Abstract

This review addresses the misplaced facts about the IUI procedure within a lucrative fertility industry. Evidence suggests IUI must be a first-line treatment option for most couples except in cases of bilateral tubal blockage and severe oligozoospermia. We introduce the concept of using ‘consecutive ejaculation’ in men with subfertility and one which can radically alter the male infertility definition, thereby providing a new approach to examining and managing male factor infertility. The review also explores various aspects affecting the IUI procedure, its determinants of success, risks and areas for future improvements. Areas such as choice of patients, clinical management of patients, the type of stimulation regime, timing and the management of sperm usage have significant bearing to whether IUI will succeed. The paper asserts that IUI should be the first choice of fertility treatment.

Abstract

Stress urinary incontinence is a condition associated with advancing age and high parity. Millions of women all over the world have suffered, in silence, embarrassment and social isolation due to this condition. Over the years, several operative procedures have evolved for correction of urinary incontinence with many of them having poor success or high recurrence rates over longterm period. This mini review covers various surgical procedures evolved over the last couple of years and recent advances in the management of urinary incontinence.

Abstract

Background In India, a large proportion of women with an unmet need for contraception are within their first year after childbirth. Therefore, concentrating efforts to educate postpartum women on the importance of attending contraceptive clinics could have a proportionally bigger impact on increasing postpartum contraception usage.

Methods Hundred and seventy-eight (178) women were followed up to determine the proportion of postpartum women who attended the family planning clinics for contraceptive counseling. The reason for non-attendance, choice and effectiveness of contraceptive method selected was determined.

Results Out of 178 postpartum women who were followed up, only 12 (6.8 %) attended the contraceptive clinic. IUD, POPs and Inj-DMPA are the preferred contraceptive methods selected by postpartum women. Hundred percent of the postpartum women who attended contraceptive selected a contraceptive method as compared to only 44 % of the postpartum women who did not attend a contraceptive clinic. Only 29.2 % of these postpartum women selected highly effective contraceptive methods as compared to 83.3 % by the postpartum women who attended family planning clinics. The common reasons cited for not attending contraceptive clinic was found to be time constraint (43.9 %) followed by ‘stay far away’ (39 %), followed by ‘already have information’ (9.7 %). Conclusions Family planning service that is scheduled to be delivered at the 6-week postpartum is rarely attended. The common reason cited by postpartum women for poor attendance in these family planning clinics was time constraint.

Abstract

Objective To determine the effects of oral misoprostol solution for induction of labour.

Study Design This is a prospective observational study.

Setting This study was conducted in Government Medical College, Aurangabad.

Method Patients undergoing induction of labour after 36 weeks of pregnancy were allocated by randomization to induction of labour with oral misoprostol solution administered 2 h apart. Delivery within 24 h after induction with oral misoprostol solution was the primary outcome on which the sample size was based. The data were analysed by Statistical Software for Social Sciences software.

Result Two hundred patients were randomly selected for induction with oral misoprostol solution. There were no significant differences in substantive outcomes. Vaginal delivery within 24 h was achieved in 80.5 % of patients. The caesarean section rate was 19.5 %. Uterine hyperactivity occurred in 4 % of patients. The response to induction of labour in women with unfavourable cervices (modified Bishop’s score < 2) was somewhat slower with misoprostol, induction to delivery interval was more, oxytocin requirement was more, and vaginal delivery rate was less.

Conclusion This new approach to oral misoprostol solution administration was successful in achieving vaginal delivery rate in 24 h in 80.5 % of patients; rate of LSCS was less 19.5 %.

Abstract

Background Uric acid is a marker of oxidative stress tissue injury and renal dysfunction, hence a correlation hypothesized.

Objectives (1) To evaluate severity of preeclampsia with raised serum uric acid. (2) To evaluate perinatal outcome in preeclampsia with raised serum uric ccid.

Materials and Methods 50 pregnant women with severe preeclampsia and 50 normotensive women were included in the study and maternal serum uric acid was estimated in both the groups.

Results In the study group comprising of 50 cases of preeclampsia, there is a positive correlation (r = 0.695 & ?0.359) between the variables in study group, and as the SBP or DBP increases, the MSUA concentration also increases. In control group, there is a negative correlation (r = -0.083 & -0.095). Perinatal complication was more in study group, 54 % were preterm compared to 4 % in control group also as MSUA value increased average gestational age decreased. Mean birth weight in study group was 1.8 kg study group of which 13 (26 %) babies were VLBW, 28 (56 %) were LBW, and 9 (18 %) babies had normal birth weight, in control group mean birth weight was 2.99 kg. There were 6 cases of ELBW babies in study group which were included in VLBW group for statistical calculation. The difference was found to be statistically significant (p < 0.05). In the study group, the MSUA concentration is found higher in LBW and VLBW babies compared to normal birth weight babies.

Conclusion There is a positive correlation between SUA & severity of preeclampsia, and a significant adverse fetal outcome is observed with raised MSUA in preeclamptic patients.

Abstract

Objective(s) We aimed at evaluating the predictive value of amniotic fluid index <= 5 on perinatal outcome in terms of effect on cardiotocography, mode of delivery, meconium in liquor, birth weight, fetal distress, APGAR score at birth and neonatal admission to ICU.

Method(s) This is a prospective study of 308 antenatal women admitted to labor ward of MIMS during February 2014–December 2015 with gestational ages between 34 and 41 weeks. All women enrolled were subjected to history taking, examination, AFI estimation and compared between those with AFI <=5 from rest.

Results The non-reactive CTG, cesarean section rate due to fetal distress, low birth weight, APGAR score < 7 and NICU admission were significantly high among those with oligoamnios than the control group.

Conclusion Oligoamnios has a significant correlation with adverse perinatal outcome.

Abstract

Introduction Abnormal uterine bleeding (AUB) is the commonest menstrual problem during perimenopause. The International Federation of Gynaecology and Obstetrics working group on menstrual disorders has developed a classification system (PALM–COEIN) for causes of the AUB in non-gravid women. The present study was conducted with the aim to study the two components of this system in clinical practice in general and to establish a clinico-pathological correlation of AUB with context of PALM component in particular.

Materials and Methods Two hundred and thirty-six perimenopausal women (aged 40 years and above till 1 year beyond menopause) admitted with complaints of abnormal uterine bleeding were studied. After thorough history and examination, a clinical diagnosis was made as per PALM– COEIN classification. Relative contribution of various causes of PALM (structural) and COEIN (functional) components was analysed. After all indicated investigations, endometrial sampling and hysterectomy specimen were assessed by histology. A clinicopathological correlation was analysed statistically.

Result PALM and COEIN components contributed almost equally for AUB when assessed clinically. On the other hand, the histological examination revealed significantly more cases of PALM (structural or anatomical) component of AUB, i.e. 50.23 versus 63.98 % (p B 0.05) The difference was mainly attributed to the detection of more cases of AUB-M (malignancy and hyperplasia) in highly significant proportions (p B .01) and coexistent cases of AUB-A;L. AUB-L was the commonest (41.1 %) aetiology overall.

Conclusion The PALM–COEIN classification system should take into account both the clinical and histopathological diagnoses in women having AUB around perimenopause as the two diagnostic modalities are complementary to each other and clinical impression should be placed into proper perspective of this classification in order to optimise outcome.

Abstract

Background The advent of effective chemotherapeutic agents for ovarian carcinoma has made radical abdominopelvic radiation redundant. Nevertheless, palliative pelvic Aimsradiotherapy still has a role in palliating local symptoms. However, its effect on progression-free survival (PFS) may be debated.

Aims To study the outcome of fractionated palliative pelvic radiotherapy in relapsed ovarian cancers in terms of symptom control and PFS.

Methods Twenty-three patients of ovarian cancers, heavily pretreated with chemotherapy and with recurrent or residual pelvic masses, were planned for palliative pelvic radiotherapy to the dose of 46–50 Gy in 23–25 fractions in 4.5–5 weeks. Symptom control and outcomes have been analyzed.

Results Post-radiotherapy, abdominal pain was controlled in 15 out of 17 patients (88.2 %), bleeding per vaginum in all 5 patients and vaginal discharge stopped in 4 out of 5 patients (80 %). On follow-up, of 23 patients, 17 (74 %) had progressive disease post-radiation, and median time to disease progression was 10 months (range 1–49). On univariate analysis, increased PFS was observed in patients who received radiation late in their course of disease, those with serous histology, and with lesser disease bulk in pelvis (<=2 cm) prior to radiation initiation.

Conclusion Fractionated palliative pelvic radiotherapy is an efficient method for symptom palliation in relapsed ovarian cancers. Patients who are heavily pretreated with chemotherapy and have a small-volume pelvic disease may show a prolonged PFS with addition of pelvic radiotherapy. Indications of radiotherapy, however, need to be defined.

Abstract

Objective To study the effect of GnRh agonist administration prior to estrogen–progesterone preparation of the endometrium on the implantation rate in frozen–thawed embryo transfer (FET) cycles in infertile patients treated with IVF/ICSI.

Design Prospective controlled study.

Setting Private center in Alexandria, Egypt.

Patients Patients undergoing frozen–thawed embryo transfer FET.

Intervention(s) Patients were divided into two groups, A and B. Group A patients consisted of 110 patients (110 cycles) who received daily subcutaneous injections of 0.1 mg of the GnRh agonist triptorelin starting from the mid-luteal phase of the cycle preceding the actual FET cycle. The dose was reduced to 0.05 mg from the second day of the cycle when daily oral estradiol valerate 6 mg was also started. Daily vaginal supplementation of micronized progesterone 400 mg b.d. was started after 12 days when the GnRh agonist was also stopped. Frozen–thawed embryos were transferred on day ? 1 of their chronological age and when the endometrium reached 12 mm in thickness. Group B consisted of 100 patients (100 cycles) who started daily estradiol valerate 6 mg administration from the second day of the FET cycle and followed the same regimen but without prior treatment with triptorelin.

Main Outcome Measures Implantation and pregnancy rates were compared among the two groups.

Results There was a significant increase in implantation rate in the GnRh agonist group (group A) compared to the estrogen and progesterone only group (group B) (44.1 vs. 21.1 %; P = 0.002*). The pregnancy rate was also significantly higher in group A compared to group B (65.5 vs. 42 %, P = 0.013*).

Conclusions GnRh agonist administration during endometrial preparation for FET increases the implantation and pregnancy rates.

Abstract

Introduction We conducted a randomized, double-blinded,placebo-controlled study, to evaluate the effect of dehy-droepiandrosterone (DHEA), on diminished ovarianreserve (DOR).

Materials and Methods Twenty patients with DORreceived DHEA (oral 25 mg three times a day). Post-sup-plementation 12 weeks, D2/3 age-specific follicle-stimu-lating hormone (FSH), anti-mullerian hormone (AMH)levels, and antral follicle count (AFC), were repeated toevaluate response. Spontaneous pregnancy rates and regu-larization of menstrual cycles were also studied as sec-ondary outcome.

Results Predominant risk factors were age[35 years(28 %) and poor responders to ovarian stimulation (23 %).There was significant improvement of AMH levels(1.15±1.49 vs. 1.53±1.62) found before and aftersupplementation in the DHEA group. When the AMHvalues between DHEA and placebo group were compared,pre- and post-supplementation, no significant differencewas found. There was decrease in FSH levels and increasein AFC value post-supplementation in both DHEA andplacebo groups which was not statically significant. DHEAsupplementation benefited clinically, as evidenced by the improvement in the menstrual abnormality spontaneousconception in two cases each.

Conclusions A significant improvement in AMH levelspre- and post-supplementation of DHEA was noted. Thesame was not seen for FSH and AFC values.