Progesterone supplementation is universally used and has been shown to be beneficial in supplementation of the luteal phase in IVF. There are multiple options and the most commonly used include intramuscular and vaginal progesterone. A progesterone vaginal ring is a novel system for luteal support with advantages of controlled release with less frequent dosing. This review examines options for progesterone luteal support focusing on the rationale for a progesterone vaginal ring. Pub-med search of the literature. A weekly vaginal ring, although not yet FDA approved, is an effective and safe alternative for luteal supplementation in IVF. Large prospective clinical trials are needed to determine the best protocols for replacement cycles.
Endometriosis is a common condition affecting a significant proportion of women in their reproductive age. Apart from the impact of endometriosis on the quality of life of these patients, it also can have an impact on the potential of these women to have a family. The options for treating women with endometriosis desiring a family include surgery or assisted reproduction techniques. The choice of treatment will depend on the stage of disease and the characteristics of the couple seeking help. We review here the latest evidence on the management of endometriosis in women desiring fertility and describe our current practice.
Objectives: To compare intravenous paracetamol and intramuscular tramadol as labor analgesics.
Methods: This prospective-randomized study conducted in 200 primigravidae in active labor, distributed into two groups of 100 women each with one receiving intravenous 1,000 mg Paracetamol and other 100 mg intramuscular tramadol. Pain intensity is recorded by McGills scale before, one and 3 h after drug administration. Perinatal outcome is recorded.
Results: No difference in pain intensity is seen before drug administration. After 1 h of drug administration, in paracetamol group, 4 % women had horrible pain, and 29 % had distressing pain, while in tramadol group, 30 % women had horrible pain, and 60 % had distressing pain. After 3 h of drug administration, in paracetamol group, 26 % had distressing pain, while in tramadol group, 51 % women had horrible pain, and 35 % had distressing pain. Labor duration in paracetamol and tramadol group was 4.3 and 5.9 h, respectively. In paracetamol group, nausea is seen in 2.2 % and vomiting in 1.1 %, while in tramadol group, nausea is seen in 6.4 % and vomiting in 4.3 %.
Conclusions: Intravenous paracetamol is more effective labor analgesic with fewer maternal adverse effects and shortens labor as compared to intramuscular tramadol.
Background: Maternal mortality and near-miss index reflect the quality of care provided by a health facility. The World Health Organization recently published near-miss approach where strict near- miss criteria based on markers of organ dysfunction are defined.
Objectives: The aim of the study was to determine the frequency of severe maternal complications, maternal nearmiss cases and maternal deaths, to analyze causes of nearmiss and maternal mortality and to determine the values of maternal near-miss indicators.
Methods: This was a prospective observational study conducted at a tertiary care centre in North India from January 2012 – March 2013. WHO’s near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.
Results: The number of women attending our facility with severe maternal complications was low (205 in 6,767 live births); as a result maternal near-miss ratio (MNMR) was low; 3.98/1,000 live births; Overall Maternal near-miss mortality ratio (MNM:1MD) was also low, 3.37:1, because of strict criterion of labeling near-miss and delay in referral to the hospital. Hypertensive disorder (37.5 %) was the commonest underlying cause for maternal mortality.
Conclusion: Basic implementation of WHO near-miss approach helped in the systematic identification and evidence- based management of severe maternal complications thereby improving the quality of maternal health in a developing country.
Purpose: Postoperative nausea and vomiting (PONV) after spinal anesthesia for cesarean delivery are distressing to both patients and surgeons. This study was designed to evaluate the efficacy and safety of palonosetron and ramosetron (both newer and highly potent 5HT3 receptor antagonists) in nausea and vomiting in cesarean delivery after spinal anesthesia.
Methods: In this randomized, double-blind study, 109 women received either palonosetron (0.075 mg) or ramosetron (0.3 mg) intravenously immediately after clamping of the fetal umbilical cord. Nausea, vomiting, adverse events, and overall satisfaction were then observed for 48 h after administration of spinal anesthesia.
Results: A complete response (defined as no postoperative nausea and vomiting) during first 0–2 h postoperative after administration of spinal anesthesia was achieved in 85.5 % of patients with palonosetron and in 83.3 % of patients with ramosetron (p[0.05). However, the corresponding incidence during 2 to 24 h was 70.9 and 53.7 %, respectively (p\0.05), while it was 63.3 and 44.4 % at 24–48 h after anesthesia (p\0.05). Along with a more complete response, the severity of nausea was also lesser with palonosetron during the corresponding study periods (2–24 and 24–48 h, respectively; p\0.05). Patients who received palonosetron were also more satisfied than those who received ramosetron (p\0.05). No difference in adverse events was observed in any of the groups.
Conclusion: To conclude, prophylactic therapy with palonosetron is more effective than prophylactic therapy with ramosetron for the long-term prevention of PONV after cesarean section
Objective: To study the clinical and histopathological presentation of ovarian masses.
Method: Retrospective analysis of 205 cases from May 2009 to June 2013.
Results: Incidence of ovarian masses was 6.9 %. Among 205 cases, 68 % were neoplastic. Among the neoplasms, 87.8 % were benign, 10 % malignant, and 2.2 % borderline. Mean ages of malignant and benign neoplasm were 41 and 39 years, respectively. 42.9 % malignant tumors presented with non-specific abdominal and constitutional symptoms. Serous cystadenoma was the commonest benign tumor (67 %) followed by Mucinous (19 %) and Dermoid (11.6 %). Most common malignant ovarian tumor was Serous cystadenocarcinoma (42.9 %). Out of the malignant cases, all were primary except one secondary deposit from Non-Hodgkin’s Lymphoma. Only 28.6 % presented at stage I, remaining presented at stage III/IV.
Conclusion: Ovarian neoplasms have twice the incidence of non-neoplasms. Mean age of malignant tumors is decreased. Rising trend in Mucinous cystadenoma is noted.
Objectives: To review the limitations, major complications, and conversion rates associated with non-descent vaginal hysterectomy (NDVH); and develop a scoring system to predict the possibility of successful NDVH.
Methods: The risk analysis of conversion rates from vaginal to abdominal route while attempting NDVH was applied to formulate a scoring system for the assessment of successful NDVH. Parameters were selected based on Kovacs guidelines to determine the route of hysterectomy.
Results: From April 2005 to December 2008, NDVH was attempted in 364/1,378 women undergoing hysterectomy for benign conditions (Gp-I). Eight out of 364 cases (2.1 %) either had to be converted to the abdominal route or had major complication. Endometriosis and repeated sections had the highest risk. Scoring system was developed based on the risk analysis. Validity of this scoring system was tested in 1,177 women from January 2009 to September 2012 (Gp-II). 460 women with a score of 16 or less underwent NDVH successfully with a conversion rate of 0.2 %.
Conclusion: Careful assessment by a simple scoring system can help in deciding the feasibility of performing NDVH.
Objectives: To study prevalence of lower genital tract infections (LGTI) (bacterial vaginosis, trichomoniasis, and candidiasis) in HIV-seropositive women and correlation with CD4 counts and antiretroviral therapy (ART).
Methods: Cross-sectional study conducted in 200 HIV-1- seropositive women (18 to 45 years) attending ART clinic of PGIMS, Rohtak. Vaginal samples sent for laboratory diagnosis of bacterial vaginosis, trichomoniasis, and candidiasis, CD4 count determined and data analyzed using Chi-square method.
Results: Prevalence of bacterial vaginosis, candidiasis, and trichomoniasis was 47.7, 43.2, and 8.8 % respectively, 30 % women with CD4 counts \200 cells/ll had LGTI, and 17.4 % women with CD4[200 Cell/ll had LGTI. Of 70 women not on ART, 18.6 % had LGTI and 30 of 130 on ART had LGTI.
Conclusions: HIV-seropositive women had higher prevalence of LGTI especially at lower CD4 counts and women on ART did not have a lower prevalence of LGTI and should be screened for LGTI to decrease HIV transmission.
