The Impact of use of Modified WHO Partograph on Labour Progress and Delivery: Outcome among Spontaneous and Induced Labour in Nulliparous Women at Term.

Labour is a normal physiological process considered by a progressive rise in frequency, intensity, and duration of uterine contractions resulting in effacement and dilatation of the cervix with descent of the fetus over the birth canal. Spontaneous or Induced labour has a significant role in the eventual mode of delivery and neonatal outcome. This study aims to compare mean duration of labour and maternofoetal outcome of spontaneous versus induced labour among nulliparous women. This was a prospective observational study conducted in the Department of Obstetrics and Gynecology in Bangabandhu Sheikh Mujib Medical University (BSMMU) from October 2016 to September 2017. The study was conducted in nulliparous women coming at term (38-41) weeks in active phase of labour (with cervical dilatation at least 4cm) either spontaneous or induced, both group of labouring women were monitored using modified WHO partograph. Outcomes measures include requirement of augmentation of labour with oxytocin, mean duration of labour, eventual mode of delivery, and the maternofoetal outcome. A total of 160 women were enrolled in this study into two groups. There was no difference in mean age group, but BMI and gestational age were noted significant (p=0.001) More women had spontaneous normal vaginal delivery among those with spontaneous labour (86.25% vs. 78.75%). The mean duration of the second stage of labour was significantly more in induced (17.65 minutes) than in spontaneous labour (14.78 minutes) with a significant P-value (p=0.001). The mean Apgar score between the groups showed almost same. No statistically significant difference was found (p>0.05). This study prevailed that, requirement of oxytocin for augmentation of labour and mean duration of labour was less in spontaneous group and most of the patient delivered vaginally but in induced group rate of caesarean was higher and requirement of oxytocin for labour augmentation was also more than spontaneous group. We observed that induced labour can be a safe procedure among nulliparous women if labour is monitored by modified WHO partograph.

Intra Uterine Contraceptive Device: Socio-Demographic Characteristics of Acceptors Acceptability and Effectiveness in a Tertiary Institution.

To assess the acceptability and efficacy immediate Postpartum Intrauterine Contraceptive Device (PPIUCD) among parturient at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh; this prospective interventional analytical study was conducted from January 2013 to June 2013. Contraceptive counseling was given to 370 eligible parturient after delivery during their postpartum hospitalization. A pre-tested structured data collection sheet was administered to all participants. Women who accepted the PPIUCD during their postpartum care were inserted with the device before discharge (within 48 hours). These women were followed up at 6 weeks for complications. The acceptance rate of PPIUCD and the percentage of actual insertions were recorded. The reasons for both acceptances and decline were also recorded. Of the 370 women counseled, a total of 132(35.67%) were inserted with PPIUCD. Parturient who had a short duration from their last child birth (2-3) were significantly associated with greater acceptance of the PPIUCD. Preference of other methods of contraception mainly short acting methods and the need to discuss with their partners were the most common reasons for declining use of PPIUCD. More than half (51.51%) of the women whom PPIUCD was inserted did so due to its long term effect. Immediate PPIUCD was demonstrably safe due to its low rates of complications. The common complications at six weeks interval were expulsion (5.8%) and lost strings (2.5%) and pelvic infection (1.66%). Acceptance of PPIUCD was relatively high probably because of its 'newness' in the community. For these women, the best opportunity to receive information about contraception is during child birth when they are in contact with healthcare providers. It is also important to emphasize and educate women on long term methods of contraception as majority of the women preferred short term methods despite their future pregnancy desires of more than three years. Couple counseling should also be promoted. The government needs to develop strategies to increase public awareness of the PPIUCD through different media sources.

A comparative study among laparoscopically assisted vaginal hysterectomy, vaginal hysterectomy and abdominal hysterectomy: experience in a tertiary care hospital in Bangladesh.

The study was undertaken to compare the efficiency and outcome of laparoscopically assisted vaginal hysterectomy (LAVH), total abdominal hysterectomy (TAH) and vaginal hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complications rate and patients recovery. A total of 750 patients were prospectively collected in the study period from January 2005 through January 2009 in a tertiary care hospital. The mean estimated blood loss in LAVH and VH group were significantly lower compared with the TAH group. As to postoperative pain, significantly less diclofenac was required in the LAVH and VH group vs the TAH group. LAVH, VH is clinically and economically comparable with TAH, with patients' benefits of less estimated blood loss; less analgesia use; less intra- and postoperative complication rates; less postoperative pain; rapid patient recovery and shorter hospital stay. The study concludes that thus, LAVH, VH is clinically and economically comparable with TAH.

Association between bacterial vaginosis and preterm delivery.

Bacterial vaginosis (BV) is one of most common presentation in women of reproductive age, and its prevalence is relatively high in the obstetric population which is responsible for preterm delivery. The present study tried to explore the association of BV with preterm delivery, and included 100 pregnant women aged 15 to 35 years, between 28 36 weeks of gestation, with abnormal vaginal discharge and clinically suspected of BV, attending obstetrics outpatient department of BSMMU were selected for the study, divided into two groups based on Amsel clinical criteria (63 culture negative and 37 culture positive for BV). Mean ± SD age of BV negative and positive subjects was 24.59 ± 5.18 and 23.89 ± 4.77 years respectively (statistically no significant difference). Likewise, socioeconomic status, educational status and gravida did not show statistically any significant difference between groups. Significantly high number of BV positive women delivered prematurely (73%) compared to BV negative (25.4%) (p<0.001). Mean ± SD gestational age also differed significantly 37.49 ± 2.53 vs. 35.24 ± 2.33 weeks (p<0.001). Our study supported that abnormal bacterial colonization, indicative of bacterial vaginosis, is strongly associated with preterm delivery.

Effect of oestrogen replacement therapy on bone mass in post-menopausal Bangladeshi women.

The female population comprises 48.66% of our total population, of which 10.30% are above the age of 49, many of whom are post-menopausal. Menopause is associated with bone-loss and its consequences. Hormone replacement therapy (HRT), particularly replacement of estrogen, prevents bone-loss. We undertook this prospective case-controlled study to find out whether or not HRT is beneficial to our women. A total of 106 patients were studied, amongst them 60 were cases and 46 were controls. The women in the first group were given either conjugated equine estrogen alone (surgical menopause group) or conjugated equine estrogen plus cyclical progesterone (natural menopause group). Results showed that there was 4.29% increase in bone mineral density in women who received hormone replacement therapy (HRT). This increase was 5.23% in early and 3.56% in late menopause group. Women with natural menopause gained more bone mass (4.22%) than women with surgical menopause (3.9%). Our results also showed that women who denied HRT (controls) lost bone mass (5.26%), the loss was more in those with surgical menopause (6.24%) than those with natural menopause (4.87%). Therefore it can be concluded that post-menopausal hormone replacement therapy prevents bone-loss. However, to evaluate the beneficial effect of long-term HRT, further studies with larger samples are recommended.

Foam separation of microbial cells.

Batch foam separation has been employed to separate Saccharomyces carlsbergensis cells from their broth without the use of any external surface-active agent. A model has been developed to predict the foamate cell concentration as well as the variation of cell concentration in the bulk liquid in the foam column as a function of time. The model assumes a linear equilibrium relation between the cell concentrations at the interface and the bulk. The foam has interface as well as interstitial liquid. The interface is assumed to be in equilibrium with the interstitial liquid, which in turn is assumed to have the same concentration as the bulk. The interfacial area is calculated by assuming the foam bubbles to be pentagonal dodecahedral in shape. The model has been found to explain the results of foam separation of cells quite well, particularly with respect to the effect of bubble size and aeration rate.