Obstetrics and gynecology

Objectives: To evaluate positron emission tomography-computed tomography (PET-CT) for the preoperative management of early-stage intermediate-and high-risk endometrial cancer (EC). Study design: Data of patients with intermediate-and high-risk early-stage EC were retrieved from a prospectively collected database. Patients with preoperative PET-CT followed by surgical staging including pelvic lymphadenectomy were analyzed. Diagnostic performance for lymph node (LN) metastasis was evaluated. Results: Overall, 45 patients were included: 27 (60%) and 18 (40%) with intermediate-and highrisk EC, respectively. Four patients (8.8%) had LN metastasis, three correctly identified at PET-CT, yielding a sensitivity of 75% (95% CI 21.9-98.7). Among 41 patients (91.2%) without LN metastasis, 38 had negative PET-CT with specificity of 92.7% (95% CI 78.9-98.1). The negative predictive value (NPV) was 97.4% (95% CI 84.9-99.9) and the positive predictive value was 50% (95% CI 13.9-86.1). Conclusions: The utility of PET-CT is limited by the low sensitivity for LN metastasis in intermediate-and high-risk early-stage EC, that may impede to consider PET-CT alone an adequate alternative to surgical retroperitoneal staging by lymphadenectomy or sentinel LN biopsy. However, the high diagnostic accuracy, specificity and NPV might support its adoption to improve the diagnostic accuracy of the sentinel LN algorithm.

Ethical decision making in women's health presents a series of unique challenges that are exacerbated considerably in under-resourced settings. Severe constraints on both autonomy and resources highlight limitations of principle-based ethics for addressing ethical dilemmas. Other useful ethical "tools" are considered in the context of 2 cases that emphasize the challenges to ethical decision making in underresourced settings. The cases confront traditional notions of patient autonomy, highlight pervasive issues with regard to allocation of resources, and demonstrate the difficulties encountered in the careful application of medical ethics.

Background: Ectopic gestation is the leading cause of maternal mortality and morbidity in first trimester and is a major cause of reduced child bearing potential. The aims of our study were to understand the clinical profile, risk factors, sites and management modalities of ectopic pregnancy at tertiary care hospital. Methods: This is a retrospective study carried out for one year at the department of Obstetrics and Gynaecology of our institute. Data of the women admitted for management of ectopic pregnancy during January to December, 2010 was collected and analysed. Results: The proportion of ectopic pregnancy was 0.7 % at our institute. Majority of women 45(83.2%) were between the age group of 21-30 years. Pelvic inflammatory disease (PID) contributed to ectopic pregnancy in 16(29.6%) women. The most common symptom was lower abdominal pain, in 50(92.6%) women. Marked pallor was present in 25(46.3%) women and 38(70.4%) women had cervical motion tenderness. Out of all women, 10(18.5%), 18(33.3%) and 26(48.1%) women were managed successfully with methotrexate, laparoscopy and laparotomy respectively. The success rate was 83.3%, 90% and 100% with methotrexate, laparoscopy and laparotomy respectively. Blood and blood products were given to 25(46.3%) women. Conclusion: Ectopic pregnancy is a growing problem of reproductive age group. Women should be encouraged regarding early reporting of missed periods and made aware of complications of ectopic pregnancy and necessity of seeking urgent medical help as early as possible so that early diagnosis and prompt conservative surgical or medical management of ectopic pregnancy can be done.

Introduction: Meconium is a dark green liquid passed normally by the newborn baby containing bile, mucus & epithelial cells. The presence of meconium in amniotic fluid is of great concern to the obstetricians. It is a potential warning of fetal asphyxia but sometimes it may be physiological with no effect on fetus. Objectives: To determine the prevalence of meconium stained liquor during labour associated risk factors and perinatal outcome in preterm, term and post term pregnancy. Materials and Method: This is a observational prospective study done on the women coming to labour room and OPD for delivery. These women were examined and records were maintained in terms of their profile, time of rupture of membrane, appearance of meconium, mode of delivery, perinatal outcome, Apgar score and compared with control group. Results: The incidence of MSL in our study is 11.01%(185 patients). There were 93 (50.2%) cases with thin staining (light green), 49 (25.9%) with moderately staining (yellow) and 44 (23.92%) with thick staining (deep green) liquor. No significant correlation was noted between maternal age and meconium staining of liquor but higher incidence of 11.6% was noted in women age group of >30 years. The incidence of staining was higher i.e. 17.1% in higher gestational age of fetus i.e. 41-42 weeks. Our study also yielded results of rising incidence of low –birth weight babies(less than 2.5kg) in meconium stained liquor cases. Instrumental vaginal deliveries (3.3%) and caesarean sections (44.6%) were found to be more prevalent in these cases. It was found that newborn with meconium stained liquor had significantly reduced APGAR scores at 1minute, 5minutes and 10 minutes(P<0.05) when compared to clear liquor cases. Meconium aspiration syndrome was more prevalent in the thickly stained group (3 patients) than in thinly stained group (zero patients). Mean Apgar Scores were significantly lower in cases complicated with thick stained liquor than in thin stained liquor or clear liquor. The incidence of admission to neonatal intensive care unit, meconium aspiration syndrome, neonatal deaths, instrumental vaginal and caesarean delivery were higher in pregnancies complicated by meconium stained liquor. Conclusion: Meconium stained liquor is associated with advance maternal age, advance gestational age, increased caesarean section rate, lower apgar scoring, increased NICU admission rate and neonata.

Background: Breastfeeding patterns in the developing world are still below the recommended levels and the potential to improve child survival remains untapped. This study investigated the breastfeeding profile and practices of Nigerian nursing mothers. Methods: This cross-sectional survey involved women at attending selected baby-friendly facilities in Ile-Ife, SouthWest , Nigeria who had breastfed their most recent baby for a minimum of six months. A self-administered questionnaire was used to obtain data on demographics, infant-maternal characteristics and breastfeeding practices. 383 mothers volunteered for this study, yielding a response rate of 95.7%. Data were analyzed using descriptive and inferential statistics at 0.05 alpha level. Results: The mean age of the respondent was 29.0 ± 4.96 years. Exclusive breastfeeding (EBF) rate was 86.2%. Breastfeeding initiation time of less than 1 hour after delivery and 24 hours rooming-in practice rate was 78.3% and 79.1% respectively. Daily breastfeeding time and total breastfeeding duration was 8.06 ± 2.33 hours and 18.3 ± 4.82 months respectively. The mean onset time for water supplementation was 4.74 ± 1.77 months with a rate of 30.3% within 1-3 months. Weaning initiation time was mostly (43.9%) within 12 to 18 month of infant's age. There was significant association between EBF practice and each of maternal education (X 2 = 6.554; P = 0.038) and SocioEconomic Status (SES) (X 2 = 19.32; P = 0.031) with most of the respondents in the lower SES (56.1%) subscribing to EBF. Conclusions: Exclusive breastfeeding (EBF) rate for the first six months among Nigerian mothers attending babyfriendly clinics was high. Breastfeeding initiation time after delivery was early, water supplementation to breastfeeding was before 5 months of the infant's life and weaning practice was late. Maternal educational level and socioeconomic status significantly influenced EBF practice.

PURPOSE:
To evaluate the effect of a collagen-fibrin sealant patch (TachoSil®) in preventing postoperative complications after inguinofemoral lymphadenectomy for vulvar cancer.

METHODS:
Double-blind randomized-controlled trial on consecutive patients undergoing bilateral inguinofemoral lymphadenectomy for vulvar cancer. Intraoperatively, inguinofemoral areas were randomized: one was treated with TachoSil®, while the contralateral had standard closure without collagen-fibrin sealant patch. Surgical outcomes, amount of drainage volume, duration of drain placement, and any postoperative complication (vulvar wound dehiscence, inguinal wound dehiscence, cellulitis, lymphangitis, lymphoceles, and hematoma) were recorded. Leg measurements were taken preoperatively and during postoperative follow-up until 6 months to evaluate lymphedema.

RESULTS:
A total of 19 patients were enrolled and 38 inguinofemoral dissections were performed. There was no significant difference between the investigational and control arm in the amount of drainage volume (p = 0.976), and duration of drain placement (p = 0.793). The postoperative complications, excluding lymphedema, were 10/19 (53%) in investigational arm and 9/19 (47%) in control arm (p = 0.74). At the end of follow-up, the prevalence of grade 1 lymphedema was 44.4% and 50% in investigational and control arm, respectively (p = 0.744); grade 2 and 3 lymphedema had a prevalence of 33.3% in both arms (p = 1).

CONCLUSION:
Application of TachoSil® does not seem to improve postoperative lymphorrhagia nor to reduce the incidence of postoperative complications in patients undergoing inguinofemoral lymphadenectomy for vulvar cancer. Considering this point, it would be useful to identify additional strategies in inguinofemoral dissection for the prevention of these complications.

Background: Unmet need for family planning is a tool to monitor the family planning program. Hence, the objective of study is to examine the prevalence of unmet need for family planning among women living in urban slum communities, Mumbai. Methods: The cross-sectional survey was conducted among currently married women aged 18-39 years and having at least one child. A total of 2797 women were selected using systematic random sampling. Information on demographic characteristics, their contraceptive behaviour and fertility intention were collected by face to face interview using structured questionnaire. Chi square test was applied and p <0.05 was considered as significant. Results: About 59.4% were currently using family planning methods and 40.6% have reported unmet need for family planning. Awareness of contraceptive methods among women with unmet need for family planning was universal. The prevalence of unmet need for family planning significantly decreased as the age and number of children increased. The prevalence of unmet need was significantly higher than met need for family planning among women having one child as compared to women having 2 or more children. Conclusions: A significant gap was observed between met and unmet need for family planning among younger women and having one child. The study emphasises the need for family planning programs to focus on younger couples having one child.

Background: Study of histopathological changes in placenta in pregnancy induced hypertension (PIH). Methods: Post delivery placentas of 130 cases were examined and findings correlated with severity of PIH. Results: The mean placental weight was 438.9 gms, 374 gms and 333.86 gms and the mean fetal weight to placental weight ratio was 6.003:1, 5.6:1 and 5.27:1 in cases of mild, moderate and severe PIH respectively. Infarction was seen in 10.25%, 33.3% and 59% and calcification was present in 15.38%, 30% and 50% of the cases of mild, moderate and severe PIH respectively. Retroplacental clot was seen in 36.4% of severe PIH cases. The mean numbers of syncytial knots were 20.4 (mild PIH), 35.97 (moderate PIH) and 59.77 (severe PIH) and 77.27% of severe cases of PIH had >40% areas showing trophoblastic hyperplasia. Conclusion: PIH adversely influences the placental morphology and histopathological examination post delivery helps investigate the mechanism of placental dysfunction in detail.

26 years, primigravida, with second degree of uterine prolapse attended to the emergency obstetrics outpatient department, in latent phase of labour. After 6 hours of admission, she entered into active phase of labour and membranes ruptured spontaneously. In spite of adequate uterine contractions, antiedema measures cervix did not dilate further. Finally, she delivered after giving Duhrssen's incision.

To compare the sociodemographical characteristics, obstetrical complications, and fetal-maternal outcomes in booked and unbooked mothers. Methods: In a prospective study over an 18 month period, outcomes of pregnancy booked for antenatal care were compared with that of unbooked women, who delivered in the Department of Obstetrics and Gynecology, NEIGRIHMS. Results: 802 patients were recruited to study. 479 (59.73%) were unbooked and 323 cases (40.27%) were booked. Compared with booked mothers, majority of unbooked mothers belonged to lower social class, came from remote areas and had a significant higher incidence of teenage pregnancy and Grand multiparity. Unbooked mothers had higher incidence of anemia (p< 0.0001), pregnancy induced hypertension (p= 0.033), post dated pregnancy (p<0.0001) and malpresentation (p= 0.013). Three maternal deaths were noted in the unbooked group compared to only one death in the booked group. Overall, maternal morbidity was 4.74%, with a significant difference between the two groups (p< 0.0001). 10.33% babies of unbooked and 6.12% of booked cases needed neonatal intensive care (p= 0.036). The incidence of meconium stained amniotic fluid, birth asphyxia, perinatal deaths, low birth weight and APGAR score <7 at 1 min and 5 min were significantly higher in babies of unbooked mothers. Conclusion: Poor utilization of antenatal care is associated with adverse fetal and maternal outcome.

Objective: To examine the correlation between spot urine PCR and 24-hour urine protein excretion in patients being evaluated for preeclampsia.
Material and Methods: A cross sectional study was conducted on 100  patients at the Department of Obstetrics and Gynecology at Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana State for a period from December 2019 to August 2020, with inclusion of singleton viable pregnancy, Gestational age between 24 and 38 weeks, Confirmed by last menstrual period and early ultrasound.
Result: Among 100 patients having mean age of 25 ± 3.266 years, among the patients 19% percent of the patients had past history of preeclampsia. Mean gestational age for the patients was 32.39 ± 3.42 weeks. Study showed 62 % of moderate urinary protein levels. There was significant correlation between spot PCR and 24 hour urine protein collection (spearman’s rho=0.7, P<0.0001).
Conclusion: Urine protein: creatine ratio is one of the important investigation in hypertensive disorder of the pregnancy. Spot Urine protein: creatine ratio can reliably be taken as a simple, accurate, and convenient replacement for tedious, time consuming 24 hour urine protein estimation, especially in countries like India where hospitals are flooded with a large number of in-patients. Therefore Urine protein: creatine ratio estimation should be introduced and adopted in practice in testing for proteinuria.

L’assistenza durante il travaglio può influenzare la donna a livello fisico e psicologico, oltre che la salute del suo bambino a breve e lungo termine. Una comunicazione efficace, il supporto e l’empatia da parte dell’equipe, così come il rispetto delle preferenze della donna, può aiutarla ad avere il controllo di quanto accade, rendendo la nascita una esperienza positiva per lei e per chi l’accompagna in questo percorso.

This paper discuss about the burden and importance of leucorrhoea, the causes of leucorrhoea, the clinical features of conditions causing leucorrhoea, diagnosis and traditional management of leucorrhoea, limitations of traditional management and need for Syndromic Approach in the management of this condition.

OBJECTIVE:
This study aimed at evaluating the effects obtained by administering 30 mg of micronised dispersible ferric pyrophosphate plus 300 mg of alpha-lactalbumin (MDFP-AL) compared to 80 mg of ferrous gluconate (FG) in pregnant women affected by iron-deficiency anemia (IDA).

PATIENTS AND METHODS:
We considered eligible all second-trimester singleton pregnancies in women affected by IDA. We excluded any other disease, twin pregnancies, any other pharmacologic/nutraceutical treatments (besides folic acid) before/during pregnancy. We randomized patients in two groups: one underwent treatment with 1 tablet of MDFP-AL/day, the other one with 1 tablet of FG/day, for 30 days. We evaluated hemoglobin (Hb), ferritin, red blood cells (RBCs), serum iron, hematocrit (Hct), and side effects at baseline (T0), after 15 days (T1) and 30 days (T2).

RESULTS:
50 women met the inclusion/exclusion criteria. We did not observe significant differences between the two groups for mean age, gestational age at the enrollment and parity. In MDFP-AL group, after 15 days (T1) Hb, ferritin, serum iron and Hct and were significantly improved respect to baseline (T0); after 30 days (T2), all the parameters, including RBCs, were significantly improved respect to baseline (T0). Similarly, in FG group the investigated parameters were improved both after 15 (T1) and 30 days (T2) respect to baseline (T0), although less in percentage terms respect to MDFP-AL group. The side effects rate was 24% in FG group, whereas MDFP-AL group did not show any significant side effect.

CONCLUSIONS:
Overall, MDFP-AL is more effective and safe than FG for the treatment of IDA in pregnant women.

The pharmacologic preparation of the endometrium before hysteroscopy may be achieved with the use of various drugs. This systematic review aims to summarize the available evidence regarding the use of desogestrel for endometrial preparation before hysteroscopic procedures. A literature search for suitable articles published in English language from inception of the database until August 2019 was performed using the following databases: PubMed/MEDLINE, EMBASE, the Cochrane Library, and Google Scholar. All original articles concerning desogestrel-only pretreatment before hysteroscopic surgery were considered eligible. Reviews, case reports/series, conference papers, studies including the use of combined hormonal preparation, and articles in languages other than English were excluded from the analysis. The literature search retrieved 3 studies that met all the inclusion criteria. The data demonstrated that desogestrel may be considered as a hormonal pretreatment drug before hysteroscopic procedures. The drug was distinctly effective and assessed as helpful by the operating surgeon in numerous patients who were administered the pretreatment of 75 μg daily. Oral desogestrel is a cheap, easily available, safe, and quite efficient alternative for endometrial preparation before hysteroscopic procedures.

ISBN 0 521 81812 5 hardback Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Nevertheless, the authors, editors and publisher can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publisher therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

Planning for a Baby:  https://youtu.be/2iwLh6XCnq8

Pregnancy with IBD: https://youtu.be/br0kciD8xJk

Motherhood with IBD: https://youtu.be/TQjt8pnMv4I


Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept—Blurred Lines—offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.

Background: Meconium is a dark greenish mass of desquamated cells, mucus, and bile that accumulates in the bowel of a fetus and is typically discharged shortly after birth. Meconium stained amniotic fluid has long been considered to be a bad predictor of fetal outcome. Presence of meconium in amniotic fluid is a potentially serious sign of fetal compromise and associated with poor perinatal outcome. This prospective observational study was undertaken to find out immediate fetal outcome in meconium stained liquor. Methods: Design: prospective study. This study was conducted from January 2014 to June 2014. The study included women with meconium stained amniotic fluid in labor with gestational age >37 completed weeks. Results: Total 100 cases were enrolled. 67% were term patient. Majority of the patients (74%) were in the age group of 21-30 years. Fetal distress occurred in 25% of babies, more in association with thick meconium (13%). Cesarean deliveries were 68%. APGAR scores in first minute was severe (0-3) in 5% and 1% at fifth minute, moderate (4-6) in 8% at first minute and was 4% at fifth minute and mild (7-10) in 86% at first minute and 94% at fifth minute. Admission in neonatal ward was 30% with perinatal mortality of 5%. Conclusions: Meconium stained amniotic fluid was associated with higher rate of cesarean delivery, increased need for neonatal resuscitation, increased rate of birth asphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome, hospital admission and mortality. Meconium stained liquor is more commonly associated with PIH, post-datism, oligohydroamnios and DM.

PURPOSE:
To evaluate the effects of D-Chiro-Inositol in women affected by polycystic ovary syndrome (PCOS).
METHODS:
We enrolled 48 patients, with homogeneous bio-physical characteristics, affected by PCOS and menstrual irregularities. These patients underwent treatment with 1 gr of D-Chiro-Inositol/die plus 400 mcg of Folic Acid/die orally for 6 months. We analyzed pre-treatment and post-treatment BMI, Systolic and Diastolic blood pressure, Ferriman-Gallwey score, Cremoncini score, serum LH, LH/FSH ratio, total and free testosterone, DHEA-S, Δ-4-androstenedione, SHBG, prolactin, glucose/IRI ratio, HOMA index, and resumption of regular menstrual cycles.
RESULTS:
We evidenced a statistically significant reduction of systolic blood pressure, Ferriman-Gallwey score, LH, LH/FSH ratio, total Testosterone, free Testosterone, ∆-4-Androstenedione, Prolactin, and HOMA Index; in the same patients, we noticed a statistically significant increase of SHBG and Glycemia/IRI ratio. Moreover, we observed statistically significant (62.5%; p < 0.05) post-treatment menstrual cycle regularization.
CONCLUSIONS:
D-Chiro-Inositol is effective in improving ovarian function and metabolism of patients affected by PCOS.

Background: Uterine fibroids are the most common benign gynaecological tumours in women. When symptomatic, heavy menstrual bleeding is the principal manifestation of uterine fibroids. Nowadays, several conservative procedures have been utilized to discourage hysterectomy or myomectomy and great interest has been focused on laser energy technology associated with mini-invasive approaches. Diode lasers demonstrated many advantages in laparoscopic and hysteroscopic surgery. Methods: To evaluate the Dual Wavelength Diode Laser System (DWLS) ablation techniques for treating fibroids, we devised an experimental system for characterizing the myolysis fibre ablation performance with a particular fibre designed to create a thermal ablation in the centre of the myoma. All the myomas were used for the experiment after a total hysterectomy and their excision from the fresh uteri. The experiment setup was composed of two beaker containers filled with isotonic saline water, temperature monitoring myoma surface and water bath, a diode laser fibre and a diode laser energy deposition system. Results: Good macroscopic results have been found for fibroids of about 60 cm3 ablated with a setting of 10 W of 980 nm + 10 W of 1470 nm and for samples of about 15 cm3 ablated with a setting of 5 W of 980 nm + 5 W of 1470 nm, where the volume of the ablated fibroids were 46.6% and 41.6%, respectively. Conclusion: This is the first ex vivo study with a new DWLS, which made it possible to understand which one of its settings could be recommended for the safest and best macroscopic results in myolysis.

Partum (puerperal), starts after the placenta is born and ends when the means of content as in ancient times (Ambarwaty, 2010). Time is very important to continue to be monitored. Childbirth is the time cleaning the uterus, such as the menstrual period. During the recovery period lasts, the mother will undergo many changes, both physical and psychological although some are physiological, but if it is not done through the assistance of midwifery care then it is possible impending situation patologis.Banyak mothers who did not know the importance of post-natal care because the mother did not understand and do not know how theneeds that should be required in the recovery process for reproduction to the original before birth. The study was descriptive method that aims to describe post partum knowledge about basic needs during childbirth in maternity home Srikaban Binjai. The population in this study were all post-partum mothers who are at home Maternity Srikaban Binjai total of 30 respondents with the technique of sampling with accidental sampling. The results showed that the majority of post partum enough that 19 respondents (63.3%), good minority of 4 respondents (13.3%)%) and less knowledge that 7 respondents (23.3%). In the post-partum mothers are advised to adhere to the advice provided midwives useful to accelerate the healing process at the time of childbirth, the midwifeis expected to continue to provide education on basicneeds during childbirth so that mothers understand them.

Aim: The aim of this study was to evaluate the relationship of scrotal circumference (SC) with plasma testosterone, seminal vesicles (SVs) weight, and its secretion as measurable indicators of fertility and also to sequence and establish phylogenetic relatedness of certain SV protein genes with other species as such integrated approach is lacking. Materials and Methods: Altogether, 59 apparently healthy male buffaloes sacrificed at slaughterhouse were selected (irrespective of breed) for measuring SC and collecting blood and paired SVs. The SC was measured at greater curvature using soft thread. In the present study, blood plasma testosterone, cholesterol, protein, and glucose in addition to SV fructose, citric acid and proteins in SV fluid were also estimated. The SV tissue was fixed in RNAlater for RNA extraction.Male buffaloes were categorized as per total SV weight into Group I (<5.0 g), Group II (5.0-7.84 g), and Group III (>8.0 g) and dentitions-I (≤18 months), II (18-24 months), and III (≥24 months) to assess the effect of weight and dentition age on SC, SV weight, and its certain secretions. Data were analyzed using linear model procedure including Tukey HSD test and Pearson's correlation coefficient. Variance inflation and condition index were also used to assess multicollinearity. Results: Gross and histomorphological evaluation of SVs did not show any abnormality. Macronutrients (plasma protein, glucose, and cholesterol) showed non-significant (p>0.05) variation between groups. The SC and SV weight varied significantly (p<0.05) with a significant positive relationship with plasma testosterone, SV protein, fructose, and citric acid. In addition, testosterone concentration also showed increasing trend from Groups I to III but increased significantly (p<0.05) from Group II to III with positive and significant correlations with SV protein, fructose, and citric acid similar to SV weight and SC. Binders of sperm protein (BSP1, 3, and 5) genes (full length) were sequenced and established an evolutionary relationship which is lacking in buffalo. Conclusion: The present findings established a significant positive correlation of SC with that of other fertility parameters related to SVs weight and its secretions: Fructose, citric acid, and protein (inclusive of BSPs sequenced full length), and testosterone. Therefore, the present integrated approach along with certain semen quality attributes reflecting epididymis function could be used as a predictive fertility marker for grading and selection of breeding bulls and their progenies to develop outstanding bull mother farm.

is an enigmatic and multifactorial disease that affects approximately 190 million patients worldwide. Almost half of them suffer from infertility. • Additionally, the highest IVF failure rates were reported in patients with endometriosis. • Hormonal agents are widely used to treat endometriosis pain symptoms. • The prolonged administration of GnRH agonists for improving IVF outcomes in patients with endometriosis is widely debated.

Background: Infertility is a very real event for part of millions of people's lives. There is no doubt that infertility is a stressful experience event and has a high impact on , couples' psychological status. Infertility creates a major and prolonged crisis. It is a stressful condition by creates heavy psychological trauma for the couples. Depression is one of the psychological disturbances which usually associated with infertility. Duration of infertility increases partner's stress; it is being the most important prognostic factor. All of those going through deserve to be heard and guided to psychological and mental health support on this journey. Therefore, the psychological health aspect of infertility needs to be part of every couple's health plan. Aim: Assess relationship between duration of infertility & mood changes and depressive symptoms'. Method: For this study, data were collected through in-depth interviews for convenience of 399 infertile female who were admitted in inpatient wards and/or attending to outpatient gynecological and infertility clinics at University Hospital, Health Insurance Hospital and General Hospital in Beni-Suef city. Results: The findings of this study indicated that, depressive symptoms were severe in infertile women aged between 25-40 years; the highest percentage of the sample reported severe depressive symptoms when infertility duration more than three years. Conclusion: Based on the findings of the present study, it can be concluded that, there is a statistically significant association between duration of infertility and depressive symptoms.

Athletic urinary incontinence is characterized by urinary loss during sports practice. This condition occurs in the case of CrossFit®, a modality based on high intensity training and functional movements, it can also be considered as having a high impact on the pelvic floor. This study aimed to compare the force and the contraction capacity of the pelvic floor musculature and urinary incontinence between female CrossFit® practitioners (AG) and nonpractitioners (CG). We performed a cross-sectional observational study in the period from December 2018 and May 2019. Complaints of urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF); the functional evaluation of the pelvic floor was performed by digital palpation; resting tone, maximum voluntary contraction, fast contractions and sustained contraction of the pelvic floor muscles was tested by electromyography. The prevalence of urinary incontinence was significantly higher in AG compared with CG (p < .001). Nevertheless, we did not find significant differences between the two groups for functional assessment and electromyographic parameters. The AG presented a prevalence 60% of UI, while CG only 9,5 (p < 0,001). Considering this point, tailored prevention strategies seem mandatory in this population, in order to allow early identification and management of urinary incontinence.

This review details the physiologic roles of two insulin sensitizers, myo-inositol (MI) and D-chiro-inositol (DCI). In the human ovary, MI is a second messenger of follicle-stimulating hormone (FSH) and DCI is an aromatase inhibitor. These activities allow a treatment for polycystic ovary syndrome (PCOS) to be defined based on the combined administration of MI and DCI, where the best MI:DCI ratio is 40:1. Moreover, MI enhances the effect of metformin and clomiphene on the fertility of PCOS women seeking pregnancy. As impaired intestinal transport may lead to unsuccessful inositol treatment, we also discuss new data on the use of alpha-lactalbumin to boost inositol absorption. Overall, the physiological activities of MI and DCI dictate the dosages and timing of inositol supplementation in the treatment of PCOS. The Diverse Physiologic Role of Inositols Inositols are cyclic polyols (C 6 H 12 O 6) with a molecular weight of 180.16; they are present in all living beings and participate in many metabolic pathways. These compounds exist in nine stereo-isomeric forms, among them myo-inositol (MI) is the most important and widely distributed in nature [1]. The cellular precursor of MI is glucose-6-phosphate (G6P), which D-3-myo-inositol-phosphate synthase isomerizes to inositol-3-phosphate (Ins3P) [2]. Inositol monophosphatase-1 then dephosphorylates Ins3P to free MI [3]. Free inositol may also be obtained by recycling inositol-1,4,5-trisphosphate (InsP3) and inositol-1,4-bisphosphate (InsP2) [4]. In humans, inositols primarily derive from dietary sources as MI [5,6]. MI can be then converted to D-chiro-inositol (DCI) by an NAD-NADH-dependent epimerase, under the stimulus of insulin (see Glossary) [7,8]. As a result, every organ and tissue can balance the level of inositols and the ratio of MI/DCI in a specific manner, regulating metabolic processes [9]. Under physiological conditions , the MI/DCI ratio averages 100:1 in the follicular fluid (FF) [9] and 40:1 in plasma [10]. Inositols are present inside cells in the free form and in plasma membrane as phosphatidylinositols, which can be phosphorylated to phosphatidylinositol phosphate (PIP) and phosphatidylinositol biphosphate (PIP2). Cleavage of PIP2 by phospholipase-C (PLP-C) leads to inositol triphosphate (InsP3), a second messenger [11]. As inositolphosphoglycans (IPGs), both MI and DCI (MI-IPG and DCI-IPG) are second messengers involved in insulin signaling and mediate different effects in humans [12,13]. Glycosyl-phosphatidylinositol lipids (PIP, PIP2), located at the inner leaflet of the cell membrane, undergo hydrolyzation upon insulin stimulus, releasing MI-IPG and DCI-IPG. The concentration of MI is elevated in tissues with high glucose consumption, such as the brain and the heart [12,14]. Indeed, MI-IPG participates in the cellular uptake of glucose, inducing the GLUT4 translocation to cell membrane [15], inhibits the adenylate cyclase enzyme, and reduces the release of free fatty Highlights Myo-inositol (MI) and D-chiro-inositol (DCI) are two stereoisomers of inositol. These natural molecules are safe and well-tolerable and have insulin-sensitizing activity. In addition, MI mediates FSH signaling. MI and DCI are dietary supplements with proven therapeutic activity in polycystic ovary syndrome (PCOS). New preclinical and clinical studies support the importance of administering a combination of MI and DCI in the 40:1 ratio. Of note, this is the physiologic ratio in blood. Inositol absorption at intestinal level and its therapeutic effect in PCOS are significantly improved with the coadministra-tion of alpha-lactalbumin. In conclusion, inositols represent an important therapeutic advance for PCOS treatment.

Introduction: Ferric Carboxymaltose (FCM), a dextran free iron formulation can be administered in large doses without the risk of severe anaphylactic reactions in postpartum anemia (PPA). Evidence suggest that FCM is highly effective in correcting anemia and restoring iron stores faster. Aims & Objective: To gather real-world clinical practice events on safety and efficacy of FCM injection in Indian patients with PPA. Materials and Methods: This was a prospective, observational, non-comparative, non-interventional, prescription event monitoring study. Data were collected from 535 postpartum iron deficiency anemia patients treated with FCM injection. Safety was assessed from adverse events reported within 1 week post FCM administration. Treatment efficacy was assessed by change in Hb from baseline, at 1 week after treatment. Results: There were no serious adverse events (AE) reported. Only 4 patients (<1%) reported AE (mild nausea, n=1; shivering, n=1; palpitation, n=1; pruritus and breathlessness, n=1). Mean change in Hb evaluated in 498 patients showed significant increase from baseline of 8.5 ± 1.2 gm/dl to 10.5 ± 1.0 gm/dl (difference = 2 ± 1.03 gm/dl; p < 0.001) at 1 week post-treatment. Increase in Hb was maximum (2.95 ± 1.08 gm/dl) in severely anemic patients with baseline Hb ≤7 gm/dl (n = 87). Safety and efficacy of FCM was rated by physicians as 'very good and good' in 99% patients. Conclusion: Intravenous FCM was safe with AE profile similar to earlier reports. Clinical utility of FCM in the treatment of PPA was demonstrated with significant improvement in Hb in 1 week.

Amniotic fluid ‘sludge’ is defined as the presence of dense aggregates of particulate matter in close proximity to the internal cervical os. It is of clinical significance in asymptomatic patients at high risk for spontaneous delivery, and in patients with preterm labor and intact membranes. Subchorionic hematoma is another ultrasound finding that is associated with a higher incidence of threatened miscarriage and preterm delivery. We report two cases of occurrence of amniotic fluid sludge in patients with previously detected large subchorionic hematoma. In the first case subchorionic hematoma and amniotic fluid sludge were detected by ultrasonography at 13 + 1 and 18 + 6 weeks' gestation, respectively, followed by preterm premature rupture of membranes, placental abruption and emergency Cesarean section. In the second case subchorionic hematoma and amniotic fluid sludge were detected by ultrasound at 11 + 3 and 15 + 5 weeks' gestation, respectively, followed by miscarriage with histological chorioamnionitis. The coincidence of subchorionic hematoma and amniotic fluid sludge in these cases points to a possible connection between these two significant ultrasound findings. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.

As an Ob & Gyn, member of National Breast Cancer Foundation and a woman I find it very important to raise awareness about the importance of early detection of Breast Cancer. Make a difference! Spread the word about mammograms and encourage communities, organizations, your friends and family members to get involved! Your help matters. Breast cancer is the most common type of tumors among the female population of the United States. One in eight women will be diagnosed with breast cancer in their lifetime.

Myo-inositol (MI) and D-chiro-inositol (DCI) are insulin second messengers, and MI is involved in follicular gonadotropin pathways which orchestrate ovulation. The tissue-specific MI/DCI ratio is modulated by insulin through aromatase and is altered in insulin resistance (IR), with reduced epimerization of MI to DCI in insulin-sensitive tissues. In ovaries, the MI/DCI ratio is 100:1, but is dramatically reduced by insulin-stimulated epimerase in hyperinsulinemic women with polycystic ovary syndrome (PCOS). Inositols have proved to be effective in PCOS, improving metabolic and hormonal state, and restoring spontaneous ovulation. In assisted reproductive technology, inositol improved ovarian stimulation parameters, although data concerning fertility outcomes are conflicting. Given their functions, inositols are an attractive treatment option for PCOS, although well-designed studies on spontaneous and non-spontaneous fertility are needed.

Welcome 1
Histeroscopy Pictures 2
Cervical Stump
Interview of the month 3
Alka Kumar
Brief Review 6
Endometrial cancer
Conundrums 11
Postmenopausal bleeding
Original Article 14
Progress in Hysteroscopy
Global Congress on 16
Hysteroscopy
Hysteroscopy Devices 18
RESECTR
Debate 20
Uniform report system

India is the second most populous country in the world, sustaining 17.01% of world population on 2.4% of world's surface area. According to Census 2011 the population of India on 1 March 2011 was 1,210,193,422. In spite of availability of wide range of contraceptives, the unmet need for family planning is estimated to be 12.8%. The common reasons for unmet need are unsatisfactory services, lack of information, and fear about side effects of contraceptive method. Studies show that pregnancies taking place within 24 months of previous birth have higher risk of adverse outcome like abortion, premature labour, postpartum hemorrhage, low birth weight babies, fetal loss, and maternal death. Apart from lactational amenorrhea, the methods which can be used by the women during postpartum period are barrier methods, progesterone only pills, sterilization (puerperal tubectomy) and IUCD (postpartum IUCD). IUCD insertion has many advantages over other methods like simplicity, minimal motivation, reversibility, free of cost availability, virtually no systemic side-effects, and high continuation rate. Insertion of IUCD in postpartum period has additional advantages of safety due to blunt insertion technique, and certainty of non-pregnancy of woman. Integrating IUCD insertion with delivery services optimizes opportunities for women to obtain an appropriate long term, reversible family planning method before returning home. Also it is seen that women are highly motivated and receptive to accept family planning methods during the postpartum period and this is the best time when a woman is in

This is a "stub" for the 2019 edition of my "cheat sheet" of info on Trota/the Trotula. The most recent version posted is from 2023 (https://www.academia.edu/97430512/). See https://independentscholar.academia.edu/MonicaHGreen/Trota-and-the-'Trotula'; for all posted materials.

If you need a copy of the 2019 version for reference purposes, please feel free to write me: monica.h.green@gmail.com.