Objectives The aim of this study was to determine day 3 Serum AMH, FSH, LH, Estradiol (E 2 ), Inhibin B levels, ovarian volume, and antral follicular count to assess ovarian function. LH (p [ 0.05), and E 2 (p \ 0.05) were increased. Serum AMH level was 4-6.8 ng/ml with optimal fertility in 26.15 % cases and 2.2-4.0 ng/ml with satisfactory fertility in 53.85 % cases. Serum AMH levels were more strongly correlated with AFC (p \ 0.0001) and ovarian volume (p \ 0.0001). Conclusion Serum AMH levels were more robustly correlated with AFC than FSH, LH, E 2 , and Inhibin B on day 3 of the cycle. This suggested that serum AMH might be taken as single test to reflect ovarian reserve.

INTRODUCTIONNationally unplanned pregnancy rate is 21% of all pregnancies.1 In India 65% of women in the first year postpartum have an unmet need for family planning, out of which only 26% of woman are using any method of contraception. Hence, contraceptive counselling has become an integral part of antenatal and postpartum programme as pregnant and postpartum women are generally highly motivated towards controlling the fertility, either in spacing out there children or stopping their fertility altogether. Postpartum period is one of the sensitive time of woman's life when she is in contact with health care facility known as crisis oriented and when both mother and newborn need a special care. Postpartum contraceptive options are limited. Barrier contraceptives and progesterone only pills, both are user and compliance dependent methods and therefore have high failure rates. Traditionally, Cu T insertion was limited to interval period. But now, recent studies on postpartum contraceptive methods have suggested the use of Cu T in postpartum period which can provide long term and effective contraception with failure rate of <1%.Percentage of institutional deliveries in India is 41%.2 As the number of institutional deliveries is increasing, postpartum Cu T insertion can provide a unique opportunity to increase the contraceptive prevalence ABSTRACT Background: The use of Cu T in postpartum period can provide long term and effective contraception and this study compares PPIUCD versus interval IUCD. Methods: 300 women enrolled in the study were divided into two groups. Postpartum group-150; Postplacental or within 10 minutes/intracaesarean/within 48 hrs of delivery. Interval Group 150; after 6 weeks of delivery / postmenstrual. Cu T 380A was used in the study. Contraindication for PPIUCD were between 48 hrs and 6 wks postpartum, chorioaminionitis, PROM >18 hrs, unresolved PPH and puerperal sepsis. All were followed up for 6 months. Results:The continuation rate at 6 months was 81.81% in interval group and 88.23% in postpartum group. Complications occurred in 15.33% cases after PPIUCD and in 19.33% cases after interval IUCD. Expulsion rate was significantly higher in PPIUCD as compared to interval insertions (6.96% v/s 2.2%; p value <0.05). Removal rate of IUCD was almost similar in both the groups (4% in PPIUCD v/s 6.0% in interval). Conclusions: PPIUCD is an effective, safe, convenient, low cost and long term method of postpartum contraception irrespective of the mode of delivery.

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:Objective s: To evaluate the variations and potential clinical use of second trimester serum markers as predictor of preeclampsia. Methods : In a prospective study β HCG, α feto protein and inhibin A levels were estimated in 50 antenatal women in the second trimester (12-24 weeks) by ELISA technique. Results were noted in terms of development of preeclampsia, mean serum levels of all three markers, mode of delivery and fetal outcome. Resuflts : Out of 50 women, 10 developed preeclampsia (20%). A significant rise of mean serum β HCG level (16130.2 MIU/ml, >2.5 MoM,p <0.001), mean serum AFP level (161.7 ng/ml, >2.5 MoM, P<0.001) and mean inhibin-A level (1248.49 pg/ml, >2.0 MoM, P<0.001) was present in those who developed preeclampsia. Out of 10 preeclamptic women one had IUD, four fetuses were growth retarded, two babies were born before term and six were low birth weight babies, whereas out of 40 normotensive women only five had IUGR, three preterm delivery and 32 delivered at term without and complication. Conclusions : A significant positive correlation between second trimester serum markers and development of preeclampsia was observed (p<0.001). Thus with the second trimester serum marker study, prediction of preeclampsia is possible at incipient stage and its adverse pregnancy outcome can be minimized.

Background: Proteinuria is a major component of preeclampsia. Urine protein measurement after 24 hour urine collection is the traditional standard method for the detection of proteinuria. It is time consuming. As an alternative, random spot sampling for a urine protein to creatinine ratio has been investigated. Objective: Screening for preeclampsia by urine albumin to creatinine ratio. Methods: The study was conducted on 202 antenatal women with gestational age 16-18 weeks. Specimens for measuring protein to creatinine ratio are obtained. Urine albumin was estimated by Bromocresol green assay and urine creatinine level was estimated by modified Jaff's reaction. Urinary albumin to creatinine ratio of 0.2 or more was considered to be abnormal. Results: Out of 202 women 30 women had urine albumin creatinine ratio > 0.2 and 12 (40%) developed preeclampsia while out of 160 women with urine albumin to creatinine ratio <0.2 only 4 (2.5%) developed preeclampsia. The sensitivity, specificity, positive predictive value and negative predictive value of the test were 75%, 89.6%, 40% and 97.5% respectively. Conclusion: Spot urinary albumin to creatinine ratio is a reasonable rule out test for significant proteinuria. The Albumin to creatinine ratio is highly predictive to detect proteinuria and can be used as a rapid alternative test.

Objective: To evaluate the role of mean arterial pressure and antenatal waist circumference in early detection of preeclampsia. Methods: One hundred ninety (190) antenatal women were studied between 14 to 16 weeks of gestation for a period of one year. Mean arterial pressure was calculated by Burton's formula and waist circumference was measured. Mean arterial pressure of 90 mm Hg or more and waist circumference of 80 cm or more was taken as cut off. Results: Out of 190 women 30 women had mean arterial pressure >90 mm Hg and out of 30 women 17(56.6%) developed preeclampsia while out of 160 women with mean arterial pressure <90 mm Hg only 21(13.3%) developed preeclampsia. Out of 80 women with waist circumference >80 cm 28 women (35%) developed preeclampsia while out of 110 women with waist circumference < 80 cm only 10(9%) developed preeclampsia. Conclusion: Mean arterial pressure is a good predictor of preeclampsia with high specificity 91.4% and negative predictive value of 86.8%. Waist circumference of 80 cm or more upto 16 weeks is a precise method of predicting preeclampsia with high sensitivity of 73.6% and negative predictive value of 90.9%.

Aim: As there is dilemma for treatment of postmenopausal vaginal atrophy, effort has been made to review the literature for the same.Background: About half of all postmenopausal women will experience symptoms related to urogenital atrophy. Vaginal atrophy becomes clinically apparent 4 to 5 years after menopause, and subjective complaints as well as objective changes are present in 25 to 50% of all postmenopausal women.

Background: Recurrent Miscarriage is defined as three or more failed clinical pregnancies at less than 20 weeks of gestation or fetal weight less than 500 grams that ends spontaneously. Ovarian reserve demonstrates reproductive potential and includes FSH, estradiol, inhibin B, and S. AMH levels. Women with very low AMH levels may have altered folliculogenesis that may influence early implantation to increase the risk of miscarriage. This study aimed to determine the serum AMH levels in patients with recurrent miscarriage and pregnancy outcomes in low (<1 ng/ml), normal (1-3.5 ng/ml) and high (>3.5 ng/ml) AMH groups and to evaluate the role of serum ovarian biomarkers in prediction of miscarriages.Methods: This was a case-control study conducted over a time period of 1 year, on 120 women attending the antenatal clinic in department of obstetrics and gynecology, Swaroop Rani Nehru Hospital, Prayagraj. The patients were divided into two groups, Group 1 (n=80) included women with previous history of abortions and Group 2 (n=40) included women with no history of abortions. S. AMH levels were analyzed and compared in both the groups.Results: In the present study, a significant negative correlation was seen between S. AMH and rate of miscarriages (p <0.05). Low AMH values were observed in patients with history of previous pregnancy loss.Conclusions: Diminished ovarian reserve contributes to recurrent pregnancy loss and should be considered part of the work-up for RPL. AMH levels in recurrent miscarriage patients were lower than those in a normal population.