A randomized study for two techniques of immediate post-partum intrauterine contraceptive device insertion in India

Background: Postpartum women are susceptible for unintended pregnancy in the first postpartum year. They should be counselled by cafeteria approach and those who opt for Postpartum Intrauterine Contraceptive Device (PPIUCD), it should be inserted in the same sitting. Aims of current study were to compare 1) The technical feasibility in terms of client discomfort, immediate expulsion, perforation and time taken in insertion of the two insertion techniques, Manually vs Kelly's placental forceps. 2) The complications of the two techniques of insertion. 3) The expulsion rates at 1, 3 and 6 months.Methods: This was a randomized study in which 150 women were recruited. Group A had 75 subjects and insertion of PPIUCD was done manually. Group B had 75 subjects and insertion was done with Kelly’s placental forceps.Results: There was no statistically significant difference in the mild discomfort during insertion by either technique. Time taken for insertion was significantly lower in group A. The combined expulsion rate (spontaneous complete expulsion and partial expulsion) at the end of 6 months was 11.9% in group A and 10.5% in group B (not statistically significant). Pain (16% in group A and 12% in group B) was the most common problem encountered by IUD users followed by menstrual problems (10.7% in group A and 8% in group B). There was no significant difference in the complication rate for the two groups (P >0.05).Conclusions: Manual technique of insertion of PPIUCD is equally good as compared to Kelly’s placental forceps and it has no economic implications for purchasing and maintenance.

Comparative evaluation of postpartum versus post MTP insertion of intrauterine contraceptive device

Background: This study was planned to evaluate acceptability, safety and continuation rate of postpartum intrauterine contraceptive device (PPIUCD) and to compare it with well accepted post MTP IUCD in Indian population.Methods: This was a prospective study conducted in VMMC and Safdarjang Hospital, New Delhi, India. Copper T 380-A was inserted in 100 woman in postpartum period and in 100 woman in post MTP period. Follow up done at 6 weeks, 3 months and 6 months. Safety was assessed in terms of expulsion, IUCD failure/pregnancy rate, perforation, removal of IUCD, visibility of strings and various complain at each visit. Continuation rate along with their level of satisfaction was compared at the end of 6 months. SPSS software, Chi-square test and student T test were used for analyzing the results. P value ≤0.05 considered as significant.Results: Acceptance of post MTP IUCD was more than PPIUCD. There was statistically no significant difference in expulsion rate, removal of IUCD and various complaints. There was no case of perforation in either group. Non visibility of strings was major cause of concern and apprehension in PPIUCD group. Only one case of pregnancy was reported in PPIUCD group while no failure was reported in post MTP group. Continuation rate and level of satisfaction were comparable in both groups.Conclusions: PPIUCD is equally safe and effective as post MTP IUCD.

Psycho sexual profile of perimenopausal and post-menopausal women visiting a tertiary care centre

Background: The objective was to study the psychosexual profile of perimenopausal and postmenopausal females visiting a tertiary care centre.Methods: The present study was carried out in the Obstetrics and Gynecological Department of Subharti Medical College and Hospital from July 2013 to June 2015.A questionnaire was made including the questions regarding the various symptoms and problems encountered by both peri and postmenopausal females. A detailed interaction in the form of history and examination was done on a total of 220 patients which included both type of females. They were then given a questionnaire which they filled it by themselves or with assistance from our side. The females in both the groups were then analysed on the presence or absence of a particular symptom and whether the difference was statistically significant or not and the data was analysed using Chi square test.Results: The study showed varied symptoms in both the type of females be it Perimenopausal or post-menopausal. The vasomotor and the psychological symptoms were more common in the perimenopausal females whereas the physical and sexual symptoms were more common in post-menopausal females. Variations from this pattern were also found. The mean age of menopause was found to be 48.3 years with only 1.81% females above 70 years.Conclusions: The perimenopausal and postmenopausal females do undergo many physiological as well as psychological changes that surely affects their social, personal as well as sexual life. Thus they require a lot of care and support and adequate evaluation so that they can be treated well.

Impact of levonorgestrel intrauterine system on metabolic parameters

Background: Hormonal contraceptive is suggested to affect parameters like body mass index, body weight, blood pressure (BP), blood sugar, lipid protein, and liver function test (LFT) but effect of LNG-IUS on those parameters is still uncertain. The aim of the present study was to study the effects of LNG-IUS on the metabolic parameters.Methods: Sixty women who opted for LNG-IUS for various indications were included in the study. Lipid profile, liver function tests (LFT), glucose levels [fasting and post prandial (PP)], and hemoglobin (Hb) were tested. Bimanual genital examination and transvaginal-ultrasonography was done prior to LNG-IUS insertion. Any problems observed were recorded. The subjects were re-evaluated after 6 and 9 months on their subsequent visits. Data were analyzed using paired “t” test. P value of <0.05 was considered statistically significant.Results: Mean age of the patients was 35.5±6.79 years. Maximum number 50 (83.3%) had abnormal uterine bleeding (ovulatory dysfunction, endometrial, iatrogenic, not yet classified) [AUB (OEIN)]. Mean pictorial blood loss assessment chart (PBAC) score of patients was 164.7±56.72 and mean Hb level 11.15±1.75g/dL. LNG-IUS showed no significant adverse effects on anthropometric parameters at 6- and 9-month follow-up. Significant change was seen in total cholesterol (TC), very low-density lipoprotein (VLDL) and high density lipoproteins (HDL) values at follow-up (p<0.0001).Conclusions: In conclusion, amongst Asian population, the LNG-IUS does not have any adverse effects on metabolic parameters, TGs, LDL and blood sugar levels

Role of LNG-IUS in adenomyosis in reproductive age group women: a prospective interventional study

Background: The objective of the present study was to observe the efficacy of LNG-IUS in the treatment of heavy menstrual bleeding and dysmenorrhoea associated with adenomyosis.Methods: LNG-IUS was inserted in forty women between 20-50 years of age presenting with heavy menstrual bleeding and dysmenorrhoea associated with adenomyosis diagnosed on transvaginal ultrasonography and followed up after 1 month, 3 months and 6 months of insertion. Subjective assessment of menstrual blood loss was done by pictorial blood loss assessment chart and dysmenorrhoea was assessed on the basis of universal pain assessment tool and side effects were noted at each visit.Results: Mean patients’ age was between 31-40 years (72.5%) and the follow up duration was 6 months. Significant improvements in dysmenorrhea, HMB and haemoglobin levels were observed. There was no significant change in the uterine volume. The most common side effect was prolonged vaginal spotting (n=26, 65%) and pain abdomen (n=13, 32.5%). LNG-IUS expulsion was observed in 1 patient (n=1, 2.5%). 3 patients underwent hysterectomy (n=3, 7.5%). The overall success rate of LNG-IUS was 82.5%.Conclusions: The LNG-IUS appears to be an effective method in alleviating dysmenorrhoea and heavy menstrual bleeding associated with adenomyosis during 6 months of study. It may be a valuable long-term alternative for the treatment of adenomyosis in young and perimenopausal women and it is a good strategy to reduce the number of hysterectomies in women with adenomyosis

Knowledge and attitude of women attending Subharti Medical College towards Pap smear

The aim of this prospective study was to assess the knowledge and attitude of women towards the Pap smear. It was carried out on the women coming to the Department of Obstetrics and Gynaecology at our University, with the help of a pre-formed questionnaire. We found that only 33% of the women were aware of the Pap smear, and of these hardly (10%) had the correct information. Sixty-five percent of the women said that they would have gotten the Pap smear done, if they had known about it earlier. Unless this knowledge amongst women is improved and their attitude is changed, the indices of cervical cancer cannot be improved.Impact statement What is already known on this subject? A Pap smear is used as a screening test to detect not only early stages of cervical cancer but also the precancerous conditions. A Pap smear is done every three years for routine screening, or every five years along with an HPV DNA test. What do the results of this study add? Despite the efforts from the medical fraternity and governments, the number of women undergoing this test in Uttar Pradesh is very minimal. This study analysed the knowledge and attitude of women towards the Pap smear. What are the implications of these findings for clinical practice and/or further research? The results have brought into light the many factors hindering an effective cervical cancer screening in India. Further actions need to be directed in the direction to address these issues

Computational and experimental therapeutic efficacy analysis of andrographolide phospholipid complex self-assembled nanoparticles against Neuro2a cells

Background: Neuroblastoma is one of the most common malignancies in childhood, accounts for approximately 7% of all malignancies. Andrographolide (AN) inhibits cancer cells progression via multiple pathways like cell cycle arrest, mitochondrial apoptosis, NF-κβ inhibition, and antiangiogenesis mechanism. Despite multiple advantages, application of AN is very limited due to its low aqueous solubility (6.39 ±0.47 μg/mL), high lipophilicity (log P ~ 2.632 ±0.135), and reduced stability owing to pH sensitive lactone ring. Objectives and results: In present investigation, a molecular complex of AN with soya-L-α-phosphatidyl choline (SPC) was synthesized as ANSPC and characterized by FT-IR and1H NMR spectroscopy. Spectral and molecular simulation techniques confirmed the intermolecular interactions between the 14-OH group of AN and the N+(CH3)3 part of SPC. In addition, molecular dynamics (MD) simulation was used to determine the degree of interaction between various proteins such as TNF-α, caspase-3, and Bcl-2. Later, ANSPC complex was transformed in to self-assembled soft nanoparticles of size 201.8 ±1.48 nm with PDI of 0.092 ± 0.004 and zeta potential of 21.7 ± 0.85 mV. The IC50 of free AN (8.319 μg/mL) and the self-assembled soft ANSPC nano-particles (3.406 μg/mL ~ 1.2 μg of AN) against Neuro2a cells was estimated with significant (P <0.05) difference. Interestingly, the self-assembled soft ANSPC nanoparticles showed better endocytosis compared to free AN in Neuro2a cells. In vitro biological assays confirmed that self-assembled soft ANSPC nanoparticles induces apoptosis in Neuro2a cells by declining the MMP (Δψm) and increasing the ROS generation. Conclusion: Self-assembled soft ANSPC nanoparticles warrant further in-depth antitumor study in xenograft model of neuroblastoma to establish the anticancer potential