Clinical study comparing immediate intra caesarean iucd insertion and extended postpartum iucd insertion in caesarean deliveries

INTRODUCTION: In India, Ministry of health and family welfare emphasis on postpartum Cu-T380A insertion which has the advantage of high motivation, safety and convenience for both patients and the service provider. Here we conducted a pilot clinical study comparing intra-caesarean Cu-T380A insertion and interval insertion in caesarean deliveries. MATERIALS AND METHODS: A systematic study with 150 patients in each group recruited clients alternately. Group A intra-caesarean insertion and Group B interval insertion in caesarean deliveries. The cases were followed up at 6weeks and 6months post-insertion with a set of parameters. Here we look for Missed strings, Expulsion and Infection rate as the primary outcome measures. Complications as the secondary outcome measures. RESULTS: Infection rate is found to be higher in Group A (2.3%) than Group B (1.6%) p=1.000 at 6th week. At 6th month, infection is higher in Group B (1.8%) than Group A (0.9%) p=0.617. Missed strings are found to be higher in intra-caesarean than interval method both at 6th week and 6th month follow up p=0.00 and p=0.00 respectively, hence significant. Expulsion rate is found to be higher in Group A (2.5%) than Group B (1.7%) p=1.000 at 6th week. At 6th month there is no IUCD expulsion in Group A (0%) than in Group B where there is (1.9%) expulsion p=0.497. There is no complications such as uterine perforation and contraceptive failures in both groups during the study period. On statistical analysis, it is found that there is no significant difference in infection and expulsion rate between the groups. For missed strings there is a significant difference between the groups with more missed strings in intra-caesarean method. CONCLUSION: To conclude that, intra-caesarean method is equally effective as interval method without any added complications for contraception in caesarean deliveries, with added advantage of high motivation, good compliance, and safety and easy for provider to deliver the services

A comparative clinical study between intra-caesarean and interval intra uterine copper device insertion in caesarean deliveries

Background: Health and family welfare of Indian Ministry, emphasis on postpartum IUCD insertion. Here we conducted a clinical study comparing intra-caesarean and interval CuT-380A insertion in caesarean deliveries.Methods: A systematic study with 150 patients in each group, recruited clients alternately. Group A Intra-Caesarean Cu-T insertion and Group B Interval Cu-T insertion in caesarean deliveries. Groups were followed up at 6th week and 6th month post insertion with a set of parameters. Missed strings, expulsion and infection rates were the primary outcome measures.Results: Infection rate is higher in Group A (2.3%) at 6th week, and at 6th month infection rate is higher in Group B (1.8%). Missed strings are higher in intra-caesarean than in interval insertion method both at 6th week and 6th month follow up p=0.000, hence significant. Expulsion rate is higher in Group A (2.5%) at 6th week, and at 6th month expulsion rate is higher in Group B (1.9%). There are no complications such as uterine perforation or contraceptive failures in both the groups during the study period. By analysis, there are no significant differences in infection and expulsion rates between the groups. For missed strings there is significant difference between the groups with more missed strings in intra-caesarean insertion method.Conclusions: To conclude, intra-caesarean method is equally effective as interval IUCD insertion method without added complications in caesarean deliveries, with advantage of high motivation, good compliance, safety and ease for the provider to deliver services.

A clinical observational study on second-trimester abortion

Background: Second-trimester abortion is an important component of the comprehensive women’s health care. Data’s regarding second-trimester abortion is still under-reporting. Though the percentage of induced second-trimester abortion is low, its morbidity is higher than the first-trimester induced abortion. The abortion related mortality usually increases with the age of gestation.Methods: A retrospective observational study was conducted in the department of obstetrics and gynecology at Sree Balaji Medical College and Hospital, Chennai, over a period of one year. The data were collected from the medical case records and we have analyzed on the epidemiology, etiologies, complications and the methods of second- trimester abortion using statistical analysis.Results: In this study, there was no standard regimen of mifepristone and misoprostol were used for second-trimester abortion.  The dosages were varied based on the gestational age of pregnancy. As the gestational age progresses, the amount of misoprostol required for the induction of second trimester abortion decreases and the difference is statistically significant. There was no reported case of rupture uterus, but varied complications such as post-abortal hemorrhage, retained placenta, need for blood transfusion, uterine perforation and one maternal death were reported during the study period.Conclusions: In order to reduce the morbidity and mortality of second trimester abortion, more policies and monitored services have to be rendered by the health system. Data regarding the second trimester abortion have to be improved.

Factors influencing plasma nevirapine levels: a study in HIV-infected children on generic antiretroviral treatment in India

Background: Nevirapine is an important component of paediatric combination HIV therapy. Adequate drug exposure is necessary in order to achieve long-lasting viral suppression. Objectives: To study the influence of age, drug dose and formulation type, nutritional status and CYP2B6 516G.T polymorphism on blood concentrations of nevirapine in children treated with generic antiretroviral drugs. Methods: A multicentre study was conducted at four sites in India. HIV-infected children receiving generic nevirapine-based fixed-dose combinations were recruited. Trough and 2 h nevirapine plasma concentrations were determined by HPLC. Characterization of the CYP2B6 gene polymorphism was performed using direct sequencing. Clinical and nutritional status was recorded. Groups were compared using the Mann–Whitney U-test and multivariable logistic regression analysis was performed to identify factors contributing to low drug levels. Results: Ninety-four children of median age 78 months were studied; 60% were undernourished or stunted. Stunted children had a significantly lower 2 h nevirapine concentration compared with non-stunted children (P,0.05); there were no significant differences in trough concentrations between different nutritional groups. Nevirapine levels were significantly higher in children with TT compared with GG and GT CYP2B6 genotypes (P,0.01). Children ≤3 years had a 3.2 (95% confidence interval 1.07–9.45) times higher risk of having sub-therapeutic nevirapine concentrations. Conclusions: Nevirapine blood concentrations are affected by many factors, most notably age ≤3 years; a combination of young age, stunting and CYP2B6 GG or GT genotype could potentially result in sub-therapeutic nevirapine concentrations. Dosing recommendations for children should be reviewed in the light of these findings