Determine the unmet need for family planning in a hilly area in a state of North India

Background: The utilization of family planning services has improved over the decade, but still the SDG’s health target to ensure universal access to sexual and reproductive health care services is yet to be achieved, unmet need being one of the  imperative component.Methods: A cross-sectional study was undertaken in the rural field practice area of Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to June 2019. Total sample size calculated was 316. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent.Results: The mean age of the participants was 30.2±6.1 years. The modern contraceptive prevalence rate (mCPR) was found to be 67.7% among women of reproductive age group (15-49 years). Male condom (36%), followed by female sterilisation (30%) were the most common methods preferred. Unmet need of family planning was found to be 10.4%.Conclusions: Besides male condoms and female sterilisation, other methods of contraception were adopted by meagre number of women. Though, the unmet need for family planning was lesser in this study, still, efforts are needed to plunge it, for ameliorating the contraceptive prevalence rate. Also, the availability of basket of contraceptive choices in government sector need sheer assiduity

A study to determine socio demographic corelates of reproductive tract infection amongst women of reproductive age group

Background: Reproductive tract infection (RTI) is a public health problem, especially in developing country like India. The associated odium with this reproductive morbidity is often a stumbling block in seeking health care. The aim was to study the prevalence of RTI symptoms and its socio-demographic corelates.Methods: A cross-sectional study was undertaken in the rural field practice area of department of community medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to September 2018. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent.Results: The prevalence of self-reported reproductive tract infections was found to be 41.2%. The prevalence was more in lower socio-economic classes, and it was statistically significant. Other socio-demographic corelates (age, education, occupation) did not showed any significant association.Conclusions: The reproductive tract infections prevalence is found to be considerably high in the women of reproductive age group. The frequency was higher among multigravida women and those using cloth during menstrual periods. RTIs are usually spurned by women and even the health care providers, so there is a need to give due consideration to this aspect of reproductive health

School refusal, depression and suicidality in an adolescent girl- the interplay of stress and vulnerability: a case report

The stress vulnerability model emphasizes the interplay of genetic vulnerability, personal characteristics and psychosocial factors in the causation of mental illness. The index case highlights the genesis of psychiatric illness in an adolescent female with a family history of bipolar disorder and substance dependence leading to impaired family interaction and family dynamics. Individual psychotherapy, family therapy and pharmacological management proved beneficial in the index case

Modified biophysical profile and perinatal outcome in high risk pregnancies

Background: Aim and objective of current investigation was to evaluate perinatal outcome in high risk pregnancy with modified biophysical profile and also evaluate the efficacy of MBPP.Methods: Type of study was observational study, 100 patient fulfilling inclusion criteria were included in study. All women were subjected to modified biophysical profile comprises amniotic fluid index and non stress test. NST was performed with cardiotocogram, real time ultrasound scanning was performed. Perinatal outcome assessed in terms of admission to NICU, low birth weight, foetal distress, low APGAR score, neonatal mortality.Results: Out of 100 cases, 55 cases had reactive NST and 45 had non reactive NST. AFI was normal in 79 cases 21 cases had abnormal AFI. Diagnostic power was maximum seen with NST i.e. 76.36% (61.90% for AFI and 71.64% for combined MBPP) it indicates that NST is a good predictor to diagnose a compromised foetus.Conclusions: This study shows that pregnancy with high risk factors are associated with more chances of intrapartum complications perinatal morbidity and mortality , if MBPP was abnormal or any one parameter was abnormal, chances of perinatal morbidity were high

Vitamin D levels in pregnant women in Uttarakhand, India

Background: A balanced, nutritious diet is an important aspect of a healthy pregnancy and its outcome. Vitamin D plays an important role in regular bone growth and in adequate function of innate immune system, including barrier function of mucous membrane. Vitamin D deficiency in adult females may increase risk of pre-eclampsia, gestational diabetes, bacterial vaginosis. The present study was undertaken to find the prevalence of Vitamin D deficiency in the women of Uttarakhand, India.Methods: The study was conducted in the Department of Obstetrics and Gynecology, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, India over a period of 12 months. Sample size was 100 pregnant females attending antenatal clinic.Results: Out of 100 subjects, 21 (21%) had deficient, 69 (69%) had insufficient and 10 (10%) had sufficient vitamin D status. Out of 21 deficient subjects, 18 (85.71%) were Hindus, 2 (9.52%) were Muslims, 1 (4.76%) was Sikh and no deficiency was seen in Christian. In the present study, deficient vitamin D status was seen in 1 (4.76%) in lower, 16 (76.19%) in middle and 4 (19.04%) subjects in upper socioeconomic status.Conclusions: It is concluded from our study that there is serious vitamin D deficiency and insufficiency in the women of Uttarakhand, India

Swyer syndrome presenting as primary infertility

Swyer syndrome was first described by Jim Swyer in 1955. It is a form of “Pure gonadal dysgenesis”. The affected female has 46, XY karyotype. A 21 year old married female came with complaints of primary infertility. On examination she has normal built with normal secondary sexual characteristics. She had normal vaginal opening with small uterus. Serum FSH was 71.54 mIU/ml. Thyroid and Prolactin was in normal range. Karyotype showed genotype of 46, XY. Diagnostic laparoscopy showed streak gonads, small uterus, and normal patent fallopian tubes. Diagnosis of Swyer syndrome was made

Study the effect of mifepristone on clinical symptoms and its side effects in patients with fibroid uterus

Background: Fibroid can lead to a variety of clinical symptoms including pain, menorrhagia, and lump in abdomen. The availability of a safe and efficient medical management options for symptomatic fibroid is of considerable clinical and public health importance. The present study is designed to see the safety and efficacy of mifepristone in the medical management of uterine fibroids.Methods: The study was conducted in the Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun over a period of 12 months. A total of 40 patients were included in the study.Results: Amount of bleeding was assessed by PBAC score, which significantly reduced by 83.9% at the end of treatment.  And 62% patients developed amenorrhoea due to mifepristone. Similarly, pain abdomen/dysmenorrhoea was assessed by Numeric Pain Rating Scale, which also showed a significant reduction in 55% patients with no pain at the end of 3 months.Conclusions: The study clearly shows that Mifepristone is a safe and effective option to manage fibroid uterus and its associated symptoms

Study the effect of mifepristone on fibroid and uterine volume

Background: Fibroid is the most common benign tumour of the uterus affecting 20% of women of reproductive age group and is the most common indication for hysterectomy accounting for about 40% of all hysterectomies in premenopausal women. This study was undertaken to study the effect of Mifepristone, which is a progesterone receptor modulator with antagonistic action, on fibroid and uterine volume.Methods: The study was conducted in the Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun over a period of 12 months. A total of 40 patients were included in the study.Results: Mean baseline fibroid volume decreased by 49.17% at 1 month and by 77.4% and 3months of treatment with Mifepristone. Mean baseline uterine volume decreased by 34.13% at 1 month, and further reduction by 58.3% at the end of treatment.Conclusions: The study shows that there is a significant reduction in fibroid and uterine volume in patients treated with mifepristone

The impact of grand multiparity on late pregnancy and early labour, hospital-based study on Garhwal region, Uttarakhand

Background: Grand multiparity has been associated with adverse outcome for both fetus and mother such as antepartum hemorrhage, malpresentation, caesarean section rate, postpartum hemorrhage, iron deficiency anemia, and a high perinatal mortality rate. This study aimed to estimate the proportion of the antenatal, intrapartum and perinatal complications outcomes related to grand multiparity. Methods: This is a prospective observational study conducted during a period of 1 year from 2021 to 2022 in the department of obstetrics and gynaecology, Himalayan hospital, Jollygrant, Dehra Dun, Uttarakhand. 60 grand multiparous patients who delivered during this period was analysed. Mothers with fetus/neonates were assessed for antenatal and obstetrical complications, mode of delivery and post-partum complications. Results: During the study period, majority of women were in age group 26-30 years (45%), from plain areas (60%), and hilly areas (40%), 85% patients delivered vaginally, while 15 patients delivered by lower segment caesarean section. The main indication of C section was previous 2 LSCS. Maternal complications noted were anemia (30%), preterm labour (23.3%), malpresentation (1.7%) and placenta previa was seen in 3.3% women. Atonic PPH was noted in 10% cases. In present study there was no maternal death reported among grand multipara. 61 babies were born, in which 1.6% neonates were still born. There were no perinatal deaths. 34.45% newborns were born with low birth weight. Conclusions: Grand-multiparity is an obstetric risk factor. Proper antenatal care, education, properly timed caesarean section in selected cases would reduce the grand-multiparity associated adverse pregnancy outcomes

Correlation of Vitamin D levels with feto-maternal outcome

Background: Vitamin D deficiency in adult females may increase risk of pre-eclampsia, gestational diabetes, bacterial vaginosis. Various malpresentation, cephalo-pelvic disproportion and difficult deliveries increases the risk of caesarean section. It may also increase the risk of fetal hypovitaminosis D, neonatal rickets and tetany, lower respiratory tract infections, low birth weight, the largest cause of infant mortality in India. This study was under taken to study the impact of vitamin D deficiency on feto-maternal outcome.Methods: The study was conducted in the Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences (HIMS), Swami Ram Nagar, Dehradun, over a period of 12 months. Sample size was 100 pregnant females attending antenatal clinic.Results: Out of 100 subjects, pre-eclampsia was seen in 15, among which 5 (23.80%) had deficient, 9 (13.04%) had insufficient and 1 (10%) had sufficient vitamin D levels. Eclampsia was seen in 3 subjects, out of which 1 (4.76%) had deficient, 2 (2.89%) had insufficient vitamin D status. IUGR was seen in 8 subjects, out of which 4 (19.04%) had deficient vitamin D levels, 4 (5.79%) had insufficient vitamin D status. Neither of the two had sufficient vitamin D status. Deficient vitamin D status with birth weight ≤2.5 kg was seen in 9 (42.85%) subjects and 12 (57.14%) subjects with >2.5 kg Insufficient Vitamin D status was seen in 22 (31.88%) subjects with birth weight ≤2.5 kg and 48 (69.56%) with birth weight >2.5 kg.Conclusions: Prevalence of vitamin D deficiency and insufficiency was noted in this region and its association with pre-eclampsia (23.80%, 13.04% and 10% in deficient, insufficient and sufficient group respectively) was seen. Higher incidence of LSCS was also present among the deficient and the insufficient group