The role of varicoceles in the etiology of male infertility continues to be controversial. Due to the numerous variables that impact the outcome of varicocele surgery, the results of various trials are often contrary. Recent studies at the molecular level have demonstrated that varicoceles can cause testicular nuclear DNA damage, apoptosis, and raised levels of reactive oxygen species. Clinical studies have shown that varicocele surgery can improve semen quality sufficient to downgrade the type of ART procedure required, can result in the appearance of sperm in the semen in some cases of non-obstructive azoospermia, and can reverse testicular growth retardation in cases of adolescent varicocele. Hence, despite contradictory clinical results, the best practice guidelines of many associations recommend varicocele surgery in men with sub-fertile semen, clinically evident varicoceles, and infertility. Ultrasonography to detect sub-clinical varicocles is not advocated. Medical therapy may help some men with mild to moderate varicoceles. Older technics of varicocele surgery by mass ligation or non-magnified dissection are associated with higher rates of recurrence, testicular artery damage, and hydrocele formation, as compared to microsurgical methods in which every vein is individually identified and ligated, while preserving the arteries and lymphatics. Laparoscopic ligation is no longer recommended.
OBJECTIVE(S) : To evaluate the perinatal mortality rate, its major determinants and its trend at a referral teaching hospital, and to suggest the policies to reduce it.
METHOD(S) : A retrospective study was done of perinatal mortality rate (PMR) among all the deliveries conducted from 1st April 1992 to 31st March, 2002 in our hospital. The factors responsible for the perinatal mortality were identified and its changing trend in the last 10 years was evaluated.
RESULTS : The PMR in the present study decreased from 138.23 in 1992 to 70.2 in 2002. Primipararity, low socio-economic status, poor antenatal attendance, and risk factors like pregnancy inducred hypertension, antepartum hemorrhage, prematurity and birth trauma, particularly asphyxia, were the major factors responsible for perinatal mortality.
CONCLUSION(S) : Poor antenatal attendance, poverty, illiteracy, and poor referral facilities were the major factors responsible for perinatal deaths. Most of the perinatal mortality is preventable by proper antenatal care, prompt referral service, and immediate and timely institution of medical treatment.
OBJECTIVE(S) : To study the incidence, causes, and possible prevention of maternal deaths.
METHOD(S) : The individual records of all maternal deaths occurring during the past 6 years from 1999 to 2004 were studied and the cause of death and the avoidable factors in each individual death were analyzed.
RESULTS : The maternal mortality rate (MMR) was 623.46 per 100,000 live births. The major causes of maternal deaths were more or less the same throughout the years of study. Major obstetric complications accounted for more than three- fourths of maternal deaths with the well known triad of toxemia (50.56%), sepsis (18.17%), and hemorrhage (9.72%) playing an important role. Anemia (4.18%) and jaundice (1.84%) were two important indirect causes of maternal deaths. Unbooked cases accounted for 87.95% of maternal deaths. More than 60% of maternal deaths were from rural areas.
CONCLUSION(S) : Majority of maternal deaths can be averted by proper intervention of 3E’s viz., emergency obstetric care (EmOC), early risk screening, and efficient obstetric services.
OBJECTIVE(S) : To study the merits and demerits of different screening and diagnostic procedures that are used at present and to find a one step procedure which serves both as a screening as well as a diagnostic tool.
METHOD(S) : This study was performed in Government Raja Sir Ramaswamy Mudhaliar lying in hospital, Chennai. Consecutive 1251 pregnant women in the 2nd or 3rd trimester were given 50 g oral glucose load for glucose challenge test, (GCT) and blood sample was collected after 1 hour. All of them, irrespective of the glucose value after the GCT, were instructed to come back after 3 days for the subsequent 75 g oral glucose tolerance test (OGTT) recommended by WHO. For stastical analysis EPI 6 was employed using independent chi-square test, chi-squre test for linear trend, Mantel – Haenzel odds ratio, and binomial proportion and corresponding exact binominal 95% confidence limits.
RESULT(S) : A total of 891 pregnant women underwent both 50 g GCT and a subsequent 75 g OGTT. Among them 144 (16.2%) were diagnosed as gestational diabetes mellitus (GDM) as per the WHO criteria of 2 hour postplasma glucose (PPG) > 140 mg/dL). Analysis of these GDM cases revealed that 113 (78.5%) had the initial 50 g value > 130 mg/dL whereas a potential 31 cases (21.5% of the total GDM cases) had the 50 g 1 hour value below the cut off level of 130 mg /dL. Normally the GTT is not done in women with negative GCT. Since in this study we performed GTT for those negative for GCT, we found that GCT lacks specificity (41.8%).
CONCLUSION(S) : Diagnosis of GDM by OGTT based on initial GCT screening leaves 21.5% undiagnosed. The two step procedure of screening with GCT and then diagnosing GDM based on the cut off values with 100 g or 75 g OGTT is not practical as the pregnant women have to visit the clinic at least twice and the number of blood samples drawn vary from 3 to 5. Hence, we suggest a single glucose challenge test with 75 g of oral glucose load and diagnosing GDM if 2 hour PPG is > 140 mg/dL as recommended by WHO. This method serves both as a one step screening and a diagnostic procedure, and is easy to perform besides being economical.
OBJECTIVE(S) : To evaluate visual inspection of cervix with acetic acid (VIA) in picking up pre-invasive and invasive cancers in abnormal cervix.
METHOD(S) : VIA was carried out in 380 symptomatic women as a pre-colposcopy procedure. Hundred patients with positive findings were then subjected to colposcopy. Directed biopsy was taken from those with abnormal appearances on colposcopy.
RESULTS : Out of 100 patients with positive findings on VIA, 75 were found to have abnormal findings on colposcopy. Cervical biopsy of these 75 patients revealed 22 cases as having low grade squamous intra-epithelial lesions, eight as high grade squamous intra epithelial lesions, and seven as pre-clinical invasive cancers. Thirty-eight showed no abnormality in their cervical biopsy.
CONCLUSION(S) : VIA is a simple method to pick up high grade squamous intra-epithelial lesions or early invasive cancer of the cervix. Colposcopy is complimentary and not essential in identifying the true cancer precursors. Hence VIA can be practiced by clinicians on wider scale to evaluate the cervix at risk.
OBJECTIVE(S) : To study the effect of tuberculosis, still a common infectious disease in the third world countries on female fertility, and the outcome of IVF-ET in these patients.
METHOD(S) : Routine hysteroscopy was done with or without laparoscopy in all patients before admitting them in our in vitro fertilization and embryo transfer (IVF-ET) program. Results of IVF-ET were analyzed.
RESULTS : The incidence of genital tuberculosis in patients presenting with infertility was 16.4%. History of extra-genital tuberculosis was present in 28.04% and tubercular abdomen in 50% of patients. Laparoscopy findings in 55 patients showed tubal involvement in 72.4% cases and frozen pelvis in 17.2%. 24.4% patients had synechias of varying degrees at hysteroscopy and 40% of them had endometrial biopsy positive for tuberculosis. The pregnancy rate after IVF-ET was 19.1% per transfer.
CONCLUSION(S) : Tuberculosis is one of the major etiological factors for female infertility. IVF-ET offers the only realistic treatment to these unfortunate women. Preliminary assessment of endometrium by hysteroscopy is helpful in assessing prognosis in these cases.
OBJECTIVE(S) : To study whether the embryos derived from a cycle where the patient suffered from ovarian hyperstimulation syndrome (OHSS) are influenced or affected because of the hyperstimulation syndrome.
METHOD(S) : In this prospective observational study 34 frozen embryo replacement (FER) cycles were analyzed. A comparative analysis was made of FER cycles when frozen embryos were derived from non-OHSS cycles (n=22) with FER cycles when frozen embryos were derived from OHSS cycles (n=12).
RESULTS : The pregnancy rate in the OHSS group was 8.33%, whereas, in the non-OHSS group it was 18.18%. This difference was not statistically significant as the number of patients in the study was small.
CONCLUSION(S) : The pregnancy rate was not significantly different statistically in OHSS and non-OHSS cycles. However until further larger studies are done, embryo cryopreservation with FER can be considered a cost effective option for OHSS patients.
OBJECTIVE(S) : To evaluate the efficacy of an intrauterine system releasing levonorgestrel (LNG-IUS, Mirena) in the treatment of women with menorrhegia .
METHOD(S) : This was a prospective, non-comparative study. Twenty patients who had menorrhagia due to non-malignant causes were included in the study (age range 20-42 years). However patients of fibroid uterus with uterine size more than 12 weeks and those with submucous fibroid were excluded. A LNG-releasing-intrauterine system was inserted on any day during bleeding or within a week of cessation of bleeding. Menstrual blood loss was assessed, before LNG-IUS was inserted, and after 3, 6, and 12 months of use.
RESULTS : The most common bleeding pattern at 3 months after insertion was spotting and after 6 and 12 months the majority of women presented with amenorrhea or oligomenorrhea. One woman requested removal of the LNG-IUS because of continuous spotting even after 4 months of insertion. The remaining women continued the use of LNG-IUS beyond 1 year.
CONCLUSION(S) : LNG-IUS is an effective treatment for menorrhagia due to benign causes and could be an alternative to hysterectomy.
OBJECTIVE(S): To evaluate the safety and effectiveness of manual vacuum aspiration (MVA) as a method of first trimester voluntary termination of pregnancy (MTP).
METHOD(S): This observational prospective study is going on since February 2003. One hundred patients who underwent MVA using double valve MVA syringe were included in the present report. In 72 cases, MVA was done for pregnancy termination and in 28 for incomplete abortion.
RESULTS: Time taken was three to eight minutes and complications were minimal.
CONCLUSION(S): Manual vacuum aspiration is a safe and effective method for 1st trimester MTP. It is inexpensive and ideal for use in developing countries where there is inadequate infrastructure and electricity is either not available or not reliable.
OBJECTIVE(S) : To estimate the knowledge and prevalence of contraception among women presenting for voluntary termination of pregnancy (MTP) or as septic and incomplete abortions.
METHOD(S) : The 281 women in the study were allotted to two groups. Group A (n=214) consisted of those who came seeking MTP and Group B (n=67) who came with incomplete or septic abortion following induced abortion. Their contraceptive knowledge attitude and practice were evaluated with the help of a pre-designed and pre-tested questionnaire.
RESULTS : Though 82.2% women were aware of the existence of a contraceptive method, only 44.2% ever used one. The most commonly used contraceptive was condom (34.5%). 82.6% were willing to undergo tubectomy in future whereas only 20.3% were willing to accept an intrauterine contraceptive device.
CONCLUSION(S) : The study highlights that awareness does not always lead to the use of contraceptives. A lot of educational and motivational activities and improvement in family planning services are needed to promote the use of contraceptives and reduce the high fertility rate.
