A study to compare acceptability, safety and continuation rates of combined hormonal pill and centchroman as post abortion contraceptives

Background: Centchroman a non-steroidal selective estrogen receptor modifier (SERM). It is highly effective contraceptive which is devoid of side effects of COCs and there is prompt return of fertility upon discontinuation. Data in terms of its acceptability and continuation rates is limited when compared to combined oral contraceptive (COC). Therefore, the study was planned to study the acceptability, efficacy and continuation rates of centchroman and compare it with the combined oral contraceptives.Methods: The study was a prospective interventional comparative randomized study carried out in the department of obstetrics and gynecology VMMC and SJH, New Delhi, for a period of 18 months from November 2018 to April 2019.Results: A total of 945 women were screened and finally 240 women who met the criteria were recruited in 2 study groups of 120 women each. Majority were in the age group 18-28 years in either groups. Patients were followed up at 2nd week and then at 1st, 3rd, 6th and 12th months after initiation of the OCP with no loss to follow up. The pearl index in this study was 0.83 for ormeloxifene. The study showed statistically significant differences with higher level of satisfaction reported with 77.5% in the ormeloxifene compared to 65% of COCs. The continuation rates for ormeloxifene and COC users were in decreasing trend with increase in duration. No untoward events were reported with either formulation.Conclusions: Both the hormonal, combined hormonal contraceptive [combined oral contraceptive (COC), MALA-N] and the non-hormonal, centchroman (ormeloxifene) oral contraceptive pills are safe, effective, well tolerated and not associated with adverse outcomes when used immediately after abortion. Continuation rates of the pills in both the groups decrease in trend with time.

Clinical outcome of post-abortion intrauterine contraceptive device insertion

Background: Clinical outcome of post abortion IUCD varies according to type of abortion, method of abortion and period of abortion. There is paucity of Indian literature regarding factor affecting clinical outcome of post-abortal intrauterine contraceptive device insertion. This study was conducted to evaluate clinical outcome of post abortion intrauterine contraceptive in terms of acceptability, safety and continuation rate.Methods: A prospective cohort study where 112 patients over period of 18 months (November 2017 to April 2019) were included in study done at VMMC and Safdarjung Hospital, New Delhi, India.Results: Total 112 patients recruited. Their age ranges from 26-30 years. Mean age of women were 28.11±4.51 years. Majority of women who underwent IUCD insertion were para2. Regardless of type of IUCD, the most common side effects associated with copper wearing IUCD were change in amount of menstrual flow. Two cases of PID after CuT380A insertion and one case of PID after cu375. No perforation occurred. Continuation rate were 86.79%. Satisfaction rate were 82.14%.Conclusions: There is higher rate of continuation and satisfaction among women who had undergone immediate post abortion OUCD insertion. Early insertion of IUCD after abortion is safe, effective and well tolerated by women. Clinical outcome of post abortion is not affected by type of copper containing IUCD i.e., Cu380A and Cu375.

A rare case of perforating intrauterine contraceptive device

The trends in the acceptability of contraceptives is globally shifting from permanent sterilisation to long acting reversible contraceptive (LARC). With the increasing use of IUCD, the knowledge of its common and rare complications has become pertinent. One of them is cervical perforation in which strings are mostly visible and hence it can be easily missed. Here we present a rare case of cervical perforation which was timely detected before it could have caused more damage. A patient complaining of IUCD associated pain should undergo thorough examination and a probability of perforation should be kept in differential diagnosis despite string visibility. A clinician has to be more vigilant about this rare complication to prevent damage to cervix and avoid unwanted pregnancy.

Evaluation of endometrial pathology in women with postmenopausal bleeding by saline infusion sonography and hysteroscopy

Background: Postmenopausal bleeding (PMB) is a common problem representing 5% of all gynaecological outpatient attendance. Objective of this study was to determine diagnostic performance of saline infusion sonography and hysteroscopy for evaluation of endometrial lesions in postmenopausal bleeding.Methods: Being a prospective cross-sectional study, the present study was conducted on 46 postmenopausal women with bleeding, admitted to department of obstetrics and gynecology VMMC and Safdarjang Hospital, New Delhi, India. After TVS, all patients with ET >4 mm underwent SIS and then scheduled for hysteroscopy when there was no active bleeding. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to compare the diagnostic accuracy of SIS and hysteroscopy.Results: Most commonly found endometrial lesions were polyp (39.13%) and endometrial hyperplasia (28.26%) among our study population consisting of 46 postmenopausal women (mean age 56.72±6.6 years). Overall sensitivity rates were 86.84% for SIS and 97.37% for hysteroscopy, while the overall specificity rates were 50% for both SIS and hysteroscopy. Hysteroscopy had PPV and NPV of 90.24% and 80% respectively whereas PPV and NPV were 89.19% and 44.44% for SIS.Conclusions: As an easy to perform, safe and well tolerated procedure yielding high diagnostic accuracy, SIS seems to be comparable to hysteroscopy for endometrial evaluation.

Pelvic floor muscle training with and without biofeedback in treatment of overactive bladder

Background: Overactive bladder (OAB) is a commonly encountered problem in gynaecological practice. It has profound effect on quality of life (QOL), affecting simple daily activities as well. Prevalence rates of OAB in Asians are 53.1%. The first line management of OAB is behaviour modification and pelvic floor muscle training (PFMT). Objective of this study was to comparative assessment of biofeedback assisted PFMT (BAPFMT) versus PFMT alone in treatment of OAB using strength of pelvic floor muscle and QOL before and after treatment.Methods: A prospective comparative randomized controlled trial was conducted to compare the effect of PFMT versus BAPFMT on OAB symptoms over period of 12 weeks. Total of 100 patients fulfilling inclusion and exclusion criteria were selected. Randomization of patients was done into two groups of 50 patients each; half of them were subjected to PFMT and other half to BAPFMT. Appropriate statistical test were applied.Results: At the end of 12 weeks of intervention, there was a significant improvement in pelvic floor muscle strength and QOL in both groups (p<0.001). The improvement in pelvic floor muscle strength was more with BAPFMT; however there was no difference in improvement of QOL between the groups.Conclusions: Addition of biofeedback to PFMT may be a useful adjunct in OAB patients.

Idiopathic thrombocytopenic purpura complicating pregnancy.

Idiopathic thrombocytopenic purpura is a relatively common but unrecognised auto-immune disorder among women of child bearing age. Nearly one-third of patients present with bleeding tendency in pregnancy. Management necessitates care of mother during pregnancy and delivery and care of the baby. Steroids remain the chief, economical and effective method of raising platelet counts, but platelet transfusion and human intravenous high dose alpha-globulin may be required. Neonatal thrombocytopenia must be expected and managed. Management of patient, since it concerns two lives, should be individualised and carefully planned in consultation with haematologist and paediatrician.