Pikee Saxena

Role of sublingual misoprostol for cervical ripening prior to vacuum aspiration in first trimester interruption of pregnancy

This is a prospective randomized clinical trial evaluating, for the first time, the effectiveness of sublingual route of misoprostol for cervical priming prior to vacuum aspiration (VA). The trial included 100 women seeking first trimester abortion who were sequentially randomized into two groups of 50 each. Patients of study group received 400 microg sublingual misoprostol 3 h prior to VA while those of the control group did not receive any premedication for cervical ripening. For all periods of gestation between 6 and 12 weeks, misoprostol significantly reduced pain score, blood loss, time duration and rate of complications without increasing the side effects. Sublingual misoprostol is an effective alternative to mechanical cervical dilatation. It can be self-administered and has a good patient-acceptability rate. As no study has evaluated the role of sublingual route of misoprostol for cervical priming before VA, wider studies should be done to advocate its routine use.

Is abnormal sperm function an indicator among couples with recurrent pregnancy loss

OBJECTIVE To determine whether or not sperm function parameters are altered in male partners of couples with a history of idiopathic recurrent pregnancy loss (RPL). DESIGN In comparison with proven fertile volunteers, sperm function parameters like hypo-osmotic swelling (HOS), acrosomal status (AS), and nuclear chromatin decondensation (NCD) were assessed in vitro from male partners of couples with a history of idiopathic RPL. SETTING Infertility clinic and andrology laboratory at National Institute of Health and Family Welfare. PATIENT(S) Male partners of couples with a history of idiopathic RPL and proven fertile male volunteers (control). INTERVENTION(S) Standard semen analysis, assessment of sperm morphology, and sperm function with tests such as HOS, AS, and NCD. MAIN OUTCOME MEASURE(S) Sperm paameters, such as HOS, AS, and NCD, were assessed in semen samples from RPL in comparison with the proven fertile control group. RESULT(S) Semen samples from the idiopathic RPL group showed below normal test scores in 57.1% of the cases for all three sperm parameters. The highest aberration (83% of cases) in sperm attributes was observed in NCD, followed by AS (45.7%) and HOS (42.9%). In contrast, abnormality in sperm morphology was limited to 5.7% of the cases. Subnormal sperm function is directly proportional with subnormal sperm motility (<50%) in 23% of the cases. Even in semen samples with normal sperm motility, sperm function scores were below normal in 31.4% of the RPL group. CONCLUSION(S) Reduction in test scores of sperm function, like HOS, AS, and NCD, in male partners of couples with idiopathic RPL suggests that sperms with altered or lowered functional competencies, if they fertilize the oocytes, may lead to the development of an unsustainable embryo resulting in early pregnancy loss. Normal sperm motility does not always ensure normal sperm function scores.

A randomised comparison between sublingual, oral and vaginal route of misoprostol for pre‐abortion cervical ripening in first‐trimester pregnancy termination under local anaesthesia

Objective:  To compare efficacy of sublingual (S/L), oral and vaginal routes of misoprostol administration for cervical priming before suction evacuation (SE) under local anaesthesia.

HPV Vaccination in India: Critical Appraisal

Cervical cancer is the third most common cancer in women worldwide. The role of human papilloma virus (HPV) in the genesis of cervical carcinoma is well documented. The HPV 16 and 18 are found to be most commonly associated with invasive cervical carcinoma. The advent of cervical carcinoma vaccine has advanced the hopes that eradication of cervical carcinoma might be possible in future. The scenario of prevention of cervical carcinoma is completely different in developed and developing countries. The implementation of the vaccination as a routine in India is still controversial. Here we have tried to critically analyse these issues in Indian context. However it is clear that cervical cancer vaccine is not an immediate panacea and cannot replace the cervical cancer screening which is mandatory in Indian context.

Rudimentary horn pregnancy mimicking as a case of placenta accreta

Pregnancy in a rudimentary horn is very rare condition and it generally culminates in rupture, in second trimester with torrential haemorrhage. The accuracy of ultrasound in diagnosing rudimentary horn pregnancy at an advanced gestation still remains elusive. We report a case of unruptured rudimentary horn pregnancy which progressed to 38 weeks of gestation. The diagnosis was missed at 24, 30 and 38 weeks of gestation on obstetric sonogram. The diagnosis was made at laparotomy when the patient was planned for caesarean section in view of placenta accreta. Rudimentary horn pregnancy, placenta accreta, mullerian duct anomalies.