Objectives : Most patients with postmenopausal bleeding do not have endometrial cancer. The primary objective was to evaluate risk factors for endometrial cancer among postmenopausal women with bleeding.

Methods : This was a retrospective cross-sectional study. Women with postmenopausal bleeding presenting to a gynecology clinic were included in the study. Data on potential risk factors for endometrial cancer or atypical hyperplasia were collected. Univariate and multivariate analyses were performed to assess the risk factors.

Results : Among 212 women studied, 24 (11.3%) women had endometrial cancer. There were 38 (17.9%) with cervical cancer and 3 (1.4%) with ovarian cancer. Women 55 or older had an odds ratio of 7.5 (95% CI 2.2 to 26.2) as compared to women below 55 years (p value = 0.002). Women with 2 or more episodes of postmenopausal bleeding had an odds ratio of 4.9 (95% CI 1.1 to 23.0) and those who had either diabetes or hypertension had an odds ratio of 3.1 (95% CI 1.3 to 7.4) of endometrial cancer as compared to those who did not.

Conclusions : A third of patients with postmenopausal bleeding had a gynecological cancer. Age, frequency of bleeding, diabetes and hypertension, and increased endometrial thickness were independent risk factors for endometrial cancer.

Background : The cases of intrauterine contraceptive device (IUCD) with missing strings have risen due to increasing popularity of postpartum IUCD in Indian women. This has lead to increase in the burden of referral cases in tertiary care centres. Manual vacuum aspiration (MVA) device is a cheap and non-invasive method, well established for surgical abortion in first trimester of pregnancy. This study was undertaken to assess if MVA device can be used in retrieving IUCD in low resource setting, hence, reducing the need for referral or need of expensive and invasive techniques.

Method : A prospective interventional study was conducted over a period of 6 months. A total of 50 women who were desirous of IUCD removal with non-visibility of strings at the external cervical os were included in the study. All cases were more than 12 weeks postpartum and had an ultrasound confirmed intrauterine location of IUCD. Women with pregnancy, extrauterine location of IUCD, active pelvic infection and cervical cancer were excluded.

Results : The incidence of IUCD with missing strings was 19.4%. Almost a third of the cases (36%) were referred from outside Delhi for IUCD removal to our centre. In 30% cases IUCD could successfully be removed using the MVA device. Majority of the IUCDs were inserted in hospital by a gynaecologist (90%), and most of the insertions were post-placental (62%).

Conclusion : Retrieval of IUCD with missing strings with MVA device is a novel method and can be an initial approach in low resource setting before referral to a higher centre for management.

Background : Intrauterine contraceptive devices (IUCDs) have been used by women in India for decades for spacing pregnancies. The increased institutional deliveries are an opportunity to provide women easy access to immediate PPIUCD services. Hence, we planned a study to evaluate the role of a novel dedicated inserter technique to improve compliance in postpartum women.

Materials and Methods : A prospective case–control study was conducted on postpartum women who underwent vaginal delivery. Cases were selected and divided randomly into two groups: the long inserter (n = 292) and control groups (n = 301 using conventional method of insertion). PPIUD was inserted by trained providers, followed by ultrasound within 48 hours of insertion to assess location and fundal placement of the IUD. Follow-up was done at 2 weeks, 6 weeks and 3 months post-insertion, and ultrasound assessment was done for IUD location at each visit. Final statistical analysis was done by using Chi-square test.

Results : There were fewer complications like pain and irregular bleeding in the long inserter group as compared to the control group. None of the cases reported missing thread in the long inserter group. Expulsion was seen in only one case from the long inserter group and five cases in the control group. Client satisfaction was good (98.4%) in the long inserter group, and with each follow-up, satisfaction level also improved in the control group (96.6%, p value− 0.03).

Conclusion : The long inserter PPIUD insertion is a safe and convenient method. It has better ease of insertion, high fundal placement and good thread visibility and has reduced risk of infections as compared to the conventional PPIUD insertion technique.

Purpose of Study To evaluate the knowledge, attitude and perception of HIV/AIDS among antenatal women and to correlate them with their socio-demographic profile.

Methods We conducted this study on 400 pregnant women attending the antenatal clinic of our hospital for the first time irrespective of their period of gestation, age and parity. All the participants were interviewed with the help of a predesigned questionnaire which included their socio-demographic details and questions to assess their knowledge and attitude toward HIV/AIDS. Data were analyzed using SPSS version 22 and expressed in the form of percentage, frequency distribution, mean, standard deviation and p value.

Results Antenatal women of the study population were having unsatisfactory knowledge about HIV/AIDS and prevention of MTCT. 26% women were totally unaware of any entity like HIV. 44% participants did not know the most common way of spread of HIV. Only half of the subjects knew the correct preventive measures for HIV/AIDS. 54% knew about MTCT, but only 24% knew about its transmission through breast milk. Knowledge and attitude was found to be significantly improving with socioeconomic status.

Conclusion Indian antenatal women have poor awareness and wrong perception about HIV/AIDS and its mother to child transmission (MTCT). Targeted educational interventions can be formulated to increase awareness among antenatal women about prevention of vertical transmission of HIV.

Introduction Pregnancy is characterized by a series of metabolic changes that promote insulin resistance. This could be due to increase in the plasma levels of one or more pregnancy-related hormones such as oestrogen, progesterone, prolactin, cortisol, and human placental lactogen (HPL). The increased insulin resistance in pregnancy is associated with development of diabetes which has implications for the future gestations also.

Aims and Objectives To determine status of insulin resistance in pregnant women and correlate the presence of insulin resistance with obstetric outcome.

Material and Method A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, KGMU, Lucknow, over a period of one year. Total 150 pregnant women were enrolled from OPD, out of which 136 women were followed up till delivery. Insulin resistance was calculated by HOMA IR index, twice in whole antenatal period (first in early pregnancy and second in late pregnancy). All women were also tested for GDM by DIPSI test (plasma glucose value after 2 h of 75 gm glucose load irrespective of last meal) as per protocol.

Results In our study, we found 71 women out of 136 (52.2%) were GDM. Total 30 women out of 136 (22.05%) were GGI (Gestational Glucose Intolerance), and total 38 out of 136 (27.9%) women were found to have insulin resistance using HOMA IR ≥ 2 as cut off. Significant correlation was found in between BMI and insulin resistance (p = 0.001) and between GDM and insulin resistance (p = 0.001). Relative risk of development of complications like Preeclampsia, neonatal hypoglycemia, and respiratory distress syndrome was higher in women having insulin resistance and GDM.

Conclusion Obstetric complications like preeclampsia, neonatal hypoglycemia, and respiratory distress syndrome are more likely to occur in women with insulin resistance, but larger studies are required to delineate whether insulin resistance alone without development of GDM will have the same implication

Background Parent to child transmission is the major mode of spread of HIV. An effective national health program (PPTCT) has been designed under NACO which helps in reducing the spread of HIV by vertical transmission and improving the life of the women and her baby.

Methods A retrospective study was done at a tertiary care hospital, including pregnant women registered and delivered, and those who came directly in labour at the hospital during a period of 10 years from January 2010 to December 2019. Pretest counselling, HIV testing, Post-test counselling were done, and antiretroviral prophylaxis was given as per the NACP guidelines. Sociodemographic characteristics, obstetric outcome and efficacy of PPTCT services were analysed.

Results Out of the 63,947 antenatal mothers included, 61,061 (95.4%) accepted HIV testing. 177 of these tested positive (0.289%) with a significant reduction in the seroprevalence over the decade. Majority of seropositive women were primigravida; housewives from urban areas, from low income and educational background and with no history of any contraceptive use. Out of 718 live births, the MTCT rate was found to be 4.5% at 6 weeks over the whole decade and was noted to be 1.8 % at 18 months which is well within the goal of PPTCT program and hence elucidating the success. Seventy-four spouses of the 177 seropositive women tested positive, 55 tested negative and 49 did not undergo the HIV testing. Decline in the number of partners not undergoing testing was elicited. The discordant couple rate in the study was 31% and showed variable trend over the decade.

Conclusions Our study has observed an overall increase in efficacy of PPTCT in terms of increased utilization of PPTCT through the decade, decrease in the vertical transmission and seroprevalence rate, increase in the acceptance rates of HIV testing by partner almost conquering the goal of NACO.

Background The physical characteristics which are known to affect the ovarian reserve are age, body mass index (BMI), occupational exposures, age at menarche and menstrual cycle length. A correlation between different physical characteristics and the ovarian reserve will help to identify areas which need to be tackled to increase the chances of fertility of women in India.

Methods In this retrospective, observational study, namely the MOTHER Study, data of women between 18 and 45 years of age, attending the selected fertility centers across different states in India were taken for evaluation. Demographic information along with information on factors potentially related to fertility like age of menarche, menstrual cycle length and occupational factors were collected by review of medical records at screening visit. Most recent AMH assay and antral follicle count (AFC) where the subject has not taken any contraceptives 12 months prior to the test were collected.

Results Age of woman, years of marriage, years of infertility and smoking have shown effect on ovarian reserve testing like AMH and AFC. The other physical characteristics which were evaluated and considered to affect the ovarian reserve like body mass index BMI, occupational exposures, age at menarche and menstrual cycle length have not shown statistically significant correlation.

Conclusion Age of woman and years of infertility are inversely proportional to ovarian reserve markers, namely AMH and AFC. Addictions like smoking and alcohol affect ovarian reserve.

Introduction Endometriosis associated pelvic pain (EAPP) is the most common complaint of patients with endometriosis. Nearly, 70% of females with endometriosis present with EAPP while endometriomas are found in 17–44% of patients.

Material and Methods A short-term single centre study was carried out in 56 patients in the age group of 15–35 years with complaints of pain and diagnosed as endometriosis either by imaging studies and/or by laparoscopy was given dienogest 2 mg OD, and effect of treatment was seen as improvement of pain score over a period of 3 months. The effect of dienogest was also seen on size of endometrioma. Patients were followed up at 1 and 3 months.

Results and Discussion Out of 56 patients, 38 (67.8%) patients reported their pain relief within 2–5 days after starting dienogest. Out of 41 patients (73%) who had severe pain at enrollment, only 1 patient (1.79%) complained of severe pain at the end of 1 month with dienogest. Successful reduction in endometriotic cyst size (>50%) was seen in 3 patients (5.3%) at the end of 1 month with dienogest. Out of 56 patients, 41 patients (73.2%) had significant pain relief (>30%) at three months of treatment. At the end of 3 months, seven patients (12.5%) had significant cyst size reduction (>50%) with dienogest. No major side effects were noted.

Conclusion Dienogest is well tolerated drug for endometriosis showing significant relief of pain. However, it was seen that though endometriomas did not grow during treatment, significant regression was uncommon.

Background An Operational Framework document for population-wide screening of common cancers in India was launched in 2016. The target age for screening is 30–65 years for cervical, breast and oral cancers. This study was designed to review the frequency and distribution of cervical lesions among women aged 21–29, 30–65 and > 65 years.

Study Design A retrospective review of all satisfactory cervical smears (n = 79,896) received over a ten-year period (2010– 2019) was conducted. Three age bands were defined: 21–29 years, 30–65 years and > 65 years. The frequency and distribution of the various epithelial cell abnormalities (ECAs) across the three age bands were calculated. Cytohistologic correlation was performed wherever available.

Results Of the 1357 ECAs (1.7% of all smears), about 16.9% were seen in the age band 21–29 years, while 4.5% presented in > 65 years of age. About 80% of the ECAs seen in younger women were low-grade squamous lesions, while 75% of lesions in women > 65 years were high-grade squamous abnormalities. Among the total 512 significant high-grade and malignant (squamous and glandular) lesions, 5.6% presented in women 21–29 years, while 10.1% were seen in > 65 years of age.

Conclusion Majority of the significant cervical lesions would be detected if the screening focuses on the 30–65 years age group. However, about 19% of high-grade squamous preneoplastic lesions (ASC-H/ HSIL) and 13% of preneoplastic glandular lesions (AGC-N) are likely to be missed if women 21–29 years and > 65 years are excluded. The cost of screening incurred by including these age groups has to be weighed against the benefits derived, especially in low-resource settings. In the absence of universal implementation of HPV immunization, there is a felt need to enhance cervical cancer awareness and encourage screening, more so in high-risk category and symptomatic females beyond the selected age group.

Objectives To study the implementation of ERAS (Enhanced recovery after surgery) pathway and its effect on duration of post-operative hospital stay and various phases of post-operative care in comparison with conventional care group.

Materials and Method Prospective study conducted in Amrita institute of medical sciences, Kochi, Kerala. Women planned for elective and scheduled caesarean section were included in the study from September 2020 to October 2020 and compared with women who underwent caesarean section in the same period receiving standard perioperative care. Women who underwent emergency and urgent caesarean section and patients with medical or surgical comorbidities were excluded. Surgical procedure was the same in both arms. Intravenous hydration was goal directed. Oral feeding was started with liquids after 2 hours, solids were given after 4 hours. Intravenous paracetamol and diclofenac were given routinely. Intravenous tramadol and fentanyl were given if needed apart from these analgesics. Foleys catheter was removed after 12 hours. Conventional care group observed 6 h of fasting pre- and post-operatively. Catheter was retained for 24 h, 2500 ml IV fluids were infused on the first day followed by 1000 ml on the second day. The duration of hospital stay was based on clinical criteria and care providers decision.

Results In ERAS arm, post-operative hospital stay was significantly reduced in comparison with conventional care group. (53.91 vs 77.71 h-p = 0.00) Early feeding, early ambulation, early catheter removal, multimodal and preemptive analgesia all contributed to early recovery of the patient.

Conclusion In ERAS pathway length of post-operative stay was significantly reduced as compared to conventional care.

Abstract

Objective To assess knowledge, attitude and practices (KAP) towards COVID-19 among pregnant women at a tertiary care hospital.

Methods This was a questionnaire-based cross-sectional analysis pertaining to COVID-19 which was conducted at a tertiary care obstetric facility in India among 200 consecutive consenting pregnant women. They were assessed for demographic details and KAP score (knowledge—17 questions, attitude—9 questions and practice—8 questions). Analysis of data was done using Statistical Package for the Social Sciences (SPSS) version 25.0.

Results The participants had adequate mean knowledge score (± SD) of 22.5 (± 3.5) were following good practices [mean score (± SD) = 15.5 (± 2.6)] and showed positive attitude for preventive measures against COVID-19 [n (%) = 194(96%)]. Low knowledge score (p-value 0.030) was seen in non-health care workers.

Conclusion This study demonstrated that majority of the pregnant women had satisfactory knowledge, positive attitude and were following practices in right manner regarding COVID-19 but continued efforts for generating awareness were warranted. As India is battling the second COVID-19 wave and in the absence of definitive cure, strengthening of health policies directed at pregnant women should be prioritized with special focus on significant gaps in KAP.

Abstract

Background COVID-19 pandemic has affected the pregnant women both physically and mentally. This study is conducted to assess, the impact on COVID-19 pandemic on psychiatric symptoms among pregnancy and to compare them with non-pregnant women.

Methods An observational study was conducted at Govt. Medical College & Hospital, Ooty (Udhagamandalam). A validated Edinburgh Depression Scale was used to screen the mental health status. Categorical variables were analysed using Chi-square test and continuous variables by independent t test. A Pearson’s correlation analysis was performed to check the association of Edinburgh postnatal depression scores with the demographic characteristics. Paired t test was conducted to find the difference in EPDS scores at baseline and study conclusion visit. Regression analysis was conducted to predict the outcome variables.

Results The Edinburgh Depression scores were significantly higher in the pregnant women group, (12.48 ± 3.753 vs. 8.00 ± 2.436; p value = 0.001; 95% CI 3.340–5.627), when compared to non-pregnant women (12.90 ± 3.731 vs. 9.20 ± 2.973; p value = 0.001; 95% CI 2.480–4.920). The Edinburgh Depression scores at the study conclusion visit was statistically significant, (11.05 ± 3.839 vs. 10.24 ± 3.872; p value = 0.008; 95% CI −1.40 to −0.213). Education, income, duration of marriage, body mass index, and suicidal ideation are some of the predictors identified in this study to cause depression among pregnant women.

Conclusion The findings of the study indicate a clinically significant increase of depressive symptoms among pregnant women. It is recommended to include routine psychological screenings and interventions during pregnancy.

Abstract

Background The COVID-19 pandemic had not only burdened healthcare systems all over the world but had also affected mental health of frontline Health Care Workers. Purpose Purpose of our study was to compare the psychological morbidity of health care workers posted in Covid labour room with their counter parts in Non Covid labour room.

Material and Methods Present study was a cross-sectional study conducted on HCW of Covid and Non Covid labour in a span of 6 months.

Results Insomnia in Covid labour room was found to be in 57% HCW as compared to none in non Covid labour room (mean score 7.47 ± 2.74 vs 1.82 ± 1.25, P Value < .0001). Depression was prevalent in 92% of participants in Covid labour room as compared to 12.5% in Non Covid labour room; however, severe depression was found in 6% participants (mean score 17.32 ± 4.88 vs 2.12 ± 1.65, P Value < .0001). Prevalence of anxiety in present study was 90% in Covid labour room and 6% in non Covid labour room (mean score 11.47 ± 4.57 vs 1.94 ± 1.43, P Value < .0001). Psychological morbidity as tested by Symptom Check List-k-9 was positive in 21.8% participants in Covid Labour room as compared to 1% in Non Covid labour room (mean score 5.57 ± 2.58 vs 2.22 ± 1.89, P Value < .0001).

Conclusion Study revealed significantly high psychological morbidity, insomnia, anxiety and depression in the health care workers in Covid labour room than Non Covid labour room.

Abstract

Background The objective of this study was to find out the effect, course of disease and management of the COVID-19 infection in pregnant women and compare it with non-pregnant population.

Method This is a retrospective study done at Sardar Vallabhbhai Patel Institute of Medical Science and Research (SVPIMSR), Smt. NHL MMC, Ahmedabad, from April 1, 2020, to September 30, 2020. All COVID-19-positive patients were divided into two groups: group A was comprised of pregnant/postpartum and group B of non-pregnant patients

Result A total of 709 women (Group A-205, Group B-504) were included in the study, In group A 90% of patients were asymptomatic, while in group B 48% asymptomatic patients. Group A had 5.9% and group B had 13.1% patients having comorbidities. In group A, smaller number of patients had raised inflammatory markers as compared to group B. Only 4% patients of group A showed significant changes on chest X-ray as compared to 16% in group B. Only 2.9% patients of group A required intensive care unit admission as compared to 10.31% patients of group B. Mean hospital stay of group A was 10.6 days, and that of group B was 12.1 days.

Conclusion In pregnancy, due to the physiological alterations in cardiovascular, respiratory and immune system, the pregnant women are vulnerable to infections. Although pregnancy is immunocompromised state, the severity of Coivd-19 disease is milder as compared to non-pregnant COVID-19-positive patients.

Abstract

Background As the novel coronavirus 2019 (COVID-19) continues its pandemic surge globally along with its social distancing norms, the physical conduction of practical examinations for medical graduates and postgraduates has become difficult. Software-based systems and social media platforms could provide alternatives for ensuring regular medical education and exam-oriented assessments. In this context, we evaluated our own experience with virtual conduction of semester practical exams for medical graduates.

Material and Methods This prospective study was conducted in Gynaecology and Obstetrics department. We employed live streaming educational video conferencing software for virtual consultation between medical students, patients (case presentations), internal and external examiners. The outcomes were evaluated in terms of conduction of various components of practical examination—Viva, case presentations, instruments, slides, specimen examination. Statistical analysis was performed by descriptive statistics through Microsoft Excel sheet.

Results Virtual conduction examination/evaluation was performed on 150 medical students by examiners from a distant location. No problems occurred except few short duration (less than 5 min) interruptions due to internet connectivity issues. 125/150 (83.5%) of medical students and all examiners (2 internal and 2 external) expressed satisfaction with virtual medical evaluation.

Conclusions 83.5% of medical students and all examiners expressed satisfaction with virtual medical evaluation during this COVID pandemic. Our findings suggest that virtual conduction of practical annual medical exams through virtual video conferencing platform appears to be an optimal alternative during COVID pandemic.

Aim To determine the socio-demographic characteristics and pregnancy outcome of Rh D alloimmunized women monitored with MCA PSV (middle cerebral artery peak systolic velocity).

Materials and Methods In total, 363 Rh D alloimmunized women attended antenatal clinic or obstetric emergency between January 2006 and December 2014. MCA PSV was the screening method for detection of fetal anemia. Intrauterine blood transfusion (IUT) was given when MCA PSV was > 1.5 MOM. Totally, 162 women (164 fetuses) received 492 transfusions. Forty-eight women had fetal hydrops at presentation. Five women (three received IUT) were lost to follow-up. Pregnancy outcome of 358 women and socio-demographic characteristics of 363 women were analyzed.

Results The perinatal mortality was 421, 66 and 87 per 1000 live births in hydrops group, non-hydrops IUT group and non-IUT group, respectively.

Conclusion Rh alloimmunization is still a major cause of perinatal morbidity and mortality. The higher gravidity, previous history of pregnancy wastage, still births and hydrops increase the requirement of intrauterine transfusion. MCA PSV is an excellent tool for monitoring of Rh alloimmunized pregnancies to detect fetal anemia. Early detection and monitoring by MCA PSV improve its outcome.

Background Progesterone is essential for the maintenance of a healthy pregnancy. Any defect in the secretion of human chorionic gonadotropin or progesterone is associated with a significantly increased risk of first-trimester abortion. Progesterone is frequently prescribed to patients presenting with per vaginal (PV) bleeding in early pregnancy and a history of recurrent pregnancy loss.

Methods Pregnant women up to 12 weeks of gestation with a history of more than two early pregnancy losses and presenting with vaginal bleeding were included in this study. All subjects were randomized to receive either vaginal progesterone 600 mg/day or oral dydrogesterone 30 mg/day. A detailed history—including menstrual history, previous pregnancies, previous miscarriages, and other risk factors–was obtained. The mean time required for the cessation of PV bleeding and continuation of pregnancy up to 24 weeks and till term was compared.

Results A total of 200 patients were randomized to vaginal progesterone 600 mg/day (n = 100) or oral dydrogesterone 30 mg/day (n = 100). While 74 patients had two miscarriages in the progesterone group, 68 patients had two miscarriages in the dydrogesterone group. The time required for complete cessation of bleeding was significantly lesser among patients who received oral dydrogesterone compared to those who received intravaginal progesterone (53.90 ± 9.09 vs. 94.60 ± 7.29 h, p < 0.0001). Numerically higher number of patients receiving oral dydrogesterone had a successful continuation of pregnancy up to 24 weeks of gestation, as well as till full term compared to progesterone group (70 vs. 75).

Conclusion Oral dydrogesterone is preferred over vaginal progesterone in patients presenting with vaginal bleeding during early pregnancy and a history of recurrent early pregnancy loss

Background Recent evidence suggests that thyrotropin (TSH) levels are population specific because of differences in ethnicity. As a result, the 2017 ATA guidelines state that treatment may be tailored as per the laboratory-specific reference ranges of TSH for the local population instead of using a fixed upper limit of 2.5 mIU/L during pregnancy.

Methodology This was a cross-sectional study in which we collected detailed clinical data of 604 pregnant women along with their TSH and spot urinary iodine excretion levels. Reflex testing for thyroid peroxidase antibodies (TPOAb) was done in women with TSH levels > 2.5 mIU/L in 1st trimester and 3.0 mIU/L in 2nd and 3rd trimester. After excluding 295 women who had high risk factors as per ATA 2017 guidelines and those who were TPOAb positive, we calculated the reference range for TSH in an iodine-sufficient low-risk cohort of 309 women.

Results With median urinary Iodine of 255 µg/l, our population had more than required iodine levels. The 5th and 95th percentiles of TSH in our study cohort of 604 women were 0.64 and 7.81 mIU/L, respectively, while the 5th and 95th percentiles of TSH for the low-risk cohort of 309 women were 0.59 and 4.48 mIU/L, respectively.

Conclusion An upper limit of 4.5 mIU/L for TSH level during pregnancy can be used to guide management decisions for low-risk North Indian women.

Objective Nearly 1.5 billion people of an Asian country are living their lives without a country-specific over-the-counter (OTC) drug list. A study was planned to assess the understanding and practice of OTC medication consumption in the pregnant population.

Methods A questionnaire-based cross-sectional study evaluating different perspectives on OTC drug consumption was planned in around 500 pregnant women attending tertiary care outpatient antenatal clinics. The association of knowledge, attitude and practice versus indications, knowledge regarding harmful effects possible, reasons for choosing OTC medication, the practice of consulting nonmedical persons and drug interactions with the disease or prescription medications was determined. Regression analysis was performed in statistical software R.

Results Seven percent (36/516) of pregnant women were found to consume oral antimicrobials without prescription. Local chemist consultation was the most common channel (72.48%) to procure the OTC medicines. Participants with good knowledge score showed an odds ratio (OR) of 1.87 (95% C.I.; 1.28–2.73), 1.6 (95% C.I.; 0.99–2.63), 1.66 (95% C.I.; 1.14–2.42) and 2.66 (95% C.I.; 1.49–4.89) for self-medication encouragement tendency possible, restricting sale of OTC medications, the habit of reading drug leaflets and understanding the potentially harmful effects, with OTC drugs, respectively. Right-attitude participants showed an OR of 1.89 (95% C.I.; 1.29–2.80) and 1.8 (95% C.I.; 1.19–2.76) for identifying knowledge of acetaminophen overdose and liver damage link as well as the disease symptom masking possibility with OTC, respectively. Participants with insufficient knowledge and attitude scores showed an association with more OTC antacid-antiemetics and analgesic use, respectively.

Conclusion Antenatal pregnant women need to be guided on avoiding OTC antimicrobial usage. Both obstetricians and regulators have to play an active role in educating pregnant women and contributing to developing country-specific OTC drug lists with the guidelines.

Purpose We aimed to assess the effect of TOT procedure on sexual function and quality of life in sexually active patients.

Materials and Methods Forty-one patients with SUI aged 18–70 years participated in this study during 2015–2019. Sexual function was evaluated by Female Sexual Function Index (FSFI), Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory Questionnaire (UDI-6) prior to TOT surgery and six months after surgery.

Results The mean IIQ-7 and UDI-6 scores were significant lower after surgery (P < 0.001). The mean FSFI score was 22.69 ± 5.48 prior to surgery and 29.79 ± 4.12 in the sixth month after surgery (P < 0.001). We found significant changes in all FSFI domains except for pain. Two patients complained of new dyspareunia after surgery. There was also a direct significant correlation between education and sexual function improvement in terms of desire (P = 0.031).

Conclusion TOT can significantly enhance sexual function with low rate of complications in patients with SUI.