OBJECTIVE:To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres.MATERIALS AND METHODS:This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha) throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included.RESULTS:Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesion (12%) in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups.CONCLUSIONS:Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.

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The purpose of this study was to identify pre-gestational and gestational factors predicting subsequent insulin requirement in patients with gestational diabetes mellitus (GDM). Maternal parameters were compared between mothers achieving glycemic control with or without the addition of antenatal insulin therapy (AIT). Insulin was required only in 8/83 (10%) patients for glycemic control. Those who needed insulin had a stronger family history of diabetes and higher first hour plasma glucose along with multiple (>1) abnormal values during oral glucose tolerance test (OGTT) in univariate analysis (p < 0.05). The first hour plasma glucose value of ≥ 9.72 mmol/l predicted requirement of AIT in GDM mothers with a sensitivity of 100% and specificity of 73%. However, only positive family history of diabetes mellitus among first degree relatives and multiple abnormal values in OGTT were independent predictors for antenatal insulin requirement in regression analysis.

Objective:The aim of this study was to determine the effect of maternal anthropometry and metabolic parameters on neonatal anthropometry.Materials and Methods:This observational cross-sectional study was conducted from January 2008 to June 2009 at a single tertiary care center. Maternal anthropometry and metabolic parameters like fasting serum insulin, lipid profile, and random blood glucose were estimated in 50 pregnant women at term. Detailed anthropometry of the neonates was performed.Results:Large for gestational age (LGA) babies had higher maternal body mass index (BMI), fasting serum insulin, and cord blood insulin levels, and lower maternal high density lipoprotein (HDL) compared to appropriate for gestational age (AGA) group (P < 0.001). Among the maternal parameters, BMI, gestational age, fasting serum insulin, and random blood sugar (RBS) had significant positive correlation, while HDL had negative correlation with birth weight (P < 0.05). However, only maternal BMI was the significant predictor of neonatal birth weight on multiple regression analysis (ß = 0.340, P = 0.01).Conclusion:The BMI of glucose-tolerant mother is more important than metabolic parameters in determining the birth weight of term babies.

A majority of the unsafe abortions are performed by untrained birth attendants or quacks leading to complications in a large proportion of these cases. Complications like bowel injury, bladder injury, uterine perforation, and septic abortion are mostly caused by unskilled hands and are detected immediately or within few days of the procedure, owing to the need for tertiary level care. Here we present a very interesting case of unsafe abortion induced by a Ryle's tube in a 32-year-old lady, which was diagnosed five years after the procedure. Considering its atypical presentation, it is the first case of its kind in the literature. The details of the case and its management are described along with appropriate pictures.

Since its introduction in 1984, laparoscopic ovarian drilling has evolved into a safe and effective surgical treatment for anovulatory, infertile women with polycystic ovary syndrome (PCOS), unresponsive to clomiphene citrate. It is as effective as gonadotropins in terms of pregnancy and live birth rates, but without the risks of ovarian hyperstimulation syndrome and multiple pregnancies. It improves ovarian responsiveness to successive ovulation induction agents. Its favorable reproductive and endocrinal effects are sustained long. Despite its advantages, its use in unselected cases of PCOS or for non-fertility indications is not prudent owing to the potential risks of iatrogenic adhesions and ovarian insufficiency.

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IntrOductIOnVitamin D Deficiency (VDD) is a pandemic, affecting populations across the globe [1]. Despite its favourable tropical location and perennial ample sunshine, India is not immune to this public health menace [2]. VDD is more likely to occur in women and elderly [3]. In particular, VDD is exacerbated in Post-Menopausal Women (PMW) owing to the loss of estrogen and age-related changes in the vitamin D receptor and vitamin D synthesis. No wonder, prevalence of VDD ranges from 50% to 90% in PMW in western world [4,5]. Similar results have been found in few studies from India as well [6][7][8].Hypovitaminosis D is increasingly being recognized as a potential novel cardiovascular risk factor. Low levels predispose to conventional cardiovascular risk factors like hypertension (HTN), adiposity, dyslipidaemia and diabetes [9][10][11][12]. Epidemiological studies also provide speculation over a possible inverse association between vitamin D status and metabolic syndrome (MetS) [13][14][15]. However, there is limited evidence regarding this relationship in Asian populations, who are at risk for cardiovascular diseases (CVDs) at lower body mass index (BMI) [16][17][18][19][20]. Additionally, prevalence of CVD risk factors has been reported to be increased after menopause owing to the risk of central obesity resulting from estrogen deficiency [21,22]. Yet, studies investigating the association between vitamin D levels and cardio-metabolic risk factors including MetS in Asian Indian PMW are scarce [6,7]. AImThe objective of our study was to determine the correlation of vitamin D levels with conventional cardiovascular risk factors like obesity, HTN, hyperglycaemia and dyslipidaemia in PMW. It also aimed to investigate the association between vitamin D status and MetS. mAterIAls And methOdsThis cross-sectional study was carried out at a teaching hospital over one year from January 2014 to December 2014. The study was approved by the ethical committee of the institute. All subjects gave their informed consent before participating in the study. Total of 64 PMW attending the outpatient clinic of Gynaecology department as well as Menopause clinic were recruited. Postmenopausal status was defined as cessation of menstruation for at least 1 year. Hysterectomised women were included if aged 45-52 years, provided they had elevated serum follicular stimulating hormone (> 40 IU/L). None of our patients were taking hormone replacement therapy. Exclusion criteria were chronic liver or kidney disease, previous or current cancer, malabsorption, sunlight allergies, endocrine disorders like Cushing syndrome, hyperthyroidism, hypothyroidism and primary hyperparathyroidism, those on drugs like oral contraceptives, statins, anti-epileptics, rifampicin, vitamin D or calcium supplementations, current or past treatment with glucocorticoids > 6 months, addiction to alcohol or drugs and those who were diagnosed to have PCOS previously.Detailed history was elicited with respect to symptoms of VDD. Clinical and anthropometric data were record...