OBJECTIVE : To study the effectiveness of chlorpromazine (Largectil) as galactogoue in adopting mothers.

METHOD : Retrospective study of 11 cases.

RESULT : Eleven women who wished to adopt newborn babies either from adopting agencies or from their own relatives presented with the request fo r in it iation of breast milk. All of them were given chlorpromazine 25 mg thrice a day for 3-4 weeks with nipple stimulation 3-4 times every day. All had established lactation by the end 'of one month and started feeding their adopted babies.

CONCLUSION : Chlorpromazine (Largectil) for 3-4 weeks along with nipple stimulation is effective and safe for initiation of breast milk in adopting mothers.

OBJECTIVE : To assess the incidence of obstetric hysterectomy, etiological factors resulting in obstetric hysterectomy and morbidity and mortality following obstetric hysterectomy.

METHODS : A retrospective evaluatory study of cases of hysterectomies done as obstetric emergency during a 5 year period was carried out.

RESULTS : Thirtysix emergency hysterectomies were performed, the incidence being 0.2006% of all confinements. Rupture uterus was the commonest indication. Febrile illness was the commonest morbidity seen in 47 .2% of cases; maternal mortality was 5.55%.

CONCLUSION : Awailing of proper antenatal care, identification of high risk cases and timely referral to a proper institution can avoid emergency hysterectomy and can also reduce the maternal morbidity and mortality.

OBJECTIVE : To compare the response of intramuscular iron-sorbitol-citrate complex with that of oral iron.

METHODS : A prospective randomized study was carried out on 200 women with uncomplicated pregnancy enroled at 24-26 weeks of gestation with a hemoglobin of >8 gm% but < 11gm%. Group A (100 women) received injectable iron - sorbitol - citrate in three intramuscular doses of 150 mg each at 4 weekly intervals Group B (l00 women) were given oral iron having 100mg elemental iron daily. Hemoglobin levels were measured at enrolment, 4 weekly thereafter and at delivery.

RESULTS : Mean hemoglobin levels in group A and Bwere 9.84 ± 1.04 gm% and 9.85 ± 1.20 gm% respectively at enrolment and 10.5 ± 0.84 gm% and 9.96 ± 0.89 gm% respectively at delivery.

CONCLUSION : Hemoglobin rise was better in the injectable group.

OBJECTIVE : To assess of nutritional status, clinico-biochemical parameters and obstetric outcome of pregnant women of the tribal communities of Purnia district of Bihar.

METHODS : Thirty three tribal pregnant women of Oraon, Santhal and Munda tribes and 15 non-tribal pregnant women (controls), in their last trimester of pregnancy and in the age group of 19 to 30 years, with gravidity of one to four and partiy of zero to three were selected by random sampling from Purnia East Block, Bihar state, for study.Mean nutrient intake of the subjects was assessed by 24 hour recall method. Serum retinol, serum ferritin and blood haemoglobin levels were estimated. Placental weight, placental diameter and birth weight of neonates were recorded. Data were statistically analyzed by 't' test.

RESULT : Results indicated a highly malnourished and severely anemic state of the subjects. Clinical parameters and obstetric outcome data of the subjects were in subnormal values, significantly inferior as compared to those of controls (p<O.OOl to 0.1). 

CONCLUSION : Tribal women of Purnia district are exposed to high risk pregnancies due to severe malnutrition and poor antenatal care.

OBJECTIVE : To analyze treatment outcome after outpatient subinguinal cremesteric disruption and venous ligation in infertile male with abnormal semen parameters.

METHODS : A prospective study was carried out at a tertiary referral center for treatment of infertility. Three hundred infertile men with varicocele and abnormal semen parameters were included. Outpatient subinguinal cremesteric disruption with venous ligation was performed on all them. The main outcome measures were improvement in sperm counts and pregnancy rate.

RESULTS : Two hundred and forty two (80.7%) of the 300 men achieved pregnancy leading to live births. The total number of motile sperms per ejaculate increased from 0.08±0.02 x 106 before th e surgery to 7.5±2.5 x 106 after it.

CONCLUSION : Subinguinal outpatient cremesteric disruption and venous ligation is a physiological, economical, and safe option for varicocele repair in men with abnormal sperm parameters. High rate of unassisted pregnancy is achievable with minimum morbidity.

OBJECTIVE : To evaluate the role of day three values of estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH) in predicting the number of mature oocytes produced in cycles stimulated with gonadotropin-releasing hormone (GnRH) agonist in a short flare-up protocol.

METHODS : In this prospective study GnRHa was commenced on the first menstrual day for controlled ovarian hyperstimulation (COH) in 223 cases and day three E2, LH and FSH levels were measured. We identified the cases from whom, three or fewer mature oocytes were obtained as inadequate responders and based on day three FSH levels in COH cycle, we determined the FSH cut-off level exhibiting inadequate response with receiver operating characteristic (ROC) curve analysis.

RESULTS : It was found that there was a statistically significant correlation between the number of oocytes and the age of the woman (r = -0.37, p<O.Ol), basal FSH level in natural cycle (r = -0.28, p<O.Ol)and day three FSH level in COH (r = -0.44, p<O.OOl). Day three FSH cut-off level in COH determining three or more mature ooeytes available was found with ROC analysis as 9.5 mID / ml.

CONCLUSION : Day three FSH level in GnRHa stimulated cycle was found to be the most significant variable in determining response to COHo

OBJECTIVE : To evaluate the efficacy of Ormeloxifene for dysfunctional menorrhagia (DUB).

METHODS : Eighty five women aged 30 to 51 years who attended the outpatient gynecology department with complaint of heavy menstrual flow were recruited for the study. Ormeloxifene (60 mg)was given orally twice a week for first 12 weeks and then once a week for up to next 12 weeks. Menstrual blood loss measurements using pictorial blood loss assessment chart (PBAC), blood hemoglobin (gm/ dl) levels and endometrial thickness were the main measurements to evaluate the efficacy of therapy. Statistical analysis was done using a paired 't' test and ,z' test.

RESULTS : The median difference between pretreatment and post-treatment PBAC score of 97.2 was statistically significant (P<O.OOl, 95% CI= 0.389 to 2.23). Seventy four out of 85 subjects (87.05%) showed a reduction in endometrial thickness as assessed by transvaginal sonography(TVS). Only se out of 85 (8.2%) women needed hysterectomy. CONCLUSION - Because of convenient dosage schedule and higher cost-benefit ratio, ormeloxifene is an effective drug therapy in dysfunctional menorrhagia.

OBJECTIVE : To determine the feasibility and safety of vaginal hysterectomy for benign nonprolapsed uteri.

METHODS : Eighty consecutive women with nonprolapsed uteri requiring hysterectomy for benign uterine conditions, without suspected adnexal disease, were treated prospectively by vaginal hysterectomy. Operating time, estimated blood los s, surgical techniques, operative complications, conversion to laparotomy when needed and length of hospital stay were recorde d for each case .

RESULTS : Vaginal hy sterectomy was successful in 76 women (95%).Morcellation, hemisection,myomectomy, were done in 60 cases (75%).The operating time, estimated blood loss, conversion to laparotomy were directly proportional to the size of the uterus. Two bladder injuries occurred; one was repaired transvaginally and the other one required laparotomy. Three women needed blood transfusion. Four conversions to laparotomy were necessary.

CONCLUSION : Vaginal hysterectomy is a safe and effective procedure for benign nonprolapsed uteri especially when uterine size is less than 12 weeks.

OBJECTIVE : To compare the standard ovulation induction protocol with the protocol of starting clomiphene citrate on the first day of cycle and for only 3 days.

METHODS : Fifty-nine women between 20 and 32 years of age, who were diagnosed as anovulatory by the criteria of World Health Organization Class II and had not received any medications for infertility were included in this prospective randamised study. Group I received clomiphene citrate 50 mg! day for 3 days starting on the first day of the cycle and group II 50 mg! day for 5 days starting on the fifth day. Estradiol level on the 11th day and estradiol and progesterone levels on the 22nd day, endometrial thickness, ovulation rate, pregnancy rate and miscarriage rate were studied.

RESULTS : In group 1, serum levels of estradiol and progesterone and the rate of ovulation were found to be lower and the rate of abortion higher.

CONCLUSION : Starting therapy with Clomiphene citrate on the first day of the cycle with short duration does not give any benefit to endocrinological and clinic outcomes.

OBJECTIVE : To find out the prevalence of various sexually transmitted diseases (STD) and cervical intraepithelial neoplasia (CIN) in our community and the correlation between them and to study the other risk factors associated with CIN .

METHODS : In this cross sectional study, 1308 sexually active women attending gynecological OPD were screened cytologically for cervical dysplasia CIN and STDs.

RESULTS : STDs were detected in 22.02% and CIN in 21.3% of our patients. Presence of SID was strongly associated with CIN (RR-2.42; 95%CI 1.68-3.45).The most prevalent genital infection detected on cytological examination was trichomonal vaginalis in 7.04% followed by human papillama virus (HPV) and herpes simplex virus (HSV) each in 4.89% of women. Individually HPV infection showed strongest association with CIN (RR-5.21; 95% CI 4.10-6.59).

CONCLUSION : There is a definite need for routine cytological screening for early detection of CIN in all patients with STDs.