Vidushi Kulshrestha

Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome.

BACKGROUND A prospective randomized trial was conducted to compare efficacy of a drospirenone-containing combined oral contraceptives (COC) with desogestrel-containing COC in women with polycystic ovary-syndrome (PCOS) not desirous of child-bearing. STUDY DESIGN Sixty women were randomized into study group [ethinylestradiol (EE) 30 mcg+drospirenone 3 mg] and control group (EE 30 mcg+desogestrel 150 mcg), treated for 6 months and followed up at 1 month, 3 months, 6 months, during treatment and 3 and 6 months post-treatment. Acne and hirsutism scoring, bodyweight, body mass index (BMI), blood pressure (BP), ultrasound parameters, lipid profile, glycemic profile and hormonal profile were compared. RESULTS Cycles were regular in both groups during treatment. Effect of regular cycles persisted in 44.83% (13/30) vs. 17.24% (5/30) in study vs. control group at 6 months post-treatment with 33.3% decreased hirsutism score in the study group (versus no change in control group) even at 6 months after stopping treatment. With treatment, BMI fell by 0.52 kg/m(2) in the study group; systolic and diastolic BP fell in the study group while it rose in the control group. Low-density lipoprotein significantly decreased and high-density lipoprotein was elevated in the study group (p<.05). The study group showed a significant fall in fasting/postprandial blood sugar and insulin and total testosterone against a rise in the control group. CONCLUSION In women with PCOS, a drospirenone containing COC has better outcome in terms of persistent regular cycles, antiandrogenic effect, fall in BMI and BP, better lipid profile, favorable glycemic and hormonal profile than desogestrel-containing COC.

Role of tranexamic acid in management of dysfunctional uterine bleeding in comparison with medroxyprogesterone acetate.

Summary Currently, tranexamic acid (TXA) is used as 4 g/day in menorrhagia This prospective randomised study included 100 cases to assess efficacy and safety of 2 g/day TXA in dysfunctional uterine bleeding (DUB) vs cyclical 10 mg twice-daily medroxyprogesterone acetate (MPA) for 3 cycles. Follow-ups were made monthly for 3 months during therapy, then 3 months after. Mean pictorial blood loss assessment chart (PBAC) score decreased from 356.9 to 141.6 in the TXA group and from the pre-treatment 370.9 to 156.6 with MPA and mean reduction of blood loss was 60.3% with TXA and 57.7% with MPA after 3 months (p < 0.005 in both groups). Lack of response during treatment was seen in three patients (6.1%) TXA and in 13 patients (28.9%) with MPA (p = 0.003). In patients who reported 3 months after stopping the treatment, 66.7% in TXA group and 50% in MPA had recurrence of menorrhagia, (p = 0.155). During the 6 months study period more hysterectomies were performed in the MPA than in the TXA group (17.8% vs 4%; p = 0.002). We conclude that TXA in 2 g/day dosage is an effective and safe option in DUB.

Genital tuberculosis among infertile women and fertility outcome after antitubercular therapy.

To compare modalities for diagnosing genital tuberculosis (GTB) and to assess fertility outcome after antitubercular therapy (ATT).

Efficacy of the levonorgestrel-releasing intrauterine system in uterine leiomyoma

To evaluate the efficacy of the levonorgestrel‐releasing intrauterine system (LNG‐IUS) in reducing menstrual blood loss (MBL) in myoma‐related menorrhagia and to assess the effect of the LNG‐IUS on uterine and leiomyoma volume.

Laparoscopic-Assisted Uterovaginal Anastomosis in Congenital Atresia of Uterine Cervix: Follow-up Study

STUDY OBJECTIVE To study the efficacy, safety, and functional outcomes of laparoscopic-assisted uterovaginal anastomosis with placement of a silicone tube as stent in congenital cervical atresia. DESIGN Descriptive study (Canadian Task Force classification II-3). SETTING Tertiary care referral hospital. PATIENTS Fourteen consecutive patients (mean [SD] age, 15.2 [2.0] years) with congenital absence of a uterine cervix, associated with partial or complete vaginal aplasia. INTERVENTIONS Laparoscopic-assisted uterovaginal anastomosis with placement of a silicone stent was performed to treat cervical agenesis. In cases with associated vaginal aplasia, modified McIndoe vaginoplasty was performed concomitantly. Follow-up assessment was performed at 1, 3, and 6 months, and then yearly. MEASUREMENTS AND MAIN RESULTS Of 14 patients with congenital cervical anomalies, cervical dysgenesis was observed in 5 (35.7%), and cervical agenesis in 9 (64.2%). All patients with cervical agenesis also had a partial or complete noncanalized vagina. The procedure was successfully completed in all patients. Main outcome measures were functional capability and postoperative complications. Mean (SD) follow-up after surgery was 3.8 (1.2) years. Postoperatively, all but 1 patient (92.8%) experienced regular menses, with complete relief of cyclical abdominal pain. One patient underwent hysterectomy because of genital infection and re-stenosis. Concomitant vaginoplasty was performed in 9 patients (64.2%) with associated vaginal aplasia, and vaginal length was 6.5 (1.2) cm at 6-month follow-up. Five patients (35.7%) are sexually active, and report it to be satisfactory. Pregnancy has been achieved in 3 of the 5 patients (60%). CONCLUSIONS Laparoscopic-assisted uterovaginal anastomosis may be considered the treatment of choice in patients with cervical agenesis, and radical treatment such as hysterectomy can be averted. The procedure is successful insofar as resumption of menstrual function. However, long-term reproductive outcome in these young girls will require further follow-up.

Efficacy and safety of ormeloxifene in management of menorrhagia: A pilot study

Objective:  To assess the efficacy and safety of ormeloxifene (centchroman) in the medical management of menorrhagia.

Utility of reverse transcriptase PCR and DNA-PCR in the diagnosis of female genital tuberculosis

This study was designed to test the utility of mRNA-based RT-PCR to detect viable bacilli, indicating active tubercular involvement, and DNA-PCR to detect present or past infection in the diagnosis of active female genital tuberculosis (TB) infection. A total of 200 subjects with complaints of infertility were enrolled in the study. Multiple sampling was done. One hundred and forty-three endometrial aspirate (EA), 94 peritoneal fluid/peritoneal washing (PF/PW) and six cornual biopsy (CB) specimens were collected for diagnosis using microscopy, culture, RT-PCR and DNA-PCR and results were compared with laparoscopic findings. RT-PCR and culture were concordant [positive in four (2.8%) EA specimens] signalling sampling from the site of active infection. Smear microscopy showed a poor detection rate while DNA-PCR showed high positivity. Sixty-one (44.85%) EA specimens, nine (9.57%) PF/PW specimens and two (33.33%) CB specimens were positive by DNA-PCR. Genital TB causing infertility (localized or secondary to TB elsewhere) can be picked up early by DNA-PCR, when it can be completely cured prior to the appearance of florid disease.

Efficacy of mifepristone in reducing intermenstrual vaginal bleeding in users of the levonorgestrel intrauterine system

To evaluate the efficacy of mifepristone to reduce intermenstrual bleeding in levonorgestrel intrauterine system (LNG‐IUS) users.

W166 RESPONSE OF THERAPY WITH VITAMIN B6, B12 AND FOLIC ACID ON HOMOCYSTEINE LEVEL AND PREGNANCY OUTCOME IN HYPERHOMOCYSTEINEMIA WITH UNEXPLAINED RECURRENT ABORTIONS

Materials and Methods: Between Jan 1st 2006 and Dec 31st, 2006, one hundred out of 4558 admissions to labor ward at El Minya Maternity University Hospital complicated with primary atonic PPH. Blood samples for Hb, and PN measurements were obtained on diagnosis, before regular PPH management was applied and at the end of third stage of labor for controls. Comparisons of clinical outcome; Hb; and PN between treatment responders and non-responders were undertaken. Results: Hemoglobin levels of all women with atonic PPH was <9g/dl and it was <7.2 g/dl in the 25 non-responders (P < 0.001). PN levels were 76.6±13.65mM/mL Vs 63.9±15mM/mL for women with atonic PPH and controls (P < 0.01). Furthermore, PN levels were significantly higher in non-responders than responders (92.3±12.3mM/mL vs. 60.9±15mM/m (P < 0.001). Frequent severer complications reported in non-responders, among whom were 3 deaths (P < 0.001). Conclusions: Preventing or treating severe anemia before labor may improve treatment response to CM and reduces complications due to NO cytotoxicity to the uterus and other organs

Spontaneous vesicovaginal fistula caused by genitourinary aspergillosis

Genitourinary aspergillosis is rare in patients who are not immunocompromised. A 39-year-old woman presented with vaginal urinary leakage with no history of previous trauma procedure or fever. The patients last delivery had been by cesarean 12 years previously and she had no history of difficult labor. Six months prior to presenting the patient had been scheduled to undergo abdominal hysterectomy for menorrhagia along with repair of a surgical hernia; only the hernia was repaired at that time as dense adhesions prevented the hysterectomy. The patient had been amenorrheic since that surgery and her incontinence began 6 days prior to presentation. (excerpt)