Objectives: To study the effect of antenatal expression of breast milk at term in improving lactational performance as compared to conventional method of initiation of breast feeding. Methods: A prospective study was carried out in 100 booked cases at term. Prior examination was done to exclude any inverted or cracked nipples and appropriate treatment instituted. Daily expression of the breast discharge once at least (any time of the day) preferably during bathing time after 37 weeks of pregnancy was introduced in randomly selected 50 pregnant women (study group). The remaining 50 women formed the control group. Results: The study group did not find it difficult to initiate breast feeding after vaginal or cesarean delivery and sufficient milk started flowing within half an hour of initiation of breast feeding in 48 (96%) women. In the control group, it happened in 36 (72%) women only. Statistical analysis using the Fisher exact test showed significant difference in the results of both the groups. No increase in any delivery complication was found associated with the study group. There was one partial breast feeding failure in the control group but none in the study group. Conclusion: Daily antenatal breast milk expression after 37 completed weeks of pregnancy significantly reduced the time for establishing full breast feeding and reduced breast feeding failures.
Objectives: To find out the intranatal care practices and its impact on the women who delivered in the last five years in Rasulpur village of West Bengal. Methods: Community based descriptive, epidemiological cross sectional study. Results: One hundred eight pregnancies had occurred among the 90 mothers. Among them, 88% were married in their teens, and 60% were illiterate. 57% of the deliveries occurred in the institution, 41% at home and 2% en route to hospital. Among the 8 stillbirths, 7 were delivered by untrained birth attendants at home. Comparison of perinatal outcome between >3 and < 3 ANC visits showed that the former was much better than the latter i.e. live birth rate was 94% vs. 84%; preterm rate 2% vs. 6% and stillbirth rate 4% vs. 10%. The saddest outcome was the four maternal deaths. Among the 44 home deliveries, in 50% cases the cord was cut by old blades while in 27% it was cut by sharpened bamboo stick. Conclusion: Immediate attention must be given to the unsatisfactory intranatal care practices still present at the village level.
Objectives: To assess the migration of low lying placenta diagnosed in the second trimester.
Methods: All the antenatal women under going routine obstetric ultrasound around 18-20 weeks were subjected to transvaginal USG to detect low lying placenta (lower edge of placenta within 3 cm from the internal os). These cases were followed 4 weekly by TVS to note the placental migration till term / delivery which ever was earlier.
Results: Of the total 507 cases, only 41 (8.08%) women had low lying placenta in the mid trimester. Follow up of these 41 cases indicated that in 29 (70.73%) cases it had migrated to the upper segment at term/delivery. The migration of placenta was 91.66% & 76.91% where the distance between the leading edge of the placenta and internal os was more than 2 cm and between 1.5-2 cm respectively. Migration was not observed in women where the distance was less than 1.5 cm. Placental migration was 64.51% in anteriorly situated placenta and 90% in posteriorly situated placenta. The rate of placental migration was 78.57%, 62.5% and 40% in women who had previous normal delivery, prior history of D&C/MRP & prior birth by caesarian section respectively.
Conclusions: The prevalence of low-lying placenta in mid trimester is 8.08%, which reduces to 2.36% at term due to placental migration. The rate of placental migration was 70.73%. Factors like the initial distance between the lower edge of the placenta and internal os, placental position and previous birth by cesarean section influenced placental migration.
Objectives : To study the nature and outcome of pregnancy in Obstetric Cholestasis. Methods : This study included 892 women admitted during the period April 2003-March 2005. Eighty three women were diagnosed as having obstetric cholestasis. The protocol for antenatal checkup and induction of labor was as per obstetric indications. All the patients were given ursodeoxycholic acid. Results: Incidence was 9.3% (83/892). Symptoms appeared after 30 weeks in 85% (71/83). Multipara were 16% (13/83) and primipara were 84% (70/83). Cesarean section rate was 66% (55/83). Intrapartum abnormal cardiotocography was noted in 7.2% (6/83) and thick meconium was in 9.6% (8/83). Women delivering after 38 weeks had a higher incidence of thick meconium, 12.9% (8/62) and abnormal CTG was 9.6% (6/62). There was no patient with meconium and abnormal CTG before 38 weeks. There was no neonatal nursery admission and no perinatal mortality. The difference regarding thick meconium was statistically not significant by Fisher’s exact test (P=0.19) although the number of cases with meconium after 38 weeks were more. Conclusions : Obstetric cholestasis is associated with increased perinatal mortality and morbidity if delivered after 38 weeks. An attempt to deliver prior to 38 weeks may improve the perinatal outcome.
Objectives: To comparatively evaluate the efficacy and safety of drotaverine and valethamate bromide in shortening the duration of labor.
Methods: The study was conducted over 200 selected uncomplicated primi and second gravidae with term pregnancy in established labor, at 3 or 4 cm cervical dilatation with adequate uterine contraction. In group I, 100 cases were given injection drotaverine IM, 40 mg every 2 hours up to a maximum of 3 injections, and in group II, the remaining 100 cases received intravenous infusion of valethamate bromide (16 mg in 540 ml of 5% dextrose) at a rate of 16 drops per minute till full dilatation. Duration of first, second and third stage of labor, cervical dilatation rate, injection delivery interval, mode of delivery, side effect if any and neonatal outcome were noted.
Results: Injection to full dilatation interval was significantly shorter in group I (113.5±74 min.) in contrast to group II (177.4±105.68 min.) (P<0.05). Irrespective of gravidity, injection to full dilatation duration was shorter in group I being 134.2±80.02 min. vs 189.58±109.24 min. in primi and 82.93±52.09 min. vs 143.56±67.05 min. in second gravidae in group I and group II respectively (P<0.05). Mean cervical dilatation rate was faster in group I as compared to group II in primi as well as in second gravidae (2.89 vs 2.01 cm/hr in primi and 4.55 vs. 2.72 cm/hr in second gravidae). Over all mean cervical dilatation rate was also significantly higher in group I (3.38 cm/hr) as against group II (2.17 cm/hr (P<0.05). Mean injection delivery interval was significantly shorter in group I (135.87±85.94 min vs. 200.19±115.04 min in group II) (P<0.05). There was no significant difference in second and third stage of labor and neonatal outcome. Adverse effects like tachycardia and dryness of mouth was more commonly associated with group II (P<0.001).
Conclusion: Intramuscular drotaverine is safe and more effective than valethamate bromide in reducing the duration of first stage and total delivery time.
Objectives: WHO recommends antenatal deworming for pregnant women where prevalence of hookworm infestation exceeds20-30%. The ongoing prospective study seeks to assess change in hemoglobin concentration and neonatal birth weight ofseverely anemic mothers, given a dose of albendazole in the antenatal period.
Methods: Out of the 139 women who reportedto the antenatal clinic, 72 with hemoglobin concentration <7gm% who formed the study group (A) received a dose of 400mgalbendazole at 28-30 weeks of gestation. Sixty seven women, who formed the control group (C) did not receive the dose. Boththe groups received 200 mg ferrous sulphate tablets twice daily till confinement. Hemoglobin concentration at term andneonatal birth weight were recorded.
Results: The mean hemoglobin concentration at term for group (A) and group (C) were10.2883 gm/dl and 9.0522 gm/dl respectively, with a mean difference of 1.2361 gm/dl between the two groups (t=4.965d.f=137, p<0.0001). There was an observed difference of 196.7g in birth weight in group (A) with respect to group (C).(t=2.54 d.f=137p<0.01).
Conclusions: Ease of single dose administration, absence of serious maternal or fetal side effects, highefficacy and low cost make albendazole the ideal deworming agent for our pregnant population.
Objectives: To study the benefits of probiotics (application of urogenital probiotic strains, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14) in cases of bad obstetric history (BOH) while preventing the post IVF pregnancy complications.
Methods: This study was carried out from January 2006 to July 2007. The study groups of 70 pregnant women were treated with probiotics (application of urogenital probiotic strains, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC – 14) along with treatment for infertility; and were compared with similar number of 70 cases from control group who were not given probiotics but were treated for infertility earlier i.e. before January 2006.
Results: The control group witnessed 44 cases (63%) that delivered successfully and fetal loss in 26 cases (37%). From the study group 56 cases (80%) delivered successfully, while 14 cases (20%) suffered fetal loss. The ratios suggest that the rate of delivery and fetal loss in the study group is statistically significant (P value is 0.0031) when compared with that of the control group.
Conclusions: Probiotics (application of urogenital strains Lactobacillus rhamnosus GR – 1 and Lactobacillus reuteri RC-14) has a definite role to play in cases of BOH. It helps in improving the vaginal flora by restoring the lactobacillus colonies and vaginal pH, thereby removing the anaerobic bacteria. It also prevents ascending infection, improves vaginal mucosal immunity and helps in safe deliveries.
Objectives: Chromosomal anomalies are common in infertile males with oligospermia or non-obstructive azoospermia. The prevalence of chromosomal anomalies in subjects with male infertility and its correlation with clinical and endocrine profile was investigated.
Methods: Consecutive 91 male subjects (mean age 23.5±5.3 years) with primary infertility were enrolled from a referral genetic center in a developing country. These patients had moderate or severe oligospermia (n=46) or non- obstructive azoospermia (n=45). Clinical (androgenization, testicular volume) and endocrine evaluation (serum FSH, testosterone and prolactin) and prometaphase and metaphase chromosome analyses by phytohemagglutin (PHA) stimulated lymphocyte culture were carried out.
Results: Ten (10.9%) subjects had chromosomal abnormality. The highest frequency of abnormal karyotypes (15.5%) was found among patients with nonobstructive azoospermia. The most frequent anomaly was 47, XXY chromosomal constitution, found in 4 (4.4%) patients with non-obstructive azoospermia. Majority of the chromosomal aberrations were sex chromosomal type. Autosomal aberration and structural aberration was seen in one patient each. All patients with numerical chromosomal anomalies had nonobstructive azoospermia.
Conclusion: We observed high prevalence of chromosomal abnormalities in infertile males with moderate or severe oligospermia or nonobstructive azoospermia. We recommend chromosomal analysis should be performed in male infertility from diagnostic, prognostic and therapeutic viewpoint.
Objectives: To evaluate the amnion graft in vaginoplasty, to assess the advantage of a flap placed over fourchette and to evaluate the benefit of gauze mould. Methods: Out of the 35 subjects of primary amenorrhea, eight with complete vaginal agenesis were selected for vaginoplasty. Half of these received split thickness skin graft and other half received amnion graft. An additional triangular flap raised locally was applied at the fourchette area in all. The mould used was made of gauze. Results: Amnion graft was taken completely and presented almost no complication as compared to skin graft with minimized hospital stay. The fourchette flap facilitated easy and painless insertion of the mould. There was no contracture or fibrosis of neovagina and introitus. Gauze mould was easy to prepare and caused no complication. Conclusion: Making a fourchette flap and using amnion graft along with a gauze mould reduced the operating time, hospital stay and allowed easy and painless mould insertion with least complications.
