Postpartum haemorrhage: a cause of maternal morbidity.

To identify and analyse the risk factors associated with postpartum haemorrhage (PPH) and assess their impact on the maternal morbidity, a prospective observational study was carried out over a period of one year in a tertiary level referral institute in Kolkata, West Bengal, India. All the cases of PPH were identified and studied. Data analyses were done using Chi-square test. Out of 210 cases of maternal morbidity, 79 (37.6%) were found to have PPH as the causative factor. Uterine atonicity was found to be the main cause leading to 45 cases (56.9%) of PPH. With respect to the mode of delivery severe PPH was found in 34.3% of vaginally and 60% of operatively delivered patients which had statistical significance. More number of severe PPH cases, 17/31 (54.8%), had delivered outside the medical college. Here comes the role of 24-hour quality emergency obstetric care (EMOC), active management of 3rd stage of labour and early referral to the higher centre. The case fatality rate of PPH during the study period was 7.5%. This finding is quite close to the observation made in a North Indian tertiary hospital based study. In order to reduce maternal morbidity and thereby indirectly maternal mortality and to improve the overall maternal health, prevention and control of PPH can play a significant role. An integrated approach at all levels of healthcare delivery system, active management of labour and efficient emergency obstetric care will help in controlling the PPH.

Role of latent genital tuberculosis in repeated IVF failure in the Indian clinical setting.

Genital tuberculosis is reported to be a major pelvic factor causing infertility in Indian women and often exists without any apparent signs and symptoms. The role of latent tuberculosis in repeated IVF failure in unexplained infertility is examined. 81 women with unexplained infertility having repeated IVF failure tested for Mycobacterium tuberculosis using PCR, ZN staining and BACTEC-460 culture were selected. Fresh IVF-ET or frozen embryo transfer (FET) was attempted on patients successfully treated with anti-tubercular drugs (ATD). ATD-treated fresh cycles (group A1) and frozen cycles (group B1) were compared to previously failed fresh cycles (group A2) and FET attempts (group B2), respectively. Main outcome measures were gonadotropin required, terminal E2, number of oocytes retrieved, fertilization rate, embryo quality, endometrial thickness and sub-endometrial blood flow (V(max)). Gonadotropin required in group A1 was significantly less as compared to group A2. Number of oocytes retrieved and grade I embryos, endometrial thickness and V(max) were significantly higher in group A1. Endometrial thickness and V(max) were significantly increased in group B1 as compared to B2. The study indicates that latent tuberculosis should be considered in young Indian patients presenting with unexplained infertility with apparently normal pelvic and non-endometrial tubal factors and repeated IVF failure.

Oral dydrogesterone versus intravaginal micronised progesterone as luteal phase support in assisted reproductive technology (ART) cycles: results of a randomised study.

The objective of this prospective, randomised study was to compare the efficacy, safety and tolerability of vaginal micronised progesterone with oral dydrogesterone as luteal phase support after in-vitro fertilisation (IVF). A total of 430 women underwent IVF/intracytoplasmic sperm injection (ICSI) treatment. Long protocol gonadotropin releasing hormone analogue down-regulation was followed by gonadotropin stimulation. Human chorionic gonadotropin was given when two or more follicles reached > or = 17 mm. After 36 h, oocytes were retrieved and IVF was performed. Embryo transfer was done at the 4-8 cell embryo stage. Luteal support was initiated from the day of embryo transfer and continued for up to 14 days. Patients were randomised to luteal supplementation with either intravaginal micronised progesterone 200 mg three times daily (n=351) or oral dydrogesterone 10 mg twice daily (n=79). In cases of a positive pregnancy test, luteal support was continued for 12 weeks. Both dydrogesterone and micronised progesterone were associated with similar rates of successful pregnancies. Vaginal discharge or irritation were reported by 10.5% of patients given micronised progesterone. Significantly (p<0.05), more patients given dydrogesterone than micronised progesterone were satisfied with the tolerability of their treatment. There were no differences between the treatments with regard to liver function tests.