A clinical study of fetal outcome following early and delayed cord clamping in births associated with anemia in pregnancy.

Background: As there is a risk for infant anaemia, early cord clamping which is usually performed at 10-15 seconds of delivery was changed to delayed cord clamping for at least for 30 seconds Delayed cord clamping (DCC) increases the blood volume and haemoglobin levels in newborns and reduces risk of iron deficiency anaemia in both term and preterm infants.Early clamping allows cord blood collection in benefit for transplantation of stem cells. Research Objective: To compare levels of haemoglobin, hematocrit and serum ferritin at birth and 4 weeks of age in babies as well as neonatal outcome following early and delayed cord clamping in births associated with anaemia in pregnancy. Study Design: An observational study. Participants: Anaemic pregnant women with period of gestation 32-40 weeks admitted in labour room for delivery were enrolled. Intervention: Grouping of the patients was done according to the timing of the umbilical cord clamping. 1. Early cord clamping (< 60 seconds) 2. Delayed cord clamping (1 - 3 minutes) Of which 58 subjects were in ECC (early cord clamping)and 62 were in DCC (delayed cord clamping)group. Results: There was no significance of ECC or DCC in developing polycythemia, IVH or hyperbilirubinemia or increased need of blood transfusion. The levels of haemoglobin, hematocrit and ferritin levels were showing significant increased among DCC as compared to ECC. Conclusion: Delayed cord clamping significantly increases the levels of haemoglobin, Serum ferritin and hematocrit at 4 weeks of age. It should be recommended in routine practice where it is not contraindicated especially in resource- poor settings.

Study of Serum Adiponectin and Interleukin-1ß Levels in Women with Gestational Diabetes.

Introduction: Pregnancy is associated with alterations in the regulation of glucose metabolism caused by actions of various placental hormones and substances that antagonise the action of insulin leading to a state of relative insulin resistance as pregnancy progresses. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Adiponectin is known to be synthesised by adipocytes as well as by the placenta during pregnancy. It has an insulin-sensitising and anti-atherosclerotic actions. Interleukin-1ß (IL-1ß) is a member of interleukin-1 cytokine family and is known to involve in immune-mediated disease and regulation of inflammation. Accumulating evidence indicates that diseases related to metabolic syndrome are characterised by abnormal cytokine production, including IL-1ß. Objectives: To evaluate serum adiponectin and IL-1ß levels in women with GDM and correlate their levels with blood glucose level. Materials and Methods: A hospital-based case-control study was conducted in which 30 cases of GDM along with age-matched normal glucose tolerance (NGT) pregnant controls were taken. Informed consent was taken and subjects were screened at 24-28th weeks of gestation for GDM by glucose challenge test (GCT), followed by oral glucose tolerance test. Socio-demographic data and clinical evaluation were done using a pre-structured perfoma. Serum concentration of adiponectin and IL-1ß was measured using enzyme-linked immunosorbent assay. Results: The mean value of serum adiponectin level was significantly lower, 5.76 µg/ml SD ± 2.01351 in cases of GDM compared to NGT controls (14.12 µg/dl SD ± 4.99734), P < 0.05. A cutoff value of serum adiponectin level ≤8.7 µg/ml gave a sensitivity and specificity of 100% when used alone for identifying cases of GDM in the present study. Serum level of IL-1ß was less than the detectable level (<6.5 pg/ml) in NGT controls. In this study, 26.7% of GDM cases showed levels >6.5 pg/ml (median 18.2 [12.8-34.62]), rest of the cases (73.3%) had levels less than 6.5 pg/ml. A significant inverse correlation was seen between serum adiponectin and HbA1c, pre-gestational BMI, and blood glucose level at GCT. There was no significant correlation of serum IL-1ß level with any of the parameters. Conclusion: GDM is associated with low level of serum adiponectin, and serum adiponectin may be used as a biomarker for detecting cases of GDM to complement blood glucose level.

A randomized control trial to study the effect of integrated yoga on pregnancy outcome in hypertensive disorder of pregnancy.

OBJECTIVE: The study aimed to evaluate the effects of integrated yoga on blood pressure and pregnancy outcome in hypertensive disorder of pregnancy. METHODS: Seventy-nine patients were randomized into study and control groups. The study group received the intervention in the form of integrated yoga for 4 weeks. Final analysis was done on 30 patients each of study and control group. RESULTS: The mean systolic BP declined by 7.43 ± 5.86 mmHg in the study group as compared to 2.50 ± 5.21 mm Hg in the control group (p value 0.002). The mean diastolic BP prior to delivery was 88.00 ± 3.71 mmHg in the study group and 92.20 ± 5.02 mmHg in the control group (p = 0.001). The maternal comfort in labor was significantly higher and the duration of labor significantly reduced in the study group. CONCLUSION: Integrated yoga effectively reduced systolic and diastolic blood pressures and increased maternal comfort during labor in hypertensive disorder of pregnancy.

Prenatal Yoga: Effects on Alleviation of Labor Pain and Birth Outcomes.

Background: This study was conducted to test the hypothesis that prenatal yogic exercises are effective in alleviating labor pain and improving birth outcomes, by comparing pregnant women undertaking yoga with a control group. Trial design: Single blinded, parallel randomized control trial. Methods: Two hundred primigravid women of 30 weeks of gestation onward who met the inclusion criteria (primigravida, 20-35 years of age, gestational age of 30 weeks, no prior experience of yoga) were randomly assigned to study (n = 100) and control groups (n = 100) by using the minimized randomization program version 2.01. The study group received the intervention in the form of integrated yoga consisting of a series of 30-min practice sessions at the 30th, 32nd, 34th, 36th, 37th, 38th, and 39th weeks of gestational age. The matched control group did not perform yoga. The patients were followed till delivery for maternal comfort, alleviation of labor pain, and birth outcome. Alleviation of labor pain was assessed by using numerical pain intensity scale (NPIS), pain behavioral observational scale (PBOS), and maternal delivery comfort questionnaire. Only the assessors were blinded. Results: Two hundred patients were randomized into 100 each in case and control groups. Final analysis was done on 75 patients in each group after exclusion due to development of complications, loss to follow-up. The requirement of induction of labor and analgesics was significantly less in the study group (p < 0.044, p < 0.045). There was significantly more number of normal vaginal deliveries (p < 0.037) and less caesarean sections (p < 0.048), shorter first stage of labor (p < 0.0003) in the study group practicing yoga. The tolerance of pain was better in the study group as shown by NPIS (p < 0.001) and PBOS scores (p < 0.0001). Postpartum, the maternal comfort questionnaire score showed higher comfort in the study group (p < 0.032). The number of low birth weight babies was also significantly less in the study group (p < 0.042). There were no adverse effects attributed to yoga. Conclusion: The study has highlighted that yoga is a noninvasive, easy to learn mind-body medicine and complementary health practice, effective in alleviation of labor pain and possibly improving birth outcome.

Study of Association of Leptin and Insulin Resistance Markers in Patients of PCOS.

Polycystic ovary syndrome (PCOS) is a common endocrinological disorder among women of the reproductive age group with long term sequelae which include diabetes mellitus, hypertension and CAD. The present study was conducted to evaluate the association of leptin-an adipokine playing an important role in carbohydrate metabolism and markers of insulin resistance among women with PCOS. Sixty diagnosed cases of PCOS as per Rotterdam criteria were enrolled in this study after informed written consent. Insulin resistance was estimated using the homeostatic model assessment-insulin resistance (HOMA-IR). HOMA-IR was calculated as the product of the fasting plasma insulin value (mU/ml) and the fasting plasma glucose value (mg/dl), divided by 405 and HOMA ß was calculated as 360 × [insulin]/([glucose] - 63) % (glucose in mg/dl). Estimation of serum leptin levels was done by ELISA using leptin ELISA kit from (DRG). A positive correlation of serum leptin levels was observed with markers of insulin resistance. Multiple regression analysis with HOMA-IR as dependent variable demonstrated a statistically significant contribution of fasting insulin levels. This study highlights the role of leptin in alterations in carbohydrate metabolism in patients with PCOS.

Uterine artery embolization: exploring new dimensions in obstetric emergencies.

The role of transcatheter arterial embolization in the management of obstetric emergencies is relatively new and not so commonly used. In the following series, the efficacy of this technique in situations such as scar site ectopic pregnancy, antepartum and postpartum obstetric hemorrhage, especially in the presence of coagulation derangement is presented.

Can maternal serum placental growth factor estimation in early second trimester predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction? A prospective cohort study.

AIM: To determine whether maternal serum placental growth factor (PlGF) estimation in early second trimester (20-22 weeks of gestation) can predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction (IUGR). MATERIAL AND METHODS: A prospective cohort study was conducted on 722 women with singleton pregnancies, screened from the antenatal clinic, and serum PlGF levels were estimated at 20-22 weeks of gestation. A cut-off value of <155 pg/mL for serum PlGF was determined by receiver operating characteristic (ROC) curve analysis for identifying pregnant women at risk of developing early onset preeclampsia and/or early onset IUGR. Preeclampsia and IUGR were classified as early onset when diagnosed by 32 weeks of gestation. Univariate logistic regression analysis was used to analyze the association between serum PlGF level <155 pg/mL and the two outcome measures (i.e. early onset preeclampsia and early onset IUGR) and odds ratio (OR) was computed. P-value < 0.05 was considered statistically significant. RESULTS: Maternal serum PlGF level <155 pg/mL at 20-22 weeks of gestation had a strong association with early onset preeclampsia (OR 8.35; 95% CI 1.79-18.94; P = 0.007) and with early onset IUGR (OR 10.73; 95% CI 4.08-20.23; P = 0.000). The sensitivity of serum PlGF < 155 pg/mL for predicting early onset preeclampsia and early onset IUGR were 82 and 84, respectively. CONCLUSION: Maternal serum PlGF level estimation in early second trimester (20-22 weeks of gestation) may be useful in predicting the occurrence of early onset preeclampsia and/or early onset IUGR.

Serum placental growth factor as a predictor of early onset preeclampsia in overweight/obese pregnant women.

The purpose of this study was to analyze whether maternal serum placental growth factor (PlGF) could predict early onset preeclampsia (<32 weeks of gestation) in overweight/obese pregnant women, and whether it could do it more effectively than in normal/underweight pregnant women. A prospective cohort study was conducted on 1678 pregnant women with singleton pregnancies, who were grouped as underweight, normal, overweight, and obese on the basis of body mass index, followed by serum PlGF estimation at 20 to 22 weeks of gestation. A cut-off value of <144 pg/mL for PlGF was determined by Receiver Operating Characteristic curve analysis to identify risk of early onset preeclampsia. Univariate logistic regression analysis revealed significantly stronger association between PlGF <144 pg/mL and early onset preeclampsia in overweight/obese pregnant women (odds ratio 7.64; 95% confidence interval 5.34-10.12; P = .000) than in normal/underweight pregnant women (odds ratio 2.95; 95% confidence interval 1.74-4.26; P = .007). Weight and PlGF levels in study women had a significant negative correlation (r = 0.663; P = .002). Serum PlGF in early second trimester could be an effective predictor of early onset preeclampsia in overweight/obese pregnant women and may be more effective than in normal/underweight pregnant women.

Is serum placental growth factor more effective as a biomarker in predicting early onset preeclampsia in early second trimester than in first trimester of pregnancy?

PURPOSE: To determine whether maternal serum placental growth factor (PlGF) is more effective as a biomarker in predicting the occurrence of early onset preeclampsia in first trimester or early second trimester of pregnancy. METHODS: A prospective cohort study was conducted on women with singleton pregnancies, screened from the antenatal clinic. Serum PlGF estimation was done at 11-14 weeks of gestation on 1,244 women and at 22-24 weeks of gestation on 1,206 women from the initial study population. A cut-off value of <228 pg/ml for serum PlGF at 11-14 weeks of gestation and <144 pg/ml for serum PlGF at 22-24 weeks of gestation were determined by receiver operating characteristic (ROC) curve analysis for identifying pregnant women at risk of developing early onset preeclampsia (<32 weeks of gestation). Univariate logistic regression analysis was used to analyze the association between serum PlGF < 228 pg/ml at 11-14 weeks of gestation and <144 pg/ml at 22-24 weeks of gestation with the occurrence of early onset preeclampsia and odds ratio (OR) was computed. P value < 0.05 was considered statistically significant in this study. RESULTS: Maternal serum PlGF <144 pg/ml at 22-24 weeks of gestation had a stronger association (OR 18.83; 95 % CI 12.08-22.24; p = 0.000) than serum PlGF <228 pg/ml at 11-14 weeks of gestation (OR 2.76; 95 % CI 1.29-3.94; p = 0.007) with the occurrence of early onset preeclampsia. The sensitivity and specificity of serum PlGF <144 pg/ml at 22-24 weeks of gestation (84 and 78, respectively) were much higher than those of serum PlGF <228 pg/ml at 11-14 weeks of gestation (58 and 66, respectively) in predicting early onset preeclampsia. CONCLUSION: Maternal serum PlGF may be more effective as a biomarker in early second trimester than in first trimester of pregnancy, in predicting the occurrence of early onset preeclampsia.

Primary hepatic pregnancy.

A 25-year-old G2P1L1 woman with 18-week pregnancy presented with right hypochondriac pain and vomiting for the past 1 week. She had borderline vitals and a diffusely tender abdomen. Ultrasound revealed a live 18-week fetus attached to the undersurface of the liver with moderate ascites. Laparotomy was carried out which revealed 500 cc of hemoperitoneum with a primary hepatic pregnancy of the right lobe of liver and bleeding from the placental site. After extracting the fetus, the placenta was left inn situ and the abdomen was packed to control the bleeding as other hemostatic measures failed. Hepatic artery embolization was done after surgery followed by relaparotomy but the abdomen had to be repacked again as the patient was unstable with uncontrollable bleeding. The patient succumbed to DIC despite adequate replacement. In retrospect, the authors conclude that embolization could have been done before surgery and partial hepatic resection attempted in the first instance.

Large nabothian cyst: a rare cause of nulliparous prolapse.

Genital prolapse is commonly observed in postmenopausal and multiparous women, However, nulliparous women contribute to 2% of prevalence. We report a case of 21-year-old female who presented with a large nabothian cyst contributing to prolapse. This is the first case reported in the literature.

Combination of uterine artery Doppler velocimetry and maternal serum placental growth factor estimation in predicting occurrence of pre-eclampsia in early second trimester pregnancy: a prospective cohort study.

OBJECTIVE: To determine the effectiveness of the combined use of uterine artery Doppler velocimetry (UADV) and estimation of maternal serum placental growth factor (PlGF) levels in early second trimester (20-22 weeks of gestation) in identifying pregnant women at risk of developing pre-eclampsia. STUDY DESIGN: Prospective cohort study on 1104 pregnant women with singleton pregnancies between May 2009 and December 2010. UADV and maternal serum PlGF estimation were done at 20-22 weeks' gestation. Association between the two variables and the occurrence of pre-eclampsia was analyzed by logistic regression analysis and odds ratio was computed. The results were considered significant when p was <0.05. RESULTS: Logistic regression analysis showed that both abnormal UADV (odds ratio (OR) 4.1; 95% CI 2.3-7.2; p=0.000) and serum PlGF<188pg/ml (OR 3.6; 95% CI 1.95-6.5; p=0.000) are independent variables in the occurrence of pre-eclampsia, and the difference between the association of these two variables with pre-eclampsia was statistically insignificant as 95% CI values overlap. Multivariate logistic regression analysis showed that a combination of abnormal UADV and serum PlGF<188pg/ml at 20-22 weeks had a very poor association (OR 1.1; 95% CI 0.3-3.8; p=0.938) with the occurrence of pre-eclampsia, as the 95% CI values encompass 1 and p is >0.05. CONCLUSION: UADV and maternal serum PlGF estimation at 20-22 weeks of gestation are strong predictors of the occurrence of pre-eclampsia when used individually but in combination their association with pre-eclampsia is not significant.

Association of bacterial vaginosis with adverse fetomaternal outcome in women with spontaneous preterm labor: a prospective cohort study.

OBJECTIVE: To compare the fetomaternal outcome in women with spontaneous preterm labor, with or without bacterial vaginosis (BV). METHODS: One hundred and fifty-two pregnant patients presenting with spontaneous preterm labor between 28 and 35 weeks of gestation were screened for BV using Amsel's criteria and Nugent score, and were divided into two groups of 30 patients each, based on the BV positive or negative screen. Both the groups were followed till puerperium, and the fetal-maternal outcome was studied. The data was analyzed using Chi-square test and Man-Whitney test. RESULTS: BV was detected in 37 out of 152 women with preterm labor (24.34%). There was a significant increase in the incidence of respiratory distress (14% vs. 6%), requirement of intermittent positive pressure ventilation (IPPV) (14% vs. 5%), admission in neonatal intensive care unit (NICU) (15% vs. 6%), and duration of NICU stay >2 days (15% vs. 6%) in patients with BV. No significant difference was found in the mean birth weight, Apgar score, incidence of neonatal sepsis, perinatal mortality, and postpartum fever between the two groups. CONCLUSIONS: BV is a risk factor for increased neonatal morbidity. More research is needed for designing appropriate screening and treatment guidelines for prevention of adverse outcomes associated with BV.

Maternal serum interleukin-6 and its association with clinicopathological infectious morbidity in preterm premature rupture of membranes: a prospective cohort study.

OBJECTIVE: To analyze the association of maternal serum interleukin-6 (IL-6) with fetomaternal outcome in preterm premature rupture of membranes (PPROM). METHODS: Serial serum IL-6 levels were measured in 45 women with PPROM at gestation 24-34 weeks. The women were followed till pueperium and fetomaternal outcome as well as the histopathology of the placenta and the umbilical cord was studied. The data were analyzed using t test and χ(2) test. RESULTS: IL-6 levels ≥ 8 pg/ml were significantly associated with puerperal sepsis and neonatal sepsis. Histological chorioamnionitis and funisitis were demonstrated in 48.8% and 13.3% women respectively and significantly correlated with elevated serum IL-6 levels and fetomaternal infection. A cut-off value of IL-6 of 8 pg/ml was found to correctly diagnose 19 out of 23 patients with infectious morbidity and showed the best sensitivity (82.6%) and specificity (86.3%) as compared to the total leucocycte count (TLC) and C-reactive protein (CRP) in diagnosing infection in PPROM. CONCLUSION: Maternal serum IL-6 can be used as a biomarker to predict preclinical asymptomatic infection in PPROM with good sensitivity and specificity.

Serum PLGF as a potential biomarker for predicting the onset of preeclampsia.

PURPOSE: Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality. Till date despite years of research into the condition, predicting the onset of preeclampsia remains a problem. Placental growth factor is one of the many angiogenic factors, which shows significant altered levels in preeclampsia compared to normal pregnancy. The present study aims to analyze whether estimation of serum PLGF levels in late second trimester can act as a predictor of preeclampsia. METHODS: A total of 150 nulliparous pregnant women admitted in antenatal wards or attending antenatal clinic were included in the study. They were divided into three groups: 30 women being normotensive and 60 each with diagnosed mild and severe preeclampsia, respectively. Serum samples collected from the study groups were subjected to ELISA, and serum PLGF level was calculated in all the samples. RESULTS: Mean serum PLGF levels were found to be significantly low in mild and severe preeclampsia as compared to normal pregnancy. Serum PLGF levels were highest at 26-28 weeks and were lowered at 28-30 and 30-32 weeks of gestation within each of the three study groups. Cutoff value of serum PLGF levels for predicting mild and severe preeclampsia was calculated statistically from the analyzed data. CONCLUSION: Estimation of serum PLGF levels at 26 weeks of gestation in nulliparous pregnant women can be used as a screening test to identify women at risk for the development of preeclampsia with very high sensitivity.

Association between placental growth factor levels in early onset preeclampsia with the occurrence of postpartum hemorrhage: A prospective cohort study.

OBJECTIVES: To determine the association between PlGF (placental growth factor) estimation in early second trimester (22-24weeks of gestation), with the occurrence of postpartum hemorrhage in pregnant women with early onset preeclampsia and whether the mode of delivery (cesarean or vaginal) has any association with increased risk of developing postpartum hemorrhage. STUDY DESIGN: A prospective cohort study was conducted on 788 pregnant women with singleton pregnancies diagnosed with early onset preeclampsia between March 2009 and June 2011. Maternal serum PlGF level estimation was done between 22 and 24weeks of gestation and a cut-off value of <122pg/ml was determined by receiver operating characteristic (ROC) curve analysis for identifying those at risk of developing postpartum hemorrhage. Association between serum PlGF level <122pg/ml and cesarean deliveries with the risk of developing postpartum hemorrhage was analyzed by logistic regression analysis and Odds ratio, which were computed. The results were considered statistically significant when P-value <0.05. MAIN OUTCOME MEASURES: Proportion of study population developing postpartum hemorrhage. RESULTS: Logistic regression analysis showed the association of serum PlGF <122pg/ml at 22-24weeks (Odds ratio 8.9516; 95% CI, 5.0728-15.7963) and that of cesarean delivery (Odds ratio 2.4252; 95% CI, 1.4573-4.0360) with the risk of developing postpartum hemorrhage. Both the associations were found to be statistically significant. CONCLUSION: Maternal serum PlGF level <122pg/ml at 22-24weeks of gestation and cesarean delivery are both strongly associated with the risk of developing postpartum hemorrhage in pregnant women with early onset preeclampsia.

Interleukin-6 as a predictor of subclinical chorioamnionitis in preterm premature rupture of membranes.

PROBLEM: One of the major challenges faced by the clinicians in preterm premature rupture of the membranes (PPROM) is to correctly identify when a significant chorioamnionitis is evolving and decide timely delivery of the fetus. Measuring interleukin-6 levels in maternal serum can be useful for the identification of asymptomatic intrauterine infections in subjects with PPROM. METHOD OF STUDY: A total of 75 pregnant women, of which 45 pregnant women presenting with PPROM between 24 and 34 weeks gestation and 30 healthy pregnant women without PPROM, were included in the study. Serum IL-6 levels were determined by solid-phase sandwich enzyme-linked immunosorbent assay (Diaclone Research, Besancon, France). RESULTS: The mean serum IL-6 value at admission in the control group was 2.48 ± 2.7 pg/mL and in the study group was 11.86 ± 14.5 pg/mL (P = 0.001). Mean serum IL-6 concentrations at admission in subjects without histological chorioamnionitis were 3.98 ± 3.9 pg/mL and in those who had histological chorioamnionitis were 20.09 ± 16.8 pg/ml (P < 0.001). CONCLUSION: Maternal serum IL-6 levels were significantly elevated in subjects with PPROM with infectious morbidity as compared to those without infectious morbidity in the present study. There was a significant rise in maternal serum IL-6 levels with increased duration of rupture of membranes and with evidence of histological chorioamnionitis and funisitis in the placenta.

OHVIRA syndrome: rare cause of chronic vaginal discharge in an unmarried female.

Chronic vaginal discharge in adolescent and young females, not responding to antibiotics, can pose a diagnostic dilemma for many gynecologists and general practitioners. Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome) is a rare congenital anomaly. We present a case of a 22-year-old unmarried female with this syndrome presenting with chronic purulent vaginal discharge. The uniqueness about the case is its much delayed presentation.

Role of inflammatory cytokines and eNOS gene polymorphism in pathophysiology of pre-eclampsia.

PROBLEM: Pre-eclampsia involves endothelial vascular dysfunction. The aim of this study was to test the hypothesis that (i) endothelial nitric oxide (NO) synthase Glu298Asp gene polymorphism limits constitutive NO production causing endothelial dysfunction and (ii) inflammatory cytokines impairs endothelium dependent relaxation in pre-eclampsia. METHOD OF STUDY: This cross-sectional study included 50 women with pre-eclampsia and 50 healthy pregnant women. Their blood samples were analyzed for NO, inflammatory cytokines and endothelial NO synthase (eNOS) gene polymorphism. RESULT: Decreased NO levels whereas increased tumor necrosis factor-alpha, interleukin (IL)-6 and interleukin-2 were found in pre-eclampsia (P < 0.001). No significant differences were found in genotype/allele distribution between two groups. Significant negative correlation was observed between NO and IL-6 in pre-eclamptic group (P = 0.001). CONCLUSION: An IL-6-mediated endothelium dependent NO-cyclic guanine monophosphate-mediated relaxation pathway may be inhibited in systemic vessels in pre-eclampsia. As observed in this study Glu298Asp eNOS gene polymorphism did not showed significant association with pre-eclampsia.

A comparative study of the effects of local estrogen with or without local testosterone on vulvovaginal and sexual dysfunction in postmenopausal women.

INTRODUCTION: A significant number of postmenopausal women suffer from distressing problems because of urogenital atrophy secondary to the decline in circulating estrogen levels. Treatment with topical hormones may provide relief in such women when used judiciously. AIM: To study the effects of local estrogen with or without local testosterone on urogenital and sexual health in postmenopausal women. METHODS: Seventy-five postmenopausal women symptomatic for urogenital atrophy and sexual dysfunction were randomly divided into two study groups and one control group. The women in study group 1 received local estrogen cream; study group 2 received local estrogen and testosterone cream; the control group received nonhormonal lubricant KY gel for 12 weeks. The urogenital and sexuality score, along with the vaginal health index and the vaginal maturation index (VMI), was calculated at the beginning of therapy and 12 weeks later. MAIN OUTCOME MEASURES: Changes in the urogenital and sexuality score along with vaginal health index and VMI. RESULTS: After 12 weeks of therapy, there was a significant improvement in all the four study parameters, which correlated well with the improvement in symptoms of urogenital atrophy and sexual dysfunction in both the study groups as compared with the control group. Improvement in sexuality score was greatest with combined estrogen-androgen therapy. There were no adverse effects and the therapies were well accepted without any compliance issue. CONCLUSION: Local estrogen either alone or with androgen is highly effective in relieving symptoms of urogenital atrophy and in improving sexual function in symptomatic postmenopausal women.