Vitamin E in the treatment of primary dysmenorrhoea

Background: The objective of this study is to determine the efficacy of Vitamin E in the treatment of primary dysmenorrhoea compared to the placebo.Methods: Sixty women, aged 17-25 years old who suffered from primary dysmenorrhoea, among 1000 Women attending the gynec OPD in Kilpauk Medical College. 30 women were given 200 units of vitamin E (each tablet twice daily) and 30 were given a placebo tablets (each tablet twice daily). The treatment began two days before the beginning of menstruation and continued through the first three days of bleeding. The severity of pain and duration of pain before and after the treatment was studied. Treatment in both groups was carried out in three consecutive menstrual periods.Results: As to the findings, the mean age of the participants was 22.6 years. There was a significant difference between the pre- and post-treatment periods in terms of pain severity (P=0.72 and P=0.002, respectively) and pain duration (P=0.514 and P=0.027, respectively) in Vitamin E group. There was a significant difference observed between the Vitamin E group and placebo group regarding the mean of pain severity and duration (P=0.002 and p=0.027 respectively).Conclusions: Vitamin E helps to relieve pain in primary dysmenorrhoea. As this is a relatively easier method for control of pain with lesser amount of side effects and as it is cost effective, it can be considered as a universal drug in the treatment of primary dysmenorrhoea

Long term clinical outcome of intra caesarean intrauterine contraceptive device insertion

Background: Adequate spacing following caesarean section prior to next pregnancy will decrease maternal and neonatal complications. Unmet need of contraception is still high in our country. Motivating women for intra caesarean copper T insertion will decrease the incidence of unintended pregnancies. Postpartum intra uterine contraceptive device (PPIUCD) insertion is an effective, long-term, reversible, nonhormonal contraceptive, best suited for Indian women. This study aims to evaluate long term complications like bleeding, pain, expulsion rate, perforation, infection, missing strings and continuation rate.Methods: This prospective observational study was carried out in a tertiary care hospital in Chennai, between January 2012-June 2015. CuT 380A was inserted immediately following placental delivery in caesarean section. They were followed up at the time of discharge, at 6 weeks, then at 6 monthly intervals till 30months.Results: A total of 235 PPIUCD acceptors were followed up for 30 months. Most of our acceptors are primipara group (n=156, 66.4%). Continuation rate is high 84.7% (n=199) at the end of 30 months. Expulsion rate was 2.55% (n=6), bleeding in 8.5% (n=20), pain in 8.9% (n=21) and infection in 0.85% (n=2) of acceptors. Removal rate at 30 months was 12.7% (n=30), majority of the removal was for opting to go for permanent method of sterilization (n=117, 7.2%), followed by planning next pregnancy (n=6, 2.55%). Pain was the cause for removal in only 0.67%, bleeding in 1.67%. Missing strings were observed in 11.9% (n=28), of which ultrasound confirmed in situ uterine cavity location in 22 acceptors.Conclusions: Intra caesarean IUCD insertion is a safe and effective method of contraception for spacing with high continuation rate, low expulsion and complication rates

Clinical profile and pregnancy outcome following tubal recanalisation

Background: Female sterilization by tubal ligation accounts for 36% of all methods of family planning used in our country. Almost half of tubal ligations are done in women younger than 25 years. These women want reversal of tubectomy subsequently, in circumstances like death of children, remarriage. This study aims to evaluate various factors affecting the outcome of pregnancies following microsurgical tubal recanalisation.Methods: It is a prospective observational study carried out at Govt Kilpauk Medical College for a total number of 50 patients who have undergone tubal recanalisation during 2011 and 2012. They were followed up till December 2016.Results: 84% of women (n-42) opted for recanalisation were in young reproductive age (<30 years) group. Conception rate was higher in younger age group (52.9% in 21-25 years). Death of children (n-37, 74%) and remarriage (n-12, 24%) were the common indications for tubal recanalisation. Outcome is better if reversal surgery is done within 4 years after sterilization (69.6%, n-16 out of 23) than after 4 years (30.4%, n-7out of 23). Conception rate (55.3%, n-21) was higher and statistically significant in subjects with final length of tube more than 4 cms (P value -0.0193). Conception rate was higher within 1 year of recanalisation (n-13, 26%), followed by 16% (n-8) in 2nd year and statistically significant (p- 0.00001). Overall pregnancy rate in our study was 46% (n-23). Out of the 23 women who conceived, 14 (61%) resulted in live birth, 3 (13%) abortions and the remaining 6(26%) had ectopic pregnancies.Conclusions: Proper selection of patients and meticulous tuboplasty technique can yield successful pregnancy outcome comparable to ART

An analytical cross sectional study on hypothyroidism in pregnancy, its maternal and fetal outcome

Background: Hypothyroidism is associated with maternal and fetal complications. This study aims to evaluate the prevalence, maternal and fetal outcome in hypothyroidism. Objective of this study was to determine whether thyroid function test can be recommended as a universal or selective screening in pregnancy.Methods: An analytical cross-sectional study with internal comparison carried out at Govt. Kilpauk Medical College & Hospital from September 2017 to July 2018 for antenatal mothers in third trimester. Serum TSH and freeT3, T4 in case of abnormal TSH were measured, grouped into subclinical and overt hypothyroidism and were treated with Levothyroxine. Six-week follow-up with TSH, pregnancy complications were observed.Results: 932 pregnant mothers were followed up. Prevalence of hypothyroidism was 10.5% (n = 98). Among the hypothyroid 62.24% (n = 61) had subclinical and 37.76% (n = 37) had overt hypothyroidism. The prevalence of anaemia was 35% in overt and 15% in subclinical hypothyroid group (p = 0.019). Preeclampsia is reported in 49% of overt and 16% of subclinical hypothyroid group (p = <0.001), statistically significant. Eclampsia was noted in 1 (1.64%) overt hypothyroid patient. Abruptio placenta was observed in 1 subclinical and 4 overt hypothyroid patients (5.1%). The incidence of preterm labour in this study subjects was 38% in overt and 20% in subclinical hypothyroid group (p = 0.048). The incidence of LBW fetus was 41% in overt hypothyroid and 21% in subclinical hypothyroid group (p = 0.041). The incidence of complication in this study was 41% in subclinical and 78% in overt hypothyroid group (p = <0.001).Conclusions: Early screening, adequate treatment and follow up will bring down maternal and fetal complications in hypothyroidism

Comparative study of Misoprostol Vs Oxytocin in Induction of Labour in Term Prelabour Rupture of Membranes

INTRODUCTION: Prelabour Rupture of membranes is a common obstetrical problem. It is a significant event as it transforms an ordinary pregnancy into a high risk one. Management depends upon careful weighing of fetal condition, neonatal intensive care facilities and presence of complicating factors. Overall incidence is 5-10% Premature Rupture of membranes is defined as “Rupture of membranes prior to onset of labour” by Embrey (1953), Flowers (1962), Downley (1958), & Eastman (1966). According to Prof. Chauha & Arulkumaran prelabour rupture of membranes is “Spontaneous breach of chorio amnion with release of amniotic fluid with latent period before the onset of labour”. Authors like Ianios(1965) and Lebher(1963) diagnose PROM only when a latent period of 1-12 hours has elapsed following amniorrhexis occurring at anytime prior to the onset of labour, regardless of period of gestation. Majority of Cases of PROM – of about 60% occur after 37 completed weeks. PROM is a significant event that transforms pregnancy into a high risk one by increasing maternal and neonatal morbidity and mortality. Maternal complications like Chorioamnionitis, puerperal fever are more common in PROM. Active management of PROM decreases complications and associated maternal and neonatal morbidity and mortality. Induction of labour is artificial or non-spontaneous initiation of uterine contractions that leads to progressive cervical dilatation and effacement resulting in delivery of baby or products of conception. Since early days of 1950’s when Oxytocin was synthesized, induction of labour has become more popular and accepted as an option in the management of PROM. Misoprostol, a methyl ester of PGE1 is being under trial for past few years in induction of labour. Misoprostol is receiving attention as a cervical modifier and labour induction agent. This study compares the safety and efficacy of Misoprostol with Oxytocin in labour induction in Term Prelabour rupture of membranes. AIM OF THE STUDY: The present study is undertaken to compare the safety and efficacy of Misoprostol with that of Oxytocin in labour induction in TERM PROM. The effects were compared between Primipara and Multipara in a selected sample. OBJECTIVES: 1) To study the effect on labour induction and compare the induction – delivery interval between 2 drugs. 2) To compare the mode of delivery between 2 groups. 3) To compare the foetal and maternal adverse effects between 2 drug groups. 4) To compare the maternal and foetal outcome between 2 drug groups. 5) To assess the cost effectiveness between 2 drugs. MATERIALS AND METHODS: SETTING: This study was carried out in the Institute of Obstetrics and Gynecology, Madras Medical College, Chennai. STUDY DESIGN: Prospective randomized control study. STUDY PERIOD: July 2004 – Feb 2006. SAMPLE SIZE: Determined by statistical analysis. Statistical analysis was done using chi square test and student ‘t’ test used in appropriate places. About 200 women were randomized to either Misoprostol or Oxytocin. Diagnosis of prelabour rupture of membranes made on the basis of history, clinical examination, and speculum examination and confirmed with USG. INCLUSION CRITERIA: 1. Singleton pregnancy, 2. Cephalic presentation, 3. Bishop’s score < 4, 4. Completed 37 weeks of gestational age, 5. Live fetus showing no signs of fetal compromise on admission CTG. EXCLUSION CRITERIA: 1. Multiple pregnancy, 2. Non cephalic presentations, 3. Bishop’s Score > 4, 4. H/o previous scar, Uterine Surgery, 5. Any medical Conditions complicating Pregnancy, 6. Hydramnios, IUGR, Gestational age < 37 weeks, 7. Women in labour, 8. Suspected chorioamnionitis. At the time of entry into study name, age, status of booking, immunization, menstrual history, marital history, obstetrical history, medical and personal history were noted down. General Condition is assessed by pulse rate, Blood Pressure, Height, Weight with particular attention to pedal odema, anemia. Cardiovascular and respiratory systems were examined. Obstetrics examination includes size of uterus, lie, presentation, attitude, foetal heart sound and rate, liquor adequacy and estimated foetal weight Pelvic examination was done to rule out cephalo pelvic disproportion and for Bishop’s scoring. USG done for foetal maturity, Liquor status and for foetal well-being. Admission CTG done. SUMMARY: 1. Misoprostol at 25μg dose repeated 6th hourly is an effective, cheap, safe and easy to use labour induction agent. 2. Induction – delivery internal is shorter in primipara in Misoprostol group compared to Oxytocin group. 3. For multipara, no significant difference in Induction – delivery interval is observed between both the groups. 4. No statistically significant difference was observed in caesarean section rate between two drug groups. 5. Neonatal outcomes were comparable between both groups. 6. Maternal complications were not significantly different between both groups. 7. No increased incidence of tachysystole / Hyper tonus / Hyper stimulation observed. 8. Misoprostol is cost effective, easy to use and stable at room temperature. CONCLUSION: Misoprostol is an effective, cheap, safe, stable at room temperature and easy to use if it is used in appropriate dosage for induction of labour in prelabour rupture of membranes at term

Clinical profile and pregnancy outcome following tubal recanalisation

Background: Female sterilization by tubal ligation accounts for 36% of all methods of family planning used in our country. Almost half of tubal ligations are done in women younger than 25 years. These women want reversal of tubectomy subsequently, in circumstances like death of children, remarriage. This study aims to evaluate various factors affecting the outcome of pregnancies following microsurgical tubal recanalisation.Methods: It is a prospective observational study carried out at Govt Kilpauk Medical College for a total number of 50 patients who have undergone tubal recanalisation during 2011 and 2012. They were followed up till December 2016.Results: 84% of women (n-42) opted for recanalisation were in young reproductive age (&lt;30 years) group. Conception rate was higher in younger age group (52.9% in 21-25 years). Death of children (n-37, 74%) and remarriage (n-12, 24%) were the common indications for tubal recanalisation. Outcome is better if reversal surgery is done within 4 years after sterilization (69.6%, n-16 out of 23) than after 4 years (30.4%, n-7out of 23). Conception rate (55.3%, n-21) was higher and statistically significant in subjects with final length of tube more than 4 cms (P value -0.0193). Conception rate was higher within 1 year of recanalisation (n-13, 26%), followed by 16% (n-8) in 2nd year and statistically significant (p- 0.00001). Overall pregnancy rate in our study was 46% (n-23). Out of the 23 women who conceived, 14 (61%) resulted in live birth, 3 (13%) abortions and the remaining 6(26%) had ectopic pregnancies.Conclusions: Proper selection of patients and meticulous tuboplasty technique can yield successful pregnancy outcome comparable to ART

Vitamin E in the treatment of primary dysmenorrhoea

Background: The objective of this study is to determine the efficacy of Vitamin E in the treatment of primary dysmenorrhoea compared to the placebo.Methods: Sixty women, aged 17-25 years old who suffered from primary dysmenorrhoea, among 1000 Women attending the gynec OPD in Kilpauk Medical College. 30 women were given 200 units of vitamin E (each tablet twice daily) and 30 were given a placebo tablets (each tablet twice daily). The treatment began two days before the beginning of menstruation and continued through the first three days of bleeding. The severity of pain and duration of pain before and after the treatment was studied. Treatment in both groups was carried out in three consecutive menstrual periods.Results: As to the findings, the mean age of the participants was 22.6 years. There was a significant difference between the pre- and post-treatment periods in terms of pain severity (P=0.72 and P=0.002, respectively) and pain duration (P=0.514 and P=0.027, respectively) in Vitamin E group. There was a significant difference observed between the Vitamin E group and placebo group regarding the mean of pain severity and duration (P=0.002 and p=0.027 respectively).Conclusions: Vitamin E helps to relieve pain in primary dysmenorrhoea. As this is a relatively easier method for control of pain with lesser amount of side effects and as it is cost effective, it can be considered as a universal drug in the treatment of primary dysmenorrhoea