Antenatal care during the COVID-19 pandemic

Background: COVID-19 pandemic has affected the daily living globally. It has added to the stress of day to day life. COVID-19 is associated with severe disease in high-risk population groups with increased mortality risk. COVID-19 and it’s impact on pregnancy needs extensive research. Early research data does not suggest any increased risk in the pregnant population and Vertical transmission is yet to be confirmed. As of now no standard protocol is available for management of COVID-19 .Social distancing is the best possible mechanism available to protect patients and health care personnel from COVID-19. The aim of this study is to know the effectiveness of protocol based Antenatal care during COVID-19 pandemic.Methods: This study was conducted at the Antenatal clinic. A total of 40 antenatal cases who satisfied inclusion and exclusion criteria were selected for the above study. They were assessed at the antenatal clinic following a modified protocol.Results: Majority of the pregnant women in the study group were primigravidas and belonged to the age group of 21-25 years. They were called for Antenatal check-ups as per the protocol specifically modified taking into consideration the COVID-19 pandemic. 80% of the deliveries in present study were normal delivery and only in obstetric emergencies LSCS was performed.Conclusions: Antenatal care in COVID-19 pandemic is challenging yet essential. Following a protocol based approach is the key to management of Antenatal care amidst the pandemic. It is cost-effective and has an easy learning curve.

Effectiveness of folic acid in unexplained infertility

Background: Folic acid is commonly used by infertile women worldwide. However, studies on the effect of folic acid in women with unexplained infertility are lacking. This aim of this study was to evaluate the effectiveness of folic acid in women with unexplained infertility.Methods: This prospective multicentric study was performed from June 2019 to July 2020 in women with unexplained infertility attending the fertility clinic. In this study, 50 women with unexplained infertility who satisfied the inclusion and exclusion criteria were started on folic acid therapy. The effectiveness of therapy was evaluated on the basis of successful conception and adverse effects if any.Results: Folic acid therapy showed a marked improvement in infertility status measured in terms of successful conception. After initial 12 weeks therapy successful conception was achieved in 40 (80%) women without any adverse effects.Conclusions: Folic acid supplementation has a positive effect on pregnancy outcome in women with unexplained infertility without any adverse effects. Folic acid is thus a safe and cost-effective option in women with unexplained infertility.

Effectiveness of modified mattress suture closing technique over conventional lower segment caesarean section closing technique

Background: The objective of this study was to compare the thickness of the scar and relative thinning of the uterinewall following conventional LSCS closing technique versus new closing technique (modified mattress Suture) and any additional surgical procedure in each group.Methods: A total of sixty patients undergoing primary caesarean for obstetric indications and who were willing for the study were included. In 30 patients uterus was closed by conventional double layer technique (the first layer is suturing with absorbable suture in a continuous running fashion. After first layer is complete, a second continuous stitch is used to invert the first layer, inverting stitch may be horizontal or vertical using same suturing material) and in 30 patient uterus was closed by new modified mattress technique. In both groups same suture material (vicryl 1-0) was used. Measurement of the thickness of scar site and corresponding posterior wall thickness was done following 6 months of caesarean section.Results: The possible parameters of better technique i.e., the mean scar thickness is more and relative as well as percentage thinning is less with this new technique of uterine closure although statistically not significant. Conclusions: Modified mattress suture technique is a single step procedure and gives the feel of double layer uterine closure. Hence the time taken, material. Used and the cost involved will be less along with excellent hemostasis.

Effectiveness of forceps delivery in modern day obstetrics

Background: There has been an alarming rise in number of caesarean sections all over the world. Instrumental delivery plays an important role to reduce this trend globally. Forceps delivery though proper training and expertise can definitely reduce the rising caesarean section rates in the modern-day obstetrics. The aim of this study is to study the effectiveness of forceps delivery in modern obstetrics.Methods: In the present observational study, 20 cases of forceps delivery were studied for maternal and foetal outcomes including postpartum hemorrhage, perineal tears, Apgar score, NICU admissions, birth injury, and mortality.Results: The most common indication for forceps application was maternal exhaustion (80%) followed by foetal distress. All the cases of forceps application in the present study were associated uneventful vaginal delivery. No any adverse maternal outcomes including perineal tears, post-partum hemorrhage was observed in this study. Average birth weight in the present study was 3.2 kgs and Apgar scores at birth and five minutes was within normal limits. No any birth injury was noted in any of the newborns.Conclusions: Forceps delivery is a safe and effective option in modern day obstetrics to reduce the alarming rise in rates of caesarean section globally. Training should be encouraged to develop the expertise of this art of forceps delivery.

Effectiveness of Cabergoline therapy in hyperprolactinemic infertility

Background: Hyperprolactinemia may be associated with ovulatory dysfunction and resultant subfertility. Hyperprolactinemia affects the pulsatile release of GnRH, which in turn impairs the secretion of FSH and LH. It may also affect the endocrine activity of ovarian follicles, resulting into luteal phase defect and ovulatory dysfunction. Hyperprolactinemia may be associated with infertility in up to one-third of women undergoing infertility workup. Women with hyperprolactinemia are generally treated with dopamine receptor agonists to reduce serum prolactin levels and regularisation of menses. The aim of this study was to study the effectiveness of cabergoline therapy in hyperprolactinaemic infertility.Methods: This prospective study was performed from June 2017 to July 2018 in women with Hyperprolactinemic infertility attending the infertility clinic at INHS Patanjali. In this study, 20 women with hyperprolactinemic infertility who satisfied the inclusion and exclusion criteria were started on four week cabergoline therapy. The effectiveness of therapy was evaluated on the basis of normalization of prolactin levels, regularization of menses, reduction in galactorrhea, successful conception and adverse effects if any.Results: The women on Cabergoline therapy showed marked improvement in menstrual irregularity, near normal prolactin levels and reduced galactorrhea. After the four week Cabergoline therapy the frequency of galactorrhea and irregular menses was reduced in 8 (80%) and 14 (93.3) per cent, of women respectively. Successful conception was achieved in 17 (85%) women after regularization of menses with no any major adverse effects.Conclusions: This study shows the effectiveness of cabergoline therapy both on lowering the serum prolactin levels and successful Conception with no any major adverse effects. Cabergoline therapy is a cost effective and safe option in hyperprolactinaemic infertility.