Rohit V. Bhatt

Professional responsibility in maternity care: Role of medical audit

In 1965, Baroda Medical College initiated a process of medical audit of maternal and perinatal deaths occurring at this institution, and consultation in peripheral medical facilities providing antenatal and obstetric care. By 1984 maternal and perinatal mortality had declined and clinical judgment in maternity care had improved.

A comparative study of intra-amniotic saline and two prostaglandin F2α dose schedules for midtrimester abortion

The efficacy, side effects, and complications of two intra-amniotic PGF2alpha dose schedules and the unaugmented intra-amniotic instillation of saline are compared. All three methods resulted in satisfactory rates of abortion within a relatively short period of time and within clinically acceptable rates of complications. Each method has its advantages and disadvantages. Further large comparative studies were needed.

Comparative evaluation of contraceptive efficacy of norethisterone oenanthate (200 mg) injectable contraceptive given every two or three monthly

A total of 2388 subjects, 1181 for 60 +/- 5-day and 1207 for 90 +/- 5-day treatment regimen with norethisterone oenanthate (NET OEN) 200 mg injection, were observed for 24 months, constituting 28,513 woman-months. This clinical trial represents the largest clinical trial undertaken on NET OEN. The observations indicated that NET OEN given at 60 +/- 5-day intervals provides adequate contraceptive protection. However, as compared to the published studies elsewhere, higher method failures were seen during the first six months of NET OEN usage, when all women were receiving the drug at 60 +/- 5-day intervals. The reasons for this discrepant observation in the present study cannot be explained. The higher method failures reported with 90 +/- 5-day regimen were mainly during the third month following the injection, suggesting reduced contraceptive efficacy of the drug during this period. Thin build women (body weight less than or equal to 40 kg) were at higher risk of involuntary pregnancy. Disrupted menstrual pattern was the major reason for discontinuation ranging between 42-43 per 100 users at the end of 24 months. Amongst these, amenorrhoea was the commonest reason for discontinuation. No change in blood pressure was observed during contraceptive usage. The majority of NET OEN users did not show any change in body weight. The overall continuation rates with NET OEN were lower than those observed in similar conditions with Cu-T 200 mm2 IUCD.

Total dose intravenous infusion of iron-dextran (Imferon) in severe anemia

Abstract 1.1. This is a study of 75 women with iron deficiency anemia who were treated by totaldose intravenous infusion of iron-dextran complex; 50 women were obstetric patients and 25 women were from the gynecologic wards. 2.2. The average hemoglobin rise after infusion was at the rate of 1 Gm. per cent per week. 3.3. Three patients had severe reactions which could have been avoided. Ten patients had mild reactions. 4.4. The use of iron-dextran complex by total-dose infusion technique does reduce the period of hospitalization, and avoids the local complications of intramuscular injections. 5.5. The total-dose infusion technique is still not safe enough to be advocated for general use. It should be given only in a hospital after proper selection of patients.

Female sterilization in small camp settings in rural India.

In an effort to provide female sterilization services in areas that lack modern surgical facilities and highly trained personnel, while avoiding the high complication rates associated with mass sterilization programs, small sterilization camps were held at six rural primary health centers (PHCs) in the Baroda District, Gujarat, India, beginning in 1972. Data collected for 2,009 women undergoing sterilization by the Pomeroy technique at these camps showed an operative and immediate postoperative complication rate of 2.1% and an early postoperative complication rate of 6.7%. These rates compare well with those found in sterilization series performed in modern, well equipped urban settings, further demonstrating that the small camp is an appropriate facility for female sterilization in rural India.

Return of fertility following discontinuation of an injectable contraceptive — Norethisterone oenanthate (NET EN) 200mg dose

Abstract The return of fertility following discontinuation of norethisterone oenanthate (NET EN) 200 mg injectable contraceptive after use for a minimum period of six months or more was studied in 69 women who discontinued the method for planning pregnancy. Former users of copper intra-uterine device (CuT 200) were enrolled as a control group. Another 161 women who had discontinued NET EN due to other reasons (e.g. amenorrhoea, excessive bleeding or personal reasons) were also studied for return of fertility after ensuring that they were not using any other method of contraception and were exposed to the risk of pregnancy. The subjects from both groups were followed for a period of one year. The cumulative conception rates at one year were 72.5 and 83.6 per 100 subjects for ex-NET EN and ex-CuT 200 users who had discontinued the method for planning pregnancy and this difference was not statistically significant (P > 0.05). The median time for conception for ex-NET EN users was 7.8 months as compared to 3.7 months in ex-CuT 200 users but the cumulative conception rates at the end of one year show that future return of fertility in NET EN users does not appear to be adversely affected. In 51 subjects who had discontinued NET EN due to amenorrhoea, the return of fertility was predictably slower and less. The return of fertility in subjects who discontinued NET EN for other reasons (e.g. excessive bleeding and other personal reasons) was similar to ex-NET EN and ex-CuT 200 users.

Immediate sequelae following tubal sterilization

Abstract A total of 32,177 female sterilizations performed by different surgical procedures under different time scales were studied with reference to the effectiveness of the procedure and immediate, short-term and longterm complications arising out of the procedure. The results of immediate sequelae only are being reported in this article. Laparoscopic technique was employed in 7.1% of cases, culdotomy in 6.9% and minilaparotomy/laparotomy in the remaining 86% of cases. The findings indicate that minilaparotomy performed in the postpartum period is most suitable and safe for Indian women under existing conditions. Complications including mortality were least when the operation was performed as a minilaparotomy in the early postpartum period. Visceral injuries were maximum with the laparoscopic technique (10.45/1000). Mortality of interval sterilization was higher than that of postpartum sterilization (6.19/10,000 Vs 0.7/10,000) but this rate is lower than the current maternal mortality of the country (41.76/10,000). In view of the results obtained, it appears that minilaparotomy will continue to be “the method” of choice on a mass scale.

A two-year follow-up study of women sterilized in India

For large-scale program implementation, it is important to document both early and long-term safety and effectiveness of female sterilization methods. The results of this controlled, prospective, two-year study of 2,053 women who underwent sterilization in Baroda, India, show a marked decline in gynecological abnormalities over time; the incidence of gynecological pathology following sterilization was not significantly higher than what might be expected in the general population. The incidence of post-sterilization gynecological surgery was low. Significantly more women had weight gain than weight loss after sterilization. After sterilization, no change in menstrual cycle parameters was reported for the vast majority of women. Both favorable and unfavorable changes in menstrual cycle parameters were noted. The one-year and two-year pregnancy rates were 0.0 and 0.4 percent, respectively. No ectopic pregnancies were reported.

A comparative study of the tubal ring applied via minilaparotomy and laparoscopy in postabortion cases.

Sterilization with tubal rings applied via minilaparotomy or laparoscopy was performed on 300 randomly selected postabortion subjects to evaluate the safety and effectivness of the two surgical methods. One hundred and forty‐nine procedures were performed by minilaparotomy and 151 by laparoscopy. Gas leakage due to equipment problems was the most common technical difficulty during laparoscopy, and difficulty in exteriorizing the tubes was the most common surgical difficulty. Women undergoing laparoscopy experienced significantly less pain during surgery and had significantly lower rates of immediate and early postoperative complications than those women undergoing minilaparotomy. The rates of gynecologic abnormalities at six and 12 months were similar for both procedures. At this writing, no pregnancies have been reported among the study subjects. The results of our study indicate that laparoscopy is superior to minilaparotomy when it is performed in a controlled hospital situation.