Impact of infertility on marital relationships among infertile couples attending OPD of a tertiary health care centre

Background: There is little empirical literature on the effects of infertility on marital relationships in India. This study was sought to examine the impact of infertility on the marital relationships of the couple at Eras Lucknow Medical College and Hospital.Methods: This is a descriptive cross-sectional design conducted on infertile women presenting in OPD (outpatient department) of Obstetrics and Gynecology Department of Era’s Lucknow Medical College and Hospital. A self-developed questionnaire was used for collecting data for the study. The questionnaire was divided into 5 sections: A to E. Data was presented in the form of descriptive statistics such as proportion and percentage.Results: This study revealed that infertility affected the sexual life of participants as it was reported that even though they still had regular sexual intercourse with their partners after realising they were infertile (64.5%), sex was only for the purpose of reproduction and not for mutual sexual satisfaction (13%). Sexual intercourse was reported to be unfulfilling as well as unenjoyable (16.4%). The psychological well-being of participants (29.60%) and stability within marital unions were also negatively affected by infertility, resulting in quarrels (13 %).Conclusions: Infertility has numerous negative implications for marital relationship. Thus, infertile persons should not be only physically examined and treated for infertility but should also be given counselling to lessen the psychological trauma attached to infertility

Socio-demographic profile of reproductive tract infections and sexually transmitted diseases in reproductive aged women

Background: RTI including Sexually Transmitted Diseases (STD) are increasingly recognized as a major cause of morbidity in India. RTI have become widespread today because of the changing social fabric and unconventional sexual behaviors. The present study was done to assess the prevalence of RTI and STD in women aged 20-45 years and to correlate the socio-demographic factors with RTI & STD.Methods: Two hundred & fifty women in the age group of 20-45 years attending the outpatient department of Obstetrics and Gynecology of VPC & IMS, Lucknow were included in the study. Out of them 215 were symptomatic and 35 were asymptomatic. All of them were offered clinical and microbiological examinations. A pretested, semi-structured interview schedule was used.Results: In this study the prevalence of RTI/STD was higher among women aged 31-35years, rural population, illiterate & less educated (90.4-97%) females, in farm workers & in students. The females having toilet access in field & outside toilet and with poor personal and menstrual hygiene, had more prevalence of RTI/STD.Conclusions: Hence we as obstetricians should try to make public aware about the importance of RTI/STD prevention, early diagnosis and prompt and complete treatment to avoid long term squealae.

A comparative study of the effect of drotaverine hydrochloride with hyoscine butylbromide in first stage of labor

Background: Prolongation of labor is one such dilemma that every obstetrician tries to avoid. The ultimate aim of the obstetrician is to accomplish the delivery in the shortest possible time without compromising maternal and fetal safety. Prolonged labor often ends up in great suffering to the parturient because of dehydration, confusion, and infection. This study aims to compare the efficacy of drotaverine hydrochloride with hyoscine butyl bromide for increasing the rate of cervical dilatation and to compare their duration of labor.Methods: This was a prospective interventional study conducted on 60 women who were randomly allocated to Group I, which was control group, women in Group II were injected hyoscine butylbromide one ampoule (20 mg) and the women in Group III were injected drotaverine hydrochloride one ampoule (40 mg) intramuscular at 3 cm dilatation of cervix. The data collected was statistically analyzed using SPSS version 15.Results: When compared to Group I (control group), Group II and Group III took lower time for all the three stages of labor. However, intergroup difference was significant only for Stage I (p0.05).Conclusions: The finding in this study suggested a significant impact of both the drugs in first stage as well as total duration of labor as compared to control group. However, no significant difference between two study groups was observed. Thus, both drotaverine hydrochloride and hyoscine butylbromide could effectively reduce first stage as well as total duration of labor

Evaluation of abnormal uterine bleeding by transvaginal sonography, sonohysterography and correlation with endometrial histopathology

Background: Abnormal uterine bleeding (AUB) in reproductive-age women is common, leading to one-third of outpatient visits by this population and this proportion crosses the two-third threshold in peri or post-menopausal group. Annually 5-10% of women of reproductive age seek medical care for AUB, which negatively impacts quality of life. The aim of the present study was to study the role of transvaginal sonography (TVS) and sonohysterography (SHG) in abnormal uterine bleeding.Methods: The present study was carried out at Department of Obstetrics and Gynaecology, Era’s Lucknow Medical College, Lucknow in collaboration with Department of Radiology and Pathology, Era’s Lucknow Medical College, Lucknow. It was a prospective study carried out over a period of 1 year. Detailed history regarding their present complaints, menstrual history along with thorough examination was noted on the proforma designed for the study. Those with active and heavy bleeding underwent TVS and D&C for diagnostic and therapeutic purposes in the same sitting. However others without active bleeding underwent TVS, SIS in mid cycle and D&C in premenstrual period.Results: The present study was carried out at Department of Obstetrics and Gynaecology, Era’s Lucknow Medical College, Lucknow in collaboration with Department of Radiology and Pathology, Era’s Lucknow Medical College, Lucknow. It was a prospective study carried out over a period of 1 year. Detailed history regarding their present complaints, menstrual history along with thorough examination was noted on the proforma designed for the study. Those with active and heavy bleeding underwent TVS and D&C for diagnostic and therapeutic purposes in the same sitting. However others without active bleeding underwent TVS, SIS in mid cycle and D&C in premenstrual period.Conclusions: The findings in present study show a relative supremacy of SIS over TVS in diagnosis of uterine abnormalities in cases of abnormal uterine bleeding

Study of antepartum haemorrhage and its maternal and perinatal outcome

Background: Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract after the period of viability until delivery of fetus. Etiology includes placenta previa, abruptio placentae, local causes, systemic causes and idiopathic origin. Objective of this study was to identify factors associated with APH, and to quantitate maternal morbidity, mortality and perinatal outcome in patients with APH at a tertiary care center in India.Methods: The study was a retrospective observational study and patient information was obtained from delivery records of 100 women presenting at gestational age of 28 weeks and above with APH. All patients with bleeding per vagina after 28 weeks of gestation were included in the study and were grouped as – Placenta Previa (PP), Abruptio Placenta (AP) or unknown causes.Results: Out of total 100 cases of APH, placenta previa contributed to 80%, abruptio placenta 19% and 1% unknown causes. Overall maternal mortality was 6%. Perinatal mortality was 42%. Prevalence of low birth weight and preterm babies was high.Conclusions: APH is a major cause of maternal and perinatal morbidity and mortality which could be prevented by early registration, regular antenatal care, early detection of high risk cases, and early referral to higher center. Good facilities for caesarean section, availability of blood banks and multidisciplinary approach with a good NICU can improve maternal and perinatal outcome of APH. The results of this study were found in good agreement with previous studies

Osteopontin is a potential target gene in mouse mammary cancer chemoprevention by Se-methylselenocysteine

BACKGROUND: Se-methylselenocysteine (MSC) is a naturally occurring organoselenium compound that inhibits mammary tumorigenesis in laboratory animals and in cell culture models. Previously we have documented that MSC inhibits DNA synthesis, total protein kinase C and cyclin-dependent kinase 2 kinase activities, leading to prolonged S-phase arrest and elevation of growth-arrested DNA damage genes, followed by caspase activation and apoptosis in a synchronized TM6 mouse mammary tumor model. The aim of the present study was to examine the efficacy of MSC against TM6 mouse mammary hyperplastic outgrowth (TM6-HOG) and to determine in vivo targets of MSC in this model system. METHODS: Twenty mammary fat pads each from female Balb/c mice transplanted with TM6-HOG and fed with 0.1 ppm selenium and with 3 ppm selenium respectively, were evaluated at 4 and 12 weeks after transplantation for growth spread, proliferative index and caspase-3 activity. Thirteen mice transplanted with TM6-HOG in each selenium group were observed for tumor formation over 23 weeks. Tumors from mice in both groups were compared by cDNA array analysis and data were confirmed by reverse transcription–polymerase chain reaction. To determine the effect of MSC on the expression of the novel target gene and on cell migration, experiments were performed in triplicate. RESULTS: A dietary dose of 3 ppm selenium significantly reduced the growth spread and induced caspase-3 activity in mammary fat pads in comparison with mice fed with the basal diet (0.1 ppm selenium). The extended administration (23 weeks) of 3 ppm selenium in the diet resulted in a tumor incidence of 77% in comparison with 100% tumor incidence in 0.1 ppm selenium-fed animals. The size of TM6 tumors in the supplemented group was smaller (mean 0.69 cm(2)) than in the mice fed with the basal diet (mean 0.93 cm(2)). cDNA array analysis showed a reduced expression of osteopontin (OPN) in mammary tumors of mice fed with the 3 ppm selenium diet in comparison with OPN expression in tumors arising in 0.1 ppm selenium-fed mice. A 24-hour treatment of TM6 cells with MSC significantly inhibited their migration and also reduced their OPN expression in comparison with untreated cells. CONCLUSIONS: OPN is a potential target gene in the inhibition of mammary tumorigenesis by selenium

Per operative findings in repeat cesarean section

Background: Cesarean section is the commonest obstetric procedure done worldwide. Incidence of cesarean section is increasing giving it a term “repeat cesarean section”. Repeat cesarean section makes future obstetrics performances and abdominal exploration risky. After any Laparotomy it is fairly common to develop scar tissue, or adhesion. The scarring and adhesion formation is known to increase the major complications rate from 4.3% to 12.5% depending on the number of previous section. Intra peritoneal adhesions have an incidence of 5.5% to 42.5%.Methods: An observational prospective study was conducted in Obstetrics and gynecology department of Era’s Lucknow Medical College, Lucknow. Total 80 cases of repeat cesarean sections were included. The case histories and intra operative findings were recorded.Results: Intra peritoneal adhesions of varied types were seen in majority of cases, out of which the most commonly seen adhesion was between parietal peritoneum and anterior surface of uterus 24(30%) and adhesion between bladder and uterus 24(30%).Conclusions: Chances of developing adhesions increases with each cesarean section, which leads to increase in morbidity of women. Thus cases of previous cesarean section should be educated about routine antenatal care

Transfusion practices in obstetrics and gynaecology in a tertiary care center

Background: This study was an effort to identify and highlight existing transfusion practices in our hospital, including the indications of various blood components used and the allergic reaction encountered. Obstetric hemorrhage remains major cause of maternal mortality worldwide and Blood transfusion can be a lifesaving intervention.Methods: This was a prospective cross- sectional study conducted on 172 patients who underwent blood and blood component transfusion. Hb concentration <7g/dL was determined to be an indication for blood product transfusion.Results: In this study the most common indication for blood transfusion was antenatal patient with anemia (32.8%) followed by ruptured ectopic pregnancy (19.5%) and postpartum hemorrhage (18.8%). Amongst gynecological patients, the most common cause for transfusion was abnormal uterine bleeding (AUB) (61.4%). Majority patients were given single unit transfusion. Adverse reactions found in our study were not statistically significant.Conclusions: Therefore this study concludes that we still need to go a long way in order to train the medical fraternity at all levels to learn to identify the valid indications for transfusion and select appropriate component for management

Status of vitamin D, paratharmone and serum calcium levels in perimenopausal women and their mutual correlation

Background: The present study was carried out with an aim to assess Vitamin D, parathyroid hormone and calcium status in perimenopausal women and to find out their mutual correlation.Methods: The present work was carried out on in the Department of Obstetrics and Gynaecology, in collaboration with Department of Biochemistry at Era's Lucknow Medical College and Hospitals, Lucknow, U.P. 80 healthy females aged 40-50 years were included in the study. Serum vitamin D, parathyroid hormone and calcium levels were assessed. Data was analyzed using ANOVA and Pearson correlation coefficient.Results: Osteopenia and osteoporosis was seen in 33 (41.3%) and 21 (26.3%) women respectively, 50 (62.5%) women had S. vitamin D levels 0.05). Correlation between Vitamin D levels and Parathyroid hormone levels was weak and not significant.Conclusions: The findings of present study highlighted that perimenopausal phase should be regarded as a transition phase where a lot of physiological changes take place resulting in bone mineral density loss and fall in serum hormonal, vitamin and mineral levels. Owing to tremendous continuing changes the relationship between these parameters is vitiated and does not show a systematic change.

Mixed Fortunes: Ancient Expansion and Recent Decline in Population Size of a Subtropical Montane Primate, the Arunachal Macaque Macaca munzala

Quaternary glacial oscillations are known to have caused population size fluctuations in many temperate species. Species from subtropical and tropical regions are, however, considerably less studied, despite representing most of the biodiversity hotspots in the world including many highly threatened by anthropogenic activities such as hunting. These regions, consequently, pose a significant knowledge gap in terms of how their fauna have typically responded to past climatic changes. We studied an endangered primate, the Arunachal macaque Macaca munzala, from the subtropical southern edge of the Tibetan plateau, a part of the Eastern Himalaya biodiversity hotspot, also known to be highly threatened due to rampant hunting. We employed a 534 bp-long mitochondrial DNA sequence and 22 autosomal microsatellite loci to investigate the factors that have potentially shaped the demographic history of the species. Analysing the genetic data with traditional statistical methods and advance Bayesian inferential approaches, we demonstrate a limited effect of past glacial fluctuations on the demographic history of the species before the last glacial maximum, approximately 20,000 years ago. This was, however, immediately followed by a significant population expansion possibly due to warmer climatic conditions, approximately 15,000 years ago. These changes may thus represent an apparent balance between that displayed by the relatively climatically stable tropics and those of the more severe, temperate environments of the past. This study also draws attention to the possibility that a cold-tolerant species like the Arunachal macaque, which could withstand historical climate fluctuations and grow once the climate became conducive, may actually be extremely vulnerable to anthropogenic exploitation, as is perhaps indicated by its Holocene ca. 30-fold population decline, approximately 3,500 years ago. Our study thus provides a quantitative appraisal of these demographically important events, emphasising the ability to potentially infer the occurrence of two separate historical events from contemporary genetic data