Utility of first trimester ultrasound before 12 weeks of gestation at tertiary care centre in western India

Background: The first trimester begins on the first day of the last menstrual period (LMP) and lasts until the end of 12 weeks of gestation. Transvaginal ultrasound is modality of choice for establishing the presence of an intrauterine pregnancy in the first trimester. The focus of our study is routine early pregnancy ultrasound. The purpose of this study was to diagnose various conditions of pregnancy at an early stage by using ultrasound.Methods: We conducted retrospective data analysis of random 250 pregnant patients who had undergone first-trimester ultrasonography USG) (transvaginal/abdominal) in their first antenatal visit at S.V.P. Hospital, Ahmedabad, Gujarat, India from March 2021 to February 2022. The patient was selected by a simple randomized method. Maternal age, parity, gestational age, and special features regarding maternal gestational history were compared with USG findings. Patients were divided into 13 groups on the basis of ultrasonographic diagnosis.Results: We noted 76.8% of patients had single, viable, intrauterine pregnancies, while 23.2% had complicated pregnancies with uterine anomalies, ovarian cysts, leiomyoma, caesarean scar pregnancy or subchorionic hematomas.Conclusions: Ultrasound measurement of fetus in first trimester is most accurate method to confirm gestational age. It is less expensive and easily available modality. First-trimester ultrasound is useful to define embryonic landmarks in developmental stages with reference to gestational age, early diagnosis of miscarriage, ectopic pregnancy, molar pregnancy, multifetal pregnancy, major fetal malformation. And also, to diagnose pregnancy with leiomyoma, caesarean scar pregnancy, uterine anomaly and pre-eclampsia with the help of uterine artery PI

Classification of Caesarean Section According to Robson Criteria: An Approach to Optimize Caesarean Section Rates at Tertiary Care Hospital in Western India

Introduction: Caesarean section (CS) rates have been increasing worldwide. For proper assessment of CS rate, the ten group Robson classification is recommended by WHO. We are analyzing the CS rates by classifying the caesarean sections using Robson‘s ten group classification. The aim of this study is to perform an analysis based on Robson‘s ten group classification system and to identify strategies to optimize CS rate in our institution. Materials and Methods: This was a retrospective observational study conducted in the department of obstetrics and gynaecology between July 2022 to December 2022 at SardarVallabhbhai Patel Institute of Medical Sciences and Research (SVPIMSR) in Ahmedabad, western India. Results: Total number of deliveries during the study period was 3121. The total numbers of CS were 1078 (34.55%) and total vaginal deliveries were 2043 (65.45%). The main contributors to overall caesarean section rate were group 5 (previous CS) (14.03%) and group 2 (nullipara, singleton cephalic,>=37 weeks) (11.40%). Women with one previous LSCS contributed majorly to the CS rate. Conclusions: Robson‘s classification is easily implementable and an effective tool for surveillance. The results can be compared between Institutions, states and countries. By using Robson classification, groups identified which contributed the most to the overall CS rate and approach to reduce the same has to be our prime objective. Any reduction in CS in nullipara group affect the CS rate in the total group of nulliparous women with a potential for vaginal birth and would also reduce number of women in group 5 (previous CS)

The efficacy of Tadalafil and Tadalafil + Dapoxetine in managing sexual dysfunction in individuals with type-2 diabetes mellitus: A clinical study

Objective: The present study was aimed to evaluate effect of metabolic parameters on erectile dysfunction (ED) in individuals with type-2 diabetes mellitus (T2DM) and to assess the efficacy of Tadalafil and Tadalafil + Dapoxetine combination. Materials and Methods: A prospective, observational, cross-sectional, bicentric study included 216 males with T2DM who are not treated with phosphodiesterase 5 inhibitors and without chronic kidney disease. The data were obtained from demographic questionnaire, clinical laboratory reports of glycometabolic parameters namely body mass index (BMI), hemoglobin A1c (HbA1c), testosterone, vitamin B12 (VitB12), and lipid profile and analyses of the International Index of Erectile Function (IIEF) questionnaire. The effect of physical and metabolic parameters on IIEF sub-domains namely erectile function; orgasmic function; sexual desire (SD); intercourse satisfaction; and overall satisfaction was evaluated. A statistical significance was evaluated using χ2 test or t-test. Result: SD is most significantly lower in subjects with imbalanced physiological and metabolic characteristics including BMI, HbA1c, testosterone, VitB12, triglyceride, high-density lipoprotein, and low-density lipoprotein. Both Tadalafil and Tadalafil + Dapoxetine significantly improved almost all IIEF parameters without any pronounced effect of either. Similarly, both the treatments improved all the IIEF parameters for subjects with high BMI except for SD. In subjects with cardiac comorbidities, the use of either treatment significantly enhanced all the IIEF scores. Conclusion: The findings of this study outline the need of careful examination of sexual dysfunction in healthcare clinics for diabetic individuals. An imbalanced physiological and metabolic profile leads to ED in individuals with T2DM. Additionally, the presence of co-morbidities further elevates the odds of ED prevalence. The treatment with Tadalafil and Tadalafil + Dapoxetine drug combination shows promising results in improving the ED but a study with larger pool of subjects is needed to determine the additional benefits of Dapoxetine

A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania

BACKGROUND: HIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy. METHODS: A randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing. RESULTS: Nearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication. CONCLUSIONS: HIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing

Efficacy and safety of fixed dose combination of Sitagliptin, metformin, and pioglitazone in type 2 Diabetes (IMPACT study): a randomized controlled trial

Abstract Background Due to the progressive decline in β-cell function, it is often necessary to utilize multiple agents with complementary mechanisms of action to address various facets and achieve glycemic control. Thus, this study aimed to evaluate the efficacy and safety of a fixed-dose combination (FDC) of metformin/sitagliptin/pioglitazone (MSP) therapy vs. metformin/sitagliptin (MS) in type 2 diabetes mellitus (T2DM). Methods In this phase 3, multicenter, double-blind study, patients with T2DM who exhibited inadequate glycemic control with HbA1c of 8.0–11.0% while taking ≥1500 mg/day metformin for at least 6 weeks were randomized to receive either FDC of MSP (1000/100/15 mg) or MS (1000/100 mg) per day for 24 weeks. The primary outcome measure was the change in HbA1c, and secondary outcomes included changes in fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and body weight from baseline to 24 weeks along with safety and tolerability. Results Among the 236 patients randomized, 207 (87.71%) successfully completed the study. All baseline characteristics were comparable between the FDC of MSP and MS groups. There was a subsequent significant reduction of HbA1c in FDC of MSP (− 1.64) vs. MS (− 1.32); between groups was [− 0.32% (95% CI, − 0.59, − 0.05)], P = 0.0208. Similar reductions were found in FPG [− 13.2 mg/dL (95% CI, − 22.86, − 3.71)], P = 0.0068, and PPG [− 20.83 mg/dL (95% CI, − 34.11, − 7.55)], P = 0.0023. There were no significant changes in body weight. A total of 27 adverse effects (AEs) and one severe AE were reported, none of which were related to the study drug. Conclusion The FDC of MSP demonstrated significant efficacy in managing glycemic indices and could serve as a valuable tool for physicians in the management of Indian patients with T2DM. Trial registration Clinical Trials Registry of India, CTRI/2021/10/037461