An Epidemiology Study to Determine the Prevalence and Risk Factors Associated with Recurrent Spontaneous Miscarriage in India.

BACKGROUND: The data on the prevalence of recurrent spontaneous miscarriage (RSM) in India are scarce. This study aimed to determine the prevalence of RSM in Indian females. METHODS: Female patients aged between 18 and 45 years with history of at least one spontaneous miscarriage were enrolled in the study. The probability of a subsequent miscarriage after the first, second, and third miscarriage was determined. The prevalence of RSM (defined as loss of ≥3 pregnancies of ≤20 weeks gestation each) between different age groups was compared using χ (2) test. Binary logistic regression analysis was applied to determine any association between RSM and the presence of risk factors. RESULTS: Of the 2398 patients screened for eligibility, 767 (32 %) had a history of at least one spontaneous miscarriage. The prevalence of RSM among the 753 enrolled patients who satisfied the eligibility criteria in the study was 7.46 %. RSM was mostly recorded in the age group of ≥33 years (14.68 %, n = 32). In patients with RSM, the second and third miscarriages were more prevalent during 7th week to end of 11th week of gestation. The probability of having a subsequent miscarriage after the first, second, and third miscarriage was 0.25, 0.34, and 0.22, respectively. There was a significant association (p < 0.05) between RSM and clotting disorders, immunological factors, infections, and genetic disorders. CONCLUSION: The study revealed a higher prevalence of RSM among the Indian women as compared to western data. Age, clotting disorders, immunological factors, infections, and genetic disorders were the significant risk factors associated with RSM.

Effectiveness and safety of dydrogesterone in regularization of menstrual cycle: a post-marketing study.

Oral administration of dydrogesterone during second half of menstrual cycle has been shown to reduce menstrual irregularities. This prospective, observational study aimed to determine continued effectiveness of dydrogesterone (prescribed between 1 and 6 cycles or longer) in menstrual cycle regularization in Indian women aged ≥18 years with irregular menstrual cycle for at least 3 months. Those achieving regular cycles (21 to 35 days, inclusive) during treatment were followed up for 6 months after cessation of dydrogesterone treatment. Of the 910 women completing dydrogesterone treatment, 880 (96.7%) achieved cycle regularization (p<0.0001 for 90% success rate) at end of treatment (EOT). Of the 788 subjects available for follow up at 6 months, 747 (94.8%) reported cycle regularity (p<0.0001 for 90% success rate). At EOT, the mean cycle duration reduced by 16.14 (±24.04) days and mean amount of menstrual bleeding decreased by 0.45 (±1.20) pads/day. While five subjects reported worst pain at baseline, none experienced it at EOT. One serious adverse event (appendicitis) and three non-serious adverse events were reported. Dydrogesterone regularizes and improves the duration of the menstrual cycle, reduces the amount of bleeding, relieves menstrual pain and prevents relapse of irregular cycles at six months after discontinuation of treatment.

Continuity of microblade technology in the Indian Subcontinent since 45 ka: implications for the dispersal of modern humans.

We extend the continuity of microblade technology in the Indian Subcontinent to 45 ka, on the basis of optical dating of microblade assemblages from the site of Mehtakheri, (22° 13' 44″ N Lat 76° 01' 36″ E Long) in Madhya Pradesh, India. Microblade technology in the Indian Subcontinent is continuously present from its first appearance until the Iron Age (~3 ka), making its association with modern humans undisputed. It has been suggested that microblade technology in the Indian Subcontinent was developed locally by modern humans after 35 ka. The dates reported here from Mehtakheri show this inference to be untenable and suggest alternatively that this technology arrived in the Indian Subcontinent with the earliest modern humans. It also shows that modern humans in Indian Subcontinent and SE Asia were associated with differing technologies and this calls into question the "southern dispersal" route of modern humans from Africa through India to SE Asia and then to Australia. We suggest that modern humans dispersed from Africa in two stages coinciding with the warmer interglacial conditions of MIS 5 and MIS 3. Competitive interactions between African modern humans and Indian archaics who shared an adaptation to tropical environments differed from that between modern humans and archaics like Neanderthals and Denisovans, who were adapted to temperate environments. Thus, while modern humans expanded into temperate regions during warmer climates, their expansion into tropical regions, like the Indian Subcontinent, in competition with similarly adapted populations, occurred during arid climates. Thus modern humans probably entered the Indian Subcontinent during the arid climate of MIS 4 coinciding with their disappearance from the Middle East and Northern Africa. The out of phase expansion of modern humans into tropical versus temperate regions has been one of the factors affecting the dispersal of modern humans from Africa during the period 200-40 ka.