Post-placental intrauterine device insertion--a five year experience at a tertiary care centre in north India.

BACKGROUND & OBJECTIVES: In view of high rate of unintended pregnancy in our country, particularly in post-partum women, there is a need for reliable, effective, long-term contraception such as intrauterine device (IUD) in post-partum women. The present study was planned to evaluate the safety and efficacy of immediate post-partum IUD insertion in women delivering vaginally or by caesarian section in a tertiary care centre facility in north India during a period of five years. METHODS: The women recruited had CuT 200B insertion immediately after delivery of placenta in vaginal or caesarean delivery. Women having post-partum haemorrhage (PPH), anaemia, pre-labour rupture of membranes >18 h, obstructed labour and distorted uterine cavity by fibroid or by congenital malformation were excluded from the study. The women were followed up at 6 wk and 6 months after delivery. RESULTS: A total of 1317 women were included in the study. Of these, 1037 (78.7%) came for first follow up. The cumulative expulsion rate at the end of 6 months was 10.68 per cent. There was no case of misplaced IUD. INTERPRETATION & CONCLUSIONS: Although the expulsion rate for immediate post-partum insertion was higher than for interval insertion, the benefits of providing highly effective contraception immediately after delivery outweigh this disadvantage, particularly in country where women have limited access to medical care.

A study of changes in homocysteine levels during normal pregnancy and pre-eclampsia.

To find out changes in homocysteine levels that occur during normal pregnancy and pregnancy with pre-eclamptic toxaemia and also to find out correlation between homocysteine concentration and preeclamptic toxaemia a study was carried out among 90 women of which 30 were control which included normotensive non-pregnant women and the study group I comprised 30 pregnant normotensive women and the study group II comprised 30 pregnant women with pre-eclamptic toxaemia. Serum homocysteine was measured in all subjects using fluorescence polarisation immuno-assay. Control group had highest mean homocysteine levels while the study group I had least mean homocysteine levels (p < 0.001). Levels were significantly higher in subjects with BP > 146/100 mm Hg as compared to subjects with BP >140/90 and <146/100 mm Hg (p=0.017). There was significant difference between study group I and II at same gestational age. Hyperhomocysteinaemia was observed in pre-eclamptic females, also it was found that homocysteine levels were directly correlated with severity of pre-eclampsia.

Correlation of phthalate exposures with semen quality.

Phthalates are widely used man-made chemical released in the environment and human exposure is mainly through diet. As the phthalate plasticizers are not covalently bound to PVC, they can leach, migrate or evaporate into the environment and as a result have become ubiquitously contaminants. The present study investigates the correlation, if any, between the phthalate esters (DEP, DEHP, DBP, DMP, DOP) and sperm mitochondrial status, ROS, LPO, SCSA, and sperm quality. The study was conducted in the urban/rural population of Lucknow visiting Obstetrics and Gynecology Department, CSMMU, Lucknow. Semen analysis was performed according to the WHO guidelines while phthalate analysis by HPLC and LPO by spectrophotometer and the sperm mitochondrial status, ROS, SCSA using flow cytometry. The questionnaire data showed no significant difference in the demographic characteristics among the groups. In general, urban population was found to have statistically significant higher levels of phthalate esters than the rural. Further, infertile men showed statistically significant (p<0.05) higher levels of pollutants in the semen than fertile men. A negative correlation between semen phthalate level viz DEHP and sperm quality and positive association with depolarized mitochondria, elevation in ROS production and LPO, DNA fragmentation was established. The findings are suggestive that phthalates might be one among the contributing factors associated with the deterioration in semen quality and these adverse effects might be ROS, LPO and mitochondrial dysfunction mediated.