No abstract

Objectives: To evaluate the female factors in infertility using laparoscopy in Kashmiri women. Materials and Methods: One hundred cases of infertility [primary and secondary] were included in this prospective study. Before the procedure, apart from complete history and detailed examination, baseline investigations (complete blood count, blood sugar, kidney and liver function tests, ECG, chest X-ray) were performed as per our institutional protocol for pre-anaesthesia check up. Laparoscopy was done in proliferative phase of menstrual cycle. To test the patency of tubes, chromotubation was done in all cases under laparoscopic vision by using 10-15 ml of autoclaved methylene blue dye. All the data was collected on pre-designed proforma and the results were tabulated and raw percentages calculated to describe the results. Results: In primary infertility group [n=82], most common laparoscopic finding was tubal occlusion in 15 (18.3%), followed by endometriotic deposits in 14 (17.1%) patients. Other findings were polycystic ovaries in 10 patients (12.2%), peritubal and periovarian adhesions in 6 patients (7.3%), fibroids in 6 patients (7.3%), genital tract tuberculosis in 5 patients (6.1%), ovarian cysts in 4 patients (4.8%), hypoplastic uterus in 2 patients (2.4%) and pelvic inflammatory diseases in 2 patients (2.4%), in this group. The commonest finding by laparoscopy in patients with secondary infertility [n=18] was tubal occlusion in 5 (27.7%), followed by peritubal and periovarian adhesions in 4 (22.2%) patients. Conclusion: laparoscopy is very effective and cheap method in evaluating infertile women and should be considered earlier in infertility workup for effective and early treatment decisions.

INTRODUCTIONPre-eclampsia is defined as new onset of hypertension and proteinuria after 20th weeks of gestation in a previously normotensive woman and it complicates 2-8% of pregnancies and contributes to considerable maternal, neonatal morbidity and mortality.1-3 The majority of maternal deaths during pregnancy are caused by medical disorders and hypertension being the commonest cause. 4 The aetiology of preeclampsia remains unknown despite continued medical research. The pathophysiology of preeclampsia likely involves both maternal and fetal/placental factors although more with the former.The risk of abnormal placentation and preeclampsia is the result of medical conditions associated with vascular ABSTRACT Background: Preeclampsia is associated with increased morbidity and mortality and it increases with severity of preeclampsia. Preeclampsia shares many characteristics of metabolic syndrome (MeS) which has led many investigators to elucidate this relationship. The aim and objective of this study was to assess the prevalence of MS in preeclampsia and its relation with its severity. Methods: The study included 130 cases (41 gestational hypertension (GHTN), 27 mild pre-eclampsia (Mild PET), 47 severe preeclampsia (Severe PET), 13 pre-eclampsia superimposed on chronic hypertension (PSHTN) and 2 eclampsia) based on pre-specified maternal characteristics according to ACOG criteria after 20 th week of gestation. Two hundred normotensive pregnant females served as controls. The frequency of MS was assessed using pregnancy adaptation of MeS definition of the NCEP-ATP III criteria in cases and controls. Results: Metabolic syndrome was found in 37.7% of preeclampsia group and 12% of control group (p<0.00). Among the components of MeS, preeclampsia group was having significantly higher sugars (30% Vs 20%) and body mass index (BMI) (23.8% Vs 7.5%) than controls. GHTN was seen in 31.5%, mild PET in 20.8%, severe PET in 36.2%, PSHTN in 10% and eclampsia in 1.5% of cases. MeS was seen in 57.4% of severe PET, 50% of eclampsia, 26.8% of GHTN, 25.9% of mild PET and 23.1% of PSHTN. The clinical course in preeclampsia with MeS was complicated by IUD (intrauterine death), IUGR (intrauterine growth retardation), preterm delivery, APH and pulmonary edema. Oligohydromnios was less common in preeclampsia with MeS. Conclusions: The frequency of MeS was higher in preeclampsia group as compared to normotensive group. MeS was more significantly higher in patients with severe preeclampsia. In our study there were no demographic, clinical and laboratory predictors of MeS in preeclampsia. On the other hand, preeclampsia patients with MeS had significant maternofoetal complications. There is a need to screen for MeS in pregnant females from the first antenatal visit in order to predict severe preeclampsia.

No abstract

Background and objectives: Abnormal uterine bleeding is a significant clinical and gynaecological concern that necessitates its safe and effective treatment. The present study aims to compare the cost-effectiveness, safety, efficacy, and health-related quality of life of ormeloxifene with medroxyprogesterone acetate in women with non-structural abnormal uterine bleeding. Materials and Methods: A prospective, randomized, single-blinded clinical trial of 367 patients was carried out at a tertiary care hospital for a period of one year from 5 January 2019 to 4 January 2020. Patients were randomized into two groups for administering ormeloxifene and medroxyprogesterone acetate for a 3-month treatment duration and were evaluated by laboratorial investigations like anaemic status, bleeding duration, endometrial thickness, pictorial blood loss assessment chart (PBLAC) score, and patient’s medical and medication history. Health-related quality of life was assessed using short form survey-36 (SF-36) questionnaire scale. Cost-effectiveness was determined on the basis of the three-month treatment regimen. Results: The mean duration of bleeding reduced from 16.88 ± 6.46 to 7.76 ± 1.55 in the ormeloxifene group and from 15.91 ± 5.04 to 8.7 ± 1.91 (p < 0.001) in the medroxyprogesterone acetate. Similarly, mean haemoglobin increased from 8.56 ± 0.77 to 10.1 ± 0.087 g/dL and from 8.60 ±0.97 to 9.551 ± 0.90 g/dL (p < 0.001), and endometrial thickness showed a reduction from 8.52 ± 1.61 mm to 6.92 ± 1.68 mm and from 8.40 ± 2.09 mm to 7.85 ± 2.0 mm (p < 0.001) in the ormeloxifene and medroxyprogesterone acetate groups, respectively. PBLAC score reduced from 289.92 ± 42.39 to 128.11 ± 33.10 and from 287.38 ± 40.94 to 123.5 ± 29.57 (p < 0.001) in these groups, respectively. Health-related quality of life improved in the ormeloxifene group more than the medroxyprogesterone group, which was evidenced by SF-36 scale parameters (physical function, energy/fatigue and pain) that changed from 24.39, 12.99, 6.25 to 28.95, 18, 9 and from 25.41, 13.6, 7.1 to 27.02, 16, 8.3 in the ormeloxifene and medroxyprogesterone acetate groups, respectively. Conclusions: The study concludes that both medroxyprogesterone acetate and ormeloxifene are safe and efficacious in controlling abnormal uterine bleeding, but ormeloxifene was the better of the two in terms of cost effectiveness, reduction in pictorial blood loss assessment score, endometrial thickness, bleeding duration (days), increase in haemoglobin concentration (g/dL) and improvement in the quality of life.