Abstract

Human immunodeficiency virus-serodiscordant couples are actively seeking reproductive assistance and often consider or practice unsafe measures to achieve pregnancy. Reproductive issues and concerns unique to these couples need to be addressed before treatment. Assisted reproduction techniques can minimize the risk of infection and complete families associated with serodiscordant couples. Since 1987, more than 4000 published attempts have been reported in which processed spermatozoa from HIV-seropositive men were used to establish pregnancy in HIV-seronegative women. When the female partner is HIV positive, intrauterine insemination (IUI) will suffice in order to prevent horizontal infection. However, when the male partner is HIV positive, a technique developed in Milan over 15 years ago, involving sperm washing, is used in order to minimize infection of the healthy partner. Some couples need further treatment, due to inherent infertility, with advanced reproductive technology (ART) procedures, such as IVF or ICSI. Recent innovative approaches such as pre-exposure prophylaxis PrEP with antiretroviral drugs may reduce further the susceptibility of the uninfected female partner. Numerous ART centers worldwide treat these couples. Most centers are equipped with separate laboratory space for collecting specimens from infected patients and provide separate storage tanks for freezing infected gametes and embryos in order to protect other patients using the facility. There are no reports of HIV infection of laboratory personnel resulting from processing the gametes/embryos for serodiscordant couples using current laboratory protocols. Cross-contamination of the gametes or embryos of other couples in the same laboratory has also not been reported. The risk is theoretical only, particularly when standard universal precautions are used.

Abstract

This review article highlights the contributions of various gynecologists from India toward surgical management of pelvic organ prolapse. It will provide an overview of the different sling operations for conservative treatment of genital prolapse. A new classification of the sling operations is put forth. The advantages and disadvantages of these operations will be discussed.

Abstract

The concept of family planning originated as birth control in 1912 to control the size of the family and prevent unplanned pregnancies transformed to family welfare and later on expanded its horizons to reproductive and child health (RCH). A wide spectrum of choices both for male and female, temporary and permanent, have been developed and offered. Developed world having stabilised population faces problem with teenage and adolescent pregnancies. Developing nations are still struggling to stabilise population and traditionally depend on permanent female sterilisation as a major method of contraception. Lot of unmet need is seen in young recently married women, post-delivery, post-abortal states. Long-acting reversible contraception which includes intrauterine device, IUD, and implants has re-emerged strongly as a first choice of contraception for women of all ages including unmarried teenage pregnancies. They are highly efficient with failure rates equivalent or better than permanent methods, cost-effective, reversible, and have the potential to replace permanent sterilisation.

Abstract

Objective: To evaluate maternal vitamin D levels in term normotensive and preeclamptic patients in labor and to assess additional factors such as maternal and cord blood levels of calcium, phosphorus, parathormone, and alkaline phosphatase and associated factors such as BMI, birth weight, and mode of delivery.

Method: This was a case control study carried out in Department of Obstetrics and Gynaecology, ESICPGIMSR, New Delhi, India from August 2012–April 2014. A total of 100 patients were divided into two equal groups (control and study groups of 50 each). Control group had women with singleton uncomplicated, term normotensive pregnant women in labor while the study group composed of term preeclamptic women in labor. Blood samples were drawn for vitamin D, serum calcium, serum phosphorus, serum alkaline phosphatase, and serum parathormone levels during first stage of labor, and subsequently, their levels were evaluated in cord blood also.

Results: All the enrolled patients had vitamin D deficiency pointing toward a universal prevalence of this micronutrient deficiency in antenatal patients. We found more incidence of severe vitamin D deficiency (90 %) in preeclamptic patients as compared to normotensive patients (62 %). Also preeclamptic group had lower median vitamin D levels (3.9 ng/ml) when compared to normotensive group (9 ng/ml). Similarly, all the neonates were found to be vitamin D deficient as assessed by their cord blood levels. Neonates born to preeclamptic mothers had lower median cord blood vitamin D levels (4.4 ng/ml) when compared to those born to normotensive mothers (7.25 ng/ml). The mean maternal calcium levels followed trends observed in vitamin D levels with preeclamptic patients having consistently lower calcium levels (mean value of 8.50 ± 0.80 mg/dl) when compared to normotensive patients (mean value of 8.89 ± 0.56 mg/dl). Preeclamptic group was found to havemore number of patients (58 %) with higherBMI when compared to normotensive group (32 % of patients). A slightly more incidence (36 %) of low birth weight babies is being born to preeclamptic mothers as compared to normotensive mothers (34 %). Significantly a more number of patients (36 %) with vitamin D levels below 15 ng/ml underwent cesarean section when compared to only 9 % of patients having vitamin D level above this level.

Conclusion: Preeclampsia is indeed associated with lower vitamin D levels, and its pathophysiology involves vitamin D and calcium metabolism.

Abstract

Objective: The aim of this study was to compare pregnancy outcomes in euthyroid women who were anti-TPO Ab? with those who were anti-TPO Ab-.

Design: This observational study comprised 1,000women in the age group of 25–35 years, having normal thyroid function tests, normotensive, non-diabetic, singleton pregnancy and attending Gyn. OPD/ANC up to 20 weeks’ gestation and those who were already in the process of abortion. anti-TPO Ab levels of > 50 IU/ml were considered as anti-TPO Ab?. Setting This study was conducted in the SMS Medical College’s attached hospital, Jaipur from April 2012 to September 2013.

Main Outcome: The estimation of the proportion of anti- TPO Abs in the hospital-based population and the comparison of pregnancy and neonatal outcomes in anti- TPO Ab? and Ab- euthyroid women were done. Results The main result showed increased rates in miscarriages (13.33 vs. 2.34 %, P < 0.001), LBWs (25 vs. 5.12 %, P < 0.001), preterm deliveries [ < 34 weeks] (5 vs. 1.80 %, P > 0.05) in anti-TPO Ab+ women.

Conclusions: The current study revealed that anti-TPO Abs are strongly associated with miscarriage and LBW irrespective of their gestational age. However, we did not find any correlation with the other complication as found in the studies by Abbassi-Ghanavati, Negro et al.

Abstract

Objective: To evaluate materno-fetal outcomes in pregnant women with jaundice.

Methods: A prospective study was conducted over a period of 6 months in a tertiary care hospital of Delhi, India. 82 pregnant women with jaundice were included. The serum was screened for viral markers, liver function tests, and coagulation status.

Results: The mean age of women was 27.3 ± 4.3 years. 43.9 % (n = 36) women were HEV positive, 36 % (n = 27) HBsAg positive, 4 % (n = 3) HAV positive and 1.3 % (n = 1) HCV positive. Intrahepatic cholestasis was diagnosed in 10.8 % (n = 8) of women. Maternal morbidity was evaluated in terms of chorioamnionitis (5.4 %, n = 3), encephalopathy (26.8 %, n = 15), and coagulopathy (67.9 %, n = 38). There were five maternal deaths, and all were unbooked with HEV-positive status and a bilirubin > 15 mg/dl with deranged coagulogram and encephalopathy and IUDs. 79 women delivered vaginally, and three had cesarean section. Of the vaginal deliveries, 59.8 % (n = 49) went into spontaneous labor, and 25.5 % (n = 21) were induced for varied reasons (BPS < 6/10 (38 %, n = 8)) and progressive derangement of LFT (38 %, n = 8). Among the 71 deliveries, 29 (40.8 %) were IUD and 42 (59.1 %) were live born. On analyzing the morbidity data, it was found that HEV-positive women (deranged coagulogram 71.05 %, IUD 75.86 %, encephalopathy 80 %) had a poorer outcome as compared to their HBsAg positive counterparts (deranged coagulogram 10.52 %, IUD 13.79 %, encephalopathy 6.66 %).

Conclusion: Urgent redressal of issues pertaining to sanitation and provision for clean drinking water for citizens of India is the need of the hour as HEV is fecooral in transmission.

Abstract

Background: Controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) is essential in improving the pregnancy rate, but supraphysiologic levels of estradiol (E2), which are attained during COH and which affect the outcome of IVF, have remained unclear. The aim of this study was to evaluate the association of E2 levels on the day of hCG with embryo quality and pregnancy rates in long protocol in IVF.

Materials and Methods: We retrospectively reviewed 128 IVF cycles. All the patients were stimulated with long protocol. The patients were categorized into three groups according to the serum E2 levels on hCG administration day (group 1; < 1500 pg/ml, group 2; 1500–3500 pg/ml, group 3; > 3500 pg/ml).

Results: Of the 128 cycles, 23 (18 %) cycles resulted in pregnancy. There were no statistically significant differences between mean age, duration of infertility, BMI and FSH on cycle day 3 in three groups. The number of the retrieved oocytes, the number of obtained embryos, the number of transferred embryos, and pregnancy rates were gradually increased from group 1 to 3 as estradiol levels increased, and these values were statistically significant (P< 0.05). In addition, the correlation between age and IVF outcome was found. Mean age in patients with positive pregnancy test was lower than that in patients with negative pregnancy test, and this difference was statistically significant.

Conclusion: This study shows that there is a positive association between estradiol level on hCG administration day and pregnancy rates in IVF cycles.

Abstract

Purpose of Study: Dilatation and curettage (D&C) and fractional curettage (F/C) are commonly performed gynecological procedures. Randomized controlled trials have concluded that topical anesthesia effectively reduces pain in endometrial sampling and hysteroscopy. Our study was aimed at investigating this modality of pain relief in setting of a developing country where, due to lack of resources, successful completion of these procedures in an outpatient setting is a necessity.

Methods: This study was a prospective, randomized, placebo- controlled, double-blind study conducted in 84 patients. All patients received either intrauterine 2 % lignocaine or normal saline along with oral NSAID and paracervical block prior to the procedure. The pain was analyzed at three steps: at the time of curette, immediately post-procedure, and 30 min later using 10-cm visual analog score.

Results: The patients in the experimental and control groups were well matched for age, parity, body mass index, menopausal status, and the indications for intervention. At all the three stages, pain perceived in the lignocaine group was significantly less as compared to that in placebo group. As compared to lignocaine group (55 %), significantly higher number of women in placebo group (88 %) perceived severe pain during endometrial curettage (p = 0.001).

Conclusions: The present study indicates that two percent intrauterine lignocaine significantly decreases the pain perception during intrauterine gynecological procedures such as D&C and F/C. This is a simple, effective, inexpensive, and low-risk intervention which can potentially increase the patient acceptability and compliance with such procedures.

Abstract

Background: In developing countries, obstetric trauma is the most common cause of genitourinary fistulae. But over the last two decades, health care facilities have been improved and the scenario has been changed.

Purpose: The aim of the present study is to share our experience with genitourinary fistula in terms of mode of presentation, diagnostic modality, and management with the emphasis on the surgical approach and a parallel review of the available literature.

Materials and Method: During a 6-year period from January 2007 to December 2013, 41 cases of genitourinary fistula, who admitted and treated in the urology department of a tertiary care center, were retrospectively analyzed for etiology, site, size and number of fistulae, clinical presentation, diagnostic modalities, and management. The literature search was done using the Medline database.

Result: Mean age of the patient was 27 years (range 16–51). Primary and simple fistulae were common. Obstetric trauma was the most common etiology (56.09 %) followed by iatrogenic (39.03 %). Vesicovaginal fistula was the most common type (78.37 %) and trigone was the most common site involved (51.72 %). 51.35 % of patients were approached successfully by the vaginal route. Ancillary procedures were required in patients for various other associated anomalies at the time of fistula repair. The success rate on follow up was 94.5 %. In the mean follow up of 3 years, 35 patients were sexually active.

Conclusion: Genitourinary fistula is a frustrating entity with potentially devastating psychosocial consequence. Its management poses a tricky challenge to the surgeon. Accurate and timely diagnosis, adhering on basic surgical principle, and repair by an experienced surgeon provide the optimum chance of cure.

Abstract

Introduction: Congenital high airway obstruction syndrome (CHAOS) is a rare, usually lethal abnormality characterized by complete or near-complete intrinsic obstruction of the fetal airway. Laryngeal atresia is the most frequent cause, but other etiologies include laryngeal or tracheal webs, laryngeal cyst, subglottic stenosis or atresia, tracheal atresia and laryngeal or tracheal agenesis. When antenatal diagnosis of possible upper airway obstruction is made, specific type of obstruction is rarely determined making the term CHAOS introduced by Hedrick et al in 1994 more appropriate.

USG Characteristics: Sonographic findings in CHAOS are characteristic and are secondary to high airway obstruction. The lungs are symmetrically enlarged, echogenic and homogenous. The distended lungs have mass effect on the diaphragm, which appears flattened or inverted, and the heart is displaced anteriorly in the midline. The heart often appears dwarfed by the surrounding enlarged lungs.

Discussion: The primary abnormality is an intrinsic obstruction of the upper airway. Normal lung development involves a continuous efflux of fluid from the fetal lungs. Laryngeal atresia/CHAOS stops the efflux of this fluid, and this retained fluid distends the alveoli with fluid giving the lungs voluminous echogenic appearance and inverting the diaphragm. Isolated airway obstruction without hydrops has a relatively favorable prognosis. CHAOS with associated anomalies and with early presentation of hydrops is an ominous sign with a high rate of fetal demise and a poor survival rate even with the ex utero intrapartum treatment (EXIT) procedure.