Of the infertile couples unable to conceive without any identifiable cause, 30 % are defined as having unexplained infertility. Management depends on duration of infertility and age of female partner. The treatment of unexplained infertility is empirical, and many different regimens have been used. Among these are expectant management, ovarian stimulation with clomiphene citrate, gonadotropins and aromatase inhibitors, fallopian tube sperm perfusion, tubal flushing, intrauterine insemination, gamete intrafallopian transfer, and IVF. The first approach to treatment of unexplained infertility generally is the use of drugs that stimulate oocyte production. For over four decades, the first-line treatment for ovarian stimulation in unexplained infertility has been clomiphene citrate. Multiple reports suggest that aromatase inhibitors may be effective alternative agents for ovarian stimulation in couples with unexplained infertility. Their administration is reported to be associated with monofollicular development in most cases, which may result in enhanced fertility and a reduced risk of ovarian hyperstimulation and multiple births, as compared to current standard therapies such as gonadotropin and clomiphene. Despite world evidence to the contrary, letrozole has been banned for use for infertility management in India since 2011.
Oral drugs, Unexplained infertility, Clomiphene citrate, Letrozole, Infertile couples, Aromatase inhibitors, IUIHeart disease is one of the common, indirect obstetric causes of maternal death. Management of these cases may challenge the entire team providing care to the mother and fetus. Advances in cardiac surgery has improved quality of life and level of functioning of cardiovascular system of patients with congenital or acquired heart disease. These diseases complicate 0.1–4 % pregnancies. Maternal complications in the form of thromboembolic, hemorrhagic episode and heart failure may occur. The fetus is in danger of effects of oral anticoagulation therapy and other medications given to the patient in order to support cardiovascular system, intrauterine growth restriction and danger of hypoxia. In recent era, we are facing more pregnant patients with previous history of surgical correction of congenital or rheumatic heart disease.
In this review, we have attempted to draw a management protocol of such patients based on the available literature and various international guidelines. In pregnant women with mechanical heart valves, recent data support warfarin use throughout pregnancy, followed by a switch to heparin and planned induction of labor. However, the complexity of this situation demands a cafeteria approach where the patient herself can choose from the available options that are supported by evidence-based information. Preconception counseling, evaluation and antenatal high-risk management protocol with the help of cardiologist and cardiac surgeon improves maternal and neonatal outcome.
Objective: The aim of the study was to find out the role of Serum lactate dehydrogenase in prediction of adverse outcomes of PE & E i.e., severity of disease and occurrence of complications.
Materials and Methods: This study was conducted in the Department of Obstetrics and Gynaecology, MGM Medical College, Indore. A total of 200 women were studied; they were divided into control (n = 100), severe preeclampsia (n = 32), eclampsia (n = 68). Demographic and hematological parameters were studied including LDH levels.
Results: The incidence of severe pre-eclampsia—1.2 % & Eclampsia 2.7 %, PE & E patients were significantly younger, with low gravidity and parity. They had significantly increased systolic and diastolic pressure, liver enzymes, uric acid, urine albumin, and LDH levels. Serum urea and creatinine were normal in majority of cases. The symptoms and complications of PE along with perinatal mortality were increased significantly in patients with LDH >800 IU/l compared with those who had lower levels. Complications like Retinopathy, ARF, Abruptio, DIC, CVA, MODS, Shock were also associated with high level of serum LDH>800 IU/L. Low birth weight of babies was also associated with high level of serum LDH levels in PE & E patients. The incidence of poor perinatal outcome was higher in PE & E patients with high serum LDH level (>600 IU/L).
Conclusion: LDH is the earliest marker seen in blood during hypoxia and oxidative stress. It is a useful biochemical marker that reflects the severity of and the occurrence of complications of PE & E; these are preventable if identified at an earlier stage and adequately managed at a higher center. Test is easily available, so screening of all cases of PE & E with LDH levels must be made mandatory.
Serum lactate dehydrogenase, LDH, Preeclampsia & eclampsia, Biochemical markerObjectives: To study the effect of antenatal breast milk expression at term pregnancy and subsequent effect on postnatal lactation performance.
Methods: A sample size of 200 pregnant women who had completed 37 weeks of gestational period was selected. The sample size was divided equally into study (group 1) and control (group 2). The pregnant women in study (group 1) were advised to gently manually express their breasts at least once daily at any time, preferably during bathing. The remaining women constituted the group 2. At the time of delivery, all the mothers were advised to initiate breastfeeding their baby within half an hour of delivery. The time from initiation of lactation to full lactation when no top feed is required was noted. Assessment of sufficient lactation was judged by the objective and subjective criteria.
Results: In the group 1, 89 % of the cases established full lactation within 6 h of delivery, whereas in the group 2 only 72 % of the cases had established full lactation within 6 h. The difference in the group 1 and the group 2 is statistically significant (P < 0.05) with regard to time interval from initiation of lactation to full lactation. Maternal perception of satisfactory lactation was statistically significantly higher in group 1 compared with group 2. In the group 1, 100 % of vaginal delivery (FTND) cases had established full lactation within 6 h compared with 81 % in the group 2. The result is statistically significant (P < 0.10). In the group 1, 80 % of the lower segment cesarean section deliveries established full lactation within 6 h, whereas in the group 2, it was 61 %. The result is statistically significant (P < 0.10). In objective criteria, the post-feed weight gain was higher in the group 1.
Conclusions: Antenatal manual breast milk expression at term shortens the time taken to from initiation to full establishment of lactation, thus significantly improving postnatal lactational performance by early establishment of plentiful milk secretion.
Lactational performance, Breast milk expression, Breastfeeding failure rateObjectives: Evaluation and comparison of safety and efficacy of vaginal and intra-cesarean insertion of Post- Partum Intrauterine Contraceptive device (PPIUCD).
Methods: An interventional prospective study conducted in the Department of Obstetrics and Gynaecology at NRS Medical College, Kolkata. PPIUCD were inserted in 263 mothers in 1-year study period. Among them, first 100 mothers who delivered vaginally and the first 100 who underwent cesarean section were regarded as study groups and were followed up for 1 year.
Results: Both modes of PPIUCD insertion were found to have very low rates of expulsion, vaginal bleeding, infection, missing strings, and also effective as contraceptive. Expulsion rate was 4 % in the vaginal group and 2 % in intra-cesarean group. Strings of PPIUCD were less visible after cesarean insertion than vaginal insertion (p = 0.028).
Conclusion: PPIUCD is an appealing approach and may become the best choice as post-partum contraception after vaginal as well as cesarean delivery.
PPIUCD, Vaginal insertion- post-placental, Immediate post-partum, Intra-cesarean insertionBackground: Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Bleeding that occurs 12 months after the last menstrual period is labeled as postmenopausal bleeding.
Aims & objectives: The aim of the present study was to study endometrial thickness by transvaginal sonography, and correlate it with the cytological pattern evaluated by endometrial aspiration and histopathological pattern of the hysteroscopic directed biopsy.
Results: Sixty patients presenting with postmenopausal bleeding in outpatient department, after applying both inclusion and exclusion criteria, were enrolled in the present study. Majority (38.33 %) of patients had atrophic endometrium or normal endometrium. Endometrium was hyperplastic in 18 (30 %) patients, polyp in 6 (10 %) patients, and growth in 7 (11.67 %) patients. On histopathology, majority of patients (38.33 %) had atrophic endometrium. Endometrial hyperplasia was detected in 14 (23.33 %) out of which 11 had simple hyperplasia while 3 had atypical hyperplasia. Endometrial cancer was detected in 8 (13.33 %) patients. Out of 8 cases of endometrial malignancy, one case was confirmed as endometrial adenocarcinoma on histopathology.
Conclusion: Role of endometrial thickness cannot be undermined for detecting patients at high risk especially with comorbid conditions. Histo-pathological evaluation is mandatory for ruling out malignancy in selected cases of PMB through hysteroscopy.
Histological pattern of endometriumPurpose: We present the management of 17 cases of urethral diverticulum in our department. We describe the various clinical presentations of urethral diverticulum, which may mimic other pelvic floor disorders and result in diagnostic delay.
Materials and Methods: We reviewed 17 cases of urethral diverticulum presented to the urogynaecology department between January 2006 and February 2011 retrospectively. Patient demographics, history, clinical evaluation, diagnostic modalities, and management plans were reviewed. All of them underwent Magnetic Resonance Imaging (MRI) prior to the procedure.
Results: The mean time from onset of symptoms to diagnosis of a urethral diverticulum was 24 ± 5.6 months. MRI identified the urethral diverticulum in all cases while voiding cystourethrography confirmed the diagnosis in 4 (23.5 %). They have been divided into two groups: Group A, (4–6 mm largest axis range) 5 (29.41 %) cases; Group B, (6–33 mm largest axis range) 12(70.59 %). All in Group A were symptomatic with recurrent Urinary Tract Infection (UTI), whereas only 8 (66.6 %) in Group B were symptomatic. Transvaginal diverticulectomy was done in 12 women who were symptomatic (70.5 %). Postoperative evaluation revealed complete resolution of symptoms, such as recurrent UTI, dysuria, and dyspareunia. One patient was unsure of surgery, while conservative approach was opted for asymptomatic patients 4 (23.5 %). The use of preoperative MRI altered the management in 2 (11.7 %) women.
Conclusion: The diagnosis of urethral diverticulum should be considered in women with recurrent UTI, dysuria, dyspareunia, and irritative voiding symptoms not responding to conservative therapy.
Urethral diverticulum, Diagnosis, Women, Magnetic resonance imagingPurpose: Present study aims to examine the relationship of the bone mineral density (BMD) with body mass index (BMI) in an apparently healthy premenopausal and postmenopausal north Indian female population.
Methods: Two hundred and fifty-five apparently healthy women were evaluated by a detailed questionnaire including all possible factors that could affect the BMD. The height and weight of all the subjects were recorded and BMI was calculated. Bone mineral density was measured by DXA (Dual Electron X-ray Absorptiometry) at L1-L4 Lumbar spine (LS) and femur neck (FN) by using the Prodigy DXA system (software version:8.50) manufactured by GE medical systems LUNAR.
Results: The population was divided into pre and postmenopausal groups. The BMD at all sites increased with BMI in both groups. In a multiple regression model, the attributability of BMI and age to variation in LSBMD and FNBMD was 10.3 and 13.9 %, respectively. In postmenopausal women, age, BMI, and a previous history of fracture together attributed to a variance in BMI of 40.1 and 27.6 % at lumbar spine and femur neck, respectively. BMI was found to be significantly associated with low BMD at both sites in premenopausal women, while the association was lost in postmenopausal females.
Conclusion: BMI is an important determinant of BMD in Indian females. However, the association is not present in postmenopausal women with osteopenia. In addition, the effect of increase in BMI on BMD has a ceiling effect, and moderate to morbid obesity might not actually be a preventive factor for osteopenia.
Bone Mineral Density, Menopause