610 research outputs found
The psychological well-being and prenatal bonding of gestational surrogates
STUDY QUESTION
How does the psychological well-being and prenatal bonding of Indian surrogates differ from a comparison group of mothers?
SUMMARY ANSWER
Surrogates had higher levels of depression during pregnancy and post-birth, displayed lower emotional connection with the unborn baby, and greater care towards the healthy growth of the foetus, than the comparison group of mothers.
WHAT IS ALREADY KNOWN
Studies in the West have found that surrogates do not suffer long-term psychological harm. One study has shown that surrogates bond less with the foetus than expectant mothers.
STUDY, DESIGN, SIZE, DURATION
This study uses a prospective, longitudinal and cross-sectional design. Surrogates and a matched group of expectant mothers were seen twice, during 4–9 months of pregnancy and 4–6 months after the birth.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Semi-structured interviews and standardized questionnaires were administered to 50 surrogates and 69 expectant mothers during pregnancy and 45 surrogates and 49 expectant mothers post-birth. All gestational surrogates were hosting pregnancies for international intended parents.
MAIN RESULTS AND THE ROLE OF CHANCE
Surrogates had higher levels of depression compared to the comparison group of mothers, during pregnancy and post-birth (P < 0.02). Low social support during pregnancy, hiding surrogacy and criticism from others were found to be predictive of higher depression in surrogates post-birth (P < 0.05). Regarding prenatal bonding, surrogates interacted less with and thought less about the foetus but adopted better eating habits and were more likely to avoid unhealthy practices during pregnancy, than expectant mothers (P < 0.05). No associations were found between greater prenatal bonding and greater psychological distress during pregnancy or after relinquishment.
LIMITATIONS, REASONS FOR CAUTION
All surrogates were recruited from one clinic in Mumbai, and thus the representativeness of this sample is not known. Also, the possibility of socially desirable responding from surrogates cannot be ruled out.
WIDER IMPLICATIONS OF THE FINDINGS
As this is the first study of the psychological well-being of surrogates in low-income countries, the findings have important policy implications. Providing support and counselling to surrogates, especially during pregnancy, may alleviate some of the psychological problems faced by surrogates.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the Wellcome Trust [097857/Z/11/Z] and Nehru Trust, Cambridge. K.K. is the Medical Director of Corion Fertility Clinic. All other authors have no conflict of interest to declare
A longitudinal study of the experiences and psychological well-being of Indian surrogates
Study question: What is the psychological well-being of Indian surrogates during and after the surrogacy pregnancy?
Summary answer: Surrogates were similar to a matched group of expectant mothers on anxiety and stress. However, they scored higher on depression during and after pregnancy.
What is known already: The recent ban on trans-national commercial surrogacy in India has led to urgent policy discussions regarding surrogacy. Whilst previous studies have reported the motivations and experiences of Indian surrogates no studies have systematically examined the psychological well-being of Indian surrogates, especially from a longitudinal perspective. Previous research has shown that Indian surrogates are motivated by financial payment and may face criticism from their family and community due to negative social stigma attached to surrogacy. Indian surrogates often recruited by agencies and mainly live together in a “surrogacy house.”
Study design, size, duration: A longitudinal study was conducted comparing surrogates to a matched group of expectant mothers over two time points: (a) during pregnancy (Phase1: 50 surrogates, 70 expectant mothers) and (b) 4–6 months after delivery (Phase 2: 45 surrogates, 49 expectant mothers). The Surrogates were recruited from a fertility clinic in Mumbai and the matched comparison group was recruited from four public hospitals in Mumbai and Delhi.
Data collection was completed over 2 years.
Participants/materials, setting, methods: Surrogates and expectant mothers were aged between 23 and 36 years. All participants were from a low socio-economic background and had left school before 12–13 years of age. In-depth faceto-face semi-structured interviews and a psychological questionnaire assessing anxiety, stress and depression were administered in Hindi to both groups. Interviews took place in a private setting. Audio recordings of surrogate interviews were later translated and transcribed into English.
Main results and the role of chance: Stress and anxiety levels did not significantly differ between the two groups for both phases of the study. For depression, surrogates were found to be significantly more depressed than expectant mothers at phase 1 (p = 0.012) and phase 2 (p = 0.017). Within the surrogacy group, stress and depression did not change during and after pregnancy. However, a non-significant trend was found showing that anxiety decreased after delivery (p = 0.086). No participants reported being coerced into surrogacy, however nearly all kept it a secret from their wider family and community and hence did not face criticism. Surrogates lived at the surrogate house for different durations. During pregnancy, 66% (N = 33/50) reported their experiences of the surrogate house as positive, 24% (N = 12/50) as negative and 10% (N = 5/50) as neutral. After delivery, most surrogates (66%, N = 30/45) reported their experiences of surrogacy to be positive, with the remainder viewing it as neutral (28%) or negative (4%). In addition, most (66%, N = 30/45) reported that they had felt “socially supported and loved” during the surrogacy arrangement by friends in the surrogate hostel, clinic staff or family. Most surrogates did not meet the intending parents (49%, N = 22/45) or the resultant child (75%, N = 34/45).
Limitations, reasons for caution: Since the surrogates were recruited from only one clinic, the findings may not be representative of all Indian surrogates. Some were lost to follow-up which may have produced sampling bias.
Wider implications of the findings: This is the first study to examine the psychological well-being of surrogates in India. This research is of relevance to current policy discussions in India regarding legislation on surrogacy. Moreover, the findings are of relevance to clinicians, counselors and other professionals involved in surrogacy.
Trial registration number: N/A
Indian egg donors’ characteristics, motivations and feelings towards the recipient and resultant child
This is the first study to examine characteristics, motivations and experiences of Indian egg donors. In-depth interviews were conducted with 25 egg donors who had donated during the previous 8 months at a fertility clinic in Mumbai. The semi-structured interviews were conducted in Hindi and English. In addition to demographic information, data were collected on donors’ motivations for donating, with whom they had discussed donation, and feelings towards the recipients. The response rate was 66%. All participants were literate and had attended school. Twenty (80%) egg donors had children and five (20%) did not. The most common motivation (19, 76%) for donating was financial need. Egg donors had discussed their donation with their husband or with close family/friends, with almost all mentioning that wider society would disapprove. The majority (20, 80%) had no information about the recipients and 11 (44%) preferred not to. The findings highlight the similarities and differences between egg donors from India and those from other countries and that egg donors are of a more varied demographic background than surrogates in India. Given that India has been a popular destination for fertility treatment, the findings have important implications for regulation and practice within India and internationally
Histochemical investigation of different organce of genus sesbania of marathwada region in maharashtra
The histochemical studies of leaves and wood of Sesbania grandiflora, Sesbania bispinosa and Sesbania cannabina are medicinally important plants of Marathwada region in Maharashtra. For histochemical studies the free hand sections of leaves and wood were taken and treated with the respective reagent in localize components, viz. starch, protein, tannin, saponin, fat, glucosides and alkaloids in the tissues
Determination of ash values of some medicinal plants of genus sesbania of marathwada region in maharashtra
The seasonal variation of total ash, water soluble ash and water insoluble ash have been investigated leaves , wood and bark of Sesbania grandiflora, Sesbania bispinosa and Sesbania cannabina, which are medicinally important. Comparative account of total ash, water soluble ash and water insoluble ash content of bark of Sesbania grandiflora showed high level of total ash (range 11.80 to 12.10 %) and low level of total ash of leaves of Sesbania cannabina ( range 5.05 to 5.35 % ) .The water soluble ash showed higher level of wood of Sesbania grandiflora (range 4.30 to 4.80 % ) and lower in leaves of Sesbania cannabina (range 1.5 to 2.05 %),Comparative account of water insoluble ash of bark of Sesbania grandiflora showed higher (range 7.20 to 7.35 % ) and lower in the leaves of Sesbania bispinosa (range 2.9 to 3.1 % ). Â
A rare case of vulval leiomyoma
Vulval leiomyomas are rare smooth muscle tumors that may arise from smooth muscle cells within erectile tissue, blood vessel wall or round ligament remnants in the labia majora and they are clinically misdiagnosed as Bartholin cyst or lipoma. In our case, a 40-year-old woman presented with 8 years history of progressively increasing painless swelling on her vulva. Clinically it was diagnosed as a solid tumour due to its consistency and location. Hence surgical excision was done. Histopathology report was suggestive of leiomyoma with hyaline changes on microscopy. Major diagnostic problem with smooth muscle tumors of the vulva is the distinction between benign and malignant form, since many vulval lesions have similar appearances making it difficult to distinguish benign from malignant lesions by gross inspection. The recommended treatment option is local excision of the mass with pathological examination
Role of maternal serum ferritin as a predictive marker in intrauterine growth restriction
Background: Intrauterine growth restriction (IUGR) is most common and distressing complication for both obstetrician and neonatologist. Measurement of maternal serum ferritin has also been used as a predictive marker of increase risk of IUGR. In pregnancy, ferritin level decreases with advancing gestation. Its lowest level is seen around 30-32 weeks of gestational age after which its concentration reaches plateau level.Methods: Total 326 antenatal women enrolled in the study. Maternal serum samples of all women were taken at 25th week and again at 30-32 weeks in trace free mineral evacuated tubes for assessment of serum ferritin by chemiluminescence. Mean of both values was calculated.Results: Mean ferritin value of women with average for gestational age neonates was 15.49 ng/ml and women with growth restricted neonates was 19.71 ng/ml. The women with mean serum ferritin above 20 ng/ml, were 6.26 times more likely to have asymmetrically growth restricted baby and 4.47 times more likely to have a symmetrically growth restricted baby when compared to women with serum ferritin value less then <20 ng/ml.Conclusions: In our study negative correlation was found between the value of serum ferritin and neonatal birth weight. In future large randomized control trial is needed to found association between maternal serum ferritin and IUGR.
Obstructive mullerian anamolies: a case series
AIM of the study was to review the heterogeneous clinical presentations and management options for some of the obstructive mullerian anomalies through a case series. Background: MĂĽllerian duct anomalies (MDAs) are a miscellaneous group of entities that result from the non-development, defective vertical or lateral fusion, or resorption failure of the mĂĽllerian ducts due to genetic mutation. 5 cases of obstructive mullerian anomaly are reviewed. Cases of OHVIRA (obstructed Hemivagina with Renal Agenesis) syndrome, transverse vaginal septum, imperforate hymen and obstructed rudimentary horn of unicornuate uterus are included. Results: We found that cyclical abdominal pain was the most common presenting complaint. There is a high incidence of associated renal anomalies. Psychosocial counselling before treatment is necessary to address the functional and emotional aspects of the patient. Surgical management was done in all patients with good postoperative outcome. Conclusion: Obstructive mullerian anomalies need to be evaluated by a meticulous examination and imaging studies to reach the diagnosis with precision. The treatment has to be tailored to the specific anomaly
Acute pancreatitis in pregnancy: a challenge for the clinician
Acute pancreatitis is one of the very rare events in pregnancy associated with high maternal and fetal morbidity and mortality. We are presenting a case of acute pancreatitis in a 25 year old G2P1L1 at 33 weeks of gestation with previous LSCS who presented to us with hypertension, epigastric pain, vomiting. Investigations revealed hyperamylysemia, hypertriglyceridemia and deranged liver enzymes. After examination and investigations, diagnosis of acute pancreatitis with pregnancy was made. She underwent caesarean section for obstetric hemorrhage and was put in intensive care for 3 days. She was discharged after. 1 week and is under regular follow up for past 6 months
Concurrent bilateral ectopic pregnancy: a rarity
Bilateral ectopic pregnancy is a rare twin gestation with only a few cases reported in the literature. We report a 30 year old woman without any high risk factor for ectopic pregnancy, who had concurrent bilateral ectopic pregnancy. A 30 year old female presented to the Gynecology emergency department complaining of vaginal bleeding and abdominal pain. The presumptive diagnosis of ruptured left sided ectopic pregnancy was made on basis of clinical findings and ultrasound finings. An emergency laparotomy was done revealed a hemoperitoneum of 1.5 liters, a ruptured left tubal pregnancy with active bleeding and right tubal un-ruptured ectopic was found. A bilateral salpingectomy was performed. Histopathology confirmed presence of chorionic villi in both tubes. In theory, laparoscopic salpingostomy is the best surgical approach in bilateral tubal pregnancy. However, bilateral salpingectomy may be necessary when both tubes are extensively damaged or are actively bleeding. Successful pregnancies have been reported after conservative surgical treatment of bilateral ectopic, but the risk of recurrence is high. Our decision for an emergency laparotomy followed by bilateral salpingectomy was based on the fact that the patient presented with acute abdomen and was haemodynamically unstable and there was extensive bilateral tubal damage. As the incidence of ectopic pregnancies is increasing concurrently with the incidences of pelvic inflammatory disease and use of assisted fertility techniques; it may be that these “rare ectopics” will become less uncommon
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