (LCPUFA) play a key role in fetal growth and development. This study for the first time examines the maternal and cord LCPUFA levels in preeclamptic mothers delivering male and female infants. In this study 122 normotensive control pregnant women (gestation≥37 weeks) and 90 women with preeclampsia wer...

Preeclampsia (PE) is a major pregnancy complication of placental origin which leads to adverse pregnancy outcome. Brain derived neurotrophic factor (BDNF) is suggested to promote trophoblast growth and regulate placental and fetal development. This study for the first time examines the levels of maternal plasma BDNF at various time points during ge...

Our previous cross-sectional studies have shown altered proportions of long chain polyunsaturated fatty acids (LCPUFA) in preeclampsia (PE) at the end of pregnancy when the pathology has already progressed. The present longitudinal study for the first time reports fatty acid proportions from 16th week of gestation till delivery and placental transp...

Our earlier studies of preeclampsia (PE) at delivery have demonstrated the alteration of one carbon cycle, reduced placental omega 3 fatty acids, altered circulating levels of angiogenic factors and differential placental gene-specific methylation patterns of angiogenic factors. This study was undertaken to examine changes in the levels of angiogen...

Abnormalities in maternal serum marker levels and fetal measurements obtained during the first trimester screening can be a marker not only for certain chromosomal disorders and anomalies in the fetus but also for specific pregnancy complications. In particular, low maternal serum pregnancy-associated plasma protein-A (PAPP-A), at 11-13 weeks of ge...

Preeclampsia and eclampsia are grave complications of pregnancy responsible for morbidity and mortality. National Eclampsia Registry of the FOGSI has helped in quantifying the magnanimity and also the clinical relevant pointers which can help in improving the health care delivery. Many complex pathogenic mechanisms are now implicated to be responsi...

Pregnancy in a rudimentary horn of a unicornuate uterus is rare [1]. An incidence of 1 in 76,000–150,000 pregnancies is reported in the literature [2].We have come across one rare case in which there was rupture of gravid non-communicating horn of the uterus after carrying the pregnancy up to 18 weeks of gestation.

Earlier studies indicate that altered angiogenesis at birth is associated with poor birth outcome in women with preeclampsia. Now, we hypothesize that the progressive gestation dependant changes in markers of angiogenesis will be more useful to predict birth weight early even in a normotensive pregnancy. This study for the first time examines the a...

Background: Strange interplay of hormones (especially inadequacy or lack of estrogen) affects the psychological health of the women & tendency to gain weight but the reasons are not sure & obesity may lead to many mental disorders. Objective: The study was aimed to correlate the quality of life in the form of psychological well-being in perimenopau...

Cord blood ABG analysis determines the level of oxygen and carbondioxide present in blood which are useful in determining the wellbeing of the newborn. If the newborn is depressed and has acidosis ,it could lead to neurologic complication in later life Measuring the values will also help in gauging, if the baby is suffering from perinatal asphyxia...

Hysterectomy is one of the most commonly performed gynecological procedures. Although the first laparoscopic hysterectomy was performed in 1989, this technique accounts for only a few of all hysterectomies performed today. To assess the safety of total laparoscopic hysterectomy through a novel technique that we have evolved, a retrospective analysi...

To describe our experience and technique of total laparoscopic radical hysterectomy with pelvic lymphadenectomy, which is the largest single- institution study. Retrospective, nonrandomized study (Canadian Task Force classification II-2). Private hospital. Two hundred forty-eight patients with International Federation of Gynecology and Obstetrics s...