Abstract

Intrauterine insemination (IUI) combined with ovarian hyperstimulation (OH) has been demonstrated to be an effective form of treatment for subfertile couples. Trials comparing different ovarian stimulation protocols combined with IUI were selected and reviewed in detail by Cantineau et al.1. A total of 43 trials involving 3,957 women were included. Seven studies (n=556) were pooled comparing gonadotropins with anti-estrogens showing significant higher pregnancy rates with the former.

Five studies (n=313) compared anti-estrogens with aromatase inhibitors reporting no significant difference. The same could be concluded comparing different types of gonadotropins (nine studies included, (n=576). Four studies (n=391) reported the effect of adding a gonadotropin-releasing hormone (GnRH) agonist which did not improve pregnancy rates, although it resulted in significant higher multiple pregnancy rates.Data of three studies (n=299) showed no convincing evidence of adding a GnRH antagonist to gonadotropins.

The purpose of Eskander’s study was to determine if the use of a GnRH agonist can improve pregnancy and livebirth rates during superovulation and IUI2. In this prospective study, women aged 18-39 years underwent 500 cycles of superovulation/IUI with (n=254) and without (n=246) GnRH agonist. There were no statistically significant difference in the live-birth, ongoing, and clinical pregnancy rates per cycle for patients who received GnRH agonist and patients who did not receive GnRH agonist. Superovulation/IUI cycles using GnRH agonist produce similar pregnancy rates to superovulation/IUI cycles without using GnRH agonist.

Schmidt-Sarosi and Yerovi3 compared the use of two GnRH agonists, nafarelin acetate (NA) and leuprolide acetate (LA), in conjunction with human menopausal gonadotropins (hMGs)/human chorionic gonadotropin (hCG) and IUI. There were no differences in: the number of days to ovarian suppression, the number of ampules of hMGs required, the number of 17-mm preovulatory follicles, or the mean peak estradiol levels. NA is, at the least, comparable to LA in effecting pregnancy after superovulation/IUI.

Abstract

A great visionary, orator, educationist, Obstetrician and Gynaecologist, Sir Arcot Lakshmanaswami Mudaliar was one of twins born in the year 1887 on 14th October at Kurnool. His twin brother was the distinguished Sir Arcot Ramaswami Mudaliar and because of their towering personalities they were called as Arcot twins in Madras.

After completing his schooling at Kurnool, he went to Madras for further studies. He obtained B.A. degree with Telugu as second language, at the Madras Christian College. Subsequently he completed his studies in Medicine in Madras and joined the Government Hospital for women and children at Egmore (Madras) where he served in different capacities for over 35 years. It is because of his magnificent skill and knowledge of the speciality that hundreds of students and thousands of patients flocked to the Maternity Hospital, Egmore (Madras).

In 1934, he was appointed as Professor of Obstetrics and Gynaecology at the Madras Medical College. In the year 1939 he became the first Indian to be Principal of the same college and also superintendent of Govt. Hospital for women and children, Madras.

In the year 1923, he was elected senate member of the Madras University. Thereafter in 1924, he was made Vice Chancellor of Madras University. He remained on this post for a record period of 27 years. By any standards he was the best known,highly respected and even feared vice-chancellor in his time. During his tenure, he made many changes in the University functioning and made the University of an International standard.

Abstract

Introduction: There are more deliveries in India than any country in the world, according to World Health Report. Review of seven articles published in The Journal of Obstetrics and Gynecology of India suggests that the perinatal mortality (PNM) in the country is 92/1,000 (16,339/177,998) births and the cause is asphyxia in about one fourth of the cases.

Methods: We reviewed the evidencebased guidelines on intrapartum fetal surveillance from four countries (UK, USA, Canada, and Australia/New Zealand).

Results: Overall there were 72 recommendations and whether they were level A, B, C, or D varied significantly (p=0.021) for the four national guidelines. The composite summary of these recommendations indicates that no single guideline is comprehensive, the composite may be better than any singular.

Conclusion: Each country needs its own recommendations to ameliorate the PNM. Accounting for the varied setting childbirths occurring in the country, a national guideline for clinicians in India may decrease the PNM secondary to asphyxia.

Abstract

Objectives: To reduce the perinatal transmission of HIV AIDS in antenatal women—a need-based project with NACO protocols, with a series of interventions.

Methods: Prospective and retrospective study, data collected from Parent-to-Child Transmission of HIVAIDS records and case sheets. Women registered for pretest counseling in antenatal OP tested for HIV, posttest counseling given, single drug NVP administered to mother and neonate, exclusive breast feeding advised for first 6 months, and infant testing for HIV done at 18 months of age by ELISA.

Results: Seroprevalence in antenatal women was 1.2%. Majority (95%) of mother-child pairs were administered single drug NVP. Institutional delivery rate for seropositive women was 70% and the perinatal transmission of HIV AIDS was 8%.

Conclusion: Improve universal counseling and testing, more number of mother-baby pairs to be administered single drug NVP, increase institutional delivery rates for seropositive women, improve follow-up services with the help of outreach workers to reduce perinatal transmission of HIV AIDS.

Abstract

Objectives: The aims of the study were to help generate information and knowledge regarding the causes and complications leading to maternal deaths (MDs) in an urban tertiary care hospital, to find if any of them are potentially preventable, and to use information thus generated to save lives.

Methods: The medical records of all MDs occurring over a period of 4 years between January 2003 and December 2006 were reviewed and correlated with maternal age, antenatal registration, mode of delivery, parity, admission death interval, and causes of death.

Results: The maternal mortality rate (MMR) ranged between 926 and 377/100,000 births in the study period. The causes of deaths were sepsis 23.84%, eclampsia /pregnancy-induced hypertension 17.69%, hemorrhage 13.84%, hepatitis 13.84%, anemia 13.07%, respiratory infections 8.46%, other indirect obstetrical causes 6.15%, and unrelated causes 4.61%. Maximum deaths (71.53%) occurred in women between 21 and 30 years of age while multigravida had MMR of 51.53%. Mortality was highest in postnatal mothers 63.06%.Unbooked cases constituted 92.31% of MDs and included 25% referred cases.

Conclusion: Overall maternal mortality was 690/100,000. MDs due to direct obstetric causes were 55.38%, indirect obstetric deaths 40%, and unrelated deaths 4.61%. The causes of potentially preventable deaths include deaths due to anemia, sepsis, hemorrhage, DIC, and anesthesia complication, and accounted for 25.38% of all deaths.

Abstract

Objective: To study the perinatal outcome after fetal reduction in multiple gestations.

Materials and Methods: This is a retrospective study of 12 patients who underwent fetal reduction for multiple gestations. The ultrasound-guided procedure was done transabdominally.

Results: Of the 12 patients who underwent fetal reduction, one had spontaneous abortion following the procedure while the other 11 delivered live babies. Conclusion: Multiple gestations have an adverse neonatal outcome. By reducing the high order pregnancies to twin gestations, the associated complications can be reduced. Ultrasound-guided fetal reduction is safe and effective method for reduction of multifetal gestations to twins or singleton, and improving the pregnancy outcome.

Abstract

Objectives: To evaluate the efficacy of vibroacoustic stimulation (VAS) and modified fetal biophysical profile (mFBP) for early intrapartum fetal assessment and prediction of adverse perinatal outcome.

Methods: In this prospective study, 210 women who were in latent phase of labor at the time of admission to the labor unit were subjected to VAS/mFBP, in which fetal startle response and fetal heart acceleration under combined B/M mode ultrasonography following VAS were observed. The results of VAS/mFBP were correlated with adverse perinatal outcome. Standard “fourfold” format was used to calculate various diagnostic values.

Results: Mean testing time was 4.86+0.72 min. Of the 210 fetuses subjected to VAS/ mFBP, 200 (95.2%) were reactive and 10 (4.8%) nonreactive. There were 198 (94.3%) favorable and 12 (5.7%) adverse perinatal outcomes. VAS/mFBP had: sensitivity 66.7%, specificity 99.0%, positive predictive value 80.0%, negative predictive value 98.0%, and accuracy 97.2%.

Conclusions: Because of its simplicity, ease of administration, short testing time, noninvasiveness, and high accuracy VAS/mFBP for early intrapartum fetal assessment is a reliable diagnostic approach.

Abstract

Objective: Interleukins (ILs) and matrix metalloproteinases actually target collagen IV in the amniochorion in premature rupture of membranes (PROM), IL-10 acts as a membrane protector. In order to counteract the immunological system involved in the pathogenesis, we have used a combination of proapoptotic bax gene P-53 inhibitor, myristoleate, with antimicrobial peptides, neutrophil defensins, and cytokine IL-10 enhancer.

Methods: A comparative prospective randomized study was conducted from July 2006 to January 2007 in patients (46 cases and 60 controls) attending the Gynecology and Obstetrics Emergency Department, Eden Medical College, Kolkata, complaining of leakage per vagina in their antenatal period between 24 and 36 weeks of gestation. Combination of bax gene inhibitor, antimicrobial peptides, neutrophil defensins, and IL-10 enhancer in scheduled protocol was prescribed and cases followed up as per fixed protocols.

Results: In the 24-30 weeks group, mean prolongation of gestational age was 6.16±3.21 as against 2.66±1.05 (significant), while in 31-36 weeks mean prolongation was 4.69±0.84 as against 4.6±0.632 (significant). In the first group mean birth weight in cases was 1.77±0.66 kg as against 1.2±0.43 kg (significant), while in the second it was 2.18±0.56 kg as against 1.76±0.45 kg (significant). Associated complications were less in cases.

Conclusion: Combination of bax gene inhibitor, antimicrobial peptides, neutrophil defensins, and IL-10 enhancer as per scheduled protocol can be advocated routinely in PROM barring a few situations with excellent fetal and maternal prognosis.

Abstract

Objective: Mycobacterial infections of the genital tract have been implicated in the etiology of female infertility. The correlation of endometrial TB PCR with laparoscopic and hysteroscopic features in patients with infertility was evaluated.

Methods: Women suffering from infertility and undergoing diagnostic laparoscopic and hysteroscopic examination were included. Endometrial specimens were assayed by Nested PCR for mycobacterium complex and the results were then retrospectively correlated with laparoscopic and hysteroscopic features.

Results: Positive TB PCR was observed in 32.18% (n=56) women. Out of these 56 patients, 48 had endoscopic abnormalities suggestive of tuberculosis (TB) and rest 8did not reveal any endoscopic abnormalities. However, of 174 patients 139 had endoscopic abnormalities with positive TB PCR in only 48. Sensitivity and specificity of endoscopic evaluation was 85.71 and 22.8%, respectively. The presence of periovarian adhesions, cornual block, tubal beading, tubercles, intrauterine adhesions, and ostial fibrosis had very strong association with positive TB PCR. Total predictive value of endoscopic evaluation in diagnosis of genital TB was 42.52%.

Conclusion: This study highlights that endoscopic evaluation is an important diagnostic tool, but can neither confirm nor exclude genital TB. Endometrial TB PCR may have to be routinely resorted to make a definite diagnosis of mycobacterial infection in endemic areas.

Abstract

Aims and Objective: To evaluate the role of serum antisperm antibody (ASA) in infertility.

Method and Material: This study was conducted in the Department of Obstetrics and Gynecology, Pt. J.N.M. Medical College, Raipur (C.G.), India, from December 2006 to July 2008 over 105 selected couples with primary and secondary infertility attending the infertility clinic. Their detailed clinical history was taken. Physical examination and routine as well as special investigations like pelvic USG, follicular study, and hysterosalpingography were done in the female. Complete physical examination and semen analysis of male partners were done. Couples were subjected to post coital test (PCT) 2-6 hours after intercourse to rule out cervical factor. Serum ASA titer in both partners was detected by ELISA. Results were interpreted for qualitative evaluation. ASA-positive cases were treated with low-dose daily oral prednisolone for 3 months and evaluated in terms of ASA titer, semen analysis, PCT result, and conception rate. The results were analyzed by statistical methods.

Results: Out of 105 couples, serum ASA-positive males were 38 (39.19%), of which definite serum ASA positive were 9 (8.57%), borderline (equivocal) were 29 (27.61%), and negative were 67 (63.08%). Among females serum ASA positive were 42 (40%), in which definite ASA positive were 19 (18.09%), borderline 23 (21.9%), and negative 63 (60%). Asthenospermia was found more common in ASA-positive men (55.56%, p=0.0001). Poor PCT was most commonly associated in husband ASA negative and wife ASA positive. Treatment with low-dose oral prednisolone resulted in significant increase in motility of sperms in male partners and decrease in ASA titer in both the patients. Pregnancy was achieved in 45.23% ASA-positive females, while among couples with ASA-positive husbands, 31.57% of wives conceived.

Conclusion: Serum ASA are considered to be cause of unexplained infertility and unexplained abnormal PCT. Antibodies against sperm prevent their motility through female reproductive tract and hamper the process of fertilization. Low-dose prednisolone was useful in infertility associated with ASA by improving sperm quality and giving rise to pregnancies.

Abstract

Objectives: To study the need for emergency contraception (EC) and evaluate the efficacy and side effects of Cu T 200 B and Levonorgestrel (LNG).

Material and Methods: A 2-years study was conducted at Kasturba Hospital, Delhi, India.

Results: A total of 68 subjects were enrolled. Of them, 16 (23.53%) chose Cu T and 52 (76.47%) chose LNG as emergency contraceptives. LNG was given to subjects who came within 72 hours of unprotected intercourse and Cu T was given to those who came after 72 hours but within 120 hours of unprotected intercourse. Reasons for EC were: no contraception used (50%), problems with barrier method (42.65%), problems with IUD (7.35%). Side effects were minimal with LNG (5.77% subjects complained of nausea). Among Cu T users 12.5% subjects complained of irregular bleeding and 18.75% had low abdominal pain. Conclusions: Both LNG and Cu T 200 B are safe and effective methods of EC with low side effects.

Abstract

Objectives: To study the age at menopause, reported symptoms of menopause, and treatment-seeking behavior of urban women.

Methods: This was a cross-sectional study on purposively selected 156 women from four different sites in Pune city between 40 and 55 years of age. Pretested semi-structured interview schedule was used for data collection. Data analysis was done using SPSS software and the correlation between menopausal symptoms and sociodemographic characteristics was tested using chi-square test.

Results: Mean age at menopause was 45.8 years. Each respondent reported nearly four symptoms. Most frequently reported symptoms were psychological (n=154) vasomotor (n=78) followed by urogenital (n=68) symptoms. Nuclear family and income levels found to have significant correlation with menopausal symptoms. Less than half (43%) patients used modern medicine while 30% did not seek any treatment.

Conclusion: It is necessary to critically inspect health needs of women in menopausal transition and incorporate specific components in the programs.

Abstract

Mrs. S, aged 27 years, G2P1A0, having one alive and healthy child delivered 7 years back by cesarean section, presented to emergency unit of our hospital, with complaints of amenorrhea for one and half months and continuous pain in lower abdomen, giddiness, and bleeding per vaginum since one day. Her general condition was satisfactory, with pulse 100/min, BP 110/70 mmHg, and normal temperature. There was no pallor, and her respiratory system and CVS were normal. On per abdominal examination, there was minimal guarding and tenderness present, and no mass was felt. Per speculum examination revealed minimal bleeding through os. Vaginal examination showed that uterus was of normal size, anteverted, and cervical movements were nontender. Right fornix was clear, but in left fornix illdefined tender mass of 3×3 cm was felt. Mild tenderness was present in left fornix.

Laboratory investigations showed positive urine pregnancy test and serum ß-HCG levels of 1,600 IU/I. Her hemoglobin was 9.3 gm%, white cell count 13,000/mm3, differential count of N81,L17, E1, M1, ESR 25 mm/hour, whereas the results for rest of the routine investigations were within normal limits. Ultrasound showed a large mixed echogenic left adenexal lesion of 6.2×3×5 cm3 size with solid and cystic components, and large amount of free fluid in pouch of Douglas, suggestive of ruptured left ectopic gestation. Uterus was empty and of normal size, shape, and echo texture. Both ovaries were normal in size and shape. Emergency laparotomy was done which revealed ruptured gestational sac implanted on sigmoid colon, 200cc of hemoperitonium was present. Products of conception and clots were removed. Part of the chorionic plate was firmly adherent to the bowel and was left behind to avoid bowel injury. Saline wash was given. Complete hemostasis was achieved. Tubercles were seen on anterior surface of uterus. Previous lower segment caesarean section scar was intact. The abdomen was closed after securing complete hemostasis. The patient withstood the surgery well. On postoperative day 8 ßHCG level was 380 mlU/ml and ultrasound of pelvis was normal. The patient was discharged on postoperative day 10. Follow-up of patient in outpatient department after 7 days of discharge showed ßHCG 34 mlU/ml. She was advised Anti Koch's treatment. Diagnosis of primary abdominal pregnancy was made according to Studdiford's criteria1. Both tubes and ovaries were in normal condition with no evidence of recent or remote injury. No evidence of uteroperitoneal fistula was found. The pregnancy was related exclusively to the peritoneal surface and was early enough to eliminate the possibility that it is a secondary implantation following a primary implantation in the tube.