Objectives: Sexually transmitted diseases (STDs) are an important cause of pelvic inflammatory disease (PID) but have often not been detected in microbiological studies of Indian women admitted to hospital gynaecology wards or private clinics. In this cross sectional study, women living in the inner city of Mumbai (Bombay) were investigated for socioeconomic, clinical, and microbiological risk factors for PID. Methods: Microbiological tests and laparoscopic examination were carried out on 2736 women aged <35 years who came to a health facility with suspected acute salpingitis or infertility or for laparoscopic sterilisation. 86 women with a clinical diagnosis of PID were not referred for laparoscopy although their characteristics are described. Associations between various risk factors and PID status were investigated and logistic regression performed on all factors that remained significant. Results: Of women with a laparoscopically confirmed evaluation, 26 women had acute and 48 chronic pelvic infection. Independent risk factors for PID were later age at menarche (>14 years), a history of stillbirth and no previous pregnancy, history of tuberculosis, STD, dilatation and curettage or previous laparoscopy, and presence of Gardnerella vaginalis. Conclusions: It is concluded that STD related risk factors applied to only a small proportion of PID cases and that other determinants of PID are important, including obstetric complications, invasive surgical procedures such as laparoscopy, and tuberculosis. (Sex Transm Inf 1998;74:426-432)
Case reportA 26 year old woman was in her first pregnancy. She had no past history of medical illness or any surgical intervention. She was obese and her pregnancy was complicated by mild gestational hypertension. At 39 weeks of gestation, she went into labour and 4 hours later delivered unaided to a baby girl weighing 2.4 kg.About 14 hours postpartum, she complained of burning epigastric pain associated with retching and vomiting. She was treated with an antacid and an anti-emetic. However, her symptoms persisted and were followed 6 hours later by severe shortness of breath. Her pulse rate was 170 beats per minute but her blood pressure and the peripheral oxygen saturation were normal. Examination of her lungs revealed reduced air entry in the left lung, but no adventitious sounds were noted. Her heart sounds were normal and there was no murmur. Abdominal examination revealed epigastric tenderness. Her uterus was involuting well. There was no abnormal vaginal bleeding.At this point, there was a high suspicion of pulmonary embolism with a possibility of pneumothorax. Serial arterial blood gas assessments showed progressive arterial hypoxaemia but there was no respiratory alkalosis or acidosis. Haemoglobin concentration was 9.8 g/dL and coagulation profile was normal. Electrocardiogram showed sinus tachycardia and there was no feature suggestive of pulmonary embolism. A chest radiograph revealed bowel shadows in the left lung. Within a short period of time she became hypotensive, restless and more severely dyspnoeic. She was electively ventilated but shortly after intubation she had a cardiac arrest. Cardiopulmonary resuscitation was started immediately and she revived well. A repeat chest radiograph again showed bowel shadows in the left lung and a marked mediastinal shift to the right (Fig. 1). A diagnosis of diaphragmatic hernia was made and an urgent laparotomy was performed.At operation the lower lobe of the left lung was collapsed. A large defect measuring 5 Â 5 cm with smooth circular edges was seen in the left dorsolateral part of the diaphragm. The greater omentum, fundus of the stomach, transverse colon, most of the small intestine (up to the terminal ileum) and the appendix (Fig. 2) were lying in the left thoracic cavity. The fundus of the stomach was gangrenous but the rest of the bowel was viable. No hernial sac was found. The central tendon of the diaphragm and the foramen of Morgagni were intact. The oesophageal hiatus was centrally located. The duodenum was traced from the pylorus to the jejunum and no associated Ladd's band was seen.The omentum, fundus of the stomach, small bowel and transverse colon were reduced into the peritoneal cavity. The gangrenous portion of the stomach was resected and appendicectomy was performed. The defect was closed with polypropylene sutures (Ethicon, Johnson & Johnson) in two layers. A chest tube was inserted into the left thoracic cavity.Post-operatively, the woman was ventilated. Her haemoglobin concentration was 8.9 g/dL. Her recovery was steady and satisfactory...
Study question What are the levels of psychological distress (anxiety and depression) and quality of life faced by infertile couple presenting with or undergoing treatment for infertility? Summary answer The levels of psychological distress and quality of life seems to be affected more in women than their husbands and may require psychological intervention. What is known already Infertility is a biopsychosocial crisis which can cause psychological distress in the form of depression and anxiety, and can impair quality of life .It often has a stressful impact on relationships and can affect a couple’s sex life. Most of the time these aspects are not explored and only medical and surgical treatment is offered depending on the cause. Assessing the psychological distress and quality of life contributes to decrease the stress and helps to improve the outcome of management by improving the relationship of the individual to achieve pregnancy. These women need psychological support, in the form of counselling. Study design, size, duration Cross-sectional study .100 infertile couples attending fertility clinics. Previous data indicate that the mean infertility specific QoL in infertile couples is 54.39 for females (nd 60.63 for males .Thus, a minimum sample size of 77 samples per group is needed to be able to reject the null hypothesis with probability 80% power. With a 30% dropout rate, the sample size is 100 samples per group. The study was conducted from Jan 2018 to June 2019. Participants/materials, setting, methods Infertile couples aged between 25 to 40years attending the Infertility outpatient clinic in OBG department, JIPMER, Pondicherry, India were recruited in to the study. Presence of a pre-existing major medical illness and presence of a major psychiatric illness were excluded from the study. After written consent, the severity of depression and anxiety was measured using the Hospitol Anxiety and Depression Scale (HADS Scale) and QoL was assessed with the Fertility Quality of Life (FertiQoL) questionnaire. Main results and the role of chance The average ages (SD) of men and women were 33.6 (4.29) and 31.3(4.03) years, respectively. Women reported higher levels of depression (p < 0.001) and anxiety (p < 0.001) as compared to their husbands. Depression and anxiety was noted more in women who were more than 32year age and prolonged duration of infertility. There was a significant association between depression, gender, duration of marriage and duration of infertility among the infertile couples.78% women felt that their attention and concentration were impaired and 63% responded that they cannot move towards their life goals . Around 72% and 60% felt drained out and lost, respectively. 57% women had fluctuant thoughts like hope and despair. More women felt were socially isolated and uncomfortable with social situations than men. 45% reported social pressure and 52% were felt angry because of fertility problem. Only 24% women were satisfied with support from friends and 37% of their family can understand them. Overall only 51% of the participants gave positive response to fertiqol questions. The total FertiQoL scores were significantly higher in the husbands than the wives (p < 0.001). Poor Qol were significantly associated with male cause of infertility (p = 0.004), primary infertility (p = 0.022) and previous history of receiving multiple treatments (p = 0.020). Limitations, reasons for caution The main limitation of the study is the cross-section study design which cannot detect exact cause of psychological distress and small sample size from single center which did not define entire population. Self reported questionairre was more subjective 5han objective which might be counfounding. Wider implications of the findings: Couples going through infertility have a varying degree of emotional moods swinging between anxiety and depression impairing QoL.,women being affected more than men.Counselor who can empathize with the couple should form an integral part of the infertility team providing psychological intervention along with infertility treatment. Trial registration number NA
It also contributes to elaborating some of the factors that contribute to a successful outcome in unexplained infertility and mild male factor infertility patients. AimTo compare the efficacy of ovarian stimulation of low-dose hMG/ CC with IUI on pregnancy rate.
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