OBJECTIVE (S): To evaluate the vaginal route for oophorectomy in women with metastatic breast cancer.
METHOD(S): Sixteen women with metastatic breast cancer, who were referred by their oncologists for oophorectomy were included in the study. After clinical evaluation and necessary counseling, they were subjected to oophorectomy via posterior culdotomy.
RESULTS: The vaginal approach without laparoscopic assistance was successful in all 16 women without any significant complication.
CONCLUSION(S): When oophorectomy is indicated we should resort to vaginal route and avoid laparotomy.
OBJECTIVE (S): To evaluate the vaginal route for oophorectomy in women with metastatic breast cancer.
METHOD(S): Sixteen women with metastatic breast cancer, who were referred by their oncologists for oophorectomy were included in the study. After clinical evaluation and necessary counseling, they were subjected to oophorectomy via posterior culdotomy.
RESULTS: The vaginal approach without laparoscopic assistance was successful in all 16 women without any significant complication.
CONCLUSION(S): When oophorectomy is indicated we should resort to vaginal route and avoid laparotomy.
OBJECTIVE(S): To assess the effect of temporary migration of male partner on various male, female and general factors causing infertility.
METHOD(S): Various male, female and general factors causing infertility and problems in infertility management were compared statistically by chi-square test and Z test in couples having temporarily migrant male partner (Study Group A; n=800) and couples staying together permanently (Control Group B; n=1200).
RESULTS: Study group showed significantly higher incidence of moderate to severe oligospermia and semen infection. Among female factors, incidence of ovulatory disorder and hormonal imbalance were not significantly different in the two groups. Various chronic pelvic inflammatory diseases were higher in study group but differences were not statistically significant. Blockage of both fallopian tubes was most significant factor causing infertility in both the groups. There was higher but not significantly different incidence of psychosexual marital problems and general ill health in the study group. Drop out rate for infertility treatment was significantly higher in the study group.
CONCLUSION(S): Migration of male partner decreases sperm count and increases semen infection
OBJECTIVE(S): To determine clinical significance and prediction of neoplasia among patients with persistent atypical squamous cells of undetermined significance (ASCUS) on Pap smear.
METHOD(S): Out of a total of 1866 patients who underwent Pap smear over a year, 86 patients with report of ASCUS were followed up for 2 years. A repeat Pap smear was done 4 to 6 months later and depending on this report, further management with colposcopy was decided.
RESULTS: ASCUS was detected in 100 (5.3%) of the 1866 patients in the first Pap smear report. Fourteen of them were lost to follow up. 75.4% lesions regressed whereas 19.7% patients had a repeat ASCUS on Pap smear after 4 to 8 months; 64% of patients with a repeat ASCUS had a normal biopsy. But 52% of the patients with normal biopsy had ASCUS for the third time after 4 to 8 months.
CONCLUSION(S): Colposcopy can be reasonably deferred till the second Pap smear. Patients with second time ASCUS should be meticulously followed up as a large number of them may have a underlying persistent disease.
OBJECTIVE(S): To determine clinical significance and prediction of neoplasia among patients with persistent atypical squamous cells of undetermined significance (ASCUS) on Pap smear.
METHOD(S): Out of a total of 1866 patients who underwent Pap smear over a year, 86 patients with report of ASCUS were followed up for 2 years. A repeat Pap smear was done 4 to 6 months later and depending on this report, further management with colposcopy was decided.
RESULTS: ASCUS was detected in 100 (5.3%) of the 1866 patients in the first Pap smear report. Fourteen of them were lost to follow up. 75.4% lesions regressed whereas 19.7% patients had a repeat ASCUS on Pap smear after 4 to 8 months; 64% of patients with a repeat ASCUS had a normal biopsy. But 52% of the patients with normal biopsy had ASCUS for the third time after 4 to 8 months.
CONCLUSION(S): Colposcopy can be reasonably deferred till the second Pap smear. Patients with second time ASCUS should be meticulously followed up as a large number of them may have a underlying persistent disease.
OBJECTIVE(S) : To determine whether metformin increases ovulation rate and pregnancy rate in women with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate.
METHOD(S) : A randomized placebo-controled trial was conducted on 36 clomiphene citrate resistant women with PCOS. Eighteen women each were randomly allocated to receive either metformin or placebo for 3 months. Pretreatment baseline hormonal assays were obtained and repeated after 3 months. Clomiphene citrate was added in women who were still ovulatory after 3 months. Six ovulatory cycles, pregnancy or anovulation even on a daily clomiphene citrae dose of 200 mg were considered end point of the study. Paired t test and Fisher’s exact test were used for statistical analysis.
RESULTS : Fasting insulin levels and serum testosterone and androstenedione decreased significantly after 3 months of metformin therapy. Ovulation and pregnancy rates were significantly higher in women who had received metformin pretreatment (P<0.001).
CONCLUSION(S) : Metformin-clomiphene citrate therapy in clomiphene citrate resistant polycystic ovary syndrome women significantly increases ovulation and pregnancy rates (P<0.001).
OBJECTIVE(S) : To evaluate vibroacoustic stimulated modified fetal biophysical profile in antepartum monitoring of high risk pregnancy.
METHOD(S) : In this prospective randomized controlled study 214 singleton high risk pregnancies were randomized to antepartum monitoring by either modified biophysical profile following vibroacoustic stimulation (VAS/mFBP) (Study Group n=110) or following mock stimulation (mFBP) (Control Group n=104).In modified biophysical profile fetal startle response and fetal heart acceleration under combined B and M mode ultrasonography following vibroacoustic and mock stimulation were observed. Various diagnostic values in predicting adverse perinatal outcome were compared between the two groups.
RESULTS : The maternal demographic factors, gestational age at the inception of monitoring, and primary indication for monitoring were similar between the two groups. Mean testing time was significantly less in the study group, as compared to controls (4.92 + 0.82 minutes and 7.77 + 1.29 minutes respectively). Of the 110 fetuses in the study group subjected to VAS/mFBP, 107 (97.3%) were reactive and three (2.7%) nonreactive and there were 106 (96.4%) favorable and four (3.6%) adverse perinatal outcomes. Of the 104 fetuses in the control group subjected to mock stimulation (mFBP); 97 (93.3%) were reactive and seven (6.7%) nonreactive and there were 96 (92.3%) favorable and eight (7.7%) adverse perinatal outcomes. The sensitivity, specificity, positive and negative predictive values and accuracy in the study group were 75%, 100%, 100%, 99.1 %, and 99% respectively as compared to 71.4%, 97.9%, 71.4%, 97.9 % and 96.2% respectively in the control group.
CONCLUSION(S) : Vibroacoustic stimulated modified fetal biophysical profile (VAS/mFBP) as a primary means of surveillance in high risk pregnancy is a reliable diagnostic approach.
OBJECTIVE(S): To compare efficacy and safety of 50 ? g vaginal misoprostol with transcervical Foley’s catheter and intravenous oxytocin for labor induction.
METHOD(S): One hundred women at term gestation, with Bishop score < 4, with various indications for labor induction were randomly allocated to receive either 50 ? g misoprostol vaginally 4 hourly (maximum 6 doses) or transcervical Foley’s catheter with intravenous oxytocin (2 mU/minute to a maximum of 32 mU/minute or till the woman goes into active labor.
RESULTS: In misoprostol group induction-delivery interval was significantly less (11.58 vs 19.45 hours) and successful induction significantly higher (98% vs 78%) as compared to catheter/oxytocin group. Eighty-eight percent women delivered within 24 hours of induction in misoprostol group whereas in the other group 72% delivered within 24 hours. Eighteen percent of women delivered with a single dose of misoprostol while 28% required the maximum dosages of oxytocin.
CONCLUSION(S): Vaginal misoprostol is a cheap, highly effective and easy to administer agent for labor induction.
OBJECTIVE(S): To identify etiological factors and to assess the neonatal mortality and morbidity associated with preterm labor and delivery.
METHOD(S): In this prospective cohort study conducted over a 8 months period (January to August 2005) 416 antenatal women admitted with threatened preterm labor and in preterm labor, with or without rupture of membranes, were recruited. They were followed up from admission till delivery and discharge. Gestational age at onset of preterm labor, associated risk factors, response to tocolytics if given, gestational age at delivery, and neonatal outcome were recorded and analyzed.
RESULTS: Incidence of preterm labor was 22% and that of preterm deliveries 20.9% Preterm rupture of membranes and infection were the commonest causes of preterm labor. Irrespective of the use of a course of betamethasone, neonatal mortality was significantly high (P<0.0001 ) in babies delivering before 34 weeks (30.4%) as compared to that in babies delivering after 34 weeks (3.4%). Septicemia, respiratory distress syndrome (RDS) and birth asphyxia were the important causes of neonatal morbidity. RDS was significantly reduced in those who completed steroid cover (P=0.029).
CONCLUSION(S): There is a high incidence of preterm labor and preterm births in our set up, compared to developed countries. Infection is one important modifiable risk factor which can be curtailed. Prolongation of delivery for 48 hours by giving tocolysis for getting the benefit of betamethasone coverage reduces morbidity due to RDS but does not reduce overall neonatal mortality below 34 weeks.
OBJECTIVE(S): To estimate the probabilities of the duration of postpartum amenorrhea (PPA) at various time intervals
METHOD(S): One hundred and twelve women were interviewed and 39% reporting continuance of amenorrhea on the date of interview were considered as censored cases. Survival analysis procedure using life table approach was applied.
RESULTS: The median duration of PPA was 5.17 months. The effect of breast feeding practice on length of amenorrhea showed interesting findings.
CONCLUSION(S): Mean and median time of onset of menses was higher in total brast feeding women than in partial breastfeeding women, though the log-rank test showed no statistical significance. A similar pattern was observed when women reporting breast feeding at fixed time were compared with those feeding on demand.
