Abstract

In the wake of political upheaval, the Human Fertilisation and Embryo Authority (HFEA) has faced increasing insecurity over its future as a pivotal regulatory body of fertility practices in the UK. HFEA regulates activities by means of licensing, audit, and inspection of fertility centers and maintaining the Code of Practice, which ensures the optimum undertaking of licensed activities by fertility centers. In 2009, amendments to the 1990 Act came into force representing an amalgamation of cumulative proposals, debates, and changes in legislation, which have shaped the world of reproductive medicine. The medical world has, in many cases, adapted to righteous political and social demands, and continues to evolve at a rapid rate. The HFEA has faced many regulatory challenges and changes, and through this study, we aim to provide an overview of some of these changes, particularly those during the last 10 years and the implications that they may have had to fertility practices.

Abstract

Purpose: According to the Consortium on National Consensus for Medical Abortion in India, on average about 11 million abortions take place annually, and around 20,000 women die every year due to abortion-related complications. This study was undertaken to determine the efficacy and the side effect profile of a regime of 200 mg of mifepristone administered orally followed by 800 mcg of vaginal misoprostol after 48 h.

Methods: 50 cases of medical abortion meeting the inclusion criteria were included. On day 1, 200 mg of oral mifepristone was given. On day 3, the patient was called back, and 800 mcg of Misoprostol administered per vaginum and was observed for 6 h. The patients were then called back for review after two weeks to make sure that the abortion was complete. Although, in most cases, this was clinically evident, an ultrasonography was repeated to confirm the completion.

Results: Out of the 50 patients, four were lost to follow up, and of the remaining 46 patients, abortions were complete in 44 (95.65 %), while two (4.35 %) patients required surgical intervention.

Conclusions: Medical abortion with 200 mg oral mifepristone and 800 mcg vaginal misoprostol is an effective, safe, reliable, and noninvasive method with a success rate of 95.65 %. The availability of this low-cost medical treatment using agents which do not require special cold storage and transport facilities and negligible operating theater time makes this provision of safe abortion feasible in settings especially of developing countries, like India, where medical facilities are limited.

Abstract

Purpose: To evaluate safety and efficacy of low molecular weight heparin given for various indications during pregnancy.

Methodology: A detailed retrospective analysis of all the patients who received low molecular weight heparin (LMWH) for various indications over a period of 3 years (2010–2012) at a tertiary care hospital in Northern India was performed.

Results: Fifty-five patients received LMWH over the period of 3 years, for various indications. Enoxaparin (1 mg/kg body weight OD/BD subcutaneously) was used. The indications were valvular heart disease with valve replacement, atrial fibrillation, or thrombus in 60 % patients; chronic deep vein thrombosis (DVT) in 7 % patients; thrombophilia in 9.1 % patients; recurrent pregnancy losses in 18 % patients; and DVT prophylaxis in 5.5 % patients. Abortion was seen in 7.2 % patients; fetal growth restriction in 10.9 % patients; and oligohydramnios, preeclampsia, gestational hypertension, placenta previa, abruptio placentae, and postpartum hemorrhage in 1.8 % patients. Stillbirth occurred in 3.6 % patients. No thromboembolic event was noted in any of the patients. None of the patients had any documented thrombocytopenia or clinical fracture.

Conclusion: Low molecular weight heparin can be used in pregnancy for various indications as an alternative to unfractionated heparin or warfarin as it is efficacious and safe.

Abstract

Background: Rubella and cytomegalovirus (CMV) screening during pregnancy is routinely carried out in India. However, its value has been questioned due to the absence of clearly effective intervention.

Objectives: This retrospective study evaluates the usefulness of rubella and CMV antibody screening during pregnancy.

Materials and Methods: Serum samples received from pregnant women and children were tested for rubella- and CMV-specific IgM antibodies by capture ELISA. The data were analyzed to determine the incidence of rubella and CMV infection during pregnancy and in congenital infections.

Results: In asymptomatic pregnant females (n = 505), rubella positivity was 3.16 % and in women with bad obstetric history (BOH) (n = 220), it was 7.72 %, while CMV positivity was 5.9 % in both asymptomatic pregnant women and in women with BOH. In children (n = 200), the overall positivity for rubella- and CMV-specific IgM antibodies was 15 and 25 %, respectively. A declining trend was observed in the incidence of both rubella and CMV infections in pregnant women and in women with BOH. In children, the incidence of congenital rubella syndrome has declined, but the incidence of CMV infection has remained almost the same in 5 years.

Conclusion: The incidence of rubella has reduced over the past 5 years and can further be prevented by providing direct protection to women and school girls with rubella vaccines. Primary CMV infection in pregnancy is the main problem, and due to the unavailability of efficient and safe treatment, routine antenatal screening for rubella and CMV should be reserved for women with obstetric complications only.

Abstract

Objective: To study the impact of Training of Traditional BirthAttendants (TBAs) onmaternal health care in a rural area.

Methods: An interventional study in the Primary Health Center area was conducted over 1-year period between March 2006 and February 2007, which included all the 50 Traditional Birth Attendants (30 previously trained and 20 untrained), as study participants. Pretest evaluation regarding knowledge, attitude, and practices about maternal care was done. Post-test evaluation was done at the first month (early) and at the fifth month (late) after the training. Analysis was done by using Mc. Nemer’s test, Chi-square test with Yates’s correction and Fischer’s exact test.

Results: Early and late post-test evaluation showed that there was a progressive improvement in the maternal health care provided by both the groups. Significant reduction in the maternal and perinatal deaths among the deliveries conducted by TBAs after the training was noted.

Conclusion: Training programme for TBAs with regular follow-ups in the resource-poor setting will not only improve the quality of maternal care but also reduce perinatal deaths.

Abstract

Aim: The aim of this study was to share our experience of clinical presentation and ultrasonographic findings in cases of ectopic pregnancy especially in the context of usage of unsupervised medical abortifacients.

Settings and Design: This is prospective study conducted over a period of 1 year extending from August 01, 2009 to July 31, 2010 in a tertiary care Armed Forces Hospital of India.

Materials and Methods: Clinically and or sonologically suspected cases of ectopic pregnancy formed the study group. Detailed clinical, menstrual, and treatment history was obtained for each patient. Ultrasonography (USG) was done with multifrequency convex (2.5–6 MHz) followed by transvaginal (6–10 MHz) probes. Operative findings were noted and recorded in each case.

Results: In the study period, a total of 1958 pregnant patients were admitted and treated, which included 1690 deliveries and 268 abortions. Based on USG findings, 16 cases (0.8 %) of ectopic pregnancy were diagnosed. While four patients were treated medically (with methotrexate), 12 cases underwent surgery. Out of 16 cases, 10 cases were suspected clinically as ectopic pregnancy. Features suggestive of menorrhagia, threatened abortion, and pelvic inflammatory disease were present in five, three, and three cases, respectively. History of intake of medical abortifacients (MA) (mifepristone followed by misoprostol) was present in 07 (43.75 %) cases. On USG, commonest abnormality was a complex adnexal mass seen in 12 (75 %) cases. Gestational sac with definite embryo within and surrounding echogenic rim was seen in five cases. Live ectopic pregnancy was diagnosed in two (12.5%) cases. Endometrial thickness was less than 10 mm in all cases who had taken MA. Pseudo gestation sac was seen in 02 (12.5 %) cases. Significant hemoperitoneum was present in 10 out of 12 cases operated. Organized hematoma in pelvis masking the presence of adnexal mass was noted in three cases.

Conclusion: Over-the-counter availability, failure to strictly follow the guidelines, unsupervised usage of MA along with atypical clinical history have increased diagnostic dilemma in ectopic pregnancy. Sonographic findings are frequently atypical in such cases. Ectopic pregnancy may remain under-diagnosed with potentially serious consequences in patients who have taken MA without prior confirmation of intrauterine gestation.

Abstract

Objective: To evaluate the clinical as well as histomorphologic features in different cases of endometrial hyperplasia along with its relative occurrence.

Materials and Methods: A one-and-a-half-year prospective study was conducted on histopathologically diagnosed cases of endometrial hyperplasia in a tertiary care hospital. Apart from relevant clinical findings, histomorphologic details were noted and statistically analyzed.

Observations: Maximum number (46.5 %) of endometrial hyperplasia occurred in patients of 41–50 years age group. Majority (55.2 %) of the patients were found to be premenopausal. Menorrhagia was the most common (49.6 %) clinical presentation followed by postmenopausal bleeding (30.8 %). Simple hyperplasia without atypia was the most common type (95.6 %) followed by complex hyperplasia without atypia (3.6 %) and complex hyperplasia with atypia (0.8 %), respectively. The study of gland–stroma ratio revealed 65:35 to be the most frequent (34 %) ratio; variable-sized glands with cystic dilatation (60.4 %) was the commonest gland architecture and most of the cases (99.2 %) showed the absence of atypia. Associated histopathological findings included a case each of endometrial adenocarcinoma and undifferentiated endometrial stromal sarcoma along with the common leiomyoma and progesterone effects.

Conclusion: Menorrhagia was the most common presenting complaint in cases of endometrial hyperplasia. The cases were mostly in the premenopausal age group. Simple endometrial hyperplasia without atypia was the commonest type diagnosed histopathologically. Histopathological examination along with clinical details is essential to give the final opinion regarding the diagnosis.

Abstract

Aim of the Study: To assess the level of awareness and knowledge of HPV infection and vaccination among 1,000 adolescent girls from secondary schools and colleges in five metro cities of India Ahmedabad, Cuttack, Lucknow, Gwalior, and Visakhapatnam. To evaluate participants own interest and barriers toward HPV vaccination for cervical cancer prevention.

Materials: This cross-sectional study was conducted by Adolescent Health Committee of FOGSI from April 2009 to March 2010 under the project ‘‘protecting young girls.’’ Girls of 13–19 years, with an average of 16 years are targeted.

Methods: A written questionnaire with two parts has been applied. A preliminary written questionnaire included questions of knowledge on cancer cervix and HPV awareness. Then, health talk on HPV is given by the researcher and group discussions lasting for 20 min. Second questionnaire was then applied to evaluate effectiveness of the talk.

Results: The study group participants are poorly aware about HPV infection and vaccination but are intensely willing to know about it and get vaccinated. 72 % of them did not know about cervical cancer or HPV. 77.2 % were not aware of the virus that causes cancer cervix. After the health talks. there is an overall significant positive improvement in both knowledge and awareness. 74.4 % of them agreed to get vaccinated.

Conclusions: This study brings out the unawareness about HPV infection and vaccination in urban adolescent girls in five metro cities in India. Results show a changing positive trend of acceptance toward HPV vaccination. Adolescent understanding of HPV is needed to have successful vaccination programs in India.

Abstract

Purpose: Ovarian cancer is the sixth common cancer in women in developed countries. In severe cases, the optimal debulking is necessary. In order to increase optimal debulking and reduce preoperative complications, neoadjuvant chemotherapy followed by debulking surgery, and then chemotherapy again is introduced as substitute for primary surgery. In this study, we aim to evaluate perioperative outcome after neoadjuvant chemotherapy with carboplatin/ paclyaxol in comparison with primary cytoreduction in patients with advanced ovarian cancer.

Methods: In this prospective study, 60 patients with advanced ovarian cancer due to the disease severity were assigned into neoadjuvant chemotherapy (n = 30) or control (n = 30) groups. In neoadjuvant chemotherapy group, patients received three cycles of carboplatin (5–6 area under the curve) and paclitaxel (175 mg/m2) preoperatively followed by interval surgery. The control group received primary surgery plus adjuvant chemotherapy. Preoperative outcome was compared between groups.

Results: Neoadjuvant group had significantly lower mean levels of CA 125 (p = 0.01) and less severe bleeding (p = 0.03) than control group. There was no significant difference between surgery time, preoperative complications, residual mass less than 1 cm, and hospital stay between groups. There was no mortality during the study.

Conclusion: Neoadjuvant chemotherapy caused less severe bleeding, but has no effect in decreasing complications after surgery; however, neoadjuvant chemotherapy followed by interval debulking surgery was not superior to primary debulking surgery followed by chemotherapy as a treatment option for patients with advanced ovarian carcinoma in this study.

Abstract

Background: Human fertility is determined by many factors such as customs, morals and habits of social groups with regard to marital obligation of life. Acceptance of family planning methods varies within and between societies and there are many factors which are responsible for such variation at community, family and individual level. Socioeconomic environment, culture and education are few of them that play a vital role. Jammu and Kashmir state in general and Kashmir valley in particular is a Muslim dominated population with traditionally a conservative society. Apart from family customs and influence of the elders, religious background has always been behind the passive resistance, or at the best indifference towards contraception. This study makes an attempt to assess the knowledge, attitude and practice of contraception in rural Kashmir.

Objective: To assess the knowledge, attitude and practice of contraception in rural Kashmir.

Study Design: Community-based Cross-Sectional study. Study period December 2006 to May 2008.

Participants: 1900 currently married women in the age group of 15–49 years of age.

Setting: Rural households.

Methods: 1900 currently married women, aged 15–49 years, selected by multi-stage random sampling technique from three districts of Kashmir valley who were interviewed at home using a pretested oral questionnaire. The assessment of various socioeconomic and other variables made as per the available standard procedures and scales.

Analysis: Percentage, Chi square test and Bivariate analysis.

Results: Knowledge of the contraceptive methods was fairly good especially for terminal methods i.e. female sterilization (97.7 %). Main source of information on contraception was obtained from mass media (60.4 %). Contraceptive practice was significantly related to number of living children, literacy, socioeconomic status and type of family.

Conclusion: What is needed is to promote and stress contraceptive methods and their advantages using mass media approach and to explore more and more participation of private sector.