Niraj N MahajanTopiwala National Medical College & B. Y. L. Nair Charitable Hospital · Department of Obstetrics and Gynecology
Niraj N Mahajan
MD (OB & GYN)
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Publications (93)
Objective:
To provide a descriptive account of the challenges and administrative preparedness for establishing and sustaining safe obstetric services during the COVID-19 pandemic at Topiwala National Medical College & BYL Nair Charitable Hospital (NH), Mumbai, India.
Methods:
The management of pregnant women with COVID-19 was implemented as per...
Objective
To assess clinical presentations, pregnancy complications, and maternal and neonatal outcomes among women with multiple gestation pregnancy (MGP) and confirmed SARS‐CoV‐2 (Covid‐19) infection and to compare the data with a pre‐pandemic period.
Methods
A retrospective study at a dedicated Covid‐19 Hospital in Mumbai, India. Data were obta...
Rates of severe coronavirus disease 2019 (COVID-19), intensive care unit admission, and maternal mortality increased among pregnant and postpartum women admitted for COVID-19 in the second wave compared with the first wave in India.
Background
Healthcare workers (HCWs) are at higher risk of contracting SARS‐CoV‐2 infection. Information regarding co‐infection of SARS‐CoV‐2 with vector‐borne diseases (malaria and dengue) is crucial especially for the countries wherein malaria and dengue are endemic. The objective was to study the prevalence, demographic, clinical presentations a...
To determine the recurrent convulsion rate using low-dose magnesium sulphate regime in eclampsia and to identify toxicity and complications with clinical parameters.
Prospective study with two different magnesium sulphate regimes in two slightly clinically different subgroups. Group A that came directly to our hospital and group B who had already r...
Introduction:
Maternal infections can affect the placenta, which acts as a fetomaternal barrier. This study aimed to determine the spectrum of morphologic alterations in the placentas of pregnancies complicated by SARS-CoV-2 infection and the impact on fetal or neonatal outcomes.
Materials and methods:
This is a prospective case-control study. O...
Synopsis
The adverse outcomes of COVID‐19 among pregnant women have been pronounced in the low‐income countries compared with low‐ and middle‐income countries.
Objective
To estimate incidence, risk of early and late-onset preeclampsia (PE) and understand their relationship with severity of COVID-19.
Methods
Pregnant women with COVID-19 (n = 1929) were enrolled from 1 April 2020 to 24 February 2022. Primary outcome measure was incidence and risk of early onset PE in women with COVID-19.
Results
The incid...
More than 533 million Coronavirus Disease 2019 (COVID-19) cases and associated 6 million fatalities were reported globally whereas 43 million cases and 0.5 million deaths in India were reported till June 2022. Maharashtra state alone reported about one-third of the total cases of COVID-19 in India in the early period of COVID-19 pandemic. The lack...
Background
Congenital cervicovaginal agenesis (CVA) with functioning endometrium is an extremely rare mullerian anomaly. Genital tract patency and fertility preservation are the major challenges in cases of CVA. With the advances in surgical techniques, management has shifted from a radical approach-like hysterectomy towards a more conservative app...
Objective:
To study clinical presentation, disease severity, pregnancy complications, and maternal outcomes in women affected with COVID-19 during the third wave as compared to the first and second waves of COVID-19.
Methods:
A retrospective, observational cohort study was conducted amongst 2058 pregnant and postpartum women with COVID-19 admitt...
Introduction
Pregnant women are at increased risk of contracting COVID-19 due to several factors and therefore require special attention. However, the consequences of the COVID-19 pandemic on pregnant women and their newborns remain uncharted. The PregCovid registry aims to document the impact of SARS-CoV-2 infection on pregnant, postpartum women a...
Importance: Following the outbreak of SARS-CoV-2 infection, it is unclear whether there is any difference in clinical presentation, disease severity, pregnancy complications, and maternal outcomes in pregnant and postpartum women during the third wave of COVID-19 as compared to the earlier two waves of COVID-19.
Objective: To assess the clinical p...
Background and objectives:
India has witnessed significant number of cases of co-infection of malaria or dengue with COVID-19, especially during the monsoon season. It has been speculated that anti-malarial immunity might have a protective role in co-infection. Retrospective analysis of co-infection of vector-borne diseases with COVID-19 was done...
Androgen insensitivity syndrome (AIS) causes feminization of the external genitalia, in 46XY individuals. We report a notable case of partial AIS (PAIS), which was treated with ventral clitoroplasty and vaginal dilatation. The patient is a 17-year-old phenotypically female, presented with primary amenorrhea, infantile vagina, clitoromegaly, and pre...
Aim: Although two-wave pattern of the coronavirus disease-2019 (COVID-19) pandemic was observed in many countries, there is limited information on the impact of both the waves on clinical presentations of ectopic pregnancy (EP) with COVID-19. Therefore, we aimed to understand the impact of the first wave and second wave of COVID-19 pandemic on wome...
Objective:
To compare spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB) rates during both waves of the coronavirus disease 2019 (COVID-19) pandemic.
Methods:
Retrospective analysis of the PregCovid registry of pregnant women with COVID-19 was performed at a dedicated COVID-19 hospital in Mumbai, India. The data of 1630 women w...
Background & objectives: The PregCovid registry was established to document the clinical presentations, pregnancy outcomes and mortality of pregnant and post-partum women with COVID-19.
Methods: The PregCovid registry prospectively collects information in near-real time on pregnant and post-partum women with a laboratory- confirmed diagnosis of SAR...
Lack of reliable data on the risk of spontaneous abortions (SABs) due to COVID-19 is leading to concern in patients, and obstetricians. The SAB rate (per 1,000 births) was significantly higher during the second wave as compared to the first wave of the COVID-19 pandemic (82.6 vs 26.7; p<0.001) as well as the prepandemic period (OR 1.7, 95%; CI 1.16...
• Stillbirth rate among COVID-19 pregnant women was higher in second wave (p=0.038)
• Preeclampsia was reported higher during the second wave among stillbirths (p=0.590)
• More stillbirths occurred at <34 weeks gestation during the second wave (p=0.214)
• Moderate-severe COVID-19 was observed only during the second wave among stillbirths
• Reducing...
For combating the SARS-CoV-2 infection, health-care workers (HCWs) have been on the forefront making them vulnerable for a higher risk of contagious SARS-CoV-2 infection.
Identification of risk factors for increased susceptibility for COVID-19 in healthcare workers is urgently required especially during the devastating second wave to reduce the mo...
Protocol for a prospective, hospital-based registry of pregnant women with SARS-CoV-2 infection in India: PregCovid Registry study.
https://pregcovid.com
Neurological complications of COVID-19 affecting both the central and peripheral nervous system and skeletal muscles are being increasingly reported. However, to our knowledge, acute neurological complications of COVID-19 are not reported to date. We report a rare case of GBS in a pregnant woman with COVID-19 who suffered from spontaneous abortion...
Introduction: For a low resource setting, COVID-19 has taken a toll on the healthcare system. Furthermore, healthcare system is at the brink of collapse due to concomitant occurrence of vector borne infections (malaria or dengue) along with SARS-CoV-2 infection. Mumbai city is an endemic region for both malaria and dengue. It is the need of the hou...
We observed that, little is still known about the impact of the SARS-CoV-2 infection on pregnant women with heart disease (HD). Aim of our study was to investigate the impact of COVID-19 on pregnancy and neonate retrospectively at BYL Nair Charitable Hospital (NH), a dedicated COVID-19 hospital in women with HD in Mumbai, India. In the initial phas...
To date, a large number of pregnant women have been infected with SARS‐CoV‐2 and these patients are at higher risk of developing certain pregnancy complications [1]. Out of 10 million people infected globally with tuberculosis (TB), a quarter of the disease burden is contributed by India [2]. Pregnant and postpartum women are at increased risk of d...
Background: Reinfection/reactivation of SARS-CoV-2 has been a matter of great interest from the immunological and vaccine perspective. However, little is known about the clinical presentation of such reinfection/reactivation. We report a case series of 9 COVID-19 patients having experienced two clinically- and/or virologically-confirmed episodes of...
Pregnant woman with delirium and COVID-19 is extremely challenging to manage especially in low income and middle income countries (LMICs). we recommend the training of healthcare workers on early recognition and appropriate treatment of psychiatric emergencies in pregnancy and post-partum period. There is a need for creating specialist mental healt...
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rapidly spreading in India and across the world. Healthcare workers (HCWs) are at increased risk of contracting COVID-19 due to direct or indirect exposure to COVID-19 patients, and require special attention. Limited information is available about its effect in...
Many low‐ and middle‐income countries (LMICs) experience high rates of malaria and other neglected tropical diseases (NTDs), such as dengue [1]. The COVID‐19 pandemic complicates these matters further as COVID‐19 in pregnant women is associated with an increased risk of preterm birth, and in some LMICs it is associated with a higher risk of materna...
Gestational trophoblastic tumors (GTTs) include choriocarcinoma, epithelioid trophoblastic tumor, and placental site trophoblastic tumor. The occurrence of mixed GTT is rare. We report such a case in a 24-year-old woman who presented with menorrhagia since 2 months and obstetric history of two abortions, one of which was a molar pregnancy. She was...
This data on undocumented or “steady state” infections in pregnant women is useful for ensuring safe obstetric and neonatal services and assessing the burden of COVID-19 in the region to plan strategies on strengthening or relaxing mass social distancing measures. We strongly recommend that the strategy of universal testing of pregnant women admitt...
It might be possible that altered immune mechanisms in
patients with SARS-CoV-2 infection may be a risk factor for developing
psychiatric illness. Neuropsychiatric sequalae can also be due to a direct
neurotoxic effect of the virus or the host’s immune response towards it. Having comorbid COVID-19 infection or the fact that these women had
to deliv...
Background: Sublingual Misoprostol 200 ug 4 hrly is as effective or less effective than vaginal Misoprostol 200ug 4hrly with 200mg oral Mifepristone in termination of second trimester pregnancy.To compare effectiveness, side-effects, and patient satisfaction of sublingual vs vaginal misoprostol administration.Methods: It was prospective randomized...
Gestational Choriocarcinoma (GCC) can arise from normal term pregnancy, hydatidiform moles, non-molar miscarriages and ectopic pregnancies. In our case, a 31 year old woman gravida 2 para 1 with irregular vaginal bleeding and pain in lower abdomen was operated for ruptured ectopic pregnancy. At laparotomy 8x6x6 cm purple coloured hematosalphinx lik...
We read with great interest the article by Tuuli and colleagues, 1 and we support the use of nonformation of the bladder flap at cesarean delivery. We agree that creation of the bladder flap had been an integral part of the standard caesarean delivery without evidence of benefit. We also congratulate the authors for including repeat cesar-ean deliv...
Worldwide, cervical cancer is considered to be the second commonest cancer as far as mortality and incidence is concerned and India contributes to about 20–30% of the global burden. This paper is based on analysis of records of persons suffering from various cancers over 25 years. Cervical cancer constituted 14.4% of all cancers of men and women pu...
In modern obstetrics, the role of internal podalic version (IPV) is limited to delivery of the second twin. A retrospective study was conducted to assess the efficacy of IPV in singleton neglected shoulder presentation with fetal demise. Women with live fetuses, previous CS or contracted pelvis were excluded. The procedure involved repositioning th...
Creation of the bladder flap, i.e., dissecting the urinary bladder from the lower segment of the uterus is a standard part of cesarean section (CS). However, it is yet to be established whether the formation of bladder flap is advantageous.
Pelosi and Ortega in 1994 introduced a new minimally invasive technique of CS, which included the omission of...
Duplicated collecting systems comprises renal units containing two pyelocalyceal systems associated with a single ureter or double ureters and is the most common upper tract anomaly.
This report presents a rare entity: an adult woman who had giant hydroureter of upper-pole moiety of the duplex kidney, which was an incidental finding during cesarean...
Objective
We report on our experience in surgical treatment of patients with intra-abdominal intrauterine devices (IUDs).
Objective
To evaluate fundal injection of blue dye and radiocolloid for lymphatic mapping and sentinel node identification in women with high-risk endometrial cancer.
We read with interest the paper by Joshi et al. on the role of internal iliac artery ligation (IIAL) in the management of postpartum haemorrhage (PPH). We would like to draw attention to certain issues. 1. The authors made no attempt to define PPH or quantify blood loss. We suggest that the World Health Organization protocol should be adopted for a...
Objective. The purpose of this study was to assess the incidence and significance of a thick, cystic-appearing endometrium in association with a history or an ovarian appearance of polycystic ovarian syndrome. Methods. An Institutional Review Board-approved, retrospective medical record review of sonographic studies from January 1, 1998, to Decembe...
Thank you for providing the opportunity to respond to the letter of Dr NMahajan and Dr K Mahajan. The authors suggest that abnormal sonographic textures may have additional diagnostic value for the diagnosis of endometrial carcinoma. In our study we have no data available concerning the homogeneity of echotexture so we could not evaluate whether th...
Many countries have now adopted fortification, where folic acid is added to flour and intended to benefit all with rise in blood folate level. During many transformations of folate from one form to another, a proportion is accidentally converted to N(5)-methyl-THF, an inactive metabolite, the so-called "folate trap". Consideration should be given t...
Adenomyoma is a benign tumour composed of smooth muscle and benign endometrium. These tumours typically originate within the uterus. An extra-uterine adenomyoma is a rare entity.
We report a case of extra-uterine adenomyoma of the ovarian ligament, which was an incidental finding during a total abdominal hysterectomy and bilateral salpingo-oophorec...
Questions
Questions (31)
29-yrs-old delivered 6 months back in a village, following which she developed severe difficulty in passing motions. Rectocele is present on examination. After all conservative failed, MRI defecography revealed severe rectocele and Recto-Rectal Intussusception. Stapled transanal resection of the rectum (STARR) is planned but will she benefit from combined rectocele repair or it should be performed in separate setting.
Explanation provided by RCOG is to identify Lethal feto–maternal haemorrhage (FMH), to find the cause of IUFD.
What to do once we find the large FMH or less FMH? Does our management changes?
I have never seen any practitioner performing fourth leopold maneuver in routine antenatal examination, except when someone is teaching UG/PG students. I personally never perform unless Pawlick grip (third leopald) is empty.
Direct trocar insertion through Palmer's point with 10 mm trocar OR Veress needle insufflation prior to trocar entry through Palmer's point? Which one is preferable or practiced?
As per rule/law, at least in India, we have to perform female sterilization with Pomeroys technique. But over the years, I came across several cases, where I feel this technique should not be used in some cases. For example
Previous 3/4 cesarean section
Previous rupture uterus and scar dehiscence this time
Scar dehiscence without labour in previous one scar
If we perform pomeroy's technque in these cases, there is a little chance of spontaneous recanalization, and surgical recanalization is never intended or advised in such cases.
