Laparoscopic ovarian drilling in clomiphene resistant polycystic ovarian syndrome: clinical response and outcome

Background: Laparoscopic ovarian drilling (LOD) is an alternative method for ovulation induction in clomiphene citrate (CC) resistant polycystic ovary syndrome (PCOS) patients instead of gonadotropins. Objective were to identify the changes in clinical and biochemical profiles and the ovulation and pregnancy rate following LOD in CC resistant PCOS patients.Methods: It was an interventional study infertility unit, department of obstetrics and gynecology, Bangabandhu Sheikh Mujib medical university, Dhaka, between from July 2014 to June 2015. Changes of the above-mentioned parameters were recorded during follow up of patients after LOD. The information is collected and recorded in the preset questionnaire.Results: The characteristics of study population were same before LOD and following LOD. Before LOD, infrequent menstruation was present in 83.3% patients whereas regular menstruation was found in 58.3% patients after 6 months following LOD. Endometrial thickness ≤8 was found in 100.0% in before LOD and endometrial thickness >8 was found in 70.0% after 6 month following LOD. Ovulation was found in 25.0% in after 3-month LOD and was found in 70.0% after 6 months following LOD. Pregnancy was found in 20.0% after 3 months following LOD and 50.0% in after 6 months following LOD. Ovulation and pregnancy outcome was significantly higher in after 6 months following LOD.Conclusions: LOD produces long-term improvement in menstrual regularity and reproductive performance. A sustained improvement observed in acne and BMI. Ovulation and pregnancy were found in 70% and 50.0% respectively after 6 months following LOD

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Antenatal Screening for Postpartum Depression

Background: To identify the risk factors for postnatal depression in antenatal patients and to detect the progression of depressive symptoms in postnatal period. Methods:In this descriptive study, 150 pregnant women were screened at booking antenatal visit for Antenatal Depression (AND) and also for risk factors with regard to Postnatal Depression (PND). Patients having hypertension, diabetes, thyroid problem were excluded from the study. PND was assessed at 4 – 6 weeks postpartum by Edinburgh Postnatal Depression Scale. Results :AND and PND were identified in 10% and 12.67% of the women respectively. All the women (100%) with AND in the current pregnancy and having past-psychiatric history developed PND. 60% of the women with previous history of AND and 90.90% of those having history of PND developed PND in current pregnancy. PND was found to be more common in low socio-economic group and in nulliparous women. Conclusion:Antenatal focus on the proper screening of the risk factors may help to identify women at risk of postpartum depression

Screening of Domestic Violence During Pregnancy

Background: To determine the magnitude andprevalence of domestic violence during pregnancy.Methods In this descriptive study five hundred andsixty women who presented for routine antenatal check upwere interviewed. Physical abuse during pregnancy wasthe primary outcome measure as determined by theUSAID's domestic violence module 2011. Frequencies ofdifferent forms of abuse were measured.Results Physical abuse was recorded in 12.6%. Majority(88.5%) experienced multiple forms of abuse.Slapping(80%) was the commonest.Conclusion: Domestic violence during pregnancy, dueto its harmful feto-maternal implications, is an issuewhich needs to be addresse

Management of Hyperemesis Gravidarum Using Steroid Therapy

Background: To compare the efficacy of short course ofsteroid with dimenhydrinate (antihistamine) in thetreatment of intractable hyperemesis gravidarum.Methods: In this descriptive study fifty patients wereassigned to receive intravenous hydrocortisone 100 mgeight hourly as a daily dose for three days.Subsequently,oral prednisolone 45 mg which was tapered off in 5 days.Fifty patients were given intravenous dimenhydrinate 50mg 3 times daily for 3 days, followed by oral tablets of50mg three times a day for 5 days . Patients were followedup daily during the therapy course and for 2 wksfollowing discharge .Results: There was a significant reduction in vomitingepisodes in the hydrocortisone group compared with thedimenhydrinate group (p < .0001). None of the patientfrom the hydrocortisone group but eight of the patientsreceiving dimenhydrinate were readmitted for intractablevomiting within 1 wk after discharge. .Conclusion: Short corticosteroids’ course is an effectivetreatment for intractable hyperemesis gravidarum