RESUMEN
OBJECTIVE: The aim of the present open label randomized controlled trial was to compare the rate of cesarean section (CS) after elective induction with that of expectant management in low-risk nulliparous women at 39 weeks. METHODS: This randomized controlled trial from a tertiary maternity care center enrolled low risk nulliparous pregnant women at 38-38+4 weeks between April 1, 2019 and December 31, 2021. Participants were randomized into either the elective induction group (e-IOL) or the expectant management (EM) group though computer generated block randomization. The primary outcome was cesarean rate and the secondary outcome include adverse maternal and perinatal outcome between e-IOL and EM groups. We performed intention to treat analysis. RESULTS: A total of 360 women were enrolled into the present study. Analysis was performed for 179 women in the e-IOL group and 180 women in the EM group. The baseline demographic characteristics including Bishop score were comparable between the groups. The CS rate in both groups was 17.3% (31/179) and 25% (45/180), which is comparable (P = 0.08). There was one intrapartum stillbirth in the e-IOL group, and two babies succumbed in the neonatal period in the EM group. The maternal and perinatal outcomes between the groups were not found to be significantly different. CONCLUSION: Elective induction of low-risk nulliparous women at 39 weeks was not associated with increased cesarean section rate. The maternal and perinatal outcomes were comparable. Large, multicentric real time randomized controlled trials are needed to understand the benefit of elective induction in low-risk nulliparous women. This should include centers with large volume of deliveries especially from emerging countries also.
RESUMEN
Background: In practice, we encounter many young infertile women with poor ovarian reserve though ovarian reserve starts to decline after 35 years of age. One of the established risk factors for poor ovarian reserve in young women is endometriosis. There are other conditions that are reported to be associated which require further research. Aims: We aimed to study the prevalence of poor ovarian reserve and to find out the associated factors in women who are <35 years of age. Settings and Design: This was a prospective observational cohort study conducted in a tertiary care setting. Materials and Methods: Women aged more than 21 years and <35 years without Polycystic Ovarian Syndrome (PCOS) or ovarian dysgenesis with normal male factor were included after ethical approval. The sample size was 166 and serum anti-Mullerian hormone (AMH) was estimated by immunoenzymatic assay and expressed in ng/ml. AMH ≤0.99 ng/ml was considered poor ovarian reserve. Apart from established risk factors, the proposed risk factors studied were age 31-35 years, presence of medical disorders, gynaecological pathology and history of repeated ovulation induction (OI). Statistical Analysis Used: Data were analysed by SPSS version 25. Chi-square test and Fisher's exact test were used to compare the variables between normal ovarian reserve and poor ovarian reserve. Risk estimation was done by logistic regression and was expressed in odds ratio (OR). Results: Poor ovarian reserve was diagnosed in 40% of this cohort, and 62% were between 31 and 35 years. After adjusting for age >30 years, women with endometrioma, hypothyroidism and prior history of ≥3 cycles of OI were found to be having poor ovarian reserve (OR was 5.7, 2.5 and 2.3, respectively). Conclusion: Poor ovarian reserve was present in 40% of young women, and significantly associated factors were hypothyroidism and history of repeated multiple OI. This could be a confounder for other underlying mechanisms driving early exhaustion of ovarian reserve in certain young women. Hence, along with established risk factors, these women should undergo AMH testing irrespective of age.
RESUMEN
Background: Recurrent pregnancy loss (RPL) is encountered in 2-5% of Obstetric population and in 50% the cause is unknown and hence it is a challenging situation for the Obstetrician to manage such women. This study was undertaken with the objectives of finding out the causes of RPL, comparing the outcome of index pregnancy between unknown RPL and known RPL and to study the pregnancy outcome with thromboprophylaxis in women with unknown RPL. Methods: Prospective observational study involving 323 women was undertaken in a tertiary care Institute South India. Women with two or more pregnancy losses without any live birth were included after ethical clearance and were investigated including thrombophilia screening. SSPS version 20 was used for statistical analysis. Comparison of pregnancy outcomes was determined with binomial test of proportions and pregnancy outcome in unknown RPL was calculated by Fisher's exact test or Chi-square test. Results: The common etiological factors were Thrombophilias (33%), followed by endocrine causes. There was no difference in miscarriage rates and live birth rates but IUGR, Stillbirth and perinatal deaths were significantly more in women with known RPL after interventions. In unknown RPL thromboprophylaxis with combination of aspirin, enoxaparin or progesterone resulted in significantly more term birth rates (93%). Conclusion: Thrombophilias were found to be the most common cause in this cohort of Indian women. In women with unknown RPL, thromboprophylaxis with Aspirin alone results in high incidence of preterm birth. Aspirin combined with Enoxaparin and or Progesterone achieves high live birth rate of term foetuses.
