A comparative study of efficacy of letrozole and clomiphene citrate for ovulation induction

Background: This study was conducted to evaluate the efficacy of letrozole as an ovulation inducing agent and to compare it with clomiphene citrate (CC) in infertile women.Methods: This study includes 100 women referred to gynecology OPD of Pt. B.D Sharma, PGIMS, Rohtak with   infertility due to dysovulation. The patients were divided in two groups each comprised of 50 patients, Alternate women were enrolled in study group (Letrozole). Ultrasonic follicular monitoring was done on day 10, 12, 14, 16 of menstrual cycle to measure the number, size of mature follicles. Endometrial thickness and trilaminar pattern of endometrium was compared in between the groups. Inj. Gonadotrophin (hCG) was given as a trigger intramuscularly when follicle size was between 18 to 21mm. After 36 hours of hCG administration ovulation was confirmed on ultrasound.Results: Mean age, parity, and the duration of infertility were similar in both groups. Ovulation rate was 81.6% in letrozole group and was higher than control group(p<.01). The average number of follicles in the control group was 1.90±0.77and 1.17±0.47 in the study group(p<.001). Endometrial thickness in the study group was 7.55±1.12mm and in the control group it was 6.06±0.87(p<.01). Pregnancy rate in study group was 48 % and control group 16%(p<.05).Conclusions: Aromatase inhibitors (Letrozole) is a new group of drugs to join the arsenal of infertility treatments. The result of this preliminary study suggests that letrozole is associated with higher ovulation rate, higher endometrial thickness and trilaminar pattern thus resulting in higher pregnancy rate. Clomiphene citrate may be replaced by letrozole as primary treatment for ovulation induction in infertile patients

Comparative study of transperineal and transvaginal sonography for localization of placenta in antepartum haermorrhage

Background: Haemorrhage is one of the leading causes of maternal mortality and morbidity in world in pregnant patients.Patients with antepartum haemorrhage confirmation of location of placenta by sonography is must for management. Transvaginal sonography(TVS) has main disadvantage of need of penetration of vagina and  provoking vaginal haemorrhage It can also result in uterine contraction & requirement of special transducer. Transperineal sonography(TPS) is more convenient and safer means of imaging the cervix and lower uterine segment overcoming the short coming of transabdominal sonography and eliminating the risk associated with Transvaginal sonography.  Thus present study was undertaken with a view to evulate patients of antepartum haemorrhage by Transvaginal as well as by transperineal sonography to compare accuracy of transperineal with Transvaginal sonography.Methods: Transvaginal probe was gently introduced for about 3-4 cm beyond the introitus. Distance between internal os and lower edge of placenta was measured. The diagnosis of placenta previa was made if placental edge was located within 5cm of internal os. Transperineal sonography was performed with convex transducer. Bladder was kept empty The transducer was positioned directly on perineum in sagittal orientation over the labia minora with center of transducer typically posterior to urethra and anterior to vaginal orifice and measurement taken.Results: TPS diagnosed placenta previa in 31 cases, 30 of which had placenta previa. TPS  negated placenta previa in 19 cases, none of which had placenta previa. So false positive rate of TPS was found to 4.7%, false negative 0% sensitivity 100% specificity 95.2%. Positive predictive value of TPS was found to be 96.7% and negative predictive value of TVS was found to be 100%.Conclusions: So, to conclude transperineal sonography is easy to perform, well tolerated accurate diagnostic tool with high sensitivity specificity, positive and negative predictive values for localisation of placenta cases of APH. TVS can be replaced by TPS in cases of APH for localisation of placenta

A prospective study of maternal outcome in antepartum haemorrhage in tertiary care center in northern India

Background: Antepartum hemorrhage (APH) is a grave obstetrical emergency. It is leading cause of maternal death. Aim of the present study was to see maternal outcome patient with APH.Methods: It was a prospective study carried out over a period of one year on 100 women admitted with the diagnosis of APH at Pt. B.D Sharma medical college, Rohtak, Haryana, India, a tertiary care center. 100 patients with antenatal hemorrhage were studied prospectively. History was taken regarding age, hemoglobin status, blood unit given, ultrasound done to note type of placenta, distance of placenta from Os noted, third stage and delayed complication recorded.Results: 40.7% patients of placenta previa had immediate LSCS. 44.4% patients of placenta previa delayed LSCS was done after expectant management. 61.76% of patients of abruptio placentae had immediate vaginal delivery. 16% had atonic postpartum haemorrhage as third stage complication. One patient lynch sutures were applied. In 2 cases bilateral internal iliac artery ligation was done. In 3 cases bilateral uterine artery ligation done to control PPH. 71% patients of APH had postpartum anemia as delayed complication.Conclusions: The single most important factor in reducing maternal mortality has been the increase use of caesarean delivery in cases of abruptio placentae. Anemia is the most common cause of maternal morbidity (80%) associated with APH in the present study

Bladder hematoma as an unusual cause or consequence of obstructed labour

Bladder hematoma is a rare complication but also an unusual mechanical cause of obstructed labour, whose incidence in India is 1-2%. The most common reason for intraluminal urinary bladder hematoma is trauma, but it can occur with cystitis, pelvic malignancy and irradiation. A large hematoma may mimic a neoplastic mass on imaging. We reported a first case of bladder hematoma as a cause or result of obstructed labour in a multipara where the diagnosis was made intraoperatively. This bladder complication also became the indication for classical caesarean section, the technique which is almost obsolete nowadays, where the indication for classical caesarean section was obligatory

Clinical outcomes of ectopic pregnancy

Background: Ectopic pregnancy (EP) is a life threatening gynaecological emergency, and a significant cause of maternal mortality and morbidity worldwide. Aim of this study was to determine and evaluate the incidence, clinical presentation, risk factors, management strategies and outcome of the patients with EP.Methods: This was a prospective study of all cases of ectopic pregnancies admitted and managed at PGIMS Rohtak over a period of 1 year. All patients admitted through accident and emergency unit as well as the gynaecology clinic that were managed in gynaecological ward were included in the study. The diagnosis of EP was made by history, clinical examination, urinary pregnancy test and ultrasound examination. Patients were managed as per hospital protocol and relevant data on age, parity, clinical presentation, risk factors, management and findings at laparotomy, and the outcome of treatment were collected.Results: The incidence of ectopic pregnancy in this study was 1.056%. The mean age of the patients was 27±3 years. Of the 102 ectopic pregnancies, 86 (84.31%) were ruptured ectopic pregnancies, while 16 (15.68%) were unruptured ectopic pregnancies. The commonest clinical complaint was abdominal pain (97 of 102, 95.09%) History of previous abortion (induced or spontaneous) was the commonest risk factor (92 of 102, 90.19%) followed by past history of pelvic inflammatory disease (56 of 102, 54.90%). History of tubal surgery was present in 27 of 102 patients (26.47%). commonest surgical procedure done was emergency laparotomy followed by salpingectomy (67 of 102, 65.68%).Conclusions: EP is an important cause of maternal morbidity and mortality in early pregnancy and has remained a reproductive health challenge. Early diagnosis and treatment can improve reproductive outcomes.

Overenthusiastic treatment of infertility by budding gynecologist leading to moderate OHSS

Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic complication of luteal phase or early pregnancy, occurring in up to 5% of women undergoing in vitro fertilization (IVF) or intrauterine insemination (IUI) procedures. A 19-year-old nulligravida married for six months presented with complaint of lower abdominal pain and lump abdomen for three days. Ovulation induction was started by a private practitioner with Clomiphene citrate (50mg OD, day3 to day 7 of menstrual cycle) followed by Human Menopausal Gonadotropin (HMG) on day10, 11, 12 and Human Chorionic Gonadotropin(HCG) on day 15 of the same cycle. Her symptoms started 14 days following injection of HCG. Abdominal examination demonstrated pelvic abdominal mass up to the level of umbilicus corresponding to 24 weeks’ size, tense, non-tender, mobile and of cystic consistency. Ultrasonograph of abdomen revealed uterus of normal size, endometrial thickness-20mm, right ovary of size 81x95x119mm with multiple cysts and left ovary of size 65x61x66mm with mild ascites. She was managed conservatively with bed rest, abdominal girth measurement, oral analgesics, intake output charting with plenty oral fluids and gentle leg exercises. Within two weeks of admission, pain was relieved and serial hematological and biochemical parameters remained normal. Repeat ultrasonography confirmed the presence of intrauterine live pregnancy and she was discharged. All gynecologists must know when, how and where to treat cases of infertility in order to prevent OHSS and its complications like renal failure, ARDS,thromboembolism,ovarian torsion and intra peritoneal hemorrhage

Short review on domperidone tablet

Oral route is presently the gold standard in the pharmaceutical industry where it is regarded as the safest, most economical and most convenient method of drug delivery resulting in highest patient compliance. Pediatric and geriatric patients find it difficult to swallow solid dosage forms like tablets. Mouth dissolving tablet that dissolve or disintegrate rapidly in oral cavity result in solution, is an ultimate remedy for this problem in addition they give pleasing mouth feeling. ODT has advantages such as patient compliance, quick onset of action, improved bioavailability. Domperidone tablet (ODT) gives relief from nausea, vomiting. This review gives us all information about pharmacokinetic, pharmacodynamic, uses, precautions, side effects of domperidone tablet

Spectrum of Opportunistic Infections in People Living with HIV: A Tertiary Care Center Experience from North India

: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are proneto opportunistic infections (OIs) given their immunosuppressed state. OIs continue to cause morbidity and mortality in HIV/AIDS patients even after highly-active antiretroviral therapy (HAART); hence, attainment of the goals on health care programs,particularly in resource-poor countries, is hard to achieve. The prevalence of specific OIs varies in different countries and evenin different areas within the same country. Little information is available about the prevalence of OI in HIV patients fromdeveloping countries, especially India. Early diagnosis and prompt treatment contribute to increased life expectancy amonginfected patients delaying progression to AIDS. Hence, the present study was carried out to elucidate current frequencies andspectrum of OIs in HIV seropositive adult patients in Haryana and to evaluate the associated risk factors for OIs. Materialsand methods: This was a cross-sectional study carried out at the Dept. of General Medicine in a tertiary care hospital in NorthIndia. Basic demographic details, anthropometric measurements, symptoms of HIV/OI, clinical examination, biochemicalinvestigations and treatment details were recorded. Patients aged 18 to 70 years and HIV seropositive subjects were includedin the study. Results: The study found that about 53.21% of HIV/AIDS patients on ART had one or more OIs. Tuberculosis(TB) was the predominant OI identified, with a prevalence of 25.71%. Candidiasis and herpes zoster were the second and thethird most prevalent OIs at 13.8% (101/731) and 7.25% (53/731), respectively. Age (43.4 ± 10.7 years), low income, illiteracy,low socioeconomic status, initial 4 months since initiation of ART, CD4 count &lt;200/mm3, body mass index of &lt;18.5 kg/m², poorART adherence, hemoglobin, albumin were strongly associated with OIs. Conclusion: The present study shows that TB is thecommonest OI in adults and the overall population of people living with HIV (PLHIV) in Haryana and proves that OIs acrossdifferent patient groups vary significantly. Various factors like adherence to HAART, socioeconomic and education status ofpatients can influence the occurrence and outcome of these deadly infections

Caesarean scar pregnancy: a case report with review of management options

Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology