Immediate post placental insertion of intrauterine contraceptive device at caesarean delivery: a prospective study

Background: In India almost 65% of the women have an unmet need for family planning in the first postpartum year. Increasing rates of institutional deliveries creates an opportunity for providing quality post-partum family planning services. Post-partum Intrauterine contraceptive device (PPIUCD), a form of long acting reversible contraception (LARC) is one of the most affective and safest method available. The present study aims at evaluating the safety, efficacy, rate of acceptance and rate of discontinuation of Intra caesarean inserted contraceptive device Copper T-380A.Methods: This was a prospective study conducted at ESIC Medical College, Sanathnagar in women delivered by caesarean section during the period between March 2018 to February 2019. Recruitment was done based on the WHO medical eligibility criteria (MEC) for PPIUCD and also their willingness to participate in the study. Follow-up visits were scheduled at 6 weeks, 3 months and 6 months.Results: Of the 265 women fulfilling the WHO MEC, 180 (67.92%) were willing to participate in the study. Total acceptance rate was 67.7%. Majority of them belonged to the age group 21-30 years (80%) and para 2 (53.88). 93.3% of the women were literates. 12 (6.66%) cases lost to follow up and the complications were studied in the rest 168 women. During follow up -38.69% had missing strings, 12.5% menstrual disturbances, 4.76% abdominal pain and spontaneous expulsion in 4.1%. No cases of perforation and pregnancy were reported. Total continuation rate was 84%.Conclusions: PPIUCD is a safe and convenient option of contraception with low expulsion rates and high continuation rates

Study on comparison of maternal and fetal outcome in hypothyroid pregnancies with and without hypertension: a controlled case study

Background: Incidence of subclinical hypothyroidism is 2.3% of pregnancies and overt hypothyroidism being 0.2%.Further incidence of hypertension one of the complications of maternal hypothyroidism strongly correlates with the levels of serum thyroid stimulating hormone (TSH). This study is designed to study maternal and fetal outcome in hypothyroid normotensive pregnancies (group 1) and hypothyroid hypertensive pregnancies (group 2) and to study the severity of hypertension in relation to thyroid function levels.Methodology: The prospective study was conducted on antenatal mothers attending MGMH,Petlaburz,OsmaniaMedicalCollege,Hyderabad during the period November 2012 to May 2014.The study was based on the analyses of 50 pregnant mothers diagnosed to have hypothyroidism .These included cases diagnosed before as well as during pregnancy .Another 50 pregnant mothers diagnosed to have hypothyroidism and developed hypertension during the course of pregnancy. Follow up was done with serum TSH and free T4 levels throughout pregnancy and outcomes were studied. Trimester specific values for thyroid function tests are used. Results: Cases suffering from overt hypothyroidism were 50% in group2 compared to 30% in group1 (chi-square=5.997, p value=0.04986).GHTN was seen in 52% of group 2 patients of which 12% belong to overt hypothyroid group. On the other hand 42% suffered from preeclampsia of which 32% belong to overt group (chi-square=16.55,p value=0.00236). A change in dosage was required in 36% in group1 & 42% in group2. Complications - preterm (grp1 4% & grp2 10%), IUD (grp1 2% & grp2 10%), IUGR (grp1 6% & grp2 14%) and Abruption (grp1 2% & grp2 6%) were observed. Conclusion: Changes in the thyroid hormone levels might be correlated with occurrence and severity of pre-eclampsia

Impact of severity of illness on the function of the hypothalamo-pituitary-gonadal axis in postmenopausal women with acute severe illness: Implications for predicting disease outcome

Background: While elevated levels of estradiol were predictive of mortality in critically ill surgical and trauma patients, their ability to predict outcome in nonsurgical patients has not been studied. We aimed to study the determinants of gonadotropin levels in acutely ill postmenopausal women with nonsurgical disease and the impact of changes in the gonadal axis on the outcome of these patients. Methods: Thirty-five postmenopausal women admitted to medical intensive care with acute severe illness and having a Simplified Acute Physiology Score (SAPS II score) ≥30 (in-hospital mortality rate ≥ 10%) were recruited. On the 5th day of hospitalization, fasting samples were collected at 8.00 am and tested for luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, free triiodothyronine, free thyroxine, thyrotropin, cortisol, prolactin, dehydroepiandrosterone, androstenedione, and sex hormone-binding globulin. Multiple linear regression analysis was performed to identify independent determinants if any of LH and FSH. Receiver operating characteristic (ROC) curves were drawn for different cutoffs of LH, FSH, and estradiol to diagnose mortality and prolonged hospitalization. Results: There was an independent negative association between the FSH and the SAPS II score (beta = −0.435; P = 0.014), but not with any of the other tested parameters (estradiol, prolactin, or cortisol). Among components of the SAPS II score, the total leukocyte count (TLC) was negatively associated with serum FSH (beta coefficient = −0.635, P = 0.013). None of these parameters were determinants of LH. On ROC analysis, neither estradiol nor gonadotropins were diagnostic for in-hospital mortality. However, among survivors, low estradiol was diagnostic for prolonged hospital stay (area under the curve = 0.785; P = 0.015). Conclusion: FSH, but not LH, is negatively associated with the severity of illness, particularly to its inflammatory component (TLC). Low estradiol in survivors was a predictor of prolonged hospital stay