Metformin therapy prevents early pregnancy loss in polycystic ovarian syndrome

The study was done to compare the early pregnancy loss rate in women with polycystic ovarian syndrome who received or did not receive metformin in pregnancy. A case control interventional study carried out at Civil Hospital Karachi, Hamdard University Hospital and Private Gynaecology clinics from January 2005 to July 2008. Eighty two non diabetic patients with polycystic ovarian syndrome who became pregnant were included in the study. A questionnaire was filled for all patients that included information on basic demography and mean age, parity, weight. Fasting blood sugar and serum insulin levels were done for all these women. Only patients with raised insulin levels [more than 10 mu/l] were included in the study and all were offered to use oral metformin throughout pregnancy as 500mg three times a day with folic acid supplements 5mg once daily. Those who agreed to take the drug throughout pregnancy and to comply with the therapy were taken as cases, while those who did not agree to take the medicine acted as controls. Patients with other causes of recurrent pregnancy loss were excluded from the study. All pregnancies were followed using serial ultrasound examination to see any pregnancy loss in the two groups. Eighty two cases of polycystic ovaries with pregnancy were seen during the study period. All cases had raised serum insulin levels. Fifty patients agreed to take metformin through out pregnancy while, 32 cases did not agree to take metformin during pregnancy and thus acted as controls. The two groups did not differ in mean age, parity, weight and mean fasting blood sugar levels. Fasting insulin levels were high in metformin group [18.40 mu/l] than in controls [12.53 mu/l]. Missed abortion rate was significantly lower [12%] in metformin group than in controls [28%] [p<0.028]. No congenital anomalies were found in both the groups on ultrasound at 16-19 weeks. Metformin treatment during pregnancy significantly reduced the rate of early pregnancy loss in women with polycystic ovarian syndrome. Metformin should be given during pregnancy in cases having polycystic ovarian syndrome with high insulin levels

Management and maternal outcome in morbidly adherent placenta

To describe the management and maternal outcome in diagnosed cases of morbidly adherent placenta. Descriptive case series. Hamdard University Hospital and Two private hospitals, from May 2005 to June 2009. All diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay were recorded. Thirty cases of morbidly adherent placenta diagnosed on doppler ultrasound scan were identified. Scheduled caesarean hysterectomy without attempting placenta removal, was done. Sub total hysterectomy was performed in 26 cases and total hysterectomy in remaining 4 cases. Two patients sustained urinary bladder injury and two went into DIC. One needed ventilatory support. No patient died in this series. Significantly reduced maternal morbidity was observed. In diagnosed cases of morbidly adherent placenta, antenatal diagnosis and avoidance of placental separation and caesarean hysterectomy results in better maternal outcome

Discuss the effects of surgical ligation and percutaneous embolization of testicular varicocele on improvements in fertility parameters

Varicocele is term used to define as abnormal dilatation of testicular vein and or its collaterals with retrograde venous blood flow. It is treated by two techniques surgical ligation and percutaneous emblization. It is claimed in various international journal that varicocele is a leading cause of male infertility and shows significant improvement in fertility parameters and pregnancy rate after treatment of varicocele either by varicocelectomy or gondal vein embolization but we have disproved this claim in our study. A retrospective study with few prospective cases. It is retrospective study with few prospective cases. We have selected all those infertile male patients who under gone varicocele treatment. We obtained hormonal assay, seminal assay as pre-treatment baseline values as well as post-treatment values at 1,2,3 and 6 months intervals. Couples were also followed for pregnancy for up to 5 years. Total cases selected were pre-treatment and post-treatment. Results were analyzed and compared with those published in national and international journals. No significant improvement was observed in fertility parameters and pregnancy rate. This signifies that varicocele is not significant and leading cause of infertility in males. Treatment of varicocele either by surgical ligation or percutaneous embolization did not showed any significant improvement in fertility parameters and pregnancy rate. This signifies that varicocele is not significant and leading cause of infertility in males