The modern era of infertility treatment was heralded over half a century ago with the introduction of new hormonal drugs that could effectively induce ovarian ovulation. However, it was quickly recognized that the birth of these new ‘‘miracle drugs’’ was associated with a remarkable increase in the incidence of high-order multiple births. Despite the fantastic improvement in our ability to monitor ovarian response during ovulation induction, and our power to control the number of embryos introduced into the womb through IVF, multiple births remain a leading cause of long-term child morbidity among infertility patients. Efforts to prevent what was coined in the 1960s as the ‘‘multiple birth epidemic’’ remain an urgent concern. A new body of research clearly points at our capacity to reduce the risk of multiple births and their associated long term morbidity without diminishing current high success rates of infertility treatment.
Ovulation induction, Gonadotropins, Assisted reproductive technology, Elective single embryo transfer Perinatal outcomeObjectives: To check the progressive increasing trend of caesarean delivery in a tertiary facility care centre.
Aims: The purpose of this study is to implement a paradigm shift in caesarean delivery by introducing a new classification system and a check list based management protocol.
Methods: The study was conducted from 1st January, 2007 to 31st December, 2008 at CNMC G&O Department. All deliveries in the year 2007 were compared retrospectively and all deliveries in the year 2008 under prospective study with implementation of a new strategic protocol. Comparative audit and analysis of deliveries in retrospective and prospective year reveals significant changes in the caesarean delivery rate.
Results: In retrospective group all women in labour were allowed for spontaneous delivery and in prospective group all women were subjected to intervention protocol and caesarean delivery done in both the groups in need for risk of fetal and maternal salvage. Incidence of caesarean delivery (CD) in retrospective group was 29 % while in the prospective group it was 18.4 %. Marked decrease in CD was observed for augmentation, induction and trial of labour (TOL) for delivery in prospective group. The result was compared with Robson’s studies following similar type of classification system.
Conclusion: Marked improvement was noticed in this new paradigm and more multicentric trial is needed to check the increasing trend of CD.
Check based protocol, Ten group classification, Paradigm shift, Trial of labour (TOL), Caesarean delivery (CD), VBAC (vaginal birth after caesarean section)Objective: To evaluate the role of 17 a hydroxyprogesterone caproate (17OHPC) in the prevention of preterm labor in high risk asymptomatic patients with a history of preterm delivery.
Methods: The study included 96 patients with a singleton pregnancy and having a prior preterm birth. They were divided in 2 groups, group I (treatment group) included 46 asymptomatic patients who were given 17OHPC injections starting from 16–20 weeks till 36 weeks and group II (control group) included 50 patients who did not receive any treatment.
Results: The incidence of preterm delivery was found to be 6.9 %. The median gestational age at delivery was 36 weeks in group I and 33 W5D in controls. 50 % cases in group I and 80 % of controls delivered prematurely in the group with a prior preterm birth between 20–28 weeks.
Conclusion: In patients who had a prior history of a preterm delivery the recurrence of a preterm birth was less in the treated group as compared to controls. The median gestational age at delivery was significantly higher in 17OHPC treated patients with history of earliest prior preterm delivery at 20–28 weeks.
Objective: To optimize the fetomaternal oucome using different modes of delivery in breech presentation.
Materials and Methods: 265 women with different parity and gestational age having singleton breech were studied during Jan 2007 to Sep 2009 at Pt. J.N.M. Medical College and associated Dr. B.R.A.M. Hospital Raipur Chhattisgarh and were assigned to either planned or emergency cesarean section or trial of vaginal delivery after counseling. Fetomaternal outcome was compared in various modes of delivery.
Observations: Incidence of breech presentation was 2.1 %, prematurity was the most common cause. 113 (42.6 %) women delivered vaginally. 54 (20.4 %) were planned for cesarean section. Emergency cesarean section was done in 98 (37 %). Although perinatal morbidity and mortality was lower in caesarean section group as compared to vaginal delivery group, but the difference became statistically insignificant after adjustment for confounding factors. (p = 0.14)
Conclusion: In view of insignificant difference in the fetomaternal outcome balanced decision about mode of delivery on a case by case basis will go a long way in improving both foetal and maternal outcome. Regular drill and conduct of vaginal breech delivery should be pursued in all maternity hospitals.
Breech presentation, Caesarean section, Perinatal outcomeObjective: To study the role of hyperhomocysteinemia in patients with intrauterine growth retardation.
Method: 76 patients with intrauterine growth retardation were studied and compared with 50 controls which included pregnant patients without any pregnancy complications. Fasting Plasma homocysteine levels were measured and statistical analysis using tests of significance and logistic regression analysis was performed. Those in the study group were given homocysteine lowering agents for 6 wks and pregnancy outcome was studied.
Results: 57.8 % women in the study group were found to have hyperhomocysteinemia. Logistic Regression analysis shows an OR of 2.45 in favor of occurrence of IUGR if homocysteine levels are raised which is statistically significant. Mean plasma homocysteine levels decreased after treatment for 6 wks but this decrease in the case of placebo group is marginal whereas the decrease in the homocysteine levels the treatment group. This implies that treatment has a definitive role in lowering of plasma homocysteine levels.
Conclusion: The present study shows that hyperhomocysteinemia is associated with IUGR and should be identified as a risk factor as correction favors pregnancy outcome.
Objectives: The present study was conducted to compare the gravidogram and ultrasound in the detection of intrauterine growth restriction.
Methods: This study was conducted in the Department of Obstetrics and Gynecology, Voluntary Health Services, Chennai (TN) from August 2007–May 2009. The study included 321 women with singleton pregnancy in a longitudinal lie. These women underwent serial symphysiofundal height measurements and ultrasound. Birth weights of the newborns were noted at the time of delivery. Gravidogram and ultrasound findings were correlated with the birth weights.
Results: The sensitivity of the ultrasound in the detection of IUGR was higher (85.2 vs 74.1 %) than the gravidogram, but the specificity was almost the same (96.6 and 95.9 %).
Conclusions: The gravidogram is a simple and inexpensive screening tool and as useful as an ultrasound in detection of intrauterine growth restriction. Both gravidogram and ultrasound, when used together, have higher detection rates.
Gravidogram, Ultrasound, Intrauterine growth restrictionObjective: To determine the maternal and perinatal outcome after expectant management of severe pre-eclampsia between 24 and 34 weeks of gestation.
Method: The maternal and fetal status was monitored by an intensive, non-invasive method among 94 women with severe pre-eclampsia between 24 and 34 weeks of gestation who were scheduled for expectant management in the OICU at a tertiary care center. Pregnancy prolongation and maternal and perinatal morbidity and mortality were analyzed by the Student ‘t’ test and the Mann–Whitney U test.
Results: The days of pregnancy prolongation and perinatal mortality were significantly higher among those managed at \30 weeks. Increasing gestational age correlated with a reduction of RDS. Maternal morbidities were significantly higher among those managed at\28 weeks. But, there was no maternal mortality.
Conclusion: Expectant management of severe preeclampsia at 30–34 weeks in a tertiary care center of a developing country is associated with good perinatal outcome and risk reduction for the mother.
Early severe pre-eclampsia, Expectant management, Perinatal outcome, Maternal morbidityObjective(s): The objective of this study was to evaluate the efficacy and safety of granisetron (5HT3 receptor antagonist) on the incidence of nausea and vomiting in cesarean deliveries under spinal anesthesia.
Method(s): In the randomized, double-blind study, 80 parturients received granisetron 40 lg/kg or placebo (n = 40 each) intravenously, immediately after clamping of the fetal umbilical cord. Nausea, vomiting, and adverse events were then observed for 24 h after administration of spinal anesthesia.
Results: A complete response (defined as no postoperative nausea and vomiting) during 0–4 h after administration of spinal anesthesia was achieved in 80 % of patients with granisetron and in 45 % of patients with placebo. The corresponding incidences during (4–24 h) were 82.5 and 55 % (P value\0.05). No difference in adverse events was observed in any of the groups.
Conclusion(s): Prophylactic use of granisetron is effective for preventing emetic episodes during spinal anesthesia for cesarean delivery.
Nausea and vomiting, Spinal anesthesia, Granisetron, Cesarean sectionObjectives: To evaluate whether the gold standard of 24-h urinary albumin excretion in preeclamptic women could be substituted by a shorter collection period.
Methods: From each woman, three spot, two 12-h, and one 24-h urine samples were collected. For each sample, urine albumin concentrations in milligram per liter were analyzed by the immunoturbidimetric method. The albumin concentrations in the spot and 12-h collections (day and night) were compared with the 24-h urine collection.
Results: Albumin concentrations in both 12-h collections were fitted closely with the concentrations of the 24-h collection. The median difference between the 24-h collection and the day collection was 43 mg/L and the correlation coefficient was 0.96 (p\0.0001). The median difference between the night collection and the 24-h collection was -31 mg/L and the correlation coefficient was 0.98 (p\0.0001).
Conclusion: The gold standard of 24-h urinary albumin concentrations in preeclamptic women can be substituted with a 12-h collection. Spot samples were weaker as compared to the 12-h collection.
Preeclampsia, Albuminuria, Shorter collection periodObjective: To find out the effect of increasing body mass index (BMI) on pregnancy outcomes in nulliparous women delivering singleton babies.
Method: This was a hospital-based observation study, based on 300 nulliparous women delivering singleton babies in June 2009—Sept. 2010. Women were categorized into three groups. Underweight (BMI\20 kg/m2), normal (BMI 20– 24.9 kg/m2), overweight (BMI 25–29.9 kg/m2), and obese (BMI[30 kg/m2) obstetric and perinatal outcomes were compared by univariate and multivariate analysis.
Results: Maximum patients who underwent LSCS were having BMI[30 kg/m2 [OR 9.558 (95 % CI 5.82–17.27)]. As compared to women of normal BMI (20–24.9 kg/m2), morbidly obese women faced the higher risk of PIH [OR 8.045 (95 % CI 3.875–16.781)]. Obese women were more likely to have post partum hemorrhage [OR 5.11 (95 % CI 1.76–14.79)] compared with women of normal BMI. Birth weight \2,500 g was more common in women with BMI\25 kg/m2 (21.21 %), while highest incidence of birth weight[4,000 g (14.29 %) is seen in women of the obese group.
Conclusions: Increasing BMI is associated with increased incidence of cesarean delivery, PIH, post partum hemorrhage, and macrosomic babies.
Body mass index, PIH, LSCS, PPH, Birth weightObjective: To study the diagnostic potential of fluorescence spectroscopy and its comparison with different screening methods, including Pap smear and colposcopy, in detecting early cervical neoplasia.
Method: The study was conducted on patients with gynecological complaints. A full gynecological workup of the patients was done along with Pap smear and colposcopy. Cervical biopsy was done in suspected cases and fresh tissue was sent to IIT for spectroscopy.
Result: There is a definite increase in NADH fluorescence (67.4 %) and a decrease in collagen fluorescence (74 %) in dysplastic tissues. When epithelial fluorescence and stromal fluorescence are considered together, diagnostic accuracy is increased to 96.5 %.
Conclusion: The clinical diagnosis of cervical neoplasia by spectroscopic methods is potentially a reliable, fast, and costeffective alternative to the conventional smear test which needs trained personnel for its interpretation. Research is still continuing to obtain a statistically significant cutoff value from in vitro studies and then use them for in vivo study.
Fluorescence spectroscopy, Nicotinamide adenine dinucleotide dehydrogenase (NADH), Cervical cancerObjectives: To evaluate the correlation of AgNOR count and colposcopy in cases of suspicious cervix.
Methods: A hundred women presenting in OPD with complaints of postcoital bleeding, discharge per vaginum, pain in the lower abdomen, or intermenstrual bleeding were subjected to colposcopy. After colposcopy, a cervical biopsy was done. Routine paraffin sectioning was done for these biopsy specimens. Histopathologic diagnosis was first established on these sections using the routine (H & E) stain. Then, further sections were cut from prepared blocks and were subjected to AgNOR staining technique. AgNOR count was taken as the mean number of black dots per 100 cells observed under a 1009 oil immersion objective.
Results: In our study, 60 % cases were colposcopy positive and 40 % were colposcopy negative. The sensitivity of colposcopy in diagnosing all grades of dysplasias was 95.4 % and the specificity was 67.86 % in our study. The positive predictive value was 70 % and the negative predictive value was 95 %. The mean AgNOR score in our study was 1.21 ± 0.51 in chronic cervicitis, 2.44 ± 0.56 in mild dysplasia, 3.48 ± 0.35 in moderate dysplasia, and 4.58 ± 0.43 and 5.91 ± 0.51 in squamous cell carcinoma, showing a progressive increase in the score. AgNOR count showed an increase from CIN to SCC in our study. The correlation coefficient between the colposcopy and AgNOR count found in our study is 0.892 and p value is\0.0001 which is highly significant.
Conclusion: The results of the colposcopy and AgNOR when used together can provide strength to the clinician and histopathologist in diagnosing early carcinoma in cases of suspicious cervix.
Silver-stained nucleolar organizing regions, Hematoxylene and eosin, ColposcopyObjectives: To find out the relation between the frequency of dysmenorrhea and body mass index in adolescents and to assess the impact of socio-demographic factors, especially rural/urban variation in the frequency of dysmenorrhea.
Methods: Cross-sectional study of 200 urban and 200 rural school going adolescent girls at Udaipur and Bedla Districts, Rajasthan.
Results: Of the 400 girls, the prevalence of dysmenorrhea was found to be very high (81.5 % rural and 76 %urban). In the rural setup, of the total girls with mild dysmenorrhea, 71.84 % had BMI\16.5, with 27.18 % underweight. All girls with moderate and severe dysmenorrhea had BMI \16.5. In the urban setup, of all girls with mild dysmenorrhea, 38.05 % had BMI\16.5 and 54.86 % were underweight. All girls with severe and 80 % with moderate dysmenorrhea had BMI\16.5. All girls with no dysmenorrhea had normal BMI. There was significant rural versus urban variation.
Conclusions: Relation between dysmenorrhea and BMI was found to be significant (p\0.01) with increased prevalence in the low BMI group. Hence, improving the nutritional status of adolescent girls may reduce dysmenorrhea.
Dysmenorrhea, Body mass index, Adolescents