Successful nonsurgical management of pelvic organ prolapse in infertility: a case series

Pelvic organ prolapse is a less commonly cited cause of female factor infertility. This could be attributed to cervical factor or to distorted utero tubal relationship. When the cervix constantly lies outside the vagina, there is impaired venous return resulting in congestion, inflammation and ulceration, which is further aggravated by friction. Cervical dryness even hampers sperm and cervical mucus interaction leading to impaired capacitation. Here, we present 4 cases of cervico vaginal descent where main presenting complain was inability to conceive and were diagnosed to have prolapse on clinical workup. These cases had successful pregnancy outcome after conservative management with the placement of vaginal ring pessary of appropriate size. This reposits the cervix inside vagina, reduces cervical oedema, dryness and restores cervical mucus formation

Transcervical Foley’s catheter: a promising option for induction of labour

We hereby report the results of a small randomized prospective study where we compared the efficiency and efficacy of transcervical extra-amniotic Foley catheter placement to intravaginal dinoprostone gel as a method of induction of labour

Unscarred uterine rupture - rare entity

Uterine rupture is a disastrous obstetric complication, with high rates of feto-maternal morbidity and mortality. The most frequent risk factor in present times is previous uterine surgery. We hereby report 3 cases of uterine rupture in unscarred uterus with varied presentation at different period of gestation so as to show the spectrum of clinical presentation of this entity. Quick recognition with prompt resort to laparotomy is crucial in influencing feto-maternal morbidity. All uterine ruptures don’t present with classical symptoms. Thus, clinicians should have high index of suspicion for uterine rupture in women presenting with some, or all, of these features, regardless of parity or history of previous uterine surgery or parity

Interesting rare case of recurrent puerperal uterine inversion: a case report

Uterine inversion is a rare obstetric emergency that may lead to severe haemorrhage, shock and eventually death. The incidence of uterine inversion varies from one in 2,000-20,000 deliveries. Recurrent uterine inversion is still rare with no exact reported incidence so far. We report a case of a near miss patient, 28 years old primiparous with complete uterine inversion with atonic postpartum haemorrhage and shock, managed by manual repositioning and tamponade insertion which got corrected. Patient had recurrent uterine inversion twice in the puerperal period on 5th and 7th postpartum day. A new approach to management was taken. Rather than going for laparotomy, vaginal manual correction followed by intrauterine tri-way foley catheter insertion was done. Gradual deflation was done leading to final permanent correction. Uterine inversion is a rare but potentially deadly complication post vaginal delivery. Mortality and morbidity can be reduced by rapid recognition and immediate replacement. For recurrent inversion prolonged intrauterine balloon placement may be needed in rare cases

A histopathological study of hysterectomy specimens and their clinical correlation in patients at tertiary health care setup in Bundelkhand region of Uttar Pradesh

Background: Women in their life time are prone to develop several neoplastic and non-neoplastic lesions in her uterus and cervix basically due to hormone responsiveness of female genital tract system. The aim of the study was to evaluate all hysterectomy specimens and to study the pattern of pathological changes of different lesions occurring in cervix and uterus associated with different age groups. Methods: This retrospective cross-sectional, study was conducted on patients undergoing hysterectomy in department of obstetrics and gynecology in MLB Medical College Jhansi and hysterectomized specimens reported to department of pathology for further evaluation. Total 35 hysterectomy specimens were included in the study with age of patients varying from 30 years to 60 years. Detailed clinical and other relevant history were taken followed by thorough gross examination and histopathological evaluation. Results: Majority of hysterectomy specimens were sent for histopathological examination in the department of pathology, out of these 30 (85%) were total abdominal hysterectomy specimen, 5 (14.28%) were of vaginal hysterectomy specimens. Out of all these cases, in 7 (20%) cases bilateral or unilateral salpingopherectomy done. Conclusions: In our study, most common surgical procedure for hysterectomy was abdominal hysterectomy 30 (85.7%) followed vaginal hysterectomy 5 (14.28%) All the vaginal hysterectomy was done for second- and third-degree utero-vaginal prolapse. Most prevalent endometrial histopathological finding in our study is non-secretive 15 (42.8%), secretive 7 (20%) followed by atrophic 6 (17.1%) as most of the patients in our study presents with abnormal uterine bleeding and menorrhagia 23 (65.7%)

Study of knowledge and contraception practices in low socio-economic women of Delhi

Background: Objective of current study was to assess the knowledge and practice of contraception among the low socio-economic women of reproductive age group in Delhi.Methods: A cross-sectional study was done on 272 low socio-economic women attending a family planning clinic at a Delhi municipal corporation hospital, of which 106 came for Medical Termination of Pregnancy (MTP) and 166 came for family planning advice. They were interrogated through a pre-designed structured questionnaire, to evaluate their knowledge and practices towards regular contraceptive methods, Emergency Contraception (EC) and medical abortion. They were counselled about the available contraceptive methods and allowed to make choices according to their suitability.Results: All women belonged to low socio-economic group according to the modified Kuppuswamy scale. 22.1% were illiterate. 47.8% were ignorant of contraception. 38.3% women were aware of EC. Only 24.2% knew about medical abortion. The main reasons cited for not using contraception was desire for male child (24.6%), fear of side effects (20%), desire for another child (20%), opposition from family members (15.4%), inaccessibility (4.6%) and inconvenience and lack of privacy (5.4%).  Conclusions: This study highlights that lack of education, knowledge and awareness led to inadequate usage of regular methods of contraception in reproductive age group women belonging to low socio-economic status. Thus only availability is not sufficient to reach optimum female health. Accessibility need to be increased by educating females and motivating couples to make adequate use of existing family planning methods and resources. In contrast the awareness for emergency contraception is more than regular methods. It mandates need to educate women that emergency contraception should not replace regular methods.

Study on maternal and perinatal outcome in eclampsia in a tertiary care hospital

Background: Eclampsia is an unpredictable multi-organ disease unique to pregnancy and is largely a preventable condition, responsible for high maternal and perinatal mortality. Methods: The present study was conducted in the Department of Obstetrics and Gynaecology in Maharani Laxmi Bai Medical College, Jhansi. It was a retrospective study conducted over a period of 12 months on all eclamptic cases attending our hospital and feto-maternal outcome data was analysed. Results: The incidence of eclampsia in our hospital was 2.22%. Most of the eclamptic cases were antepartum eclampsia constituting 81.48%. During the study period there were a total of 2430 obstetric admissions out of which 54 were eclamptic cases. There were 89 near miss cases and 21 maternal deaths. 16 (17.97%) near miss cases and 7(33.33%) maternal deaths were due to eclampsia. 37.03% patients had complications. Pulmonary edema/ARDS was the most common complication seen in our study. Early neonatal mortality in our study was 11.11%, 11 new-borns needed NICU care. Prematurity was the most common cause. Conclusions: Adequate screening, monitoring and routine check-up during and after pregnancy may prevent worsening the maternal and foetal outcome. Lack of antenatal care is a common risk factor for eclampsia is and this needs to be addressed to prevent this serious complication of pregnancy

Impact of MGNREGA on Rural Wages in India: Findings from the Rural Price Collection (RPC) Surveys (2001-2011)

Professional paper for the fulfillment of the Master of Public Policy degree.Governments in developing countries have experimented with a variety of poverty alleviation programs over the last few decades, including conditional and unconditional cash transfer programs, microcredit, and employment guarantee schemes, among others. The most successful and perhaps the most extensively studied poverty alleviation program has been Mexico’s PROGRESA, which adopted a human-capital investment approach towards lowering poverty rates. Another increasingly studied poverty alleviation program has been India’s Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) of 2005.1 Unlike PROGRESA, however, MGNREGA seeks to alleviate rural poverty by providing guaranteed employment to beneficiaries in public works. This paper assesses the impact of MGNREGA on rural wages in India, using the National Sample Survey Office’s (NSSO) Rural Price Collection (RPC) surveys from 2001-11. Additionally, I look at the gendered impacts of the program to specifically assess whether MGNREGA has led to reduction in wage inequality by gender in rural India

Role of regular yoga practice in improvement of various pulmonary parameters in first year medical students

Background: tress at any stage of life virtually produces several respiratory limitations and reduces tolerance to physical efforts, sometimes leading to pulmonary diseases in individuals. Various yoga and Pranayama like Kapalbhati and Nadi-sodhan involves powerful strokes of exhalation, which trains the subject to make full use of diaphragm and abdominal muscles.Methods: This study is performed on 1st yr. medical students whose stress level is in higher side due to academic burden. 55 medical students were selected as participants through counseling and were divided into Yoga group (n= 27) and control group (n=28). Pulmonary functions of subjects were tested using Pony FX advanced desktop spirometer manufactured by Cosmed. Yoga is performed 1 hr/day for 6 days /week for 12 weeks by yoga group.Results: Pulmonary functions tested in Yoga and control group were FVC, FEV1, PEF and FVC/FEV1. There were significant improvements in pulmonary functions in yoga group. In Yoga group (FVC- 5.8% increases, FEV1- 5.2% increase, PEF- 34% increase and FVC/FEV1- 3.15% increase). In control group also, all parameters increased but P value was not significant.Conclusions: This study concludes that practicing Yoga has shown a significant improvement on pulmonary functions in 1st year medical students