Objective: To compare acceptability, safety, efficacy, complications and induction-abortion interval of misoprostol and ethacridine-lactate(0.1%) for midtrimester pregnancy termination.
Method: Twenty-five women of 13-20 weeks pregnancy were randomized in two groups. In group-I, 600 ? g misoprostol was given vaginally followed by 400 ? g 8 hourly upto a maximum 48 hours. In group-II, 150 ml of ethacridine was instilled extraamniotically. Success rate, induction-abortion interval, complications and satisfaction were studied and analyzed using unpaired t-test.
Results: Misoprostol was 92 % effective as compared to ethacridine with 80% effectiveness. Mean induction-abortion interval in group-I was 13.94 hours and in group-II, it was 28.86 hours (p < 0.0001). In group-I, 84% aborted within 24 hours, and 92% within 36 hours whereas in group-II 16% aborted within 24 hours and 68% within 36 hours while 32% women in group-I and 44% in group-II experienced complications.
Conclusion: Misoprostol is safer, more effective and acceptable than ethacridine for mid trimester termination of pregnancy.
OBJECTIVE(S) : To evaluate the effectiveness of placental blood drainage via the umbilical cord in reducing the duration of blood loss in third stage of labor, and the incidence of postpartum hemorrhage.
METHOD(S) : A randomized controlled trial was carried out on 200 pregnant women. In the study group the placental end of the cut umbilical cord was unclamped immediately after it was cut and in the control group it remained clamped. Placenta was delivered by controlled cord traction. Intravenous methergin was given after delivery of placenta in both the groups. The duration of third stage and the amount of blood loss were noted. The results were analysed by ‘Z’ test and unpaired ‘t’ test.
RESULTS : The duration of third stage was 5 minutes in the study group and 7.4 minutes in the control group. This difference was statistically significant (P<0.001). The average third stage blood loss was 175 ml in the study group and 252 ml in the control group. This difference also was statistically significant (P< 0.001). The incidence of postpartum hemorrhage was decreased in the study group (3% vs 10%). None of the women required blood transfusion.
CONCLUSION(S) : Placental blood drainage is a simple safe and noninvasive method which reduces the duration of blood loss in third stage thereby preventing postpartum hemorrhage.
OBJECTIVE(S) : To examine the role of fetal arterial Doppler in neonatal outcome
METHOD(S) : Seventy consecutive women with high-risk pregnancy were enrolled in the study group and 70 women withno obstetric complication were enrolled as control group. Both groups were subjected to serial ultrasonography anddoppler studies of the umbilical and middle cerebral artery. Neonatal outcomes were recorded. Statistical analysis includedmean ± SD and median (centiles). Z test was used as test of significance.
RESULTS : Perinatal morbidity and mortality were significantly higher in the study group. Sixteen (22.85%) neonates instudy group required neonatal intensive care unit admission. Cesarean section was required in 25 (35.71%) subjects ascompared to 16 (22.85%) controlss.
CONCLUSION(S) : Although fetal Doppler studies have an important role to play in the assessment and optimal timing ofdelivery, they do not appear to be independently associated with neonatal outcome.
OBJECTIVE(S) : To evaluate the results of chemotherapy in high-risk gestational trophoblastic tumors.
METHOD(S) : This is a retrospective analysis of 48 cases of high-risk gestational trophoblastic tumors (WHO scoring system) evaluated for 7 years from1995 to 2002. All women received either EMA only / EMA+CO regimen as first-line chemotherapy (EMA only = etoposide, methotrexate, actinomycin; EMA+CO = etoposide, methotrexate, actinomycin+ cyclophophamide and vincristine). Intrathecal methotrexate was given to patients suspected of brain metastasis and as prophylaxis in women having pulmonary metastasis. Second line chemotherapy EMA+CO / EMA-EP / PVB (i.e.CP- cisplatin, etoposide, PVB-cisplatin,vinblastine,bleomycin) was given to women having poorer response to primary chemotherapy or showing progression of disease.
RESULTS : Only 39 women could be evaluated because nine women were lost to follow-up. Of these, 24(61.5%) achieved remission with the first line chemotherapy and an additional eight (20.5%) achieved remission with second line chemotherapy. Thus complete response rate was 32/39 (82%). Toxicities of chemotherapy were evaluated
CONCLUSION(S) : Gestational trophoblastic tumors are curable if properly scored and treated. The preferred primary chemotherapy in high-risk gestational trophoblastic tumors is EMA-CO regimen.
OBJECTIVE(S): To study the efficacy and safety of tranexamic acid in reducing blood loss during and after the lower segment cesarean section.
METHOD(S): A randomized, case controlled, prospective study was conducted on 100 women undergoing lower segment cesarean section (LSCS). Fifty of them were given tranexamic acid immediately before LSCS were compared with 50 others to whom tranexamic acid was not given. Blood loss was collected and measured during two periods. The first period was from placental delivery to end of LSCS and second from the end of LSCS to 2 hours postpartum. Hemoglobin, urine analysis, liver and renal functions were tested in both the groups.
RESULTS: Tranexamic acid significantly reduced the quantity of blood loss from the end of LSCS to 2 hours postpartum: 75.71 ml in the study group versus 133.03 mL in the control group (p=0.001). It also significantly reduced the quantity of blood loss from placental delivery to 2 hours post-partum: 372.71 mL in the study group, versus 469.70 ml in the control group. (P=0.003). No complications or side effects were reported in either group.
CONCLUSION(S): Tranexamic acid significantly reduced the amount of blood loss during and after the lower segment cesarean section and its use was not associated with any side effects or complication like thrombosis. Tranexamic acid can be used safely and effectively in women undergoing LSCS.
OBJECTIVE(S) : To study cervical changes in copper –T (Cu-T) users, along with effect of Cu-T on cervical exfoliative cytology by Pap test and to ascertain the safety of Cu-T with reference to cervical dysplasia.
METHOD(S) : Two hundred and eighty two women with Cu-T in situ were subjected to detailed history taking, clinical examination and Pap smear study. These women were compared with 100 asymptomatic women and having no Cu-T insitu matched for age, parity and socioeconomic status.
RESULTS : 47.6% of subjects had normal cytology as compared to 58% of the controls. Atypia of squmous cells of undertermined significance were seen in 1.4% of the subjects as compared to 2% of the controls. There was increased acceptance of Cu-T for family planning (73%), even though backache (44.6%) and menorrhagia (38.2%) occurred.
CONCLUSION(S) : There is no precipitous carcinogenicity of Cu-T but a long term follow up is needed. Subjects fitted with intrauterine devices deserve continuous surveillance but are not subjected to increased risk of malignancy because of their choice of birth control method.
copper T users ● Pap test ● dysplasiaOBJECTIVE(S): To compare NuvaRing with Desogen for cycle pretreatment prior to controlled ovarian lyperstimulation (COH) in vitro fertilization (IVF) cycles.
METHOD(S): In this prospective randomized study conducted from May 2003 to August 2004, 79 patients undergoing COH for IVF cycles were included and randomized to received pretreatment with or Desogen estradiol (n=40) or NuvaRing (n=39) for 12-21 days starting from day 3 of their cycle. Cycle monitoring was done by transvaginal ultrasound or estradiol (E ) levels. The main outcome measure was ovarian suppression. Chi square test and t test were used for statistical analysis.
RESULTS: Ovarian volumes and antral follicle counts were similar before and after hormonal manipulation. E levels before and after contraceptive use were similar in both the groups. The luteinizing hormone (LH) level after contraceptive use was significantly suppressed in both the groups. The NuvaRing group required less total dose of follitropin ß. Pregnancy and implantation rates were similar in both the groups.
CONCLUSION(S): Both NuvaRing and the oral contraceptive Desogen are good and comparable choices for cycle pretreatment prior to IVF.
OBJECTIVE(S): To assess factors that influence the outcomes in a frozen embryo replacement cycle (FERC)
METHOD(S): An analysis of 205 fresh IVF/ICSI cycles and their first FERC was performed in a University hospital in UK.
RESULTS: The ongoing clinical pregnancy rate and implantation rate was 25.9% and 12.8% respectively in fresh and 16.1% and 7.5% respectively in frozen cycles. In FERC, the mean age (SD) of women with an ongoing pregnancy was comparable to those with a negative outcome 32.85 ± 3.57 vs 33.53 ± 4.31 years. Also, women with a non-tubal cause of subfertility appeared to have a better outcome. The ongoing pregnancy rates were not influenced by the laboratory technique of fertilisation ICSI 20.39% vs IVF 11.76% (P=0.093) nor by the number of embryos transferred. The risk of multiple gestation was comparable in fresh and frozen cycles.
CONCLUSION(S): FERC increases the cumulative pregnancy rate by nearly 16%. An ongoing pregnancy in the fresh cycle, age, laboratory technique, length of cryostorage and number of embryos transferred do not appear to influence conception rates in FERC. A nontubal etiology of subfertility has a better pregnancy outcome.
OBJECTIVE(S) : To study the clinical parameters of patients who present with vault prolapse and the modalities of its treatment.
METHOD(S) : A retrospective study of 13 cases of vault prolapse seen during the 5 year period from 1999 to 2004 was carried out. The data regarding the clinical parameters like age, parity, symptomatology, POP-Q staging, type of previous hysterectomy and the interval between hysterectomy and the onset of symptomatic vault prolapse were collected and analyzed.
RESULTS : The commonest symptom after a mass protruding from the vagina is difficulty in voiding urine. Most patients present with Stage II of POP Q system. The patients are equally distributed about the median value of Stage II (Normal distribution). Greater degrees of vault prolapse follow vaginal hysterectomy, compared to abdominal hysterectomy. The utilization of sacrospinal colpopexy is significantly less despite its various advantages.
OBJECTIVE(S): To assess the maternal mortality rate at a referral center in a metropolitan city.
METHOD(S): A retrospective study of 30 maternal deaths over a period of five years from 1st July, 2000 to 30th June 2005.
RESULTS: Over the study period there were 26,444 deliveries, giving a maternal mortality rate of 113.44. Postpartum hemorrhage was the leading direct cause and anemia the leading indirect cause. Most women died within 24 hours of admission. The age group of 20 to 30 years was crucial. Most deaths were in unregistered cases transferred from outside.
CONCULSION(S): The maternal mortality rate is much lower than the national MMR of 407 yet most deaths could have been avoided with the help of quick, efficient and well-equipped transport facilities and by promoting overall safe motherhood.
maternal mortality ● postpartum hemorrhage ● anemia.OBJECTIVE(S) : To determine the prevalence of HIV during pregnancy, demographic factors of pregnant women testing positive for HIV and the utilization of therapeutic interventions to minimize the risk of mother-to-child transmission (MTCT) in prevention of parent to child transmission (PPTCT) services.
METHOD(S) : Pregnant women presenting to tertiary care center in Kolkata from 1st January, 2004 to 31st December, 2005 had HIV serology performed by Rapid Test after receiving counseling in groups of 10-15. Care was administered using a standard protocol by a multi-disciplinary team of healthcare personnel. Antiretroviral prophylaxis with nevirapine was given to seropositive women and their children.
RESULTS : Of the 25,394 new antenatal booking visits 22,850 (89.98%) women attended pretest counseling and 21,369 (83.23%) of them accepted HIV testing. Thirty-five women were found to be seropositive. Seroprevalence rate of HIV infection was 0.16%. Majority of the 35 HIV infected women were primiparous, Hindu, addiction free, and with multiple sex partners of the husband or the woman herself sex partners. Only 28 (28/35, 80%) came for collecting their reports and 19 of them received treatment at our hospital. Of the 35 seropositive women five (17.85%) opted for pregnancy termination and 14 have delivered and all of them have live born babies. All these mothers and their newborns (100%) have received nevirapine prophylaxis.
CONCLUSION(S) : The seroprevalence of HIV infection among antenatal women is low. Uptake of interventions aimed at reducing the risk of mother-to-child HIV transmission is high but the follow up of children is limited.
