Transcervical Foley’s catheter: a promising option for induction of labour

We hereby report the results of a small randomized prospective study where we compared the efficiency and efficacy of transcervical extra-amniotic Foley catheter placement to intravaginal dinoprostone gel as a method of induction of labour

Study of knowledge and contraception practices in low socio-economic women of Delhi

Background: Objective of current study was to assess the knowledge and practice of contraception among the low socio-economic women of reproductive age group in Delhi.Methods: A cross-sectional study was done on 272 low socio-economic women attending a family planning clinic at a Delhi municipal corporation hospital, of which 106 came for Medical Termination of Pregnancy (MTP) and 166 came for family planning advice. They were interrogated through a pre-designed structured questionnaire, to evaluate their knowledge and practices towards regular contraceptive methods, Emergency Contraception (EC) and medical abortion. They were counselled about the available contraceptive methods and allowed to make choices according to their suitability.Results: All women belonged to low socio-economic group according to the modified Kuppuswamy scale. 22.1% were illiterate. 47.8% were ignorant of contraception. 38.3% women were aware of EC. Only 24.2% knew about medical abortion. The main reasons cited for not using contraception was desire for male child (24.6%), fear of side effects (20%), desire for another child (20%), opposition from family members (15.4%), inaccessibility (4.6%) and inconvenience and lack of privacy (5.4%).  Conclusions: This study highlights that lack of education, knowledge and awareness led to inadequate usage of regular methods of contraception in reproductive age group women belonging to low socio-economic status. Thus only availability is not sufficient to reach optimum female health. Accessibility need to be increased by educating females and motivating couples to make adequate use of existing family planning methods and resources. In contrast the awareness for emergency contraception is more than regular methods. It mandates need to educate women that emergency contraception should not replace regular methods.

A large posterior vaginal wall cyst simulating rectocele: an account of an unusual perplexing case

Benign cystic lesions of the vagina are uncommon, often being an asymptomatic incidental finding revelled during routine gynaecological examination. Large vaginal wall cysts > 5cm size are a rare gynaecological entity. Most of the work available in literature accounts their mullerian genesis. Large epidermal inclusion cysts are further rarer. Thus, here is described a case illustrating an exceptional case of large epidermal inclusion vaginal wall cyst mimicking rectocele. Also, clinical considerations and relevant literature review on the same has been addressed. A 40 year old lady P2L2 presented in gynecology OPD with complaints of feeling of fullness in the vagina associated with some mass protruding out of the vagina for last few years. Careful evaluation indicated it to be a large posterior vaginal wall cyst 7x6 cm, aping enterocele, lying separate from rectum. The cyst was then surgically excised without any intraoperative or postoperative complications. Giant vaginal cysts are an uncommon occurrence. Meticulous clinical evaluation, bolstered with pertinent investigations can help in clinching the diagnosis early

Host immune responses to chlamydial inclusion membrane proteins B and C in Chlamydia trachomatis infected women with or without fertility disorders

<p>Abstract</p> <p>Background</p> <p>With an increase in the number of putative inclusion membrane proteins (incs) in chlamydial genomes, there is a need for understanding their contribution in host-pathogen interactions. Thus in this study we determined the host mucosal and peripheral immune responses to incs (IncB and IncC) of Chlamydia trachomatis (CT).</p> <p>Methods</p> <p>Female patients (n = 296) attending the gynaecology out patient department of Safdarjung hospital, New Delhi were enrolled for the study and were clinically characterized into two groups; CT-positive fertile women (n = 38) and CT-positive women with fertility disorders (n = 29). Uninfected healthy fertile women were enrolled as controls (n = 31). Gene specific PCRs were used for detection of incB and incC genes in endocervical samples of CT-positive patients. ELISA and Western blot assay were used for detection of IgA and IgG antibodies to IncB and IncC in cervical washes and sera. Effect of IncB and IncC stimulation of cervical cells and PBMCs on cellular proliferation and cytotoxity was determined using MTT assay and Lactate dehydrogenase (LDH)-cytotoxicity assay respectively. Modulation of cytokines (Interleukin (IL)-1 Beta, IL-4, IL-5, IL-6, IL-10, Interferon-gamma, IL-12, Tumor Necrosis Factor-alpha and Granulocyte macrophage colony-stimulating factor (GM-CSF)) in cervical cells and PBMCs upon stimulation with IncB and IncC was determined by real-time reverse-transcriptase (RT)-PCR and ELISA. Further, CD4 positive T cells were purified from cervical cells and peripheral blood mononuclear cells (PBMCs) and secreted cytokines (Interferon-gamma and IL-4) were evaluated by ELISPOT and real-time RT-PCR.</p> <p>Results</p> <p>Using MTT assay, significantly high proliferative responses (P < 0.05) were observed in inc-stimulated cervical cells and PBMCs from CT-positive fertile women compared to CT-positive women with fertility disorders and controls. Interferon-gamma, IL-12 and GM-CSF were found to be elevated in inc-stimulated cervical cells and PBMCs of CT-positive fertile women compared to CT-positive women with fertility disorders and controls (P < 0.05). In contrast, IL-1 Beta, IL-4, IL-5, IL-6 and IL-10 levels were found to be higher in CT-positive women with fertility disorders compared to CT-positive fertile women and controls (P < 0.05). Interferon-gamma secreting cells and mRNA expression in inc-stimulated cervical and peripheral CD4 positive T cells were significantly higher (P < 0.05) in CT positive fertile women compared to CT-positive women with fertility disorders.</p> <p>Conclusion</p> <p>Our data overall suggests that CT incs, IncB and IncC modulate host immune responses and may have a role in protection/pathogenesis of genital chlamydial infection in women.</p

A rare case of fourth consecutive fallopian tube ectopic pregnancy

We present a case of consecutive fourth tubal ectopic in a patient which was managed by emergency laparotomy and salpingectomy. The first two tubal ectopic pregnancies occurred on the right side while the subsequent two occurred on the contralateral side. The patient was planned for IVF-ET

Evaluation of Hematological Parameters in Partial Exchange and Packed Cell Transfusion in Treatment of Severe Anemia in Pregnancy

Objectives. Anemia is a major public health problem throughout the world which assumes prominence in pregnant mothers. Patients with severe anemia continue to present themselves at term or in labor. This study was conducted to compare the improvements in hematological parameters of patients receiving partial exchange blood transfusion and transfusion of packed cells without exchange. Methods. One hundred and twenty-five severely anemic antenatal mothers were admitted from outpatient service. Partial exchange transfusion was given to sixty-six patients while fifty-nine received transfusion of packed cells with frusemide cover. Results. The two groups were comparable in terms of age, height, weight, religion, diet, education, occupation of self and husband, and income. Hemoglobin level in Group 1 was comparatively less than Group 2 at prelevel (5.2 ± 1.5 versus 6.6 ± 2.3, P = 0.001) and postlevel (7.2 ± 1.5 versus 8.6 ± 1.8, P = 0.001), respectively, but there was no significant difference between the two modes of transfusion (2.09 ± 1.6 versus 2.01 ± 1.5, P = 0.78). Conclusion. The study produced an equally significant improvement in hematological parameters in partial exchange and packed cell transfusion. Platelet counts were significantly less in partial exchange as compared with packed cell transfusion

Modulation of cytokines and transcription factors (T-Bet and GATA3) in CD4 enriched cervical cells of Chlamydia trachomatis infected fertile and infertile women upon stimulation with chlamydial inclusion membrane proteins B and C

<p>Abstract</p> <p>Background</p> <p>Chlamydial Inclusion membrane proteins (Incs), are involved in biochemical interactions with host cells and infecting Chlamydiae. We have previously reported the role of two Chlamydia trachomatis (CT) Incs, namely IncB and IncC in generating host immunity in CT infected women. Emerging data shows involvement of Inc stimulated CD4 positive T cells in aiding host immunity in infected fertile and infertile women through the secretion of interferon gamma. However the lack of data on the intra-cytokine interplay to these Incs in infected cell milieu prompted us to investigate further.</p> <p>Methods</p> <p>A total of 14 CT-positive fertile, 18 CT-positive infertile women and 25 uninfected controls were enrolled in this study. CD8 depleted, CD4 enriched cervical cells were isolated and upon stimulation with IncB and IncC, modulation of cytokines (Interleukin (IL)-1 Beta, IL-4, IL-5, IL-6, IL-10, Interferon-gamma, IL-12, IL-23, Tumor Necrosis Factor-alpha and Granulocyte macrophage colony-stimulating factor (GM-CSF) and T cell lineage regulating transcription factors T-Bet and GATA3 was determined by real-time reverse-transcriptase (RT)-PCR and ELISA.</p> <p>Results</p> <p>Significant higher expression (P < 0.05) of Interferon-gamma, IL-12, IL-23 and GM-CSF were found in Inc-stimulated CD4 enriched cervical cells of CT-positive fertile women and contrastingly high IL-1 Beta, IL-4, IL-5, IL-6 and IL-10 levels were found in CT-positive infertile women. Positive correlation (P < 0.05) was found between Interferon-gamma and T-Bet levels in CT-positive fertile women and IL-4 mRNA and GATA3 levels in CT-positive infertile patients upon IncB and IncC stimulation.</p> <p>Conclusion</p> <p>Overall our data shows that CT IncB and IncC are able to upregulate expression of cytokines, namely interferon-gamma, IL-12, IL-23 and GM-CSF in CT-positive fertile women while expression of IL-1 Beta, IL-4, IL-5, IL-6 and IL-10 were upregulated in CT-positive infertile women. Our study also suggests that Incs are able to modulate expression of T cell lineage determinants indicating their involvement in regulation of immune cells.</p

In infertile women, cells from Chlamydia trachomatis infected site release higher levels of interferon-gamma, interleukin-10 and tumor necrosis factor-alpha upon heat shock protein stimulation than fertile women

<p>Abstract</p> <p>Background</p> <p>The magnitude of reproductive morbidity associated with sexually transmitted Chlamydia trachomatis infection is enormous. Association of antibodies to chlamydial heat shock proteins (cHSP) 60 and 10 with various disease sequelae such as infertility or ectopic pregnancy has been reported. Cell-mediated immunity is essential in resolution and in protection to Chlamydia as well as is involved in the immunopathogenesis of chlamydial diseases. To date only peripheral cell mediated immune responses have been evaluated for cHSP60. These studies suggest cHSPs as important factors involved in immunopathological condition associated with infection. Hence study of specific cytokine responses of mononuclear cells from the infectious site to cHSP60 and cHSP10 may elucidate their actual role in the cause of immunopathogenesis and the disease outcome.</p> <p>Methods</p> <p>Female patients (n = 368) attending the gynecology out patient department of Safdarjung hospital, New Delhi were enrolled for the study and were clinically characterized into two groups; chlamydia positive fertile women (n = 63) and chlamydia positive infertile women (n = 70). Uninfected healthy women with no infertility problem were enrolled as controls (n = 39). cHSP60 and cHSP10 specific cytokine responses (Interferon (IFN)-gamma, Interleukin (IL)-10, Tumor Necrosis Factor (TNF)-alpha, IL-13 and IL-4) were assessed by ELISA in stimulated cervical mononuclear cell supernatants.</p> <p>Results</p> <p>cHSP60 and cHSP10 stimulation results in significant increase in IFN-gamma (P = 0.006 and P = 0.04 respectively) and IL-10 levels (P = 0.04) in infertile group as compared to fertile group. A significant cHSP60 specific increase in TNF-alpha levels (P = 0.0008) was observed in infertile group as compared to fertile group. cHSP60 and cHSP10 specific IFN-gamma and IL-10 levels were significantly correlated (P < 0.0001, r = 0.54 and P = 0.004, r = 0.33 respectively) in infertile group.</p> <p>Conclusion</p> <p>Our results suggest that exposure to chlamydial heat shock proteins (cHSP60 and cHSP10) could significantly affect mucosal immune function by increasing the release of IFN-gamma, IL-10 and TNF-alpha by cervical mononuclear cells.</p

Role of cervical dendritic cell subsets, co-stimulatory molecules, cytokine secretion profile and beta-estradiol in development of sequalae to Chlamydia trachomatis infection

BACKGROUND: Chlamydia trachomatis infection of the female genital tract can lead to serious sequelae resulting in fertility related disorders. Little is known about the mechanism leading to Chlamydia induced pathology and factors responsible for it. As only some of the women develops reproductive disorders while majority of the women clears infection without any severe sequalae, mucosal immune response in women with or without fertility disorders was studied to identify factors which may lead to final clinical outcome of chlamydial infection. METHODS: Myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) populations in cervical mucosa and peripheral blood were analyzed in controls and Chlamydia positive women with or without fertility disorders with multicoloured flow cytometric analysis. Cervical cytokines (IL-6, IL-8, IL-10, IL-12, TNF-alpha and IFN-gamma), C-reactive protein levels and sex hormone levels in serum were quantified by ELISA. RESULTS: In cervix of Chlamydia positive women with fertility disorders, significantly high (P < 0.05) numbers of pDCs were present with increased CD80 expression. pDCs correlated significantly with C-reactive protein levels, IL-6 and IFN-gamma levels in women with fertility disorders. In contrast, mDCs showed significant upregulation of CD1a during chlamydial infection and correlated significantly with IL-12 levels in Chlamydia positive fertile women. β-estradiol levels were significantly higher in women having fertility disorders as compared to fertile women and have significant correlations (r = 0.65; P < 0.05) with pDCs numbers, CD80 expression, IL-6 levels and IFN-gamma levels in these women. CONCLUSION: These results suggest that development of sequalae in some women can be a result of interplay of many factors including type of dendritic cell, co stimulatory molecule expression, cytokine secretion pattern and hormone levels

Capillary haemangioma of fallopian tube: a rare but dangerous incidental finding

Haemangiomas are tumors of vascular origin. They are frequently observed in soft tissue and skin. Vascular tumors of female pelvic organs are extremely rare. Although, majority of these lesions are detected incidentally, they can mimic various benign and malignant lesions clinically and radiologically. Fallopian tube capillary haemangioma is very rare benign neoplasm. Only one case of capillary haemangioma of fallopian tube has been reported. A 44-year-old female with menorrhagia, underwent hysterectomy with bilateral salpingoopherectomy. Both the fallopian tubes were grossly unremarkable. Microscopic examination revealed a well circumscribed vascular neoplasm, consistent with capillary haemangioma, CD34 immunostaining highlighted the vascular endothelium.  Although benign in nature, haemangioma of the fallopian tube can present with complications. Rupture of the haemangioma can be lethal when present with hemoperitoneum