Objectives: Background-Contraception is the intentionalprevention of conception through the use of various devi-ces, sexual practices, chemicals, drugs or surgical proce-dures. An effective contraception allows a physicalrelationship without fear of an unwanted pregnancy andensures freedom to have children when desired. The aim isto achieve contraception in maximum comfort and privacy,with minimum cost and side effects. Some methods, likemale and female condoms, also provide twin advantage ofprotection from sexually transmitted diseases. The burdenof unsafe abortion lies primarily in developing countries.Here, contraceptive prevalence is measured among cur-rently married women of reproductive age, and levels havenot yet reached those that exist in developed countries.
Conclusion: In countries like India, there is a dire need forcontraceptive methods to be more women friendly, acces-sible and provide adequate privacy. Providers also need to be sensitive to special needs of adolescents as they are at acritically vulnerable segment.
Contraception, Condoms, Vasectomy, Tubectomy, STDsIntroduction: To determine the prevalence of inconti-nence and its relation to various factors like age, parity,mode of delivery and birth weight.
Methods: After informed consent, a questionnaire wasfilled by a trained interviewer.
Results: The prevalence of incontinence was 18.6%.Incontinence was reported in 12.5% of primis as comparedto 26.4% in multis. The incidence of incontinence rose asage advanced. Sixteen percent developed incontinencefollowing LSCS whenever 19.8% developed incontinenceafter normal delivery.
Conclusion: Pelvic floor dysfunction occurs commonlyfollowing childbirth, with increasing parity urinary incon-tinence particularly stress incontinence was more common.No significant reduction in incidence of incontinence fol-lowing LSCS was noted in this study.
Anal incontinence post delivery, Urinary incontinence post deliveryObjectives: To evaluate the parameters of oxidative stressand anti oxidant defense in preeclampsia and thereby findany etiological correlation.
Methods: Study was carried out on pregnant and nonpregnant women attending or admitted in the Obstetrics andGynecology Department of SSG Hospital, Baroda between1st June 2007 to 31st May 2008. Each serum sample fromdifferent groups was evaluated for malondialdehyde (MDA),a product of lipid peroxidation process as a marker for oxi-dative stress and reduced Glutathione, Superoxide Dismu-tase, and Catalase for antioxidant enzyme activity and acomparison drawn and analyzed usingt-test andv2test.
Results: The levels of MDA (a lipid peroxidation product)increased significantly in pregnancy compared to non-pregnant females and further significantly increased inpreeclampsia compared to normal pregnant females. Thesuperoxide dismutase levels, catalase levels and vit-Elevels were found to be increased in preeclamptic femalesas compared to normal pregnant females.
Conclusion: Preeclampsia is found to be a condition withmarkedly increased oxidative stress as is evidenced byhighly significantly increased levels of MDA, a marker oflipid peroxidation. Levels of antioxidant enzymes, viz.reduced glutathione, superoxide dismutase, catalase andvitamin E have been found to be increased in preeclampsia ascompared to normal pregnant females. This may be a com-pensatory mechanism for handling the increased oxidativestress.
Oxidative stress, Antioxidants, PreeclampsiaObjectives: Secondary PPH has received little attention.In more than half of cases the etiology is not made out.Vascular abnormalities like pseudoaneurysm and AVmalformation are rare but detectable and easily treatable.
Methods: This is an analysis of five women presentingwith severe secondary PPH after the 3rd to 6th week ofpostpartum. All women were post LSCS with no identifi-able cause and referred for further management. They werediagnosed to have pseudoaneurysm by angiography anduterine artery embolisation was done.
Results: Five women were analysed. Four of them had apseudoaneurysm and were embolised one woman washemodynamically unstable and hence taken up forhysterectomy.
Conclusion: Pseudoaneurysm is an important vascularabnormality especially following LSCS. Uterine arteryembolisation is safe and reliable alternative technique andprevents a hysterectomy.
Pseudoaneursym, Uterine artery embolization, Secondary postpartum hemorrhageObjectives: To correlate the severity of the disease,maternal and perinatal outcome with Lactic Dehydroge-nase (LDH) levels in serum in patients of preeclampsia andeclampsia.
Methods: A prospective comparative study was conductedin the department of Obstetrics and Gynecology in thecollaboration with department of Pathology, CSM MedicalUniversity, Lucknow. Out of 146 women studied, 39 werenormal pregnant women, 35 were of mild preeclampsia, 36of severe preeclampsia and 36 of eclampsia. The statisticalanalysis was done by Chi-square test (for proportional data)analysis of variance and sample ‘‘t’’ test (for parametricdata).
Results: LDH levels were significantly elevated in womenwith preeclampsia and eclampsia (\0.001). Higher LDHlevels had significant correlation with high blood pressure(P\0.10) as well as poor maternal and perinatal outcome.ConclusionHigh serum LDH levels correlate well withthe severity of the disease and poor outcomes in patients ofpreeclampsia and eclampsia.
Lactic, Dehydrogenase, Preeclampsia, Eclampsia, Maternal outcomeObjective: To study the role of uterine artery notch oncolor Doppler ultrasound and roll over test in prediction ofPIH.
Methods: 100 women with high risk pregnancies werestudied for presence or absence of uterine artery diastolicnotch by Doppler ultrasound at 16–28 weeks. Same womenwere then subjected to roll over test at 28–32 weeks.
Results: The primary outcome was that uterine diastolicnotching alone and combined together with roll over testshows a high specificity (98.53%) for predicting PIH thanroll over test (76.47%) alone. PPV of uterine artery dia-stolic notching (83.33%) was higher than roll over testalone (54.29%) and both tests combined together (80%).
Conclusion: After analyzing all the results, it has beenconcluded that uterine artery Doppler notching is betterpredictor for PIH than roll over test or even combinedDoppler?Roll over test together.
Uterine artery notching, Color Doppler, Roll over test, Pregnancy induced hypertensionAims and Objective(s): Evaluating feto-maternal outcomein pregnancies with abnormal liquor volume.
Material and Method(s): 200 pregnant subjects between 20and 42 weeks of gestation, who were clinically suspected tohave an abnormal amniotic fluid volume (oligohydramnios orpolyhydramnios) were subjected to ultrasonographic (USG)assessment of amniotic fluid index. The subjects were closelymonitored through pregnancy, labour and puerperium.
Observation(s): Ultrasonically, abnormal liquor volumewas confirmed in 90–93% clinically suspected patients. Postterm pregnancy (38.5%), PROM (30%) and prolongedpregnancy (23.5%) were associated with oligohydramnios.Fetal congenital anomalies (31.1%), diabetes mellitus(20%), PIH (17.7%), twin pregnancy (6.6%) and Rhincompatibility (4.4%) were associated with polyhydram-nios. The incidence of labour induction, fetal labour intol-erance, CS for fetal distress and 1 min Apgar of\7 was highin oligohydramnios subjects. Premature labour complicated40% of polyhydramnios pregnancies. The overall incidenceof congenital anomalies (14%) and perinatal mortality(20%) in subjects with abnormal liquor volume was signif-icantly higher (P\0.001) than in women with normalliquor volume (0.3, 2.3% respectively).
Conclusion(s): A good clinical examination can pick upmost subjects of abnormal liquor volume. Abnormal liquorvolumes are associated with increased maternal morbidityand adverse perinatal outcome.
Oligohydramnios, Polyhydramnios, Congenital anomalies, Premature ruptureof membranes (PROM), StillbirthObjective: To test the classification system Re. Co. De. toimprove our understanding of the main causes associatedwith fetal deaths.
Method: The study included 348 women who wereadmitted with intrauterine deaths. After the stillborn babieswere examined along with the placenta. The causes wereclassified according to Re. Co. De. system.
Results: The analysis of the new classification (Re. Co.De.) allowed attributable causes to about 90% of cases ofstillbirth explained while 10% where unexplained. Thecommonest cause was found to be toxaemia of pregnancy,followed by IUGR, rupture uterus, obstructed labour,abruptio placentae etc.
Conclusion: The Re. Co. De. system gives us a betterunderstanding of antecedents of stillbirth and the clinicalpractices, which need to be addressed to reduce perinatalmortality and have a better obstetric result in the nextpregnancy.
Relevant condition of death, Stillbirth, Perinatal mortality, Eclampsia, IUGRObjective: The present study was conducted with the aimto assess and comparatively evaluate the safety and effi-cacy of misoprostol alone and mifepristone with miso-prostol for second trimester termination of pregnancy.
Methods and Materials: The study was conducted on 200selected cases, divided in two groups of 100 cases each. Inthe study group mifepristone was given 200 mg 12 hbefore intravaginal insertion of 600lg of misoprostolfollowed by 400lg every 3 h up to a maximum of 5 dosesor until the abortion occurs, whichever occurs early. In thecontrol group only misoprostol was inserted in the samedose regime. The results were analyzed.
Results: The success rate in both regimens was 100%. Meaninduction abortion interval from the insertion of the firstmisoprostol tablet was significantly shorter in the mifepri-stone pretreated group 6.72±2.26 h as compared to12.93±3.4 h in the misoprostol alone group (P\0.001).The mean blood loss was slightly higher in the control group.The mean dose of the misoprostol required was significantlyless in the study group 1,186±291.64lg as against1,736±320.20lg(P\0.001). The side effects observedin both the groups were similar mainly nausea vomiting,fever, abdominal cramps.
Conclusion: Pretreatment with mifepristone 12 h beforeintravaginal misoprostol significantly improves the induc-tion abortion interval.
Second trimester termination of pregnancymifepristone, MisoprostolObjective: To compare maternal and neonatal outcomesof vacuum versus forceps application in assisted vaginaldelivery.
Material and Method: Women in labor with vertex pre-sentation were delivered by vacuum and forceps. A total of120 cases were included in this prospective study. Maternaland neonatal morbidity were compared in terms of perineallacerations, episiotomy extension, post-partum hemor-rhage, Apgar score, instrumental injuries, NICU admis-sions PNM etc.v2test was used to analyze the data.
Observations: Maternal morbidity viz. episiotomy exten-sion as well as first and second degree perineal tear weresignificant in the forceps group (P=0.0001 andP=0.02,respectively). With regards to neonatal morbidity, no sta-tistically significant difference was noted.
Conclusion: Vacuum and forceps should remain appro-priate tools in the armamentarium of the modern obstetri-cian. However, ventouse may be chosen first (if there is nofetal distress) as it is significantly less likely to injure themother.
Vacuum extraction, Forceps, Maternal morbidity, Neonatal outcomeObjectives: To identify whether electively induced laborplaces the mother or her fetus at an increased risk ascompared to her spontaneous labor cohort. To quantify therisk of cesarean section in the induced group.
Methods: A prospective analysis comparing 200 elec-tively induced parturients with 200 matched controls wholabored spontaneously, in 1 year from April 2007 to April2008. The parturients were between 37 and 41 weeks ofgestation and had no complications necessitating induction.
Results: Induction per se was not associated with a sta-tistically significant increase in cesarean section rates. Onlywhen associated with nulliparity, low bishop score, andbirth weight[3.5 kg, the risk of cesarean increases.
Conclusion: Elective induction does not appear to pose anincreased risk to the mother or her fetus in a carefullyselected patient population. However, when associatedwith risk factors the cesarean rate increases. Henceinformed consent should be taken before induction.
Elective induction, Cesarean section ratesObjectives: To study the present status and effect of par-adigm shift in the epidemiology of HIV amongst pregnantwomen in urban set up.
Aims: The purpose of the study is to evaluate the para-digm shift in overall screening and management strategy ofHIV in antenatal women for last four and half years in anurban medical college.
Methods: The study was conducted from 1st January 2004to 30th June 2008 and all registered and unregisteredpregnant women who attended ICTC clinic and also foremergency admission (unregistered) were counseled andblood samples were tested as per NACO guidelines withcafeteria choice of opt in and opt out strategy. Reactivewomen in antenatal period were counseled and discussedabout anti-retroviral therapy (ART) and universal treatmentregime. Seroprevalent women were counseled about theirspouse, personal habits and demographic status. Markedimprovement was seen in the use of contraceptive and drugabuse. During labor mother and baby were given nevira-pine as per NACO guidelines.
Results: The seroprevalence of HIV reactive women inour Centre was 0.23, 0.19, 0.14 and 0.12% in the year2004, 2005, 2006, 2007 and zero prevalence in 2008 tilldate. Spouse positivity was noted in 80, 58.33, 72.72 and70% in the set period from 2004 to 2008.
Conclusion: Marked improvement was noticed in all thestrategic points from registration, counseling, screeningand availability of improved diagnostic kits for screeningHIV 1 and HIV 2.
Integrated Counseling and TestingCentre (ICTC), Paradigm shiftObjectives: The purpose of this study is to analyze thepotential benefits of aerobic exercises at different intensi-ties in the management of pre menstrual syndrome.
Methods: The study design is quasi-experimental; sixty-one female subjects were randomly allocated into threegroups, Group A (mild intensity), Group B (moderateintensity) and Group C (severe intensity) and the inter-vention were given for 6 weeks. The study setting wasgeneral community settings. The outcome measures weremenstrual symptom questionnaire, VO2max, forced vitalcapacity (FVC), maximum voluntary ventilation (MVV)and lipid profile (HDL, LDL, TGL).
Results: There is significant decrease in menstrual symp-toms in both Groups B and C. However, Group C improvedwith increased rate of perceived exertion. LDL levels didnot change significantly but HDL, TGL, VO2max, FVC,and MVV improved significantly in Groups B and C, butremains significantly unchanged in Group A.
Conclusions: This study encourages the employment ofregular, moderate intensity aerobic exercise as a potentialintervention for pre menstrual syndrome.
Aerobic exercise, Pre menstrual syndrome, Metabolic changes, Menstrual symptoms, Quality of life