Evaluation of nitric acid donor, transdermal glycerol trinitrate patches for facilitating cervical ripening: a randomised controlled trial.

PURPOSE: To evaluate the efficacy and safety of transdermal glycerol trinitrate skin patches as an additive and effective agent for facilitating cervical ripening for labour induction. METHODS: This was a double-blinded prospective randomised clinical trial carried out in a major obstetric unit in India. Women who planned for labour induction were randomly allocated for induction either by combined application of glycerol trinitrate skin patches [GTN patch] and intracervical dinoprostone gel or by the gel only. Sample randomisation was done using a stratified block randomisation technique with a sealed envelope. The numbers designating the group allocation sequence were concealed from doctors, research staff, and investigators. Six hourly improvements were assessed in the modified Bishop's score, induction-delivery time interval, the need for oxytocin, maternal side effects and foetal outcomes. Data were analysed using SPSS software. RESULTS AND DISCUSSION: Recruitment Bishop scores, parity and gestational age were matched in both cases and the control group. The modified Bishop's score was statistically improved in study groups, as evidenced compositely and irrespective of parity. The two groups appeared to have no significant differences regarding other outcomes. The additional application of the GTN patch seems helpful to accelerate the progress of labour but could not yield any favourable labour outcome. The GTN patch does not impose additional feto-maternal adverse effects apart from increased incidences of headaches.

Maggots in prolapsed uterus - Polluted progress of life style.

Myiasis is infestation by dipterous larva that thrives on host's living or necrotic tissue and cause massive tissue infection. We present a case of Myiasis in uterine cavity of a prolapsed uterus of a 77-year-old multiparous lady of West Midnapore District, West Bengal, India. It is a very rare case as only a few reports have been previously published in literature. She had presented with genital pruritus and vague perennial discomfort for last 1 month along with bleeding and foul smelling discharge from vagina for last 2 days. Pelvic examination revealed 'Stage-IV' genitourinary prolapse according to POP-Q classification, with a big excavatory ulcer indwelled with maggots of Musca domestica. About 80 to 90 such maggots were subsequently manually removed with a forceps under anaesthesia. She was advised to undergo definitive surgical treatment for prolapsed uterus. Owing to very low socioeconomic condition or for the fear of the operation, the patient ultimately never turned up.

Symphysiotomy: Is it obsolete?

AIM: To compare the maternal and neonatal outcomes of symphysiotomy (SYM) and cesarean section (CS), when they were performed in women presenting with obstructed labor. MATERIAL AND METHODS: This was a prospective comparative cohort study. Symphysiotomy was performed in 25 women who presented with obstructed labor. The controls were 50 women on whom CS was performed due to obstructed labor. Maternal mortality and morbidity due to postpartum hemorrhage (PPH), sepsis, genitourinary trauma, pelvic pain and gait problems were analyzed and compared between cases and controls. Neonatal mortality and morbidity due to birth asphyxia, intracranial hemorrhage, cephalohematoma and hypoxic ischemic encephalopathy were also compared following the two procedures. RESULTS: Maternal mortality was similar in both the cesarean section group (CSG) and symphysiotomy group (SG), but SYM has less morbidity than CS, and also preserves the uterus from scars. Transient pelvic pain was the most common maternal morbidity following SYM, whereas PPH and wound sepsis were the most common complications after CS. Neonatal mortality and morbidity were similar in both cases and controls. Lastly, SYM is a simple, low-cost and quicker procedure than CS. CONCLUSION: Symphysiotomy is an alternative management in women with obstructed labor. It has a role in low-resource settings, where CS is unaffordable, unavailable or unsafe. For the vast majority of the poor population, who may not have even have one proper meal a day, it can be of benefit to have a woman's pelvis made permanently adequate so that traditional birth attendants can conduct her subsequent labors.

Malignant phylloides tumor of breast in a pregnant woman with coincidental nulliparous vaginal prolapse.

Malignant phylloides tumor is a relatively rare and rapidly growing tumor of the breast. Presentation during pregnancy is uncommon. Reports regarding malignancy in these tumors differ greatly in incidence, and most of them are stromal malignancies. We report this case in which 24-year old primigravid patient in the 36(th) week of her pregnancy had a malignant phylloides tumor of breast with sudden growth and fine needle aspiration cytology of the breast was positive for malignancy. Ultimately after her caesarean delivery, excision biopsy was in favor of a malignant process. Pregnancy with nulliparous prolapse is also a rare condition. Those conditions are not associated with each other, but presence of two rare conditions in the same time in the same person is unique.

Yours faithfully -- prevention of parent to child transmission (PPTCT).

The objective of this study is to find out the reasons behind drop out of the mothers from the prevention of parent to child transmission (PPTCT) programme, thereby going undiagnosed of their HIV serostatus. A retrospective 6-year study was undertaken among mothers attending antenatal clinic and the unbooked cases delivering at the medical college. The percentage of mothers taking pretest counselling was 95.19; 94.09 per cent agreed to have their blood tested among those who had registered at the antenatal clinic only. Of them, 33 were found to be seropositive, 12 being found in 2009 alone. But the daily average of unbooked cases delivering at this institution was 16.42 out of 28. And a huge number (58.9%) were unregistered ie, unknown HIV serostatus deliveries were taken place during this 6-year of study (2004-2009). By this study we have found out that our ignorance, work pressure and patients' lack of knowledge, fear of so called 'HIV-AIDS', social stigmas are creating the big gaps in PPTCT programme and thus made it unsuccessful.

Knowledge and information on psychological, physiological and gynaecological problems among adolescent schoolgirls of eastern India.

BACKGROUND: Sex education aims to reduce the risks of potentially negative outcome from sexual behavior such as fear and stigma of menstruation, unwanted and unplanned pregnancies and sexually transmitted infections including HIV. Hence, this study was conducted to determine sex education knowledge level of school going adolescents in semi urban area of Midnapore, West Bengal, India. METHODS: A cross-sectional study was conducted in two selected premier secondary school of girls in the Midnapore Town from September - October 2007. A total of 521 adolescent aged 10-19 years were selected randomly from two secondary schools of girls. However, schools were selected purposively. All information was collected by using open-ended pre-tested questionnaire. RESULTS: Of the total subjects 94.2% of them were in the age of 13-16 years. Nearly, 94% respondents reported their age at menarche and maximum i.e. 54% respondents experienced in the age of 11 - 13 years. It was observed that 18%, 60.7% and 21.3% of the respondents had good knowledge, moderate or some knowledge and very poor knowledge of puberty, pubertal problems and their prevention. Thirty three percent said that they had faced one or some other kind of physical problems and out of them 60% indicated that they had visited to a doctor for their problems. The suffering of any gynecological problems had 2.48 (95% CI: 1.42 - 4.36) and 1.94 (95% CI: 1.01 - 3.73) times greater among subjects with little or some knowledge and minimum or no knowledge compare to subjects with good knowledge of sex education. CONCLUSION: Thus, the results show that not only knowledge regarding sex education was poor among the subjects but also their knowledge regarding sexual infections including AIDS was not satisfactory. School based sex education programs are particularly good at providing information, skills development and attitude clarification in more formal way through lesson within the curriculum. Therefore, appropriate sex education program should be initiated from the adolescence to prevent health hazards.