Effect of sperm DNA fragmentation on blastocyst formation rate and subsequent IVF outcome

Background: Male infertility associated with sperm DNA alteration has raised a new issue in assisted reproduction techniques (ARTs).Methods: It was a retrospective analytical study on 250 cases of routine IVF/ICSI performed at Swagat ART Centre from January 2017 to January 2020. We divided the patient according to the sperm DNA fragmentation index (DFI) as normal DFI≤15%, n=95, a moderate DFI≤30%, n=89, and a high DFI group >30%, n=66. Oocytes of each patient were almost equally divided and fertilization method was adopted as half IVF half ICSI or only ICSI in poor quality (oligo, astheno, teratozoospermia or with two or all three defect and compared the fertilization, cleavage, embryo formation, blastocyst formation, pregnancy and early embryo formation rate among these six groups. Results: Fertilization, cleavage, embryo formation, and clinical pregnancy rates were reported as higher in ≤15% DFI group of both IVF and ICSI-ET (87.3±26.2, 77.7±26.1, 68.2±28.8, 50.8 in IVF and 78.3±17.8, 70.3±31.2, 67.2±28.8, 57.6 respectively). Significant differences (p<0.01) are observed among all six groups. Higher abortion rate is observed in high DFI group of both IVF and ICSI.Conclusions: High sperm DFI causes low blastocyst formation and pregnancy outcome. Higher abortion rate observed in high DFI group indicated need of further study.

Obstetric and perinatal outcomes of expectant management and immediate induction of labour in term premature rupture of membranes: promising outcomes from expectant management cohort

Background: Premature rupture of membranes (PROM) is common obstetric entity, the management even at term is controversial and there is no consensus for definite protocol of management. Objective of the present study is to compare the effectiveness, safety of expectant management of 24 hours and immediate induction with PGE2 gel in terms of maternal and fetal outcome in term PROM.Methods: 200 women were randomized to group A expectant management and group B immediate induction, after strict Inclusion and exclusion criteria. In expectant group waiting period was 24 hours. Multiple end points were examined throughout management. Chi square test and independent t tests were performed for statistical analysis. P value<0.05 was considered significant.Results: Demographic parameters of patients, maternal and gestational age were similar in both groups. Primigravidae were more in both groups A and B. Vaginal delivery rate is more in expectant group and Caesarean Section rate is high in immediate induction group. CS rate was 37% and 23% in group A and B respectively; the difference is statistically significant (p value=0.031). ‘ROM to delivery interval’ was more in group A (16.31±8.67 hrs and 13.85±5.46 hrs) (p value=0.0256). Hospital stay was comparatively more in group A (5.40±0.81 days and 4.11±0.86 days) (p value=0.435). Infective morbidity of mother and baby was low in both groups and no difference was seen.Conclusions: An expectant management allows a good number of women to go into labour and deliver vaginally without an increase in CS rate and infectious morbidity for mother and fetus.

Incidence and risk factors for surgical site infection post-gynecological operations in a tertiary hospital in Egypt: a retrospective study

Background: Surgical site infection (SSI) is the most common complication of surgical procedures in gynecology and it poses a significant burden for both patients and healthcare systems. Our objective was determining the incidence and risk factors for SSI post-gynecological operations during the period of five years.Methods: A matched case-control study at Minia maternity university, Egypt where A total of 18772 cases had undergone different gynecological procedures. The 876 cases were complicated with SSI (SSI cases group) and 2 matched controls per case were chosen from the rest of the cases and served as the control group (n=1752 cases).Results: The overall incidence of SSI post-gynecological operations was 4.67% and post-hysterectomy was 7.57%. SSI group had a significantly higher number of cases with diabetes, obesity, high parity (>4), increased blood loss and those had prolonged duration of surgery compared to the control group (all p<0.01).Conclusions: The identified risk factors are crucial for risk stratification of SSI and prioritizing interventions to improve the outcome. These results could give a picture for SSI post-gynecological operations in our country and identifying these risk factors is crucial for risk stratification of SSI and prioritizing interventions to improve the outcome.

Comparative study of mifepristone followed by misoprostol with misoprostol alone for treatment of early pregnancy failure: an interventional randomised clinical study in a tertiary care hospital

Background: Early pregnancy failure (EPF) is a common experience for women. Medical management allows for expulsion of the nonviable pregnancy in a controlled manner without any surgical risk. The aim of this study was to compare efficacy and safety of mifepristone followed by misoprostol with misoprostol alone in management of EPF.Methods: This was a prospective comparative interventional randomised clinical study conducted at Shri Maharaja Gulab Singh hospital, Jammu, Jammu and Kashmir India from November 2019 to October 2020. A total of 200 patients with gestational age less than 13 weeks and ultrasound diagnosis of EPF were included in the study and randomly divided into two groups, group A (100 patients) received tab. mifepristone 200 mg orally 24 hrs before the use of Tab misoprostol 800 ug per vaginally. If no expulsion occurs within 4 hours, repeat doses of 400 ug misoprostol were given per vaginally at 4-hourly interval to a maximum of 2 doses in women less than or equal to 9 weeks by ultrasound and 4 doses in women more than 9 weeks by ultrasound. Group B (100 patients) received only Tab misoprostol in similar doses without prior mifepristone. The study was performed after approval from the institutional ethical committee. The data was analysed using computer software Microsoft Excel, Statistical and IBM SPSS version 21.0. The statistical difference in mean value between two groups was tested using unpaired ‘t’ test. The qualitative data was compared using Fischer’s exact test.Results: The success rate was higher in group A 92% than group B where it was 76%. The mean induction-abortion interval and dose of misoprostol required for expulsion were 6.56±.66 hrs in group A and 10.40±4.33 hrs in group B and 1126.88±536.06 ug in group A and 1583.33±364.58 ug in group B. The patients in group A experienced significantly less side effects than those in group B, 19% versus 32% and also required fewer blood transfusions than group B, 2% versus 5%.Conclusions: In the present study we came to the conclusion that mifepristone followed by misoprostol is more effective, safe and acceptable than misoprostol alone.

Effect of autologous platelet rich plasma on anti-mullerian hormone and antral follicle count in sub fertile women with poor ovarian reserve

Background: Ovarian aging may be reversible. Platelet rich plasma (PRP) has growth factors that promote cellular proliferation and folliculogenesis. Recently published studies and case reports suggest that ovarian rejuvenation can be done by PRP treatment. The objective of the study was to evaluate the effect of platelet rich plasma on ovarian reserve markers such as anti mullerian hormone (AMH) and antral follicle count (AFC) in sub fertile women with poor ovarian reserve (POR).Methods: The self-controlled quasi experimental study was carried out on 29 sub fertile women with poor ovarian reserve. They were selected for laparoscopic tubo-peritoneal evaluation as they could not afford in vitro fertilization. During laparoscopy, 5 ml of pre prepared autologous PRP was injected into each ovary. Post-PRP AMH and AFC were measured at every cycle for a period of at least three (3) months and compared with base line values.Results: Mean age of participants was 35.9±3.2 years. Baseline AMH was 0.31±0.17 ng/ml and baseline AFC was 3.41±0.73. AMH was raised on first, second and third cycle from base line values in 58.62%, 86.21% and 91.30% of the study population respectively. AMH changes in all three cycle were statistically significant. Pregnancy occurred in three (10.34%) women during the study period.Conclusions: The injection of autologous PRP into human ovaries is a safe procedure to improve ovarian reserve markers (AMH and AFC) in women with POR.

Low dose magnesium sulphate regimen and maternal outcome of patients with eclampsia

Background: Preeclampsia, a serious pregnancy complication which is commonly characterized by high blood pressure, presence of protein in the urine and sometimes swelling in women's feet, legs and hands. With this condition, patient’s high blood pressure often results in seizures. Generally, the outcome remains good, however, eclampsia can be life threatening and disastrous.Methods: This cross-sectional study considered 114 patients who meet inclusion criteria and agreed to will-fully participate in the study were evaluated for different parameters. Patients who developed eclampsia during intra-natal and postnatal period were included in the study. The aim of the study was to evaluate the maternal outcome among all patients of eclampsia treated with low magnesium sulphate dosage therapy. Results: The present study revealed, very low fit recurrence rate, low mortality rate, zero treatment failure rate, no toxicity and (99.12%) success rate.Conclusions: Apart from zero percent treatment failure rate, Low maternal mortality and fit recurrence rate encouraged us to continue the treatment with low dose MGSO4 regimen. Thus, low dose magnesium sulphate has been found very effective in treating the eclmpsia and at the same time maintains the high safety margin.

Comparison of efficacy of 600 and 800 micrograms vaginal misoprostol in early pregnancy failure in SMGS: a tertiary health care hospital in Jammu, India

Background: Misoprostol use in early pregnancy failure is varied and dose is not well established. Aim of this study was to compare efficacy and side effects of 600 versus 800 micrograms vaginal misoprostol in early pregnancy failure.Methods: A randomized prospective observational study was conducted in the postgraduate department of obstetrics and gynaecology, SMGS hospital Jammu from November 2018 to October 2019 after getting approval from the ethical committee. Hundred patients (50 in group A and 50 in group B) admitted in labour room before 12 weeks of gestation with an ultrasound diagnosis of early fetal demise (missed abortion or brightened ovum) were treated medically with different doses of vaginal misoprostol.Results: The success rate in patients in group A is 72% and group B is 88%, p=0.045 (difference is statistically significant). Patients who required suction and evacuation were 28% in group A and 12% in group B.Conclusions: Use of misoprostol for medical management of 1st trimester missed/anembryonic is an effective, cheap, safe and convenient alternative to surgical evacuation. It was concluded that 800 micrograms vaginal misoprostol is more effective than 600 micrograms vaginal misoprostol. But 800 micrograms misoprostol has more side effects than 600 micrograms vaginal misoprostol.

A comparative study to evaluate pregnancy related issues among women aged 35 years old and beyond

Background: The pregnancy complications associated with women over 35 years of age are becoming more frequent. Late or too late remains the thread bearing discussion these days. Multiple studies have reported that women with 35 years of age or beyond are more vulnerable to develop obstetric complications. The present study has been conducted to reckon the strength of the association between maternal age and obstetric issues pertaining to women.Methods: This prospective study considered 217 single consecutive pregnancies which were divided into two groups based on age of patients. Group A consists of 163 pregnant women aged < 35 years and group B consists of 54 pregnant patients aged ≥35 years. The study was conducted at government medical college, Lala-Ded, and hospital Srinagar.Results: In spite of the underlying mechanisms, rigorous statistical analysis revealed the negative impact of extreme maternal ages on pregnancy. We found a significant difference between group A and group B with respect to early pregnancy loss, C-section, antepartum, intrapartum and postpartum complications (p<0.001).Conclusions: Evidently, it was demonstrated that women aging 35 years or above are more vulnerable to develop multiple intrapartum and postpartum complications than younger women in group B.

β-hCG levels in second trimester as a predictor of gestational hypertension and preeclampsia

Background: Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, and remain amongst the most significant and intriguing unsolved problems in obstetrics. The goal of this study is to test the hypothesis that women with high serum β-hCG levels in early pregnancy are at higher risk of developing gestational hypertension and preeclampsia.Methods: This is a prospective study done in 200 women between 13 and 20 weeks of gestation, selected randomly for this study. Serum β-hCG estimation was done by Sandwich chemiluminescence immunoassay method and calculated in multiple of median (MOM). They were followed till delivery for development of gestational hypertension and preeclampsia. Results were analysed statistically.Results: Out of 200 cases, 43 (21.5%) cases developed PIH. β-hCG levels were considered raised if the levels were >2 MOM. Out of 39 cases with beta HCG levels >2 MOM, 32 (82.1%) developed PIH whereas 7 (17.9%) remain normotensives against. Also, higher levels of beta HCG are associated with increased severity of PIH (p<0.000). The sensitivity was 82%, specificity was 93.2% and positive predictive value was 74.3%.Conclusions: The study conclude that elevated serum β-hCG levels in women with second trimester pregnancy indicates increased risk of gestational hypertension and preeclampsia and raised β-hCG levels are associated with severity of disease

Study of feto-maternal outcome in patients with hepatitis E infection during pregnancy

Background: Hepatitis E is considered as a common cause of high maternal morbidity and mortality particularly in third trimester and also high perinatal morbidity and mortality. Thus, this study is conducted to evaluate the feto-maternal outcome in patients infected with hepatitis E during pregnancy.Methods: It is a retrospective observational study conducted in department of obstetrics and gynecology at L. G. hospital. Fifty pregnant women with clinical hepatitis in third trimester of pregnancy were included in this study and thorough investigation were carried out. Patients were monitored till postpartum period and fetal monitoring data were collected from neonatal ICU.Results: In this study, majority of pregnant patients with hepatitis B were admitted during monsoon season suggests that HEV outbreaks are more common during monsoon months. Majority of the patients (70%) were emergency cases. Majority of these patients (82%) were belonged to lower socio-economic class. Co-infection with HAV was in 2% and with HBV in 4%. S. bilirubin >15 mg/dl in 16% of patients. PT and APTT were raised in 28% of patients. FDP was raised in 70% of patients. 76% were delivered vaginally and 22% were delivered by LSCS. Most common complication in HEV infected pregnant women was disseminated intravascular coagulation (DIC) (26%). Maternal mortality rate is 14%. Out of 50 patients, 88% delivered live baby, out of which 72% needed NICU admission. Perinatal mortality rate was as high as 28%.Conclusions: Hepatitis E infection and pregnancy is a deadly and fatal combination. Specifically, in 3rd trimester of pregnancy, acute hepatitis E has a grave prognosis with high maternal morbidity and mortality. Prevention is the mainstay of controlling HEV especially in developing countries.