Y. S. Nandanwar

Using automated voice calls to improve adherence to iron supplements during pregnancy: a pilot study

For years, researchers have explored the use of mobile phone reminders to improve adherence to medication. However, few studies have measured the direct medical benefit of those reminders, especially for low-literate populations in the developing world. This paper describes the use of automated voice calls to promote adherence to iron supplements among pregnant women in urban India. Unlike prior studies, we assess impact via a direct measurement of hemoglobin (Hb) levels in the blood. We enrolled 130 pregnant women from a low-income area of Mumbai, India and randomly assigned them to control and treatment groups. Both groups received a counseling session and a free supply of medication. The treatment group also received short audio messages, three times per week for a period of three months, encouraging them to take iron supplements. Results suggest that automated calls positively impacted Hb levels. However, because we could only recover 79 women for follow-up, and the effect size was small, our results lack statistical power (average change in Hb = 0.43 g/dL, 95% CI = -0.13 0.98 g/dL, p=0.13). We conclude that automated calls deserve further consideration for reducing maternal anemia, and we share our lessons learned for the benefit of future interventions.

A study of transobturator tape in stress urinary incontinence

Background: Stress urinary incontinence (SUI) is commonly encountered in gynecological practice. Nowadays, midurethral sling surgeries in the form of transobturator tape (TOT) surgery are recommended in its treatment. Aims and Objectives: To assess the outcome and patient satisfaction of TOT surgery in the treatment of SUI. Materials and Methods: A prospective study was undertaken for patients of SUI who underwent TOT surgery by the outside in method and followed up for 5 years. The patients were assessed clinically and by the Patient Global Impression of Improvement (PGI-I) preoperatively and at postoperative day 3, discharge and 3 months follow-up. Results: Successful surgical treatment with TOT was seen in all patients at the time of discharge. There was no recurrence of SUI seen up to 1 year, but at 5-year follow-up two patients had a recurrence of SUI on examination though they did not complain of SUI. Urinary retention, tape extrusion, and groin stitch infection were the commonly seen complications following surgery. On subjective assessment, 61 patients were completely satisfied at day 3, and all patients were completely satisfied at discharge and 3 months follow-up as per the PGI-I score. Conclusion: TOT gives an excellent outcome in the treatment of SUI.

Contraceptive Use and Unintended Pregnancies Among HIV-Infected Women in Mumbai.

Background: Access to reproductive health services in Human Immunodeficiency Virus (HIV) programs can greatly enhance programs potential to limit the spread of disease, reduce unintended pregnancies and safeguard the health of infected people. Objectives: To assess (i) knowledge, attitude, and use regarding contraceptives; safe sex and dual protection; (ii) fertility desires and unintended pregnancies post HIV and (iii) symptoms of reproductive tract infection/sexually transmitted infection (RTI/STI) among women infected with HIV. Materials and Methods: A cross-sectional study among 300 currently married HIV-positive women who had not undergone permanent sterilization with no immediate desire for pregnancy. Study site was Integrated Counseling and Testing Centers (ICTC) in tertiary hospitals of Mumbai and women were interviewed using a semistructured questionnaire. Results: In spite of good awareness about modern methods, 42.7 felt that contraceptives other than condoms were harmful to use due to their HIV status. Knowledge on dual protection was limited to condom (75%). Condom use increased from 5.7% pre-HIV to 71.7% post-HIV, with 89.6% reporting regular use. Future fertility desire was expressed by 8.7% women. Induced abortions post-HIV was reported by16.6% women, as pregnancies were unintended. About 69% wished to use dual contraceptive methods for effective protection if it was not harmful to be used by people living with HIV (PLHIV). Conclusion: Data reveals a need to promote modern contraceptive methods along with regular condom use to prevent unintended pregnancies and improve health-seeking behavior for contraception. Health system models that converge or link HIV services with other reproductive health services need to be tested to provide comprehensive reproductive healthcare to infected women in India.

A prospective study to compare the efficacy and safety of tioconazole and clotrimazole vaginal gel in patients suffering from vulvovaginal candidiasis

Background: Vulvo vaginal candidiasis is an extremely common gynaecological condition. While clotrimazole has been the mainstay of treatment of this pathology, newer medications are now available. The study aims to compare the efficacy, compliance and safety of tioconazole single dose intravaginal gel application and clotrimazole vaginal gel for 3 days in patients suffering from vulvovaginal candidiasis. Methods: A prospective, multicentric, open label, randomized, controlled, parallel group clinical trial of 220 women with 110 in each group for the evaluation of the effects of tioconazole vaginal gel in patients suffering from candidial vaginitis. Patients were divided into two groups; Group I received tioconazole vaginal gel as topical single dose therapy administered by the treating doctor and Group II received clotrimazole vaginal gel self-administered by the patient for three days. Response to therapy in both groups was studied and compared. Results: At the end of day 7, mean score of vaginal discharge quantity had a fall of 93.3% and 92.3% in tioconazole and clotrimazole group respectively but difference was statistically insignificant. Microbiological cure rate in both the groups was similar. Reduction of vaginal irritation, vaginal itching, vaginal burning, pain in the vulval area, pain during urination or during sexual intercourse, vaginal erythema, tenderness and swelling were also comparable in both the groups. Conclusions: Tioconazole gel single dose intravaginal application is as effective as clotrimazole gel three day intravaginal application. tioconazole is safe, well accepted and tolerated by the patients and will be useful in the treatment of vulvovaginal candidiasis.

Pregnancy outcome in cases of rupture uterus: a clinical study

Background: The aim of the study was to evaluate and analyze the risk factors, maternal and perinatal outcome in cases of ruptured uterus. Methods: It is retrospective observational study was designed from January 2015 to December 2015. A total of 69 patients diagnosed with ruptured uterus during the study period were included. Results: The incidence of uterine rupture was 0.64%. The uterine rupture in scarred uterus seen in 66 (95.6%) cases and unscarred uterus 3 (4.4%) cases. Forty five (65.3%) patients did not receive any antenatal care. Sixty six (49.1%) of the cases underwent previous uterine surgery due to cesarean. Other observed predisposing factors were induced/augmented labor seen in 39 cases (29.1%), prolonged labor in 8 (6%), macrosomic fetus 8 (11.6%), grand multiparous 10 (7.5%), multiple pregnancies 4 (3%) and malformed baby 2 (1.5%), cephalopelvic disproportion 2 (1.5%), instrumental deliveries 1 (0.7%) respectively. Primary repair of uterus was performed in 52 (75.2%) of the patients. Subtotal abdominal hysterectomy was performed in 10 patients (15.2%). There were seven fetal deaths and two maternal deaths recorded during the study period. Conclusions: Uterine rupture is a major contributing factor for maternal and perinatal morbidity and mortality. Proper antenatal care and early referral of women at risk to tertiary center will significantly improve maternal and perinatal outcome. Uterine rupture is amongst the preventable obstetric complication that carries severe risks both to the mother as well as the baby. Health education of people, training and supervision of health personal will reduce incidence especially in remote areas.

Prediction of pre-eclampsia: role of placental laterality by ultrasonography

Background: Pre-eclampsia, the most common medical complication of pregnancy, continues to be one of the leading causes of maternal morbidity and mortality. Women with mild and moderate degrees of gestational hypertension can often be treated conservatively and delivered at or near term with good perinatal outcome. The objective of this study was to find out whether placental laterality as determined by ultrasound done between 20-24 weeks can be used as a predictor of development of preeclampsia. Methods: In this prospective study, a total of 200 low risk singleton pregnant women attending the antenatal clinic at tertiary teaching institute were included. The location of the placenta was determined by ultrasound at 20-24 weeks. The women were divided into two groups- group A with Central placenta and group B with Lateral placenta. The end point of the study was the development of preeclampsia as per the ACOG criteria or delivery. Results: Out of 200 antenatal women, 161 had central placenta (Group-A) and 39 had unilateral placenta (Group-B). A total of 32 women developed preeclampsia, of which 19 (59.38%) had unilaterally located placenta at 20-24 weeks. This relationship was statistically highly significant (P<0.0001). The sensitivity, specificity, positive predictive value and negative predictive value of using placental laterality as a screening test were 59.38%, 88.10%, 48.72% and 91.93% respectively. Conclusions: Placental laterality as determined by ultrasound at 20-24 weeks; is a simple yet reliable and cost effective predictive screening test for development of preeclampsia.

Prospective observational study of near-miss obstetric events at two tertiary hospitals in Mumbai, Maharashtra, India

To review the incidence and patterns of near‐miss obstetric events (defined as “A woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy”), as well as studying the classification criteria for near‐miss events.

Improving dual protection among women infected with HIV

Background The PPTCT program in India focuses on prong 3 (Provision of Nevirapine to pregnant infected mothers) and reports quote that it reaches only 32% of pregnant mothers who need it. Preventing unintended pregnancies among HIV positive women (Prong 2) could help reduce the burden on Prong 3. To improve use of dual protection and prevent unintended pregnancies among women infected with HIV, an operational research study was implemented in two randomly selected tertiary hospitals in Mumbai (supported by ICMR).