Efficacy of combined clomiphene citrate and gonadotrophin therapy

To measure the success rate of combined clomiphene citrate and gonadotrophin therapy in infertile patients. Observational analytical study. June 2009 to June 2010. In this observational analytical study, total of 100 infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotrophin [CC - hMG] regime and maximum of three treatment cycle were given. Out of 100 patients in our study, 74% [2/3 rd] patients were less than 30 years of age and 26% [1/3rd] were between 30 - 40 yrs of age. Primary infertility was seen also in 2/3rd of patients [73%] and secondary infertility in remaining 1/3rd [27%] of patients. Polycystic ovary [PCO] was the commonest cause of an ovulation seen in 62% of patients, obesity in 24% of patients and in 14% of patients cause was unknown [unexplained infertility]. on average only 4.1 Inj of gonadotrophin were required to get a mature follicle on an average 12th day [12.41 day] of the cycle. As concerned the treatment outcome, 82% of patient reported back after first course of treatment. Urine pregnancy test was positive in 18%. Remaining 64% patent were offered second course of treatment, out of which only 35% agreed for further treatment. After second course of treatment positive urine pregnancy test was seen in only 5% of patients. Remaining 30% of patients were advised third course of treatment. Out of these 30%, 8 patients took gonadotrophin regime, 10 patients agreed on follicle tracking only, 8% of patients refused further treatment and 4% did not report back. Our study shows the success rate of 23% with CC-HMG combined treatment which is double the CC alone and equal to HMG alone, thereby reducing the cost of treatment without sacrificing efficacy. In other words combined CC-HMG regime is cost effective technique in the management of infertile patients

Elective caesarean section; short antibiotic prophylaxis versus prolonged antibiotic therapy

To compare short antibiotic prophylaxis versus prolonged antibiotic regime in terms of morbidity control of infection in patients undergoing elective caesarean section. It was a experimental study done in Gynae/Obs unit I Holy Family Hospital Rawalpindi over a period of one year. Total of 200 patients selected randomly were admitted in antenatal ward for elective caesarean section. All these booked patients with age less then 40 years, gestational age of > 38 weeks, Hb >10g/dl, with no signs of genitourinary or respiratory tract infection were included in the study. These patients were divided in two groups with 100 patients in each group. In group I, short antibiotic prophylaxis in form of three doses of injectable antibiotic was given. In group II prolonged antibiotic regime was given as 5 days course. Augmentin was chosen as it has proven efficacy and good coverage for microorganisms of urogential tract and skin. Injection Augmentin was given in dose of 1.2g [1g Amoxycillin + 200mg clavulanic acid] I/V x BD. All operation were performed by transverse lower segment caesarean section by registrars and consultants. Anaesthesia used was mostly spinal and more than 80% of the patients were having body mass index of <30. These patients were followed in postnatal ward for post operative infectious morbidity till discharge. Data collected through proformas was entered in computer and analyzed using SPSS. Over all post operative infectious morbidity in group I was 29% and in group II30% [p = 0.877]. Post operative fever in group I was 09% and group II 08% [p = 0.800], while frequency of endometritis was found to be same in both groups which was 03%. No case of chest infection was recorded in both groups. Only 5% patients in group I and 4% patients in group II were reported to have urinary tract infection [p = 0.733]. The most common complication found during study was wound infection, the rate being 12% in group I and 15% in group II [p = 0.535]. So the overall results showed no statistically significant difference between two groups. Short antibiotic prophylaxis is as effective as prolonged antibiotic regimen. As it is cost effective and most of our patients come from low socio economic class, so this short antibiotic prophylaxis should be recommended routinely for all elective caesarean sections