Obstetrical outcome of pregnancy complicated with first trimester bleeding and subchorionic hematoma

Background: First trimester bleeding complicates around 20-27% of pregnancy. Objective of this study was to evaluate and compare the feto-maternal and pregnancy outcome in patients presenting with live pregnancy complicated with first trimester bleeding and subchorionic hematoma with those without subchorionic hematoma.Methods: In this prospective observational study, based on ultrasonography, live pregnancies were categorized into two groups, first group having first trimester bleeding with subchorionic hematoma and second with first trimester bleeding only without any hematoma. They were evaluated for the end outcome of pregnancy in terms of abortion and continuation. Continued pregnancies were evaluated for antenatal complications, delivery and intrapartum events along with fetal outcomes.Results: Outcome of pregnancies presenting with first trimester bleeding in terms of abortion was similar in both the groups, 22.8% and 21.5% with hematoma and without hematoma respectively. Incidence of preeclampsia was 11.4% and Fetal growth restriction was 7% in pregnancies with first trimester bleeding with hematoma and was significantly higher than those without hematoma which was 3.07% for preeclampsia and 3% for fetal growth restriction. Incidence of antepartum haemorrhage was higher in hematoma group but the result was not statistically significant. 20% pregnancies with first trimester bleeding with hematoma had preterm deliveries, while it was 7.7% in pregnancies without hematoma and the difference was statistically significant. Low birth weight had occurred in 20% of babies in first group of patients while 4.6% in second group, difference being statistically significant.Conclusions: We found that live pregnancies with first trimester bleeding and subchorionic hematoma were associated with similar risk of miscarriage and antepartum haemorrhage while increased risk of preeclampsia, fetal growth restrictions, preterm birth, non-reassuring fetal heart pattern, caesarean delivery and low birth weight baby when compared to patients with first trimester bleeding without subchorionic hematoma. There was no difference in 5 minutes Apgar score and the NICU admission in both the groups

A study on safety and feasibility of caesarean myomectomy: at a private institute

Background: Myomectomy at the time of caesarean delivery is controversial because of the risk of intractable hemorrhage and increased postoperative morbidity. The incidence of myoma associated with pregnancy is reported at 0.3-5%, with a majority of myomas not requiring surgical intervention during pregnancy or delivery. Recent studies consider it to be safe in selected patients and thus allow women to have a better obstetric outcome in future pregnancies, and to avoid hysterectomy. It relieves symptoms associated with fibroids and negates the need for later surgery or sonographic follow-ups for the fibroid after delivery.Methods: We performed a prospective cohort study of 15 patients with myomas who underwent myomectomy at the time of Caesarean section at MGM Hospital between January 2016 and December 2016. In a predesigned proforma, patient’s details such as age, parity, antenatal course, gestational age at delivery, type of Caesarean section, size and location of the fibroids, blood loss, postoperative morbidity and perinatal outcome were noted.Results: The incidence of hemorrhage in the study group was 20%. There was no significant increase in the incidence of postpartum fever (6.6%), operating time (50 min), and length of postpartum stay (5.6 days). No patient required hysterectomy. Size of fibroid did not appear to affect the incidence of hemorrhage, although intramural myomas were more associated with hemorrhage.Conclusions: This study shows that myomectomy during caesarean section is a safe procedure and is not associated with major intraoperative and postoperative complications

Global challenges of implementing human papillomavirus vaccines

Human Papillomavirus vaccines are widely hailed as a sweeping pharmaceutical innovation for the universal benefit of all women. The implementation of the vaccines, however, is far from universal or equitable. Socio-economically marginalized women in emerging and developing, and many advanced economies alike, suffer a disproportionately large burden of cervical cancer. Despite the marketing of Human Papillomavirus vaccines as the solution to cervical cancer, the market authorization (licensing) of the vaccines has not translated into universal equitable access. Vaccine implementation for vulnerable girls and women faces multiple barriers that include high vaccine costs, inadequate delivery infrastructure, and lack of community engagement to generate awareness about cervical cancer and early screening tools. For Human Papillomavirus vaccines to work as a public health solution, the quality-assured delivery of cheaper vaccines must be integrated with strengthened capacity for community-based health education and screening

AN AYURVEDIC AND CONTEMPORARY OVERVIEW OF MENOPAUSE: A CONCEPTUAL APPROACH

Menopause is generally defined as the cessation of menses for period of 12 months or a period equivalent to three previous cycles or the time of cessation of ovarian function resulting in permanent amenorrhea. During the period of menopause the women enters an estrogen deficient phase which leads to the various symptoms. This period is generally associated with manifestation of aging process in women. Other symptoms include hot flushes, sweating, mood changes, loss of libido etc. These symptoms affect the quality of life of the female.Hormone Replacement Therapy (HRT) is the only alternative available for menopausal syndrome in modern medicine. It also has a wide range of side effects on the body of the female.In Ayurveda the context of menopause is depicted as “Jarapakwa avastha†of body and Rajonivrutti. Rajonivrutti janya laksana is a group of symptoms produced by degenerative changes in the body. Degenerative changes are explained in Ayurveda as Dhatukshaya lakshana. Vata dosha dominance is seen in the later stage of life. To combat the degenerative process of the body tissue, Acharyas have described Rasayana Chikitsa. Rasayana includes drugs which promotes longevity and improve the quality of life. Thus an effort is being made here, to study the effect of Rasayana therapy, on Menopausal syndrome, conceptually, based on Available information in Ayurvedic texts and other contemporary resources. The basic Rationale for this study is to establish a reliable platform for further Research on the Said subject

Diagnostic hystero-laparoscopy in work-up of female infertility

Background: Infertility is a growing concern of the society. In many cases the exact cause of infertility may not be elucidated, whether it is tubal, ovarian, uterine, or a combination of factors. This paper aims to understand the role of diagnostic hystero-laparoscopy in evaluation of cases of infertility.Methods: This prospective study included 200 infertile women and it was conducted at department of Obstetrics and Gynaecology, MGM Hospital, during the period between January 2016 to December 2016. All the infertile patients either with primary or secondary infertility were included after thorough evaluation.Results: Out of 200 cases, 118(59%) patients had primary infertility and 82(41%) had secondary infertility. While laparoscopy detected abnormalities in 49% of the cases, significant hysteroscopy findings were noted in only 23.5% of cases. The most common laparoscopic abnormalities were endometriosis (32%) and unilateral tubal lockage (24%). On hysteroscopy, periosteal adhesions were the commonest abnormality in both the groups.Conclusions: Diagnostic hystero-laparoscopy is a safe and cost-effective method and should be considered when there are abnormal HSG results, a past history of pelvic infection, pelvic surgery and /or unexplained secondary infertility during management of infertile couple. Evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies which are usually missed by other imaging modalities, can be diagnosed as well as managed in some cases by hystero-laparoscopy

Hypervascular retained products of conception: dilemma of diagnosis and management

Retained products of conception (RPOC) are a partial retention of placental tissue after dilation and curettage (D&C) procedures or vaginal deliveries. Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascularity in the context of retained products of conception. This raises the possibility of serious intra‐operative haemorrhage because of the possibility of arterio‐venous malformation. The aim of this article is to discuss the diagnosis and management options of retained products of conception (RPOC) with increased vascularity where simple dilatation and curettage may lead to life threatening haemorrhage and endanger the life of the patient and to enlighten the importance of evaluation of vascularity in all cases of RPOC prior to dilatation and curettage in order to avoid the dreaded complication of massive haemorrhage

Vaginal foreign body in a 6 year old girl: a game for the child but a challenge for the gynaecologist

A 6 year old girl visited our gynaecology out-patient department of S.R.N hospital, Allahabad, India with the complaint of relapsing blood stained vaginal discharge for 3 months. Different gynaecologists, including us, tried treating the condition with different courses of antibiotics. To each, the girl responded only for few days and relapsed again. We investigated completely into the background of the child's home and school environment, her playing habits and her behaviour with her kins. Then, we got her various investigations done but with no derangement. With the backup of her history, examination and investigations, we performed another detailed examination of her genitals. The findings were intriguing as to their cause, and it definitely was a lesson to all of us.

Fantasías de libertad: una comparación entre la servidumbre por contrato y el complejo industrial fronterizo en Exit West, de Mohsin Hamid, y Sea of Poppies, de Amitav Ghosh

Este artículo se propone reorientar el marco de análisis en el que se ha considerado la mano de obra india que trabaja en la modalidad de servidumbre por contrato –suministrada desde la India colonial a plantaciones de caña en el Caribe, isla Mauricio e islas Fiyi, entre otros lugares–. Aunque la servidumbre por contrato suele tratarse de manera aislada o se considera un «nuevo sistema de esclavitud» (Tinker, 1974), este artículo adopta las intervenciones de Lisa Lowe (2015) y Clare Anderson (2009) para afirmar que la servidumbre por contrato como «innovación colonial» (Anderson, 2009) debe considerarse en estrecha relación con el tráfico transatlántico de esclavos y los asentamientos penales coloniales, y las maneras como esos sistemas conectados hacen posible un cambio y una transformación del imperio británico entre los siglos XVIII y XIX. De conformidad con los presupuestos de esta edición, este artículo usa el espacio imaginativo de Exit West, de Mohsin Hamid (2017), y Sea of Poppies, de Amitav Ghosh (2008), para argumentar que el sistema de servidumbre por contrato y el actual complejo industrial fronterizo nos ofrecen semejanzas específicas que permiten una comparación productiva. La representación que hace Ghosh de la servidumbre por contrato, sostengo, reifica la contradicción central del liberalismo de mediados del siglo XIX, que las narrativas coloniales libertarias imaginan como una superación exitosa de la esclavitud mediante la libertad en la forma de libre comercio ampliado, aun cuando directamente exigen y oscurecen la violencia colonial y niegan las mismas libertades a ciertos cuerpos racializados, como los trabajadores en servidumbre. De igual manera, la novela de Hamid permite un alivio a la actual tensión manifiesta entre la fantasía neoliberal del flujo de mercancías, mano de obra y capital sin fronteras ni regulaciones, y la reciente fortificación fronteriza, una disonancia que repite las disonancias del liberalismo. En un esfuerzo por unir un linaje de momentos históricos que exponen las líneas defectuosas de las fantasías liberal y capitalista de libertad, comparo la servidumbre por contrato del complejo industrial fronterizo para demostrar en últimas cómo la fortificación de las fronteras en realidad no se opone, sino que promueve los deseos neoliberales de fronteras abiertas

Glimpses of women’s lives in rural Bihar: impact of male migration

Bihar has a rich history of out-migration from the state, which goes back to as early as the nilieteenth century. However, during the last few decades, migration for work has increased manifold. The sheer scale of out-migration in contemporary Bihar is astounding. At any given point of time, as many as nearly one-half of the total number of working men are absent from the state, as they are working elsewhere in urban and rural centres in the country and abroad. Migration from the state is almost exclusively that of the male population and is embedded in the lives ana life choices of the people. It is not just a livelihood strategy but a way of life in rural Bihar. While there is considera_ble research on various aspects of migration including the nature and pattern of/nigrationfrom Bihar, the profile of migrant workers, migration destinations and other such correlates of a migrant's life outside the village, there is sparse literature on the impact of this migration on people, especially on the women who are left behind in the village. Many research questions remain unanswered. How are institutions such as patriarchy in the village affected by male_migration? How does male migration influence women's well-being and agency? Does migration have an effect on women's mobility? Does it empower or disempower the women who are left behind? What role does technology such as mobile phones play in enabling those left behind to communicate with their migrant family members? What impact does this have on the women left behind in the villages