A triple-blind, randomized controlled trial, comparing combined letrozole and clomiphene versus only letrozole for ovulation induction in women with polycystic ovarian syndrome.

OBJECTIVE: To evaluate the efficacy of combination treatment of letrozole and clomiphene citrate (CC) in comparison to that of letrozole alone to induce ovulation in infertile women with polycystic ovary syndrome (PCOS). METHODS: The current study was designed as a single-center, double-arm and triple-blind, randomized, controlled trial. The study was prospectively registered with the clinical trials registry in India and was conducted after approval from the institutional ethics committee. Study patients were randomly assigned to treatment with either a combination of 2.5 mg of letrozole and placebo (n = 40) or a combination of 2.5 mg of letrozole and 50 mg of CC (n = 40) starting from cycle days 3 to 7 for a single treatment cycle. RESULTS: Ovulation induction with combined letrozole and CC provided a higher ovulation rate, with a 35% absolute difference in its favor. The authors found an ovulation rate of 73% versus 38% (P = 0.003) for treatment with a combination drug and letrozole alone, respectively, while the ovulation rate ratio was 1.93 (95% CI, 1.24-3.01). CONCLUSION: Combined treatment of letrozole and clomiphene may be considered as one of the first-line ovulation induction agents for infertile women with PCOS because of its affordability and better safety profile.

Perinatal Outcomes in Premature Placental Calcification and the Association of a Color Doppler Study: Report from a Tertiary Care Hospital in Eastern India.

Introduction: Placental calcification, identified before the 36th week of gestational age, is known as premature placental calcification (PPC). PPC could be a clue for the poor fetal outcome. However, its association with adverse perinatal outcomes is yet to be confirmed. Objective: The primary objective was to determine and compare the perinatal outcomes in pregnancies with and without documented premature placental calcification. Methodology: The present study was a prospective cohort study performed from October 2017 to September 2019. We consecutively enrolled 494 antenatal women who presented to our antenatal OPD after taking consent to participate in our study. Transabdominal sonographies were conducted between 28-36 weeks of gestation to document placental maturity. We compared maternal and fetal outcomes between those who were identified with grade III placental calcification (n = 140) and those without grade III placental calcification (n = 354). Results: The incidence of preeclampsia, at least one abnormal Doppler index, obstetrics cholestasis, placental abruption, and FGR (fetal growth restriction) pregnancies were significantly higher in the group premature placental calcification. We also found a significantly increased incidence of Low APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) scores, NICU (Neonatal Intensive Care Unit) Admission, Abnormal CTG (cardiotocography), meconium-stained liquor, and low birth weight babies in those with grade III placental calcification. Conclusion: Clinicians should be aware of documenting placental grading while performing ultrasonography during 28 to 36 weeks. Ultrasonographically, the absence of PPC can define a subcategory of low-risk pregnant populations which probably need no referral to specialized centers and can be managed in these settings.

Clinical Profile of Obstetric Patients Getting Admitted to ICU in a Tertiary Care Center Having HDU Facility: A Retrospective Analysis.

BACKGROUND: The critically ill obstetric patient represents a challenge that usually requires a multidisciplinary approach. Lack of awareness and the absence of regular antenatal care make the critically ill patients to be referred late and sometimes in moribund conditions. The objective of the present study is to determine the incidence, predictors and outcome of obstetric ICU admissions. METHODS: This retrospective study was conducted over a period of 2 year from July 2015 to June 2017 in Department of Obstetrics and Gynecology at Institute of Medical Sciences, BHU, Varanasi, India. RESULTS: Out of a total of 4986 deliveries, 756 patients underwent HDU admission, while 92 obstetric patients were admitted to ICU during this study period. Maximum number of patients (73.91%) were in the age-group of 20-35 years, 64.13% of patients constitute lower socioeconomic status group, 68.47% of patients reside in rural area and there was inadequacy in receiving antenatal care in case of 60.86% of patients. Maximum number of patients were admitted for a period of 4-7 days. Blood transfusion (64.1%), the use of inotropic drugs (45.6%), central line placement (44.5%) and mechanical ventilation (26.08%) were the major interventions performed in ICU. Obstetric hemorrhage was found to be the most frequent clinical diagnosis leading to ICU admission (31.5%) followed by hypertensive disorders (25%). CONCLUSION: In addition to timely referral, health education and training of health professionals may improve clinical outcome and better obstetric practice, especially in countries like India. Obstetric ICU dedicated for the management of only obstetric patients should be constructed in order to compensate for heavy burden critically ill women.

Effect of Orlistat Versus Metformin in Various Aspects of Polycystic Ovarian Syndrome: A Systematic Review of Randomized Control Trials.

BACKGROUND: Polycystic ovarian syndrome (PCOS), a commonly prevalent endocrinopathy among reproductive age group women, is most often associated with obesity. Increased insulin resistance appears to be the central pathophysiologic mechanism responsible for various complications of PCOS. This makes 'weight loss' as the first-line treatment approach in PCOS. So various trials have tried to compare metformin (an insulin-sensitizing agent) and orlistat (an anti-obesity drug) aiming to achieve weight loss and hence higher ovulation rate for the group of obese PCOS patients. Keeping an eye on all these background facts, we designed this systematic review and metaanalysis to compare the effects of metformin and orlistat on various aspects of PCOS and to pick the better among the two drugs. MATERIALS AND METHODS: This is a systemic review of randomized control trials that studied the effectiveness of orlistat versus metformin in terms of improvement in ovulation rate, weight loss, lipid profile, etc. Systematic literature search over the period January 2000-December 2016 was performed in the following electronic databases: Medline, embase, google scholar, pubmed and The Cochrane Library and only randomized controlled clinical trials were included in our study. All authors carefully went through all sources of information independently. RESULTS: According to this study, weight loss, testosterone level after 4 weeks of treatment, total serum cholesterol and triglyceride level showed significant fall in orlistat-treated group. CONCLUSION: Our review shows that orlistat is a more effective drug than metformin and should be the preferred drug in obese PCOS in combination with weight loss.