Abstract

Background/Purpose: Maternal to child transmission (MTCT) is responsible for over 90 % of all childhood HIV infections. Lack of awareness regarding HIV and preventive practices against MTCT maybe one of the reasons behind high HIV transmission rates. In our study, we assessed the knowledge of HIV/AIDS in antenatal women, attending a tertiary care hospital in India as well as their attitude toward voluntary counseling and testing (VCT) for HIV.

Materials and Methods: This was a cross-sectional descriptive study carried out from May–July 2012 using a pretested interview-based questionnaire given to 386 antenatalwomen after obtaining consent. Data were abstracted for knowledge of HIV,MTCT, and attitude toward VCT. Results were expressed as percentages using SPSS v.16 software.

Results: Amongst the respondents, 92.5 % had heard of HIV and in 41 % of them, the source of information was through mass media. 81 % were aware of sexual intercourse as a mode of transmission of HIV while 55 % knew that sharing sharp objects and infected blood products can spread HIV. 37.6 % of respondents were aware of MTCT and 44 % heard of antiretroviral therapy as a method of prevention of MTCT. While 68 % were willing to get tested for HIV, 18.9 % knew about the steps involved and 44 % knew where to get VCT.

Conclusion: There exists a lack of adequate knowledge regarding HIV and preventive practices against MTCT. Health education and awareness campaigns on MTCT prevention and VCT promotion should target women in their antenatal period in order to increase acceptability and
accessibility of these services.

Abstract

Objectives: To compare the effectiveness, side effects, and patient satisfaction of buccal versus vaginal misoprostol administration in first and second trimester induced abortions.

Methods: In first trimester, women received oral mifepristone followed by misoprostol either by buccal or vaginal route. In second trimester, women received oral mifepristone followed by repeated doses of misoprostol either by buccal or vaginal route. A comparative analysis using SPSS was done.

Results: In first trimester, success rate of medical abortion was 96 % in buccal group and 88 % in vaginal group. Nausea was the most common adverse effect which was similar in both groups. In second trimester, success rate was 96 % in buccal group and 80 % in vaginal group. A statistically higher incidence of nausea was noticed in buccal group. Patient satisfaction level was almost similar in both the groups in both trimesters.

Conclusions: Buccal and vaginal routes of misoprostol administration have similar efficacy and patient satisfaction level for first and second trimester induced abortions. Hence, buccal route may serve as an alternative to vaginal misoprostol.

Abstract

Background: The discrimination between benign and malignant adnexal masses is central to decisions regarding clinical management and surgical planning in such patients.

Purpose of Study: To determine if the RMI (RMI 2) can distinguish between benign and malignant adnexal masses.

Method: A prospective cohort study was conducted of 58 women with an adnexal mass referred to a teaching hospital for diagnosis and management.

Results: RMI[200 had a sensitivity of 70.5 % (95 % CI 46.87–86.72), a specificity of 87.8 % (95 % CI 74.46–94.68), a positive predictive value of 70.5%, and negative predictive value of 87.8 %. ROC showed that cut off value of 25 achieved a sensitivity and specificity of 82.35 and 43.9 %, respectively, and a cut off value of 1,000 gave a sensitivity and specificity of 58.81 and 97.56 %, respectively. The association between RMI and disease status was not statistically significant for mucinous tumors.

Conclusion: RMI is a reliable tool in differentiating benign from malignant adnexal masses. It is simple, easy to use and cost effective. However it’s predictive accuracy was less for mucinous as compared to serous epithelial ovarian cancers. The study is limited by its small sample size.

Abstract

Objective: To evaluate maternal vitamin D levels in term normotensive and preeclamptic patients in labor and to assess additional factors such as maternal and cord blood levels of calcium, phosphorus, parathormone, and alkaline phosphatase and associated factors such as BMI, birth weight, and mode of delivery.

Method: This was a case control study carried out in Department of Obstetrics and Gynaecology, ESICPGIMSR, New Delhi, India from August 2012–April 2014. A total of 100 patients were divided into two equal groups (control and study groups of 50 each). Control group had women with singleton uncomplicated, term normotensive pregnant women in labor while the study group composed of term preeclamptic women in labor. Blood samples were drawn for vitamin D, serum calcium, serum phosphorus, serum alkaline phosphatase, and serum parathormone levels during first stage of labor, and subsequently, their levels were evaluated in cord blood also.

Results: All the enrolled patients had vitamin D deficiency pointing toward a universal prevalence of this micronutrient deficiency in antenatal patients. We found more incidence of severe vitamin D deficiency (90 %) in preeclamptic patients as compared to normotensive patients (62 %). Also preeclamptic group had lower median vitamin D levels (3.9 ng/ml) when compared to normotensive group (9 ng/ml). Similarly, all the neonates were found to be vitamin D deficient as assessed by their cord blood levels. Neonates born to preeclamptic mothers had lower median cord blood vitamin D levels (4.4 ng/ml) when compared to those born to normotensive mothers (7.25 ng/ml). The mean maternal calcium levels followed trends observed in vitamin D levels with preeclamptic patients having consistently lower calcium levels (mean value of 8.50 ± 0.80 mg/dl) when compared to normotensive patients (mean value of 8.89 ± 0.56 mg/dl). Preeclamptic group was found to havemore number of patients (58 %) with higherBMI when compared to normotensive group (32 % of patients). A slightly more incidence (36 %) of low birth weight babies is being born to preeclamptic mothers as compared to normotensive mothers (34 %). Significantly a more number of patients (36 %) with vitamin D levels below 15 ng/ml underwent cesarean section when compared to only 9 % of patients having vitamin D level above this level.

Conclusion: Preeclampsia is indeed associated with lower vitamin D levels, and its pathophysiology involves vitamin D and calcium metabolism.

Abstract

Objective: The aim of this study was to compare pregnancy outcomes in euthyroid women who were anti-TPO Ab? with those who were anti-TPO Ab-.

Design: This observational study comprised 1,000women in the age group of 25–35 years, having normal thyroid function tests, normotensive, non-diabetic, singleton pregnancy and attending Gyn. OPD/ANC up to 20 weeks’ gestation and those who were already in the process of abortion. anti-TPO Ab levels of > 50 IU/ml were considered as anti-TPO Ab?. Setting This study was conducted in the SMS Medical College’s attached hospital, Jaipur from April 2012 to September 2013.

Main Outcome: The estimation of the proportion of anti- TPO Abs in the hospital-based population and the comparison of pregnancy and neonatal outcomes in anti- TPO Ab? and Ab- euthyroid women were done. Results The main result showed increased rates in miscarriages (13.33 vs. 2.34 %, P < 0.001), LBWs (25 vs. 5.12 %, P < 0.001), preterm deliveries [ < 34 weeks] (5 vs. 1.80 %, P > 0.05) in anti-TPO Ab+ women.

Conclusions: The current study revealed that anti-TPO Abs are strongly associated with miscarriage and LBW irrespective of their gestational age. However, we did not find any correlation with the other complication as found in the studies by Abbassi-Ghanavati, Negro et al.

Abstract

Objectives: To determine the, incidence, etiology, management, maternal, and fetal outcome and to evaluate trends in our area and recommend preventable measures.

Methodology: This prospective study is done between Jan 2012 and Aug 2013 in Pt. J.N.M. Medical College Raipur. All the women who had ruptured uterus were included. Relevant history was taken, women were assessed, adequate intervention done, and were followed up till 6 months after discharge.

Results: A total number of deliveries were 11,323. Out of 11,323 deliveries, 9,844 women were without prior LSCS, 1,479 women were with prior LSCS. A total of 40 cases of rupture uterus were there 25 in women with prior LSCS and 15 in women without LSCS. Thus, incidence among women with prior LSCS was 1.69 % and for women without LSCS was 0.152 %. Overall incidence of uterine rupture was 0.35 %. Major risk factors found were unbooked status (92.5 %), injudicious use of oxytocin (52.5 %), and unjustified VBAC trial (44 %). Bladder injury was found in 20 %. Extension to cervix was found commonly in uterus with no previous section (46.66 %). Blood transfusion was required in 92.5 %. Perinatal mortality was 85%. Only one maternal death was there (2.5%).

Conclusions: Developed countries have incidence of uterine rupture 0.000 % in women without LSCS and 1 % in women with prior LSCS[1]. Thus, by directly comparing, our study of 20 month revealed that women stand 1,500 times higher risk for rupture even without previous cesarean section and 1.7 times in women with previous section in comparison to the developed countries. The overall burden of women with previous section being admitted for delivery is 12.28 %. 62.50 % women who had rupture uterus were those with previous section. Thus, careful selection of these women for trial of labor and a compulsory institutional delivery is recommended. We recommend use of oxytocin in titrated dose which clearly indicated by an obstetrician only, and it should be a prescription drug strictly.

Abstract

Objectives: This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy.

Methodology: One hundred and fifty women aged 29–52 years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome.

Results: Among women with endometrial polyps, 62 % had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6 % of cases (3.3 % hyperplasia with atypia and 1.3 % carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p\0.001; OR 4.61; CI 1.9–27), polyp volume [10 ml (p\0.001; OR 5.83; CI 4.31–9.17), and multiple polyps (p = 0. 01; OR 2.05; CI 1.09–3.76). Notably, the odds ratio of polyp volume[10 ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women.

Conclusions: Polycystic ovary syndrome, polyp volume greater than 10 ml, and increased polyp number represent the markers of risk for premalignant and malignant transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume B10 ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.

Abstract

Objectives: To study the efficacy and safety profile of isosorbide mononitrate (IMN) as an agent for cervical ripening.

Methodology: This study was conducted in the Department of Obstetrics and Gynecology, M Y Hospital & M G M Medical College Indore from September 2011 to February 2013. Pregnant women attending the antenatal clinics were screened for possible participation in the study after explaining the nature of the study. This study was conducted on 150 patients. An initial dose of 40 mg IMN was applied in the posterior vaginal fornix, and the same dose was repeated after 6 h. Cervical ripening was assessed by the change in Bishop Score 12 h after the initial application.

Results: In a study of 150 cases, mean maternal age was 22.2 ± 2.6 years (range 19–35 years) and mean gestational age was 40.5 ± 1.07 (range 40–42 weeks). 52 women were primigravidas, while 98 were multigravidas. The mean Bishop Score—before drug administration was 1.94 ± 1.3 (range 0–5), and mean fetal heart rate was 137 ± 6.2 bpm. The mean of Bishop scores before IMN administration was 1.94 ± 1.3, while mean of Bishop score after drug administration was 6.7 ± 2.2; mean difference was equal to 4.76. P value was equal to 0.0001. By conventional criteria, this difference is considered to be statistically significant. The mode of delivery 96 (64 %) delivered vaginally, while 54 (36 %) were delivered by Cesarean section. Mean Apgar score at 1 min was 8.2 ± 0.9 SD (range 7–10), while mean Apgar score at 5 min was 9.4 ± 0.6 (range 8–10). The only side effect noted was headache, and 30 cases (20 %) complained of headache.

Conclusions: IMN seems to be effective, safe, inexpensive, and well-tolerated agent for cervical ripening. It is cost effective and safe with minimal side effects.

Abstract

The incidence of pre-term low birth weight still prevails in developed as well as developing countries though the numbersmay vary. Periodontitis is a chronic inflammatory process with multifactorial etiology and adversely affects the outcome of pregnancy which becomes a major public health problem. The association of periodontitis as risk factor for preterm birth has been in extensive research in the past two decades when a number of studies investigated this relationship. However, definite connection has not been proved yet and research is still ongoing. This article describes about the possible relationship that can exist between pre-term lowbirth weight infants and periodontal disease.

Abstract

Objectives: To ascertain the prevalence, presentation, diagnosis, severity, and complications of HELLP syndrome. Materials and Methods This is a prospective observational study analyzing the conditions and the data of 24 cases of HELLP syndrome in a tertiary care hospital. The analysis was done for the demographic characteristics, presentation of these patients, complications associated, and the perinatal outcome.

Results: 0.45 % of the patients admitted for delivery developed HELLP syndrome. Majority of the patients developed the condition in 30–36 weeks period of gestation, while five patients developed it in the postpartum period. The condition led to 12.5 % of maternal and 45.8 % of perinatal mortality.

Conclusion: HELLP syndrome is an important cause for maternal and perinatal morbidity and mortality.

Abstract

Objectives: To study the diagnostic potential of optical imaging and its comparison with colposcopy, in detecting early cervical dysplasia

Methods: The study was conducted on 200 patients attending the outdoor of UISE maternity hospital with symptoms suspicious of cervical lesions. All patients were subjected to colposcopy, followed by histo-pathological examination. Out of all HPE, 18 samples each from normal and dysplastic histology were sent to IIT Physics lab, Kanpur for optical imaging. Statistical analysis was done using sensitivity, specificity, PPV, and NPV. Chi square test was applied to calculate p value

Results: In optical imaging, depolarization images had shown significant changes in the epithelium region of the dysplastic tissue as compared to normal one. It is found that the mean value of depolarization power for normal cervix tissues is less than 0.32, while for dysplastic tissues it is greater than 0.32

Conclusions: Optical imaging is fast, non-invasive tool with high sensitivity and specificity, comparable to colposcopy (sensitivity 88.9 vs 100 %, specificity 83.3 vs 86.6 %) and thus is useful in both for screening and diagnosis of cervical dysplasia

Abstract

Objectives: Evaluation of double cross plasty for management of obstructive or non obstructive transverse vaginal septum.

Methods: 13 patients presented either as cryptomenorrhoea or as infertility/dyspareunia were diagnosed to have transverse vaginal septum. They were subjected to double cross plasty and were subsequently followed up for period of two years.

Results: 13 patients presented either as cryptomenorrhoea or infertility/dyspareunia. Nine patients had transverse vaginal septum at low level, three at midlevel, and one had high-level septum. The thickness of septum was 1–3 cms in 12 patients. Double cross plasty was performed in all patients. One patient with high vaginal septum which was thick needed bilateral labial flaps. All patients were followed up to period of 2 years and none had restenosis. Three patients had pregnancies with vaginal delivery in two of them.

Conclusions: Double cross plasty for management of transverse vaginal septum is a better technique compared with currently used surgical methods. In our series, it did not cause restenosis and some of our patients were able to deliver vaginally.

Abstract

Objective: To evaluate materno-fetal outcomes in pregnant women with jaundice.

Methods: A prospective study was conducted over a period of 6 months in a tertiary care hospital of Delhi, India. 82 pregnant women with jaundice were included. The serum was screened for viral markers, liver function tests, and coagulation status.

Results: The mean age of women was 27.3 ± 4.3 years. 43.9 % (n = 36) women were HEV positive, 36 % (n = 27) HBsAg positive, 4 % (n = 3) HAV positive and 1.3 % (n = 1) HCV positive. Intrahepatic cholestasis was diagnosed in 10.8 % (n = 8) of women. Maternal morbidity was evaluated in terms of chorioamnionitis (5.4 %, n = 3), encephalopathy (26.8 %, n = 15), and coagulopathy (67.9 %, n = 38). There were five maternal deaths, and all were unbooked with HEV-positive status and a bilirubin > 15 mg/dl with deranged coagulogram and encephalopathy and IUDs. 79 women delivered vaginally, and three had cesarean section. Of the vaginal deliveries, 59.8 % (n = 49) went into spontaneous labor, and 25.5 % (n = 21) were induced for varied reasons (BPS < 6/10 (38 %, n = 8)) and progressive derangement of LFT (38 %, n = 8). Among the 71 deliveries, 29 (40.8 %) were IUD and 42 (59.1 %) were live born. On analyzing the morbidity data, it was found that HEV-positive women (deranged coagulogram 71.05 %, IUD 75.86 %, encephalopathy 80 %) had a poorer outcome as compared to their HBsAg positive counterparts (deranged coagulogram 10.52 %, IUD 13.79 %, encephalopathy 6.66 %).

Conclusion: Urgent redressal of issues pertaining to sanitation and provision for clean drinking water for citizens of India is the need of the hour as HEV is fecooral in transmission.

Abstract

Background: Controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) is essential in improving the pregnancy rate, but supraphysiologic levels of estradiol (E2), which are attained during COH and which affect the outcome of IVF, have remained unclear. The aim of this study was to evaluate the association of E2 levels on the day of hCG with embryo quality and pregnancy rates in long protocol in IVF.

Materials and Methods: We retrospectively reviewed 128 IVF cycles. All the patients were stimulated with long protocol. The patients were categorized into three groups according to the serum E2 levels on hCG administration day (group 1; < 1500 pg/ml, group 2; 1500–3500 pg/ml, group 3; > 3500 pg/ml).

Results: Of the 128 cycles, 23 (18 %) cycles resulted in pregnancy. There were no statistically significant differences between mean age, duration of infertility, BMI and FSH on cycle day 3 in three groups. The number of the retrieved oocytes, the number of obtained embryos, the number of transferred embryos, and pregnancy rates were gradually increased from group 1 to 3 as estradiol levels increased, and these values were statistically significant (P< 0.05). In addition, the correlation between age and IVF outcome was found. Mean age in patients with positive pregnancy test was lower than that in patients with negative pregnancy test, and this difference was statistically significant.

Conclusion: This study shows that there is a positive association between estradiol level on hCG administration day and pregnancy rates in IVF cycles.

Abstract

Purpose of Study: Dilatation and curettage (D&C) and fractional curettage (F/C) are commonly performed gynecological procedures. Randomized controlled trials have concluded that topical anesthesia effectively reduces pain in endometrial sampling and hysteroscopy. Our study was aimed at investigating this modality of pain relief in setting of a developing country where, due to lack of resources, successful completion of these procedures in an outpatient setting is a necessity.

Methods: This study was a prospective, randomized, placebo- controlled, double-blind study conducted in 84 patients. All patients received either intrauterine 2 % lignocaine or normal saline along with oral NSAID and paracervical block prior to the procedure. The pain was analyzed at three steps: at the time of curette, immediately post-procedure, and 30 min later using 10-cm visual analog score.

Results: The patients in the experimental and control groups were well matched for age, parity, body mass index, menopausal status, and the indications for intervention. At all the three stages, pain perceived in the lignocaine group was significantly less as compared to that in placebo group. As compared to lignocaine group (55 %), significantly higher number of women in placebo group (88 %) perceived severe pain during endometrial curettage (p = 0.001).

Conclusions: The present study indicates that two percent intrauterine lignocaine significantly decreases the pain perception during intrauterine gynecological procedures such as D&C and F/C. This is a simple, effective, inexpensive, and low-risk intervention which can potentially increase the patient acceptability and compliance with such procedures.

Abstract

Background: In developing countries, obstetric trauma is the most common cause of genitourinary fistulae. But over the last two decades, health care facilities have been improved and the scenario has been changed.

Purpose: The aim of the present study is to share our experience with genitourinary fistula in terms of mode of presentation, diagnostic modality, and management with the emphasis on the surgical approach and a parallel review of the available literature.

Materials and Method: During a 6-year period from January 2007 to December 2013, 41 cases of genitourinary fistula, who admitted and treated in the urology department of a tertiary care center, were retrospectively analyzed for etiology, site, size and number of fistulae, clinical presentation, diagnostic modalities, and management. The literature search was done using the Medline database.

Result: Mean age of the patient was 27 years (range 16–51). Primary and simple fistulae were common. Obstetric trauma was the most common etiology (56.09 %) followed by iatrogenic (39.03 %). Vesicovaginal fistula was the most common type (78.37 %) and trigone was the most common site involved (51.72 %). 51.35 % of patients were approached successfully by the vaginal route. Ancillary procedures were required in patients for various other associated anomalies at the time of fistula repair. The success rate on follow up was 94.5 %. In the mean follow up of 3 years, 35 patients were sexually active.

Conclusion: Genitourinary fistula is a frustrating entity with potentially devastating psychosocial consequence. Its management poses a tricky challenge to the surgeon. Accurate and timely diagnosis, adhering on basic surgical principle, and repair by an experienced surgeon provide the optimum chance of cure.

Abstract

Objective Near miss audit improves understanding of determinants of maternal morbidity and mortality and identifies areas of substandard care. It helps health professionals to revise obstetric policies and practices.

Methods A retrospective review of obstetric case records was performed to assess frequency ad nature of maternal near miss (MNM) cases as per WHO criteria. For each case, primary obstetric complication leading tomaternalmorbiditywas evaluated. Obstetric complications were analyzed to calculate prevalence ratio, case fatality ratio, and mortality index.

Results There were 6,357 deliveries, 5,273 live births, 247 maternal deaths, and 633 MNM cases. As per WHO criteria for Near miss, shock, bilirubin[6 mg%, and use of vasoactive drugs were the commonest clinical, laboratory, and management parameters. Hemorrhage and hypertensive disorders of pregnancy were leading cause of MNM (45.7 and 24.2 %) and maternal deaths (28.7 and 21.5 %). Highest prevalence rate, case fatality ratio, and mortality index were found in hemorrhage (0.53), respiratory diseases (0.46), and liver disorders (51.9 %), respectively.

Conclusion Developing countries carry a high burden of maternal mortality and morbidity which may be attributed to improper management of obstetric emergencies at referring hospitals, poor referral practices, and poor access/ utilization of health care services.

Abstract

Background: Bone turnover is high during lactation. However, studies on bone status of Indian urban mothers are scarce. Hence, the objective was to conduct a crosssectional study on the lactation-related changes in bone health status of Indian mothers postpartum using Dual X-ray Absorptiometry (DXA) at 3 time points: within a week of delivery, at 1- and 3-years postpartum. We also explored the association of dietary calcium intake, physical activity, serum vitamin D status, and dietary traditional food supplements (Dietary Food supplements) with bone health.

Methods: A cross-sectional study was conducted; 300 full-term, healthy primiparous women (28.6 ± 3.4 year) were randomly selected and categorized into 3 groups: 128 mothers within 7 days of delivery (Group A), 88 with 1-year-old children (B), and 84 with 3-year-old children (C). Anthropometry, lactation history, physical activity, diet, biochemical tests (vitamin D, parathyroid hormone), body composition, areal bone mineral density (a-BMD) at total body (TB), AP spine (APS), and dual neck femur (DF) were assessed by DXA (GE-Lunar DPX).

Results: Significantly higher APS-BMD (mean ± SD) was observed in Group C (1.107 ± 0.098 g/cm²) than that in A (1.045 ± 0.131 g/cm²) (p < 0.05). When adjusted for breastfeeding practices, mean (±standard error) APS-BMD was lowest in women in Group A (1.024 ± 0.013 g/cm²), but was higher at 1-year (1.079 ± 0.02 g/cm²) and at 3-years postpartum (1.111 ± 0.019 g/cm²), though differences were significant only between groups A and C (p < 0.05). Most mothers from all 3 groups consumed inadequate amount of nutrients except dietary fat and showed low physical activity. Multiple regression analysis indicated that dietary calcium, moderate physical activity, serum vitamin D, and consumption of dietary food supplements were not significant predictors of APS-BMD (p > 0.1).

Conclusion: Prevalence of nutrient and vitamin D deficiencies, low physical activity, and poor sunlight exposure were major concerns in Indian lactating mothers; improvement in bone mass at APS was observed at 3-years which was most likely due to physiologic changes.

Abstract

Objective: To determine the incidence, indications, risk factors, and complications of emergency peripartum hysterectomy (EPH) and to evaluate total versus subtotal hysterectomy for EPH.

Materials and Methods: This is a retrospective case series involving thorough examination of the files of all women who had EPH between January 2000 and December 2012 in the department of Obstetrics and Gynecology, Al-Jahra hospital, Kuwait after taking approval from the ethics committee. Incidence, indications, risk factors, type of hysterectomy, and complications of EPH were obtained from patient files.

Results: There were 63,337 deliveries of which 70.3 % were vaginal deliveries, and 29.6 % were by cesarean section (CS). Sixty-eight women underwent EPH representing an overall incidence of 1 case per 1,000 deliveries. The indications for EPH included abnormal placentation (77.4 %), uterine atony (14.5 %), and uterine rupture (8.1 %). There was one maternal death. Maternal morbidity occurred in 25 (40.3 %) women. The most common complications were mild to severe coagulopathy (19.35 %) and injury to the urinary tract (17.74 %). Injury to the ureter was avoided by placing ureteric stents preoperatively. Our population was significant in having higher rate of CS deliveries (91.9 %), women with prior CS (83.87 %), and high parity (mean 5.8).

Conclusion: Abnormal placentation was the most common indication to perform EPH. The relative risk of EPH was 27 for CS deliveries as compared to vaginal deliveries. There was no significant difference between subtotal versus total hysterectomy with respect to age, parity, previous CS, operative time, blood transfusion, and intra and post operative complications.

Abstract

Objective: This was the first Indian multicenter study at six specialty hospitals, to assess the real-life usage of the vaginal ring in daily clinical practice.

Methods: This open-label, prospective, single-arm, nonrandomized, interventional study enrolled 252 women aged [18 years, seeking contraception with no contraindications to the use of combined hormonal contraceptive. Women were provided the ring with a monthly follow-up schedule for three cycles. Cycle control, acceptability, tolerability, and safety assessments were recorded at each visit.

Results: Regular menstrual bleeding was reported by 76.2 % (192/252) at baseline. In study completers, regular bleeding was seen in 94.1 % (192/204), 97.5 % (199/204), and 98 % (200/204) in the 1st, the 2nd, and the 3rd cycles, respectively. Most (94.2 % [195/207]) women were very satisfied or satisfied with the ring, and 93.2 % (193/207) would recommend it to others. No pregnancies or serious adverse events were reported.

Conclusion: The study demonstrated that NuvaRing is a highly effective contraceptive method with an excellent cycle control. It is well tolerated and accepted by Indian women.