Reproductive tract infection and health seeking behaviour of eligible couples--an appraisal.

A community-based cross-sectional study was conducted in Paschim Midnapur district of West Bengal during March 2009 to August 2009 to find out the prevalence of reproductive tract infection and the health seeking behaviour. The respondents were 2000 currently married women (15-49 years age group) selected by stratified multistage random sampling. House to house visit and data collection by interview technique was done by faculty members of community medicine of Calcutta National Medical College and other medical colleges through predesigned and pretested schedule. The prevalence of reproductive tract infection was 11.7%, which was higher in 30-35 years age group (19.4%). Reproductive tract infection was indirectly proportional to literacy status. Prevalence of reproductive tract infection was significantly higher among those who did not use sanitary napkin / clean sun-dried domestic clothes. The occurrence of reproductive tract infection was lower who used to practise barrier method of contraception. Majority of symptomatic females complained about vaginal discharge (29.2%). Information, education, communication regarding small family norms, reproductive hygiene and contraceptive practice to be enhanced in the community through intervention (interpersonal communication and mass media) in future to reduce the reproductive tract infection morbidities.

Current trends in delivery of eclampsia patients.

This study tried to identify if there was any current trend in delivering eclampsia patients in terms of choice of mode and time of delivery and reasons for such choice and whether they influenced outcomes. Initial assessment findings, choice of mode of delivery, delivery outcomes were analysed in 608 consecutive cases of antepartum and intrapartum eclampsia, caesarean section rate was very high (71.05%). Majority of caesarean sections were done to promptly deliver those patients who were in early labour or not in labour, thus, unlikely to deliver vaginally within about 6 hours. Only those in advanced labour and likely to deliver vaginally within a short period were allowed vaginal delivery indicating considerable selection. Both maternal mortality rate and perinatal mortality rate were much lower with early caesarean section (0.95% and 3.80% respectively) than with vaginal delivery. Both also steadily increased with increasing admission--delivery interval, apparently independent of mode of delivery indicating that improved foetomaternal outcomes associated with early caesarean section actually resulted from prompt delivery. Thus there was a definite trend of liberal use of caesarean section, whenever needed, to ensure prompt delivery of eclamptic patients and this, in turn, improved outcomes.

Genital fistula--our experience.

Genital fistulas cause immense physical and psychosocial problem in women's life. The present study was conducted to note the varieties of genital fistula as well as their causative factors and the results of the operative corrections. Altogether 42 patients with different varieties of genital fistula were enrolled in the study. The causative factors of the genital fistulas, specially, that of vesicovaginal fistulas were thoroughly enquired. After confirming the diagnosis, the operative corrections were undertaken. Among the varieties of genital fistula, 76.19% were vesicovaginal fistula, 11.90% were rectovaginal fistula and 4.76%, 4.76% and 2.38% cases of ureterovaginal, urethrovaginal and vesicocervical fistulas respectively. The primipara women were the major sufferers of genital fistulas due to obstetric grounds. Regarding aetiologies of vesicovaginal fistulas, 71.87% patients had obstetric reasons, after prolonged labour, instrumental delivery and after caesarean section due to obstructed labour. Abdominal hysterectomy (44.44%) topped the list of the gynaecological causes of vesicovaginal fistulas. The cases of ureterovaginal fistulas were after abdominal hysterectomy. One case of urethrovaginal fistula was due to some chemical application for correction of genital prolapses. The rectovaginal fistulas were mostly due to obstetric reasons. The success rate after the first attempt of repair of vesicovaginal fistula was 82.75% and overall failure was 10.34%. The other varieties of fistulas were repaired with 100% success rate. The incidence of genital fistulas can be reduced by vigilant obstetric care and meticulous surgery.

A study of prophylactic use of 15-methyl prostalglandin F2alpha in the active management of third stage of labour.

To compare active management of third stage of labour with 15-methyl prostaglandin F2alpha (PGF2alpha) and conventional management with methylergometrine as prophylaxis for postpartum hemorrhage, a randomised comparative study was carried out at Calcutta National Medical College and Hospital, Kolkata on 100 women. They were randomly allotted to one of the two groups. Group A included 50 women who received 15-methyl PGF2alpha (125 microg) intramusculary at the time of delivery of the anterior shoulder and group B included 50 women who underwent conventional management of the third stage of labour where methylergometrine 0.2 mg was given after delivery of placenta. Main outcome measured were duration of third stage, amount of bleeding and side-effects. The present study showed that there were significent reduction of the duration of third stage as well as reduction of amount of bleeding particularly when 125 microg of 15-methyl PGF2alpha was given intramuscularly at the time of delivery of the anterior shoulder in comparison to coventional method of management of third stage of labour with methylergometrine. Placental expulsion occurred within 4 minutes in group A and 16.5 minutes in group B. The amount of bleeding following delivery was 95.6 ml in average in group A and 249.6 ml in average in group B. 15-methyl PGF2alpha (125 microg) is certainly effective in prevention of postpartum haemorrhage particularly in developing country like India where this complication contributes a major factor for maternal mortality.

Unilateral lower limb oedema in pregnancy.

A 21 years old lady was admitted with severe pain and swelling of left lower limb in a pregnancy of 34 weeks of period of gestation. On examination there was pitting oedema of the whole left lower limb with extreme tenderness. Doppler USG of left femoral vein showed a thrombus in the process of recanalisation and no significant flow was demonstrated inside the lumen and USG for foetoplacental profile showed a single live foetus of gestational age 34 weeks. The case was diagnosed as deep venous thrombosis in pregnancy. She was treated with heparin injection 5000 unit subcutaneously twice daily throughout pregnancy along with antibiotics. In spite of proper management she developed extensive ulceration in left lower limb. She delivered normally a healty male child after induction with oxytocin dirp. The postpartum period was uneventful. Throughout this period heparin was continued and she was referred to surgery department for skin grafting.