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Mahey R, Singh SV, Gupta P, Rana A, Rajput M, Cheluvaraju R, Manchanda S, Bhatla N. Diagnostic and management dilemmas of pregnancies at the utero-tubal junction: A case series and management algorithm. Int J Gynaecol Obstet 2024. [PMID: 38757568 DOI: 10.1002/ijgo.15587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE A pregnancy at the utero-tubal junction is a rare type of ectopic pregnancy and is associated with high maternal morbidity if it remains undetected. In the present study we discuss four cases of ectopic pregnancies at the utero-tubal junction which caused diagnostic and management dilemmas. METHODS Four cases of early pregnancies with the gestational sac (G-sac) implanted near the utero-tubal junction are described. In case 1 this was suspected after a failed attempt at dilatation and curettage at our hospital, cases 2 and 3 presented with amenorrhea and pain abdomen and case 4 was diagnosed on first pregnancy documentation scan after frozen embryo transfer. RESULTS As initial two-dimensional (2D) transvaginal scan (TVS) failed to diagnose the exact location of the G-sac, three-dimensional (3D) TVS helped to localize the exact location of pregnancy and subsequent individualized management. Case 1 had a partial intramural ectopic pregnancy managed by laparotomy and removal of the ectopic sac. The second and third cases were eccentric uterine pregnancies. The fourth was an interstitial ectopic pregnancy managed by a laparoscopic loop and stitch technique. CONCLUSION This case series describes the role of 3D TVS for the evaluation of pregnancies implanted at the utero-tubal junction and individual management of eccentric intrauterine, interstitial ectopic and intramural ectopic pregnancies. A diagnostic algorithm for such types of cases and management options is discussed.
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Affiliation(s)
- Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalini V Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Paridhi Gupta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Anubhuti Rana
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Rajput
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohitha Cheluvaraju
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Pattnaik SS, Sarangi SC, Mahey R, Tripathi M. Physical fitness in Indian women with epilepsy on anti-seizure medications and its association with reproductive status, quality of life and stigma: A cross-sectional study. Epilepsy Behav 2024; 156:109823. [PMID: 38704986 DOI: 10.1016/j.yebeh.2024.109823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To determine the status of physical fitness, reproductive abnormalities, QOL and epilepsy associated stigma in women with epilepsy (WWE) and their association with ASM therapy and seizure frequency. METHODS This cross-sectional study included WWE of reproductive age (18-50 years) on antiseizure medications (ASMs) for at least three months before enrolment. Physical fitness was assessed using International Physical Activity Questionnaires (IPAQ) and Body composition analysis. Subjects were interviewed for menstrual abnormalities [menstrual disturbance or Polycystic Ovary Syndrome (PCOS)/hirsutism]. Validated questionnaires were used for assessment of, QOL (QOLIE-10) and Stigma in epilepsy (Epilepsy Stigma Scale). Sub-group analysis was done to compare the above parameters on the basis of a) type of therapy (mono or polytherapy), b) type of ASMs treatment (conventional, newer, or conventional + newer ASMs), and c) seizure type and (d) seizure frequency. Correlation and regression analysis were done to find out the association among different variables with physical fitness. RESULTS The overall prevalence of poor physical fitness, reproductive abnormalities, worsened QOL and stigma in the enrolled WWE (n = 203) were 21.18 %, 20.19 %, 52.7 %, and 21.67 %, respectively. Sub-group analysis revealed that WWE on monotherapy (n = 99) had higher median IPAQ score (p = 0.002), comparatively less reproductive abnormalities (24.03 %, p = 0.008), and higher stigma (24.03 %, p = 0.04) than polytherapy group. WWE on conventional ASMs had significantly higher IPAQ scores compared to newer and conventional + newer ASMs groups (p = 0.02). The prevalence of poor physical fitness and stigma was significantly higher in WWE with higher number of seizures (p = 0.007, <0.001, respectively). No significant difference in QOL was observed on the basis of ASM type and therapy; however, WWE with generalized onset seizures had worsened QOL compared to those with focal onset seizures (p = 0.04). A significant negative correlation was found among seizure frequency and IPAQ score in WWE (p = 0.04). CONCLUSION WWE on polytherapy were physically less active, higher occurrence of reproductive abnormalities, and stigma compared to the monotherapy group. WWE with higher seizure frequency had poor physical fitness, and higher stigma compared to those with lesser number of seizures. These findings may aid value in optimization of ASM treatment in WWE of reproductive age.
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Affiliation(s)
| | | | - Reeta Mahey
- Dept. of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Manjari Tripathi
- Dept. of Neurology, All India Institute of Medical Sciences, New Delhi, India.
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Shreenidhi RA, Mahey R, Rajput M, Cheluvaraju R, Upadhyay AD, Sharma JB, Kachhawa G, Bhatla N. Utility of Visceral Adiposity Index and Lipid Accumulation Products to Define Metabolically-Unhealthy Polycystic Ovary Syndrome in Asian Indian Women - A Cross Sectional Study. J Hum Reprod Sci 2024; 17:50-57. [PMID: 38665608 PMCID: PMC11041319 DOI: 10.4103/jhrs.jhrs_14_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/28/2024] Open
Abstract
Background Polycystic ovary syndrome (PCOS) women are at risk of developing diabetes, cardiovascular disease and metabolic syndrome (MetS) due to insulin resistance (IR) and hyperandrogenism (HA). Both visceral adiposity index (VAI) and lipid accumulation product (LAP) are simple outpatient department-based metric tools that have been introduced to screen PCOS women who are metabolically unhealthy and are at risk of development of MetS. Aims The aim of the study was to evaluate VAI and LAP in women with PCOS and to correlate them with metabolic and endocrine markers. The study also assessed these parameters amongst different PCOS phenotypes and determined their usefulness to define metabolically healthy PCOS (MH-PCOS) and metabolically unhealthy PCOS (MU-PCOS). Settings and Design The design of the study was a cross-sectional study. Materials and Methods Two hundred PCOS women were included in the study, and all the clinical, anthropometric, hormonal, biochemical and metabolic markers were assessed. The cohort was divided into MH-PCOS and MU-PCOS by the modified National Cholesterol Education Programme criteria. VAI and LAP were calculated and correlated with clinical, endocrine and metabolic parameters. Statistical Analysis Used Univariate and multivariate logistic regression analysis was used to study the independent role of VAI and LAP to predict MetS. Adjusted and unadjusted odds ratios were calculated. Receiver-operating characteristic (ROC) analysis was done to define cut-offs in Asian Indian women. Results VAI and LAP had good ability to correctly discriminate MU-PCOS from MH-PCOS (area under the curve [AUC] [95% confidence interval (CI)]: 0.89 [0.82-0.95]) and (AUC [95% CI [0.81-0.92] =0.86) using ROC, respectively. The sensitivity of VAI and LAP corresponding to the optimal cut-off of ≥2.76 and ≥48.06 (Youden) was 84.09% and 79.55%, respectively. Similarly, the specificity of VAI and LAP was 85.26% and 79.49%, respectively. VAI has a positive predictive value of 61.7% (95% CI [23.7%-40.3%]) and a negative predictive value of 95% (95% CI [88%-99.1%]). LAP has a positive predictive value of 53% (95% CI [40.3%-65.4%]) and a negative predictive value of 93.3% (95% CI [87.6%-96.9%]). PCOS women having VAI ≥ 2.76 had 19.3 times ([95% CI: 6.50-57.70]) more chance of developing MetS. PCOS women having LAP (≥48.06) have 3.7 times ([95% CI: 1.35-10.60]) more odds. There was no difference between ROC curves of VAI and LAP (P = 0.32). Conclusion VAI cut-off ≥ 2.76 and LAP with a cut-off of ≥ 48.06 may be used as markers for predicting MetS amongst PCOS women.
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Affiliation(s)
- R. A. Shreenidhi
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Rajput
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohitha Cheluvaraju
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish D. Upadhyay
- Department of Statistics, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Singh N, Kashyap A, Malhotra N, Mahey R, Vatsa R, Patel G. Comparison of the effects of two different trigger strategies - dual (hCG + Leuprolide) versus hCG trigger - in antagonist non-donor IVF: a randomized controlled trial. JBRA Assist Reprod 2023; 27:467-473. [PMID: 37698459 DOI: 10.5935/1518-0557.20230040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE Conventionally, hCG is used as a 'faux' LH surge to bring final oocyte maturation due to structural similarity with LH. Although GnRH agonists induce a more physiological gonadotropin surge for follicular maturation, they have been associated with luteal phase deficiency. Our aim was to assess whether adding a gonadotropin-releasing hormone agonist (GnRHa) to hCG trigger improves oocyte maturation and the number of high-grade embryos in GnRH antagonist IVF cycles. METHODS This was a single center, open-labelled, randomized controlled trial including 100 patients between 21-38 years (tubal factor, male factor, unexplained infertility, with normal ovarian reserve) undergoing IVF using the GnRH antagonist protocol. Patients were randomized to receive either the dual trigger (Leuprolide acetate 1mg + rhCG 250µg, n=50) or a single hCG trigger (rhCG 250µg, n=50). Analysis was done by ITT. Independent-t and chi-square tests were used in the comparisons of normally distributed quantitative variables and qualitative variables. RESULTS With similar baseline characteristics, the number of MII oocytes (7.82 vs. 5.92, p=0.003) and day-3 grade-1 embryos (4.24 vs. 1.8, p<0.001) and consequently, number of embryos cryopreserved (2.68 vs. 0.94, p<0.001) were significantly higher in the dual trigger group. However, the fertilization (91.82% vs. 88.51%, p=0.184) and clinical pregnancy rates between the two groups (21% vs. 19.6%, p=0.770) were comparable. Serum LH levels 12 hours post trigger were high in the dual trigger group (46.23mIU/ml vs. 0.93mIU/ml, p<0.0001). CONCLUSIONS This study found that the addition of GnRHa to hCG trigger leads to improved embryological outcomes and the possibility of cryopreserving surplus embryos, thereby increasing cumulative live births.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Aryan Kashyap
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Vatsa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Patel
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Mahey R, Gupta P, Cheluvaraju R, Kataria K, Manchanda S, Rajput M, Bhatla N. Atypical Mayer-Rokitansky-Küster-Hauser Syndrome with Bilateral Inguinal Hernia of Adnexa-Laparoscopic Transabdominal Preperitoneal Repair with Ovarian Plication. J Minim Invasive Gynecol 2023; 30:609-610. [PMID: 37031857 DOI: 10.1016/j.jmig.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Reeta Mahey
- Department of Obstetrics and Gynaecology (Drs. Mahey, Gupta, Cheluvaraju, Manchanda, Rajput, and Bhatla), All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Pallavi Gupta
- Department of Obstetrics and Gynaecology (Drs. Mahey, Gupta, Cheluvaraju, Manchanda, Rajput, and Bhatla), All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rohitha Cheluvaraju
- Department of Obstetrics and Gynaecology (Drs. Mahey, Gupta, Cheluvaraju, Manchanda, Rajput, and Bhatla), All India Institute of Medical Sciences, New Delhi, Delhi, India.
| | - Kamal Kataria
- Department of Surgical Disciplines (Kataria), All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Smita Manchanda
- Department of Obstetrics and Gynaecology (Drs. Mahey, Gupta, Cheluvaraju, Manchanda, Rajput, and Bhatla), All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Monika Rajput
- Department of Obstetrics and Gynaecology (Drs. Mahey, Gupta, Cheluvaraju, Manchanda, Rajput, and Bhatla), All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology (Drs. Mahey, Gupta, Cheluvaraju, Manchanda, Rajput, and Bhatla), All India Institute of Medical Sciences, New Delhi, Delhi, India
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Singh N, Malhotra N, Mahey R, Patel G, Saini M. In vitro fertilization as an independent risk factor for perinatal complications: Single-center 10 years cohort study. JBRA Assist Reprod 2023; 27:197-203. [PMID: 37014951 PMCID: PMC10279444 DOI: 10.5935/1518-0557.20220041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Assisted Reproductive Technology (ART) has made great strides in the past forty-years, but no medical treatment comes without side effects. Despite several studies reporting high incidences of perinatal complications, the association is inconclusive. Also, the effect of racially and ethnically distinguished Asian population undergoing ART on perinatal outcomes is not well studied. Therefore, this study attempts to compare various perinatal outcome parameters in ART, and spontaneously conceived singleton pregnancies from a single high-volume tertiary care center. METHODS This is a retrospective cohort study from a single tertiary infertility center, carried out from January 2011 to September 2020. The study included 1,125 IVF conceived babies (AB group) and 7,193 spontaneous conceived babies (SB group). The groups were compared using the Pearson Chi-square test and adjusted odds ratio, calculated using the multivariate analysis. RESULTS Most of the perinatal complications, such as preterm birth (PTB), early preterm birth, low birth weight (LBW), extremely low birth weight, small for gestational age, large for gestational age babies, neonatal intensive care unit (NICU) admission, need for surfactant, meconium aspiration syndrome, neonatal seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, and patent ductus arteriosus was significantly increased in the AB group when compared to the SB group (p<0.05). In-vitro fertilization (IVF) independently increases the risk of LBW (aOR 2.530; 95% CI 2.194-2.917), PTB (aOR 4.004; 95% CI 3.496-4.587), NICU admission (aOR 2.003; 95% CI 1.610-2.492) and neonatal seizures (aOR 9.805; 95% CI 5.755-16.706).Conclusions: All ART-conceived pregnant patients should receive antenatal counselling regarding perinatal complications and should deliver at a tertiary care center with appropriate NICU support.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Patel
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Saini
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Yadav A, Noor N, Mahey R, Singh N, Dwarakanathan V, Malhotra N. Serum progesterone on the day of human chorionic gonadotropin (hCG) trigger as a predictor of in-vitro fertilization (IVF) outcome - a retrospective analysis of seven years. JBRA Assist Reprod 2023; 27:156-162. [PMID: 35916460 PMCID: PMC10279434 DOI: 10.5935/1518-0557.20220023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/01/2022] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To investigate the relationship between progesterone (P4) levels on the day of hCG trigger and IVF outcomes. METHODS This is a retrospective analysis of IVF cycles from January-2013 to December-2019 from a single center. Women (21-39 years) submitted to IVF treatment for various infertility factors were included, while donor oocyte cycles and cancelled cycles were excluded from the study. The primary outcome measure was live birth rate. RESULTS A total of 2149 cycles were analyzed. Of these, 223 (10.38%) were in the low P4 group (<0.5 ng/ml), 1163 (54.12%) in the normal P4 group (0.5-1.5 ng/ml), and 763 (35.50%) in the high P4 group (>1.5ng/ml). The groups were comparable with respect to age, factor of infertility and baseline AMH. The antagonist protocol was significantly more prescribed to the high P4 group (p<0.001). Live birth rates were 14.4%, 21.6%, and 21% (p<0.001), respectively, in three groups. Univariate analysis found that total cetrotide dose, total number of retrieved and fertilized oocytes, total number of embryos formed, transferred, and vitrified, and P4 on the day of hCG (p<0.001) were statistically significant after adjusting for age and BMI. In multivariate logistic regression after adjusting for age and BMI, only high P4 (aOR:0.60; p<0.001), total cetrotide dose (aOR: 0.82; p<0.001), and total utilizable embryos (aOR:1.11; p=0.029) were statistically significant. CONCLUSIONS Having an elevated serum progesterone level on the day of hCG trigger was associated with lower pregnancy rates, but this is still not a robust marker to predict live births. More good quality evidence is needed.
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Affiliation(s)
- Anshu Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | - Nilofar Noor
- All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Neena Malhotra
- All India Institute of Medical Sciences, New Delhi, India
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Bansiwal R, Mahey R, Malhotra N, Singh N, Saini M, Bhatt A, Nilima N, Mani K, Cheluvaraju R, Rajput M, Bhatla N. Comparison of Cumulative Live Birth Rate (CLBR) According to Patient Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) Stratification Among Low Prognosis Women Undergoing IVF-ICSI Cycles. J Reprod Infertil 2023; 24:117-131. [PMID: 37547574 PMCID: PMC10402454 DOI: 10.18502/jri.v24i2.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/25/2023] [Indexed: 08/08/2023] Open
Abstract
Background The purpose of the current study was to evaluate patient-oriented strategies encompassing individualized oocyte number (POSEIDON) criteria, validate stratification of low prognosis women, and prognosticate their reproductive potential in terms of cumulative live birth rate (CLBR) in Indian women. Methods Out of 4048 women who underwent IVF/ICSI, 3287 women met the criteria for final evaluation of CLBR. They criteria were divided into (a) group 1a as cases with <4 oocytes retrieved and 1b with 4-9 oocytes retrieved; (b) group 2a as cases with <4 oocytes retrieved and 2b with 4-9 oocytes retrieved; (c) group 3 (<35 years, AMH <1.2 ng/ml, AFC <5); and (d) group 4 (≥35 years, AMH <1.2 ng/ml, AFC <5). Non-POSEIDON group was sub-divided into normo-responders (10-20 oocytes) and hyper-responder (>20 oocytes). Results Overall CLBR was two-fold lower in POSEIDON group as compared to non-POSEIDON group (p<0.001). For every one-year increase in the age, the odds of CLBR decreased by 4% (OR 0.96, CI 0.93-0.99) in POSEIDON group and by 5% (OR 0.95, CI 0.92-0.98) in non-POSEIDON group. For every unit increase in number of oocytes retrieved, the odds of CLBR increased by 1.22 times (OR1.22, CI 1.16-1.28) in POSEIDON group and by 1.08 times (OR 1.08, CI 1.05-1.11) in non-POSEIDON group. Among POSEIDON groups, the highest values in CLBR belonged to group 1b followed by 3, 2b, 4, 1a, and 2a. Conclusion POSEIDON stratification of low-prognosis women undergoing IVF may be considered valid to prognosticate and counsel women undergoing IVF. Prospective studies will strengthen its validity among different ethnic populations.
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Affiliation(s)
- Reeta Bansiwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Monika Saini
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashok Bhatt
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nilima Nilima
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rohitha Cheluvaraju
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Monika Rajput
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Mahey R, Rana A, Cheluvaraju R, Vyas S, Raj R, Bhatla N. An unusual association of type II Mayer-Rokitansky-Kuster-Hauser syndrome, turner mosaic syndrome and tubo-ovarian inguinal hernia- case report and review of literature. J Ovarian Res 2023; 16:43. [PMID: 36814312 PMCID: PMC9948362 DOI: 10.1186/s13048-022-01067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/28/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Herniation of ovaries and Mullerian structures into inguinal canal is usually reported in infants and is rare among adults. We are presenting a rare case of Mullerian agenesis and Turner mosaic syndrome with tubo-ovarian inguinal hernia. CASE PRESENTATION A 17-year-old girl presented with complaints of primary amenorrhea, phenotypical features of Turner syndrome with left inguinal hernia and severe hypertension. Baseline hormonal analysis was normal. Karyotype revealed Turner mosaic with 46XX (85%); 45XO (15%). MRI showed Mullerian agenesis with normally located right ovary in pelvis and left ovary prolapsed through deep inguinal ring into the canal of Nuck. Anti-hypertensives were started and patient optimized for surgery. Laparoscopic hernia repair and repositioning of left ovary into the pelvis was done. Patient had uneventful post-operative course and was discharged in stable condition on anti-hypertensive medication. Future reproductive issues and need of passive vaginal dilatation or vaginoplasty before marriage were explained to the patient and family. CONCLUSION This is the first ever reported case with unusual association of atypical MRKH, Turner mosaic syndrome and tubo-ovarian hernia into the inguinal canal. The case emphasizes the need and importance of complete work up of these atypical cases as patients may have more than one cause of primary amenorrhea and complete evaluation is must before any medical or surgical intervention.
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Affiliation(s)
- Reeta Mahey
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India.
| | - Anubhuti Rana
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Rohitha Cheluvaraju
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Surabhi Vyas
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Ritu Raj
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
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Sudhakaran S, Bhatla N, Mathur SR, Mahey R, Vashist S, Natarajan J, Kachhawa G, Kumari R, Tanwar P. Evaluation of cervical cancer screening during pregnancy in India: Human papillomavirus testing can change the paradigm. Natl Med J India 2023; 36:17-21. [PMID: 37615134 DOI: 10.25259/nmji_768_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Background The World Health Organization's call for elimination of cervical cancer envisages 70% screening coverage of women aged 35 and 45 years by an effective test. In India, this target seems unrealistic as awareness and access to cancer prevention services are poor. However, the institutional delivery rate is now >80%. We evaluated the acceptability and feasibility of human papillomavirus (HPV) testing and its role in screening during pregnancy. Methods This observational study recruited 275 pregnant women aged >25 years between 12 and 34 weeks of gestation for screening by cytology and HPV testing. Colposcopy was advised if either test was positive. Acceptability and feasibility were assessed by a questionnaire. Results Cytology and HPV reports were available for 269 subjects. The median age was 28 years and median parity was two. Only 98 (36.4%) had heard about carcinoma cervix. Awareness improved with education (p < 0.001). On cytology, only 4 (1.5%) were abnormal (atypical squamous cells of undetermined significance 3; low-grade squamous intraepithelial lesion 1). The prevalence of high-risk HPV infection was 8.2% (22/269). On colposcopy, all had the Swede score <5. No high-grade cervical intraepithelial neoplasia or carcinoma was detected. Pre-procedure, 183 (68.0%) subjects expressed apprehension, post-procedure 114 (42.4%) of them had realized that their apprehensions were unfounded. Women found screening to be more uncomfortable after 28 weeks of gestation (n=26/68; 38.2%; p<0.001). Physicians found the cervix more difficult to visualize after 20 weeks of gestation (p<0.001). Conclusions HPV screening at 16-20 weeks of pregnancy is acceptable, feasible, and can greatly improve screening coverage in resource-limited settings. Pregnancy is a good opportunity to improve awareness of the screening programmes.
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Affiliation(s)
- Surabhi Sudhakaran
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Shachi Vashist
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Jayashree Natarajan
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Pranay Tanwar
- Department of Laboratory Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Mahey R, Cheluvaraju R, Kumari S, Kachhawa G, Kumari A, Rajput M, Bhatla N. Robert's Uterus versus Juvenile Cystic Adenomyoma - Diagnostic and Therapeutic Challenges - Case Report and Review of Literature. J Hum Reprod Sci 2023; 16:79-86. [PMID: 37305779 PMCID: PMC10256944 DOI: 10.4103/jhrs.jhrs_10_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 06/13/2023] Open
Abstract
This case report highlights the diagnostic dilemma and therapeutic challenges encountered while managing adolescent girls with progressive dysmenorrhoea and management of Robert's uterus. Two girls aged 20 years and 13 years presented with severe progressive dysmenorrhoea. In the first case, laparoscopy revealed juvenile cystic adenomyoma (JCA) of 3 cm × 3 cm on the left side anteroinferior to the round ligament. Laparoscopic resection of the lesion was done, and histopathology revealed features of adenomyosis. In the second case, there was a globular enlargement of the right half of the uterine body with round ligament and adnexa attached to the lesion (Robert's uterus). In view of severe symptoms, complete resection of the lesion and partial resection of hemi-uterus was done, followed by myometrial defect closure. Both cases were initially diagnosed as JCA, and the final diagnosis was made on laparoscopy. Both girls had complete symptomatic relief from the next menstrual cycle and have been under follow-up for 24 months and 18 months, respectively. Due to the rarity of conditions, Robert's uterus and JCA are usually misdiagnosed with each other or with other Mullerian anomalies such as a non-communicating unicornuate uterus. Radiologists and clinicians should be aware of these different pathologies causing similar symptoms. Understanding the pathology, early diagnosis, timely referral and correct surgical procedure are emphasised to improve reproductive outcomes.
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Affiliation(s)
- Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohitha Cheluvaraju
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Rajput
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Gupta Y, Singh C, Goyal A, Kalaivani M, Bharti J, Singhal S, Kachhawa G, Kulshrestha V, Kumari R, Mahey R, Sharma JB, Malhotra N, Bhatla N, Khadgawat R, Tandon N. Continuous Glucose Monitoring System Profile of Women with Gestational Diabetes Mellitus Missed Using Isolated Fasting Plasma Glucose-Based Strategies Alternative to WHO 2013 Criteria: A Cross-Sectional Study. Diabetes Ther 2022; 13:1835-1846. [PMID: 36103111 PMCID: PMC9663780 DOI: 10.1007/s13300-022-01317-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/24/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The aim of the study was to evaluate the differences in the continuous glucose monitoring system (CGMS)-based glycemic parameters between women with normoglycemia and early gestational diabetes mellitus (GDM) identified on the basis of mild fasting plasma glucose elevation (FPG, 5.1-5.5 mmol/L) and/or post-load plasma glucose elevation (PLG, 1-h ≥ 10.0 mmol/L or 2-h ≥ 8.5 mmol/L). METHODS This cross-sectional study included women with singleton pregnancy (8+0 to 19+6 weeks of gestation) and normoglycemia or GDM per World Health Organization (WHO) 2013 criteria. We evaluated the glycemic parameters of clinical interest using blinded CGMS evaluation and reported them per standard methodology proposed by Hernandez et al. RESULTS: A total of 87 women (GDM, n = 38) were enrolled at 28.6 ± 4.5 years. Among women with GDM, 10 (26.3%) had isolated mild FPG elevation (5.1-5.5 mmol/L), 10 (26.3%) had isolated PLG elevation (1-h ≥ 10.0 mmol/L or 2-h ≥ 8.5 mmol/L), and 7 (18.4%) had a combination of both. The remaining 11 (28.9%) had elevated FPG (≥ 5.6 mmol/L) with or without PLG elevation. Thus, when an isolated FPG cutoff ≥ 5.6 mmol/L is used to diagnose GDM, 27 (71.0%) women would be perceived as normoglycemic. Such women had significantly higher CGMS parameters of clinical interest, such as 24-h mean glucose, fasting glucose, 1-h and 2-h postprandial glucose (PPG), 1-h PPG excursion, and peak PPG. CONCLUSIONS An isolated FPG threshold, especially the higher cutoff ≥ 5.6 mmol/L, can potentially miss a large proportion of women (nearly three-fourths) diagnosed with GDM per WHO 2013 criteria. Eventually, such women fare significantly differently from normoglycemic women in various CGMS parameters of clinical interest.
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Affiliation(s)
- Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Charandeep Singh
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, 110029, India
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Raj R, Mahey R, Bhatla N, Manchanda S, Kumari A, Ranjan R. Laparoscopic Inguinal Gonadectomy in a Case of Partial Androgen Insensitivity Syndrome and Bilateral Gonads in Inguinal Canal. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Kachhawa G, Mahey R, Varun N, Kamalakar D, Rakhi R, Sharma J, Bhatla N. 8697 Vaginoplasty in MRKH: A Single Center Experience. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Mahey R, Cheluvaraju R, Kachhawa G, Singh S, Bhatla N. 8995 Laparoscopic Hernia Repair in a Patient with Mayer-Rokitansky-Kuster-Hauser Syndrome, Turner Mosaic Syndrome and Tubo-Ovarian Hernia. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cheluvaraju R, Mahey R, Kumari A, Bhatla N. 8974 Laparoscopic Loop and Stitch Technique in Tubal Stump Ectopic Pregnancy. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Singh N, Malhotra N, Mahey R, Patel G, Saini M. Two-six Hours is the Optimal Timing of Intracytoplasmic Sperm Injection After Oocyte Pickup: Single-centre 10 Years Cohort Study. J Hum Reprod Sci 2022; 15:382-387. [PMID: 37033130 PMCID: PMC10077744 DOI: 10.4103/jhrs.jhrs_106_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 04/11/2023] Open
Abstract
Background Optimal incubation period for oocyte competence remains contentious despite intracytoplasmic sperm injection(ICSI) being in practice for 34 years. Dilemma exists as the current literature favors both early and delayed denudation with equivocal results. With ever-rising demand for the procedure this conundrum continues to plague the clinical outcomes. Aims This study attempts to provide a consensus regarding optimal time duration required for incubating the oocytes after oocyte pickup(OPU) and time to perform ICSI. Settings and Design A retrospective study in a tertiary centre. Materials and Methods A retrospective 10-year cohort study including 726 ICSI cycles was conducted in a single tertiary care infertility centre. All cycles comprised at least one metaphase-II oocyte injected with one good quality sperm followed by fresh embryo transfer. The cohort was broadly divided into two groups: (a) Group 1: OPU-ICSI <4 hours(n=466) and (b) Group 2: OPU-ICSI>4 hours(n=260). Statistical Analysis Used The fertilization(FR) and clinical pregnancy rates(CPR) were compared using the Pearson Chi-square test. The OPU-ICSI interval were subdivided into one-hourly intervals and CPR was compared after adjustment for multiple comparisons by holm method. Results The FR and CPR were similar between Group 1 and Group 2(p>0.05). Comparing CPR for each one-hourly OPU-ICSI interval revealed no significant clinical difference (p>0.05) amongst one another, however, the CPR was maximum for 2-3 hours as the OPU-ICSI interval. Conclusion With no significant clinical difference amongst various temporal groups, this study advocates and reinstates 2-6 hours as the optimal timing for ICSI after the OPU. This will also translate into better time management for both embryologists and clinicians and help them prioritise the laboratory workflow.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Patel
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Saini
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Mahey R, Ramaswamy A, Cheluvaraju R, Manchanda S, Bhatla N. Rare variant of atypical Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with breast malformation: case report and review of literature. Clin Dysmorphol 2022; 31:141-144. [PMID: 35165209 DOI: 10.1097/mcd.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Smita Manchanda
- Radiology, All India Institute of Medical Sciences, New Delhi, India
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19
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Yadav V, Sharma JB, Kriplani A, Bhatla N, Kachhawa G, Mahey R, Kumari R. Obstetrics outcome in pulmonary tuberculosis. Indian J Tuberc 2022; 69:305-310. [PMID: 35760479 DOI: 10.1016/j.ijtb.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/20/2020] [Accepted: 12/23/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND To evaluate the maternal and perinatal outcome in pulmonary tuberculosis cases as compared to low risk pregnancies in a tertiary referral hospital. METHODS A total of 15 cases of pulmonary tuberculosis over a period of two years who delivered in our unit was studied in the retrospective study. The maternal and perinatal outcome in them was compared with 191 low risk pregnancies who delivered at the same time in the hospital after taking into account inclusion and exclusion criteria. RESULTS The mean age and mean parity was 25.73 ± 2.85 and 28.75 ± 3.11, 2.1 and 1.9 in the 2 groups. Symptoms of pulmonary tuberculosis were cough (100%), chest pain (80%), expectoration (100%), hemoptysis (33.3%), fever (93.33%), anorexia (86.66%) and loss of weight (80%). Symptoms in study patients were significantly more common in study patients. The presence of associated medical problems was similar in the 2 groups. The prevalence of oligoamnios, gestational diabetes mellitus, antepartum hemorrhage and intrahepatic cholestasis was similar in the 2 groups. Prevalence of preterm labor was 53.33% in study group which was significantly higher than in controls (8.9%). Risk of premature rupture of membrane was also significantly higher in the study groups (53.33%) as compared to control groups (8.9%). Mean gestational age was also significantly lower (36.2 weeks) in study group as compared to 38.6 weeks in control group. The incidence of cesarean delivery was similar in the 2 groups (26.66% vs 28.79%). The mean birth weights was 2308.6 gm in the study group as compared to 2707.56 gm in control group. Fetal growth restrictions and Respiratory distress syndrome in babies was significantly higher in study group than in control group. Low APGAR score (<8) was also higher (33.3%) in study group as compared to control group (2.61%). CONCLUSION Pulmonary tuberculosis during pregnancy is associated with increased perinatal morbidity, low birth weight, poor APGAR and increased respiratory distress rates.
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Affiliation(s)
- Vikas Yadav
- Department of Obstetrics and Gynecology, SMS&R, G. NOIDA, UP, India
| | - J B Sharma
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India.
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
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Kashyap A, Singh N, Malhotra N, Mahey R, Perumal V, Vatsa R, Patel G, Saini M. O-292 Comparison of effect of two different trigger regimens; single (hCG) versus dual (hCG + Leuprolide) on outcome of fresh IVF cycles: A randomized controlled trial. Hum Reprod 2022. [PMCID: PMC9384440 DOI: 10.1093/humrep/deac106.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does adding gonadotropin-releasing hormone agonist (GnRHa) to hCG trigger increases the number of high-grade embryos in GnRH antagonist protocol in fresh non-donor IVF?
Summary answer
Final oocyte maturation triggered by dual trigger increases the number of MII oocytes thus transferring good-quality embryos and cryopreserving surplus embryos compared to hCG trigger.
What is known already
hCG has been conventionally used as a ‘faux’ LH surge to bring about final oocyte maturation due to structural similarity between the two. GnRH agonist, on the other hand, induces a more physiological gonadotropin surge for follicular maturation, but is associated with luteal phase deficiency. Recent studies have shown that combining GnRHa with hCG trigger improves oocyte maturation and embryo quality with the added benefit of a luteal phase support, thereby improving IVF outcomes in terms of both embryological and reproductive outcomes.
Study design, size, duration
A single-center, open labelled, randomized controlled trial including 100 normal responder patients between 21-38 years undergoing IVF using GnRH antagonist protocol between January 2020 to August 2021. The study excluded patients with the presence of other variables of adverse outcomes like diminished ovarian reserve (AFC < 5 or AMH < 1.2 ng/ml), endocrine disorders, thin endometrium (<6mm), previous history of uterine surgeries, and high responders.
Participants/materials, setting, methods
100 patients undergoing fresh IVF cycle using GnRH antagonist protocol were randomized after informed consent to receive either dual trigger (Leuprolide acetate 1 mg + rhCG 250 mcg, n = 50) or single hCG trigger (rhCG 250 mcg, n = 50). Oocyte retrieval was done 35-37 hours after trigger followed by IVF/ICSI, as indicated. Oocyte and embryo grading was done using Istanbul consensus. Analysis was done by ITT. Outcomes were analyzed using Independent t-test and Chi-square test.
Main results and the role of chance
The baseline characteristics were comparable in both arms. the number of MII oocytes retrieved (7.82 versus 5.92, p = 0.003) and the number of day-3 grade-1 embryos (4.24 versus 1.8, p < 0.001) were higher in the dual trigger group, whereas fertilization rates between the two groups (91.82% versus 88.51%, p=NS) were comparable. Consequently, the number of embryos cryopreserved (2.68 versus 0.94, p < 0.001) were significantly higher in the dual trigger group. However, the implantation rate between the two groups (21% versus 19.6%, p = 0.770) was comparable. The serum LH levels 12 hours post trigger were measured in both the arms and as expected, high serum LH values were documented in the dual trigger group (46.23 mIU/ml vs 0.93 mIU/ml, p < 0.0001).
Limitations, reasons for caution
Due to the impact of the Covid-19 pandemic causing an intermittent pause in IVF services at our center, a smaller sample size of 100 patients could be enrolled in the study, and reproductive outcomes in terms of live births and cumulative live births could not be assessed
Wider implications of the findings
This study, though small, has contributed to some evidence of redesigning the dual trigger in all antagonist cycles, with the exception of high responders and PCOS patients. The addition of GnRHa to hCG trigger has led to the possibility of cryopreserving surplus embryos thereby increasing the cumulative live births.
Trial registration number
CTRI/2020/08/027030
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Affiliation(s)
- A Kashyap
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - N Singh
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - N Malhotra
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - R Mahey
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - V Perumal
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - R Vatsa
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - G Patel
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
| | - M Saini
- India Institute Of Medical Sciences- New Delhi, Department of Obstetrics and Gynaecology All , New Delhi, India
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21
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Patel G, Singh N, Malhotra N, Mahey R, Saini M, Sethi A. P-799 To evaluate the effect of Intra-ovarian platelet rich plasma instillation on the clinical outcome of women with diminished ovarian reserve: A prospective interventional study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Does intra-ovarian instillation of platelet rich plasma (PRP) improves the clinical outcome of IVF cycles in women with Diminished Ovarian reserve (DOR)?
Summary answer
PRP instillation leads to consistent improvement in Antral follicle count (AFC), thus achieving clinical pregnancy rate of 33.3% per cycle in women with DOR.
What is known already
There is rising incidence of females with diminished ovarian reserve (DOR) especially among Asian ethnicity. With the emergence of regenerative medicine, multiple studies have evaluated the role of intra-ovarian PRP, demonstrating a beneficial role in improving ovarian reserve parameters (serum Follicular stimulating hormone (FSH), serum anti-Mullerian hormone (AMH), AFC). Despite its’ favorable effects on biochemical markers and AFC, data regarding improvement in clinical outcome remains elusive and led to inception of this study.
Study design, size, duration
A prospective interventional study was conducted at Division of Reproductive Medicine of a tertiary care institute. 41 infertile females aged 20-39 years with DOR (AMH <1.2 ng /ml; AFC<5) were enrolled in the study during a 6-month period beginning from August 2021.
Participants/materials, setting, methods
After informed consent, patients received fresh autologous PRP, prepared from 30 ml venous blood. 1.5ml of PRP instilled in each ovarian stroma between day 7-10 of menstrual cycle under sedation. Patients were followed up for three-consecutive months to assess ovarian reserve parameters including serum FSH, AMH and AFC. Patients showing significant improvement in parameters were recruited for fresh IVF cycles using Antagonist protocol with 1% transdermal testosterone. Outcomes were analysed using linear mix effect model.
Main results and the role of chance
The average platelet concentration in PRP was ∼10,00,000 platelets/µL. The mean age of enrolled patients was 31.22±4.16 years. Linear improvement in AFC (3.63 vs 6.98 vs 7.97 vs 6.90, p<0.001) was observed from baseline to three consecutive follow-up months with maximal response witnessed in second month in 57.1% of those undergoing IVF cycle. However, there was no significant difference in Serum FSH (p=0.11) and AMH (p=0.16) from the baseline post intervention. Of the 41 patients, 35 (85.3%) responded to the treatment and underwent IVF antagonist cycle. 5 out of 35 IVF cycles were cancelled mid-cycle due to poor ovarian response. The mean dose of gonadotropin requirement was 2667.5±281.1 IU (Follicular stimulating hormone) and 1400±337.3 IU (Human menopausal gonadotropin). The average number of oocytes retrieved was 5.7±2.2 whereas mean number of MII oocytes was 4.63±1.85. The fertilization rate and the cleavage rate were 92.4% and 74.1% respectively. Of the thirty patients, eight patients underwent day 2 transfer due to poor grade of embryos. Mean number of grade 1- day 3 embryos was 1.25±0.55 with surplus embryos available for cryopreservation in 14 patients. The overall clinical pregnancy rate per transfer was 33.33%. No adverse events were reported.
Limitations, reasons for caution
This was a prospective single arm study. A randomized controlled trial comprising a “no-treatment” arm would establish a Level-I evidence. However, “no-treatment” arm in a developing country like ours, imposes financial burden on the couple with no guaranteed clinical success and thus raising ethical concern and need for ovarian rejuvenation.
Wider implications of the findings
With the impetus to provide a biological child to these DOR women, intra-ovarian PRP instillation as a method of ovarian rejuvenation holds promising results. Evidently, PRP is not only effective in improving ovarian reserve but this translates into an improved reproductive outcome in a population, previously limited to oocyte donation.
Trial registration number
REF/2022/01/051033
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Affiliation(s)
- G Patel
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - N Singh
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - N Malhotra
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - R Mahey
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - M Saini
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
| | - A Sethi
- All India Institute of Medical Sciences- New Delhi, Division of Reproductive Medicine- Department of Obstetrics and Gynaecology , New Delhi, India
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Gupta Y, Singh C, Goyal A, Mani K, Bharti J, Singhal S, Kachhawa G, Kulshrestha V, Kumari R, Mahey R, Sharma JB, Malhotra N, Bhatla N, Khadgawat R, Tandon N. CGMS profile of women diagnosed as GDM by IADPSG criteria and labelled as normoglycemic by alternate criteria in early pregnancy. J Diabetes Investig 2022; 13:1753-1760. [PMID: 35661435 PMCID: PMC9533043 DOI: 10.1111/jdi.13865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/02/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION We aimed to evaluate and compare CGMS-based glycemic parameters in women in early pregnancy (<20 weeks of gestation) who were classified as: a) GDM by IADPSG but normoglycemia by alternate (UK NICE, CDA and DIPSI) criteria, and b) normoglycemia by both (IADPSG and alternate) criteria. MATERIAL AND METHODS In this cross-sectional study, eligible women underwent standard 75-g OGTT, followed by the placement of a CGMS. Glycemia-related parameters were calculated using the standard approach for CGMS data in pregnancy. RESULTS We enrolled 96 women at 14.0 ± 3.2 weeks of gestation. Of the women diagnosed as GDM by IADPSG criteria, 34.2%, 26.3% and 44.7% were classified as normoglycemic by UK NICE, CDA and DIPSI criteria, respectively. Mean 1-h postprandial glucose and time above range were significantly higher in women who were GDM by IADPSG, but normoglycemia by CDA criteria, compared to women with normoglycemia using both criteria. Similarly, mean 1-h postprandial glucose, 2-h postprandial glucose, peak postprandial glucose, 1-hr postprandial glucose excursion and time above range were significantly higher in women who were not identified as GDM by UK NICE criteria. Finally, women missed by DIPSI criteria had significantly higher mean 1-h postprandial glucose, 2-h postprandial glucose, peak postprandial glucose, postprandial glucose excursion, 24-h glucose, and time above range parameters. CONCLUSIONS More than a quarter of women diagnosed as GDM by IADPSG criteria are not identified by alternate criteria. Such women are significantly different from normoglycemic women in terms of several CGMS-based glycemic parameters of clinical significance.
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Affiliation(s)
- Yashdeep Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Charandeep Singh
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Alpesh Goyal
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Agarwal N, Mahey R, Kulshrestha V, Kriplani A, Saraya A, Sachdev V. Serum Bile Acids in Intrahepatic Cholestasis of Pregnancy (ICP), Versus Pregnant and Nonpregnant Controls in Asian Indian Women and a Proposed Scoring to Optimize Management in ICP. J Obstet Gynaecol India 2022; 72:218-224. [DOI: 10.1007/s13224-021-01501-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/15/2021] [Indexed: 01/17/2023] Open
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Kumari A, Mahey R, Kachhawa G, Kumari R, Bhatla N. Knowledge, attitude, perceptions, and concerns of pregnant and lactating women regarding COVID-19 vaccination: A cross-sectional survey of 313 participants from a tertiary care centre of North India. Diabetes Metab Syndr 2022; 16:102449. [PMID: 35279009 PMCID: PMC8896870 DOI: 10.1016/j.dsx.2022.102449] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
Abstract
AIM The study aimed to assess the knowledge, attitude, perceptions, and concerns of pregnant and lactating women regarding COVID-19 vaccination. METHODS A cross-sectional survey was conducted using a pre-validated questionnaire to assess the knowledge, attitude, perceptions, and concerns about COVID 19 vaccination among pregnant and lactating women. RESULTS Most (90%) of the study participants(n =313) agreed that it was essential to get vaccinated for COVID-19 and were aware that pregnant (72.2%) or lactating women (65.2%) are eligible for vaccination. There was a significant positive association between willingness to pay for the vaccine and the socio-economic status (p<0.01). Women residing in rural areas wanted to wait to see the effect of the vaccine on other pregnant and lactating women (p<0.001). The major factors associated with vaccine hesitancy were unforeseen future effects of vaccines on the foetus (58.6%) and rapid development and approval of vaccine without including pregnant and lactating women in vaccine trials (53.6%). These factors were positively associated with socioeconomic status (p<0.05) and residence (p<0.01) CONCLUSION: The safety concerns regarding the COVID-19 vaccine is a major reason for vaccine hesitancy. The policymakers should advocate, investigate, and publicize relevant data on vaccine efficacy and safety among these women.
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Affiliation(s)
- Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
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Sethi A, Kumar L, Mathur S, Mahey R, Kachhawa G, Bhatla N. Prognostic Significance of HE4 Tissue Expression in Serous Epithelial Ovarian Carcinoma. South Asian J Cancer 2022; 11:125-132. [DOI: 10.1055/s-0042-1742711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background Human Epididymis protein 4 (HE4) is expressed in ovarian cancer. Preoperative serum testing is still not widely available. This pilot study aimed to investigate the magnitude of expression of HE4 in tissue sections of serous epithelial ovarian carcinoma, its correlation with clinical outcome, and the feasibility of HE4 immunohistochemistry as a prognostic marker.
Materials and Method In this ambispective study, immunohistochemistry (IHC) was used to evaluate tissue sections of ovarian serous epithelial carcinoma at primary cytoreductive surgery. On HE4 immunohistochemistry (IHC), the magnitude of HE4 expression was assessed categorically as high or low HE4 expression and semiquantitatively by the H-score, and correlated with clinical outcome in terms of survival status, progression-free survival, and overall survival.
Results Of 32 cases, most (n = 31, 96.8%) were positive for HE4 IHC. The mean age was 49 ± 8.2 years; 29 (90.6%) patients were in FIGO stage IIIC; 25 (78.9%) had ≥1cm residual disease after surgery; 31 (96.8%) received adjuvant chemotherapy, either 3-weekly (n = 25, 81.2%) or dose-dense weekly (n = 6, 18.8%) regimen. The majority (n = 31, 96.8%) had a high-grade tumor, of whom 19 (59.4%) had high HE4 expression and 13(40.6%) patients had H-score in the range of 5 to 8. The mean H-score was 6.97 ± 3.61 (range 0 to 12). The overall survival of the study population at 64 months was 36.65% (95% CI: 8.59–66.34), with median overall survival of 59 months. A new scoring system was developed combining categorical HE4 expression and serum CA-125 levels; the combination of HE4 expression with postoperative CA-125 levels was found to be the best prognostic marker for overall survival (p = 0.05). A composite score of 2 identified patients with poor progression-free survival (HR 4.64, p = 0.039) and overall survival (HR 5.45, p = 0.05).
Conclusion The new composite scoring system using HE4 IHC with postoperative serum CA-125 levels offers an extremely useful option for prognosticating patients with serous epithelial ovarian carcinoma than serum CA-125 alone. This is useful where preoperative records are not available to the treating clinician.
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Affiliation(s)
- Ankita Sethi
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Rajasekaran K, Malhotra N, Mahey R, Khadgawat R, Kalaivani M. Myoinositol versus metformin pretreatment in GnRH-antagonist cycle for women with PCOS undergoing IVF: a double-blinded randomized controlled study. Gynecol Endocrinol 2022; 38:140-147. [PMID: 34590929 DOI: 10.1080/09513590.2021.1981282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To study the effects of myoinositol (Myo) in comparison to metformin (Met), in reducing the risk of OHSS and improving ART outcome in PCOS women undergoing IVF. DESIGN Double-blinded randomized controlled trial (CTRI/2018/05/014196). SETTING ART Clinic, AIIMS, New Delhi patients: 102 infertile PCOS women undergoing IVF cycles were enrolled after evaluating for eligibility and allotted as 50 in group 1 (Myo) and 52 in group 2 (Met) after randomization. INTERVENTIONS Recruited patients received Myo 2 g twice daily (group 1) and Met 850 mg twice daily (group 2). Pre- and post-treatment clinical (menstrual pattern, BMI), hormonal profile (LH, FSH, testosterone, prolactin [PRL], and AMH), biochemical parameters (HOMA IR, fasting glucose, and insulin), ovarian with antral follicle count (AFC) and side effect profile were assessed. After 3 months of therapy, patients were recruited for IVF cycle by antagonist protocol was involving controlled ovarian stimulation, cycle monitoring, oocyte recovery, insemination of oocytes and follow up with fertilization, cleavage, transfer of good grade cleavage embryos, or blastocysts pregnancy outcomes and OHSS incidence and medications was continued until the day of OPU. MAIN OUTCOME MEASURES Primary outcome was OHSS and clinical pregnancy rate including spontaneous, IVF, and cumulative pregnancy rate including FET. Secondary outcome was ART outcomes and the change in biochemistry and hormonal profile between groups and inter group after medications at 12 weeks. RESULTS Incidence of OHSS (Myo 5 (10.0) (n = 50), Met 10 (20.0) (n = 50) p .07) was not statistically different between groups. Clinical pregnancy rate (Myo 18 (36.0) (n = 50), Met 9 (18.0) (n = 50) p .04) cumulative pregnancy rate including FET (Myo 16 (43.2) (n = 37) vs. Met 10) 22.7) (n = 44) p .05) and spontaneous conception (prior to IVF) Myo 13 (26.0) (n = 50), Met 6 (12.0) (n = 50) p .07) was significantly high in Myo group. No between group difference in ovarian stimulation outcomes including duration and dosage of gonadotropins, E2, P4 levels, number of follicles >14 mm on day of trigger. Number of oocytes retrieved and grade of maturity were similar between groups. Fertilization, cleavage and number of good grade embryos were significantly higher in Myo group. However, implantation rate and number of embryos for freezing were similar between groups. Myo had improvement in fasting insulin, HOMA, Sr.AMH, and SHBG suggesting decreased insulin resistance. CONCLUSIONS Myo is equally beneficial as Met in reducing the risk of OHSS and has better ART outcome in PCOS women undergoing antagonist cycles.
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Affiliation(s)
- Keerthana Rajasekaran
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Singh N, Malhotra N, Mahey R, Saini M, Patel G, Sethi A. Comparing maternal outcomes in spontaneous singleton pregnancies versus in vitro fertilization conception: Single-center 10-year cohort study. JBRA Assist Reprod 2022; 26:583-588. [PMID: 35822701 PMCID: PMC9635605 DOI: 10.5935/1518-0557.20220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE A successful assisted reproductive technique (ART) cycle is not flawless, and several studies have reported high incidences of maternal complications, but the association is inconclusive. In addition, the racial and ethnic effects of the Asian population undergoing ART on maternal outcomes is not well studied. This study attempts to compare various maternal outcome parameters ART and spontaneously conceived singleton pregnancies from a single high volume tertiary care centre. METHODS A retrospective cohort study from a single tertiary infertility center was conducted from January 2011 to September 2020. The study included 1125 IVF conceived singletons (AP group) and 7193 spontaneous conceived singletons (SP group). The groups were compared using the Pearson Chi-square test and the adjusted odds ratio calculated using multivariate analysis. RESULTS Maternal outcomes like gestational hypertension, pre-eclampsia, gestational diabetes (GDM), oligohydramnios, chorioamnionitis, operative, and instrumental delivery were significantly different in the two groups (p<0.05). The AP group had a significantly increased risk of GDM (aOR 1.093; 95% CI 1.076-1.110) and pregnancy-induced hypertension (PIH) (aOR 1.577; 95% CI 1.288-1.930) as compared to the SP group. IVF significantly increases the risk of abruption by 2 times (p=0.028), and independently increases the risk of caesarean section by 3.1-fold (p<0.001). But overall the IVF is the protective factor for oligohydramnios (p=0.024). CONCLUSIONS ART increases the likelihood of pregnancy-related maternal complications, such as PIH, GDM, abruption, chorioamnionitis, and an increased rate of caesarean delivery. Thus, all patients undergoing ART procedures should receive pre-conceptional counselling regarding the associated obstetric risks and consider ART pregnancy as a high-risk pregnancy.
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Affiliation(s)
- Neeta Singh
- Division of Reproductive Medicine, Department of Obstetrics and
Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Division of Reproductive Medicine, Department of Obstetrics and
Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Division of Reproductive Medicine, Department of Obstetrics and
Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Saini
- Division of Reproductive Medicine, Department of Obstetrics and
Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Patel
- Division of Reproductive Medicine, Department of Obstetrics and
Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankita Sethi
- Division of Reproductive Medicine, Department of Obstetrics and
Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Malhotra N, Gupta M, Yadav A, Vanamail P, Mahey R. Knowledge, attitude, and intentions towards fertility preservation in cancer patients among healthcare workers in Northern India. JBRA Assist Reprod 2021; 26:305-309. [PMID: 34713685 PMCID: PMC9118969 DOI: 10.5935/1518-0557.20210087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To study the knowledge, attitude, and intentions towards fertility preservation (FP) in cancer patients among healthcare workers (HCWs) in Northern India. Methods The survey discussed in this study was a 23-item structured questionnaire on oncofertility designed based on previous studies on the topic. A link to the questionnaire was sent through WhatsApp to healthcare workers involved in the care of cancer patients. Their responses were analyzed subsequently. Results More than a third (37.7%) of the 750 HCWs contacted answered the questionnaire. The group included gynecologists, surgeons, and oncologists. Although 90% of the respondents were aware of the harmful effects of cancer therapy on ovarian function, 76% claimed they had only partial knowledge about fertility preservation (FP). Only a fourth of the respondents were aware of the time needed for oocyte cryopreservation and a third had knowledge of the number of semen samples required for FP. Among HCWs involved in the care of young cancer patients, only 50% reported that they had referred patients for FP. The most common reason for not referring patients for FP was lack of knowledge about FP (43%). More than 90% claimed they wanted to improve their knowledge about oncofertility through continued medical education programs and seminars. Conclusions The study emphasizes the need for establishing well-structured networks to improve knowledge about FP among HCWs, so that cancer patients are offered the chance of using their gametes to have children after they have been cured from cancer.
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Affiliation(s)
- Neena Malhotra
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monica Gupta
- All India Institute of Medical Sciences Department of Obstetrics & Gynecology New Delhi India Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Anshu Yadav
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumail Vanamail
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Kachhawa G, Senthil Kumar KV, Kulshrestha V, Khadgawat R, Mahey R, Bhatla N. Efficacy of myo-inositol and d-chiro-inositol combination on menstrual cycle regulation and improving insulin resistance in young women with polycystic ovary syndrome: A randomized open-label study. Int J Gynaecol Obstet 2021; 158:278-284. [PMID: 34624138 DOI: 10.1002/ijgo.13971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/04/2021] [Accepted: 10/06/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the effect of myo-inositol and d-chiro-inositol in combination (MI + DCI) with combined hormonal contraceptive (CHC) on menstrual cycle regulation in young Indian women with polycystic ovary syndrome (PCOS). METHODS Seventy young women with PCOS aged 15-24 years with delayed cycles were randomized into two groups and were treated for 6 months with MI + DCI (550 + 150 mg, 3.6:1 ratio) twice a day and CHC (ethinyl estradiol 20 µg + drospirenone 3 mg) once a day. RESULTS Spontaneous menses resumed in 28 (84.85%) young women on MI + DCI, compared with withdrawal bleeding in 34 (100%) on CHC. The mean cycle length reduced with both MI + DCI (124.54 ± 8.08 to 57.75 ± 3.00 days, P < 0.001) and CHC (105.88 ± 7.96 to 30.53 ± 2.95 days, P < 0.001). Regular menstrual cycles were established in 9 (27.27%) young women with MI + DCI (P = 0.001) and 30 (88.23%) with CHC (P < 0.001). Three months after stopping the treatment, 24 young women (85.71%) on MI + DCI and 25 (73.53%) on CHC continued to have spontaneous cycles. Anti-Müllerian hormone decreased with both the drugs (P = 0.001), whereas luteinizing hormone (P = 0.001) and testosterone (P = 0.04) decreased with CHC and homeostatic model assessment of insulin resistance (P < 0.001) with MI + DCI. CONCLUSION Myo-inositol and d-chiro-inositol in combination (3.6:1 ratio) are effective in regularizing menstrual cycles and improving insulin resistance. TRIAL REGISTRATION Clinical Trials Registry of India (CTRI/2018/03/012643). http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=20969&EncHid=&userName=myo-inositol.
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Affiliation(s)
- Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Krithika V Senthil Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Malhotra N, Gupta M, Yadav A, Jaiswal P, Bansiwal R, Singh N, Upadhyay AD, Bhatt A, Mahey R. Multivariate analysis of oocyte donor and recipient factors affecting cumulative live birth rate in oocyte donor IVF (OD-IVF) cycles. JBRA Assist Reprod 2021; 25:549-556. [PMID: 34338480 PMCID: PMC8489827 DOI: 10.5935/1518-0557.20210027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To study donor and recipient factors affecting cumulative live birth rate (CLBR) in oocyte donor IVF (OD- IVF) cycles. Methods The present retrospective study was conducted at the ART center of a tertiary care referral hospital after ethical approval, and included all OD-IVF cycles done between January 2014 - October 2019. Donor parameters included age, body mass index (BMI), ovarian reserve markers, serum estradiol (E2) on trigger day, and number of total/grade 1 oocytes; recipient parameters included age and BMI. The primary outcome was CLBR resulting from one complete donor-recipient (D-R) cycle through fresh/frozen embryo transfer. Secondary outcomes included number of total and grade 1 oocytes, fertilization rate, cleavage rate and clinical pregnancy rate (CPR). Results We analyzed 262 D-R cycles for donor characteristics and 260 cycles for CLBR. The mean age of the recipients was 35.20±4.05, and for donors it was 25.29±2.03 years. The CPR and CLBR per started cycle was 60% and 55.7%, respectively. Recipient BMI and grade 1 oocytes were found to be independent predictors of CLBR in multivariate analysis. As the number of grade 1 oocytes increased, the likelihood of live births increased by 10% (95% CI, 1.04 - 1.32, p=0.008). Recipient BMI ≥25kg/m2 reduced the chances of CLBR by 50% (95% CI, 0.27 - 0.81, p=0.007). Conclusions Number of grade 1 oocytes and recipient BMI significantly affect CLBR in OD-IVF cycles. Recipients with BMI ≥25kg/m² may be advised to lose weight and improve CLBR likelihood.
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Affiliation(s)
- Neena Malhotra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monica Gupta
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Anshu Yadav
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Jaiswal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Bansiwal
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Bhatt
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Boddu A, Bhatla N, Vashist S, Mathur S, Mahey R, Natarajan J, Malik R, Vanamail P, Rai S, Kumari A, Dar L, Wig N. Cervical Cancer Screening in HIV-Positive Women in India: Why, When and How? J Obstet Gynaecol India 2021; 71:304-312. [PMID: 34408351 PMCID: PMC8310826 DOI: 10.1007/s13224-020-01419-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer is an AIDS-defining illness, and HIV-positive women are at high risk. The present study aimed to determine the magnitude of the problem, compare the performance of screening tests and assess factors affecting participation. METHODS HIV-positive women aged 30-59 years attend the anti-retroviral therapy (ART) clinics were screened by conventional Pap, HPV testing (Hybrid Capture 2) and visual inspection with acetic acid (VIA). A cohort of HIV-negative women from the community matched for age and parity were screened similarly. Screen-positive women underwent colposcopy and biopsy. Factors affecting participation were assessed. RESULTS Pap, VIA and HPV were positive in 48 (23.8%), 65 (32.2%) and 76 (37.6%) subjects, respectively, among HIV-positive women, and in 12 (5.9%), 10 (4.9%) and 12 (5.9%) subjects, respectively, among HIV-negative women. CIN2 + was present in 12 (6.4%) HIV-positive women and in 1(0.5%) HIV-negative woman (p = < 0.004). Sensitivity of HPV, Pap and VIA for detection of CIN2 + lesions was 91.7%, 75.0% and 75.0%, respectively; specificity was 68.4%, 83.9% and 72.5%, respectively. Lack of availability of screening facilities in the ART clinic and long waiting times were a strong deterrent to participation among HIV-positive women. CONCLUSIONS There was higher prevalence of HPV infection and CIN2 + lesions in HIV-positive women. VIA showed equivalent sensitivity to Pap and could be a good substitute in low resource settings. Setting up cervical screening services in ART clinics and sensitising physicians can improve outcomes among these women.
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Affiliation(s)
- Amulya Boddu
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Shachi Vashist
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Jayashree Natarajan
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Ria Malik
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Shweta Rai
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Aruna Kumari
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences AIIMS, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences AIIMS, New Delhi, India
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Deori TJ, Ramaswamy G, Jaiswal A, Loganathan V, Kumar R, Mahey R, Yadav K, Kant S. Compliance with iron folic acid (IFA) tablets and associated factors among pregnant women attending ante-natal care clinic at Sub District Hospital, Ballabgarh. J Family Med Prim Care 2021; 10:2006-2011. [PMID: 34195139 PMCID: PMC8208205 DOI: 10.4103/jfmpc.jfmpc_1742_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/27/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction: Anemia is a common public health problem among children, adolescent girls, women in reproductive age groups, pregnant and lactating women, with an estimated prevalence of 50.3% among pregnant women according to National Family Health Survey (NFHS) 4. Iron deficiency is regarded as the most common cause of anemia among pregnant women globally and in India. This study was aimed to estimate the prevalence of compliance to iron folic acid (IFA) tablets among pregnant mothers attending ante-natal care (ANC) clinic in a Sub-district hospital (SDH) situated in north India and the various factors associated with non-compliance to IFA tablets. Methodology: A cross-sectional facility-based study was conducted among pregnant women attending the ANC clinic at SDH, Ballabgarh. A pretested, semi-structured interview schedule was used to obtain socio-demographic data, information related to IFA therapy that they receive, their compliance and the factors that are related to missing of the doses. Data were entered using Epicollect 5 software and Stata version 13.0 was used for statistical analysis. Results: A total of 484 pregnant women were enrolled in our study. More than 3/4th (77.1%) of the pregnant women were compliant to IFA tablet supplement given to them. The compliance was more in the study participants belonging to older age groups, lower socio-economic status and those with hemoglobin levels >11 gm/dl. The most common reason for non-compliance was found to be “forgetfulness” (63.0%) followed by “side effects” (49.5%). Conclusion: Compliance with IFA tablets was better among pregnant women who were non anemic and those with good compliance to IFA tablets had better hemoglobin levels.
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Affiliation(s)
| | - Gomathi Ramaswamy
- National Centre of Excellence and Advanced Research on Anemia Control (NCEAR -A), New Delhi, India
| | | | | | - Rakesh Kumar
- Centre for Community Medicine, AIIMS, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Kapil Yadav
- Centre for Community Medicine, AIIMS, New Delhi, India.,National Centre of Excellence and Advanced Research on Anemia Control (NCEAR -A), New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, AIIMS, New Delhi, India.,National Centre of Excellence and Advanced Research on Anemia Control (NCEAR -A), New Delhi, India
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Prabhakar P, Mahey R, Gupta M, Khadgawat R, Kachhawa G, Sharma JB, Vanamail P, Kumari R, Bhatla N. Impact of myoinositol with metformin and myoinositol alone in infertile PCOS women undergoing ovulation induction cycles - randomized controlled trial. Gynecol Endocrinol 2021; 37:332-336. [PMID: 32945218 DOI: 10.1080/09513590.2020.1810657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate the benefits of myoinositol plus metformin versus myoinositol alone in infertile polycystic ovarian syndrome (PCOS) women undergoing ovulation induction cycles. MATERIALS AND METHODS Total 116 infertile PCOS women were randomized: Group I (n = 57): metformin (1500 mg) plus myoinositol (4 g) per day; Group II (n=59): myoinositol 4 g per day. Subjects were advised to try for spontaneous conception. Those who did not conceive after three months were given three cycles of ovulation induction. Primary outcome was clinical pregnancy rate after 6 months. Secondary outcomes were improvement in metabolic and endocrine parameters, ongoing pregnancy, abortion and multiple pregnancy rate. RESULTS Baseline demographic, metabolic and hormonal parameters were comparable in two groups. After 3 months of therapy, both study groups had comparable improvement in metabolic and hormonal parameters. After 6 months, clinical pregnancy rate was 42.0% in Group I and 45.5% Group II respectively (RR 0.92(95% CI:0.60-1.43) (p > .05). Side-effects (mainly gastrointestinal) were significantly higher in Group I than group II. CONCLUSIONS Myoinositol (4 g) might be used alone as an insulin sensitizer to improve metabolic, hormonal and reproductive outcome in infertile PCOS women. Further studies with large numbers are warranted to confirm the role of myoinostiol as a sole insulin sensitizer.
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Affiliation(s)
- Priyanka Prabhakar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monica Gupta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
- Department of Statistics and Demography, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Gupta M, Jaiswal P, Bansiwal R, Sethi A, Vanamail P, Kachhawa G, Kumari R, Mahey R. Anxieties and apprehensions among women waiting for fertility treatments during the COVID‐19 pandemic. Int J Gynaecol Obstet 2020; 152:441-443. [PMID: 33155288 PMCID: PMC9087520 DOI: 10.1002/ijgo.13468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Monica Gupta
- Department of Obstetrics & Gynaecology All India Institute of Medical Sciences New Delhi India
| | - Parul Jaiswal
- Department of Obstetrics & Gynaecology All India Institute of Medical Sciences New Delhi India
| | - Reeta Bansiwal
- Department of Obstetrics & Gynaecology All India Institute of Medical Sciences New Delhi India
| | - Ankita Sethi
- Department of Obstetrics & Gynaecology All India Institute of Medical Sciences New Delhi India
| | - Perumal Vanamail
- Department of Obstetrics & Gynaecology All India Institute of Medical Sciences New Delhi India
| | - Garima Kachhawa
- Department of Obstetrics & Gynaecology All India Institute of Medical Sciences New Delhi India
| | - Rajesh Kumari
- Department of Obstetrics & Gynaecology All India Institute of Medical Sciences New Delhi India
| | - Reeta Mahey
- Department of Obstetrics & Gynaecology All India Institute of Medical Sciences New Delhi India
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Singh C, Gupta Y, Goyal A, Kalaivani M, Garg V, Bharti J, Singhal S, Kachhawa G, Kulshrestha V, Kumari R, Mahey R, Sharma JB, Bhatla N, Khadgawat R, Gupta N, Tandon N. Glycemic profile of women with normoglycemia and gestational diabetes mellitus during early pregnancy using continuous glucose monitoring system. Diabetes Res Clin Pract 2020; 169:108409. [PMID: 32882343 DOI: 10.1016/j.diabres.2020.108409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
AIM We studied women between 8 and 20 weeks of gestation with the aim of evaluating and comparing those having normoglycemia and GDM according to WHO 2013 criteria. METHODS In this cross-sectional study (2017-2019), eligible pregnant women underwent a 75-g OGTT, followed by placement of a CGMS. RESULTS Women (n = 96, 58 with normoglycemia and 38 with GDM) were enrolled at 14.0 ± 3.2 weeks of gestation. Mean preprandial, 1-h and 2-h postprandial and peak glucose values were significantly higher in women with GDM. Peak glucose value was achieved 60.0 ± 12.3 and 64.3 ± 11.6 min after meal in the normoglycemia and GDM group, respectively. 24-h mean glucose (5.8 ± 0.6 vs. 5.3 ± 0.4 mmol/L), mean daytime glucose (6.0 ± 0.6 vs. 5.5 ± 0.4 mmol/L) and mean nocturnal glucose (5.4 ± 0.7 vs. 5.0 0 ± 0.5 mmol/L) were significantly higher in women with GDM. Total time spent in range was significantly lower in the GDM group compared to the normoglycemia group (92.1 vs. 98.2%). CONCLUSIONS This study highlights differences in glycemic patterns between women with normoglycemia and GDM in the context of a South Asian population where burden of GDM is high but good quality data in early pregnancy are limited.
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Affiliation(s)
- Charandeep Singh
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Alpesh Goyal
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Garg
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai B Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nandita Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Bhatla N, Mahey R, Gupta M, Anukriti K. Laparoscopic Inguinal Gonadectomy in a Case of Familial Complete Androgen Insensitivity Syndrome and Inguinal Mass. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mahey R, Sharma A, Kumari A, Kachhawa G, Gupta M, Meena J, Bhatla N. The impact of a segregated team roster on obstetric and gynecology services in response to the COVID-19 pandemic in a tertiary care center in India. Int J Gynaecol Obstet 2020; 151:341-346. [PMID: 33011974 PMCID: PMC9087524 DOI: 10.1002/ijgo.13408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022]
Abstract
Objective To determine the impact of roster reorganization on ensuring uninterrupted services while providing necessary relief to healthcare workers (HCW) in the obstetrics department of a tertiary care center amid the COVID‐19 outbreak. Methods The COVID‐19 rostering response began in April 2020 and evolved in two phases: (1) development of new areas for screening and managing suspected/positive cases of COVID‐19; and (2) team segregation according to area of work. The impact of these changes on HCWs and patients was assessed 3 months later. Results Developing separate areas helped to minimize the risk of exposure of patients and HCWs to those with COVID‐19. Residents and consultants worked intensively in clinical areas for 1 week followed by 1–2 weeks of non‐clinical or standby assignments, providing adequate opportunity for isolation. Frequent re‐evaluation of the roster was nevertheless required as the pandemic progressed. Segregating teams vertically significantly reduced the number of contacts identified on contact tracing and quarantine leaves, while maintaining patient satisfaction with no increase in adverse events. Residents found the roster to be “smart” and “pandemic‐appropriate.” Conclusion The “COVID emergency roster” helped ensure quality care with minimum risk of exposure and sufficient breaks for physical and psychological recovery of HCWs.
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Affiliation(s)
- Reeta Mahey
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Aparna Sharma
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Monica Gupta
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
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Mahey R, Gupta M, Bansiwal R, Sethi A. Successful IVF outcome after repeat laparoscopic ovarian drilling in a case of resistant PCOS. BMJ Case Rep 2020; 13:13/9/e235628. [PMID: 32912889 DOI: 10.1136/bcr-2020-235628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Ovulation induction (OVI) is the first-line treatment option for infertile women with polycystic ovary syndrome (PCOS). We report a case of resistant PCOS who responded to OVI after laparoscopic ovarian drilling (LOD) but suffered miscarriages in first trimester on three occasions, had late-onset moderate ovarian hyperstimulation syndrome (OHSS) in one cycle and recurrent anovulation. She underwent one in vitro fertilisation (IVF) cycle but it resulted in poor oocyte yield (four oocytes) and failed conception. Second LOD followed by IVF resulted in successful outcome in terms of good oocyte yield and successful live birth as well as supernumerary embryos frozen for future use. Repeat LOD may be considered in selected PCOS patients who fail to have successful pregnancy outcome despite multiple OVI cycles, have chronic anovulation, persistently raised serum antimullerian hormone and luteinising hormone, history of OHSS during OVI and prior poor response in IVF cycle.
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Affiliation(s)
- Reeta Mahey
- Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Monica Gupta
- Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Reeta Bansiwal
- Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Ankita Sethi
- Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Sharma JB, Deoghare MK, Bhatla N, Kachhawa G, Mahey R, Kumari R, Seth A, Sharma A. A comparative study of autologous rectus fascia pubovaginal sling surgery and synthetic transobturator vaginal tape procedure in treatment of women with urodynamic stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2020; 252:349-354. [PMID: 32659641 DOI: 10.1016/j.ejogrb.2020.06.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare short term results of autologous rectus fascia pubovaginal sling surgery with synthetic transobturator vaginal tape procedure in treatment of female stress urinary incontinence (SUI) STUDY DESIGN: It was a comparative study on 30 women between 25-65 years of age with urodynamic proven SUI who were randomly allocated to autologous rectus fascia pubovaginal sling surgery (Group I)(15 women) and synthetic transobturator vaginal tape procedure (Group II) (15 women). Preoperative and postoperative ICIQ (International Consultation on Incontinence Questionnaire) score, urodynamic study and serum CRP and IL-6 were done in all cases. RESULTS The baseline characteristics in terms of age, body mass index (BMI), parity, mean ICIQ score and mean preoperative CRP and IL-6 levels were similar in two groups. Mean operative time was significantly longer (55.60 ± 5.77 vs 25.27 ± 4.32 minutes, p = 0.001) in group I than group II. Mean hospital stay of 7.1 ± 1.2 vs 1.2 ± 0.4 days, mean duration of catheterization 5.8 vs 1.2 day (<0.01) and postoperative urinary retention requiring recathterization were all significantly higher in group I than II. Wound infection was more in group I than in group II (p = 0.01) while groin pain was significantly more in group II (p = 0.01). One patient developed vesicovaginal fistula, while one patient required cutting of tape in group I. Pdet at Q max (Detrusor pressure at peak urine flow) increased significantly in both the groups after surgery. ICIQ score was zero in both the groups indicating 100 % success. Surgical trauma was more in group I as shown by significantly higher CRP levels. CONCLUSION The success rate of the two groups was similar but, autologous rectus fascia sling surgery took longer, had more complications and urinary retention as compared to transobturator vaginal tape procedure.
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Affiliation(s)
- J B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Alpana Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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Malhotra N, Vignarajan CP, Dolkar D, Mahey R, Vanamail P. Follicular Flushing Versus Direct Aspiration at Oocyte Retrieval in Poor Responders Undergoing in vitro Fertilization: A Randomized Controlled Trial. J Hum Reprod Sci 2020; 13:150-154. [PMID: 32792765 PMCID: PMC7394092 DOI: 10.4103/jhrs.jhrs_59_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/25/2019] [Accepted: 02/28/2020] [Indexed: 11/04/2022] Open
Abstract
AIM This study aims to study the effect of follicular flushing at oocyte retrieval on Assisted Reproductive Technique (ART) outcomes in poor responders undergoing in vitro fertilization. SETTINGS AND DESIGN A prospective randomized controlled trial was conducted in the ART center of our hospital. MATERIALS AND METHODS A total of 71 patients who responded poorly during controlled ovarian stimulation were recruited. Patients were randomized to follicular flushing or to direct aspiration group. The primary outcomes of the study were the total number of oocytes retrieved and the number of metaphase (M II) oocytes retrieved. Secondary outcomes were anesthesia time, procedure time, fertilization rate, cleavage rate, total number of embryos, number of embryos transferred, number of Grade 1 embryos, failed oocyte recovery, failed fertilization, implantation rate, clinical pregnancy rate, miscarriage rate, and live birth rate. STATISTICAL ANALYSIS USED Chi-square test and Student's t-test. RESULTS The total number of oocytes retrieved, number of M II oocytes, fertilization rate, cleavage rate, total number of embryos, number of Grade 1 embryos, failed oocyte recovery, failed fertilization, implantation rate, miscarriage rate, and live birth rate were comparable between the two groups. The anesthesia and procedure time was significantly higher in the flushing group. CONCLUSIONS Follicular flushing does not result in a significant improvement in the ART outcomes despite increasing procedure and anesthesia times.Trial registration number CTRI/2017/07/009062.
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Affiliation(s)
- Neena Malhotra
- Department of Obstetrics and Gynaecology, ART Center, All India Institute of Medical Sciences, New Delhi, India
| | | | - Disket Dolkar
- Department of Obstetrics and Gynaecology, ART Center, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, ART Center, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynaecology, ART Center, All India Institute of Medical Sciences, New Delhi, India
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Singh N, Girish B, Malhotra N, Mahey R, Perumal V. Does Double Dose of Recombinant Human Chorionic Gonadotropin for Final Follicular Maturation in In vitro Fertilization Cycles Improve Oocyte Quality: A Prospective Randomized Study. J Hum Reprod Sci 2019; 12:310-315. [PMID: 32038081 PMCID: PMC6937770 DOI: 10.4103/jhrs.jhrs_125_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/05/2019] [Accepted: 11/01/2019] [Indexed: 11/04/2022] Open
Abstract
Context In in vitro fertilization (IVF) cycles, the recommended dose of recombinant human chorionic gonadotropin (r-hCG), for triggering final follicular maturation is 250 μg, although there is some disagreement. Aims The aim of our study was to assess the effect on the number of mature oocytes retrieved after triggering ovulation in IVF cycles using 250 μg or 500 μg of r-hCG. Settings and Design Prospective, single-center, randomized study. Subjects and Methods 100 women undergoing IVF with embryo transfer. The primary outcome measure was the total number of oocytes retrieved per follicle, number of mature oocytes, and number of embryos generated. The secondary outcomes included clinical and biochemical pregnancy rates and incidence of ovarian hyperstimulation syndrome. Results Mean number of oocytes retrieved (6.5 ± 4.0 vs. 6.4 ± 3.9, P = 0.3) and mean number of mature oocytes (4.0 ± 2.3 vs. 3.2 ± 2.3, P = 0.09) were similar in the two groups; however, mean number of oocytes retrieved per follicle was found to be higher with 500 μg r-hCG (67.4 ± 23.9 vs. 77.5 ± 23.3, P = 0.04). In the subgroup of poor responder women, there was a significant increase in the number of mature oocytes retrieved with double dose of r-hCG (2.2 ± 1.8 vs. 3.7 ± 1.9, P = 0.06), leading to improvement in fertilization and clinical pregnancy rates. Conclusions Double dose of r-hCG for final follicular maturation in IVF cycles resulted in improvement in mean number of oocytes per follicle but did not result in improved pregnancy rates in the women. In the subset of poor responders, 500 μg r-hCG seems to be more advantageous than the lower dose, although larger randomized trials are needed to generalize this strategy.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavana Girish
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanamail Perumal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Gupta M, Yadav R, Mahey R, Agrawal A, Upadhyay A, Malhotra N, Bhatla N. Correlation of body mass index (BMI), anti-mullerian hormone (AMH), and insulin resistance among different polycystic ovary syndrome (PCOS) phenotypes - a cross-sectional study. Gynecol Endocrinol 2019; 35:970-973. [PMID: 31081410 DOI: 10.1080/09513590.2019.1613640] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
One hundred and fifty infertile polycystic ovary syndrome (PCOS) women were classified into four phenotypes on the basis of Rotterdam criteria. Homeostatic model assessment of insulin resistance (HOMA-IR) with a cutoff ≥2.5 was considered as a measure of insulin resistance (IR). Maximum number of patients, 57 (38%) in our cohort belonged to phenotype A or the classical phenotype with all 3 features of Rotterdam criteria. Mean body mass index (BMI) in all phenotypes was more than 25 kg/m2 and the highest was seen in phenotype B. According to BMI categories in the four phenotypes, more number of women was in the obese category in phenotype A (24.5%) and B (56.5%) in comparison to phenotype C (18.2%) and D (10.8%) (p<.001). There was no difference in median HOMA-IR among different phenotype categories (p=.718). The median value of anti-mullerian hormone (AMH) was highest in phenotype A (11.68 ng/ml [7.94-16.46]) and significantly more in comparison to B phenotype (Kruskal-Wallis, p=.018). Thus there is heterogeneity in AMH levels and BMI in different PCOS phenotypes with higher levels in the most severe phenotypes. There is, however, no correlation of IR among the different phenotype groups and further investigation is needed to characterize its role in phenotypic classification.
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Affiliation(s)
- Monica Gupta
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Ritu Yadav
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Anisha Agrawal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences , New Delhi , India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences , New Delhi , India
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Kriplani A, Dalal V, Kachhawa G, Mahey R, Yadav V, Kriplani I. Minimally Invasive Endoscopic Approach for Management of OHVIRA Syndrome. J Obstet Gynaecol India 2019; 69:350-355. [PMID: 31391743 DOI: 10.1007/s13224-019-01240-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/12/2019] [Indexed: 11/25/2022] Open
Abstract
Background Herlyn-Werner-Wunderlich syndrome is an uncommon entity characterized by uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis (also called OHVIRA syndrome). Due to rarity and varied presentations, often correct diagnosis is missed out during work up, leading to management problems. We describe our dependence on detailed preoperative work up and minimally invasive endoscopic approach in management of the eight patients of OHVIRA syndrome. Methods In this retrospective case series study, eight patients of OHVIRA syndrome were managed from January 2012 to March 2018 with the help of improved imaging facility and diagnostic work up. Precise diagnosis helped in adopting minimally invasive approach in management. Patients were reviewed, focusing on presentation, radiologic findings and surgical management. Results Median age at diagnosis was 19 years (range 13-41 years). Abdominal pain and dysmenorrhea were the main presenting complaint. All patients except one had associated ipsilateral renal agenesis. Surgical excision of the obstructed hemivaginal septum and hematometra drainage was the main treatment. In seven patients, vaginoscopic resection of vaginal septum was done with resectoscope except one 41-year-old patient, where resection of vaginal septum was performed laparoscopically along with hysterectomy. Conclusion Vaginoscopic resection of obstructed hemivaginal septum is an effective method. Management has shifted to minimally invasive approach due to improved imaging, precise preoperative diagnosis and proper understanding of the disease.
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Affiliation(s)
| | | | - Garima Kachhawa
- 3Obstetrics and Gynaecology Department, AIIMS, New Delhi, India
| | - Reeta Mahey
- 3Obstetrics and Gynaecology Department, AIIMS, New Delhi, India
| | - Vikas Yadav
- 3Obstetrics and Gynaecology Department, AIIMS, New Delhi, India
| | - Isha Kriplani
- 3Obstetrics and Gynaecology Department, AIIMS, New Delhi, India
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Agrawal A, Mahey R, Kachhawa G, Khadgawat R, Vanamail P, Kriplani A. Comparison of metformin plus myoinositol vs metformin alone in PCOS women undergoing ovulation induction cycles: randomized controlled trial. Gynecol Endocrinol 2019; 35:511-514. [PMID: 30614289 DOI: 10.1080/09513590.2018.1549656] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The present study was planned to evaluate the benefit of synergetic effect of Metformin plus Myo-inositol versus Metformin alone in infertile polycystic ovarian syndrome (PCOS) women undergoing ovulation induction. One hundred and twenty infertile PCOS women were randomized: Group I (n = 60) received Metformin (500 mg) plus Myoinositol(600 mg) three times a day; Group II received Metformin 500 mg three times a day. Subjects were advised to try for spontaneous conception. Those who did not conceive after 3 months, were given three cycles of ovulation induction + intrauterine insemination. Hormonal and biochemical profile parameters were done at baseline and after 3 months of therapy. Primary outcome measure was live birth rate. Secondary outcomes were improvement in menstrual cycle, hormonal and biochemical parameters, spontaneous conception, abortions, multiple pregnancy, and ovarian hyperstimulation syndrome. Baseline demographic, hormonal and biochemical parameters were comparable in two groups. There was a significant improvement in menstrual cycles (cycle length and bleeding days) in Group I as compared to Group II. The improvement in biochemical and hormonal parameters were comparable in the two groups after 3 months. Live birth rate was significantly higher in the Group I as compared to Group II [55% (33/60); 26.67% (16/60); p = .002]. The study concluded significantly higher live birth rate in women receiving the combination as compared to metformin alone.
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Affiliation(s)
- Anisha Agrawal
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
| | - Reeta Mahey
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
| | - Garima Kachhawa
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
| | - Rajesh Khadgawat
- b Department of Endocrnoligy , All India Institute of Medical Sciences , New Delhi , India
| | - Perumal Vanamail
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
| | - Alka Kriplani
- a Department of Obstetrics and Gynecology , All India Institute of Medical Sciences , New Delhi , India
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Jose A, Mahey R, Sharma JB, Bhatla N, Saxena R, Kalaivani M, Kriplani A. Comparison of ferric Carboxymaltose and iron sucrose complex for treatment of iron deficiency anemia in pregnancy- randomised controlled trial. BMC Pregnancy Childbirth 2019; 19:54. [PMID: 30717690 PMCID: PMC6360702 DOI: 10.1186/s12884-019-2200-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/23/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of intravenous Ferric Carboxymaltose. (FCM) in comparison with intravenous Iron sucrose complex (ISC) for treatment of iron deficiency anemia in pregnancy. METHODS A randomized clinical trial was conducted from (January 2016-August 2017). at a tertiary hospital. Pregnant women diagnosed with moderate to severe iron deficiency anaemia were screened for the study. One hundred patients were randomized to receive either intravenous FCM or ISC. Primary outcome was rise in hemoglobin (Hb) from baseline after 12 weeks. Secondary outcomes were change in RBC indices, serum iron studies, improvement in fatigue scores, number of visits and perinatal outcome. RESULTS Mean rise in Hb at 12 weeks was significantly higher in FCM group (29 g/L vs 22 g/L; p value < 0.01). FCM was associated with greater improvement in fatigue scores. Number of visits were significantly less in FCM group. No serious adverse events were noted in either group. CONCLUSION Treatment with FCM resulted in rapid replenishment of iron stores in pregnant women with significantly higher Hb rise over a 12 week period. The convenient dosing with lesser number of total doses to complete the treatment will lead to better compliance in community setting. CLINICAL TRIAL REGISTRATION ( WWW.CTRI.NIC.IN ): CTRI/2015/09/006224. Registered on 21/07/2017 (Trial registered retrospectively).
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Affiliation(s)
- Ambily Jose
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Saxena
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Kriplani A, Dalal V, Mahey R, Kachhawa G, Thariani K, Kriplani I, Vanamail P, Sharma JB. Long-Term Outcome of Laparoscopic Sacrohysteropexy for Uterovaginal Prolapse in Young Women. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Venus Dalal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Karishma Thariani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Isha Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Perumal Vanamail
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Yadav V, Malhotra N, Mahey R, Singh N, Kriplani A. Ovarian Sensitivity Index (OSI): Validating the Use of a Marker for Ovarian Responsiveness in IVF. J Reprod Infertil 2019; 20:83-88. [PMID: 31058052 PMCID: PMC6486569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In this study, an attempt was made to validate the use of OSI as a measure of ovarian response during IVF treatment and to correlate OSI with age and BMI and other measures of ovarian response such as AMH, antral follicle count (AFC), total dose of administered gonadotrophins, and duration of stimulation. METHODS This study was a retrospective comparative cohort one. The study included a total of 2150 women who underwent the first IVF cycle between January 2008 and December 2017 at our center using long-agonist protocol. Patients were divided into four subgroups according to the circulating AMH level: below the 25th percentile (AMH 0.25-1.1 ng/ml, subgroup A), between 25th and 50th percentiles (AMH 1.2-1.6 ng/ml, subgroup B), between the 50th and 75th percentiles (AMH1.7-2.6 ng/ml, subgroup C), and above the 75th percentile (AMH 2.7-8.5 ng/ml, subgroup D). Qualitative data were analyzed by Chi-square or Fisher's exact test. The p<0.05 was considered statistically significant. RESULTS The four subgroups formed on the basis of the AMH level did not significantly differ for age, BMI and infertility duration. OSI was significantly correlated to age (r=0.167; p=0.001), and has negative correlation with AFC (r=-0.236, p=0.001) and AMH levels (r=-0.123, p=0.001). Multiple linear regression analysis was done on OSI with other independent variables such as age, BMI, AFC, AMH. Analysis showed that approximately 8% variation in the value of OSI can be attributed to these variables with the highest correlation with antral follicle count. CONCLUSION The present study showed that OSI appears to be a highly reliable index of ovarian responsiveness to recombinant FSH and can be useful to estimate the FSH dose.
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Affiliation(s)
| | - Neena Malhotra
- Corresponding Author: Neena Malhotra, Department of Obstetrics and Gynecology, AIIMS, Ansari nagar, Delhi 110029, India, E-mail:
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Abstract
Background: Empty follicle syndrome (EFS) is a condition in which no oocytes are retrieved from normally growing ovarian follicles after ovarian stimulation. It is a rare and frustrating condition of obscure etiology. Objective: The objective of this study was to estimate the incidence of EFS and study factors related to it. Design: This was a retrospective study. Setting: This study was conducted in hospital-based research center. Methods: In 1968 in vitro fertilization cycles from January 2010 to August 2016 were studied. Agonist, antagonist, and miniflare protocols were used for the stimulation. Results: The incidence of EFS is 2.38% (47/1968 cycles). Antagonist protocol group (76.59%, n = 36) had highest incidence of EFS (6.69%). Literature on EFS depicts decreased ovarian reserve (DOR) as the main cause, but only 4.25% of patients had DOR in our study. Interestingly, polycystic ovary syndrome and unexplained infertility were found in 31.9% of the cases. Serum anti-Müllerian hormone (AMH) levels (mean ± standard deviation [SD]) were 4.47 ± 3.54 ng/ml, and antral follicle count (AFC) was 15.30 ± 8.07 (mean ± SD) emphasizing that diminished ovarian reserve is not the main factor for EFS. All patients (n = 95) who underwent ovum pickup on day when any patient had EFS were taken as control. Patients with EFS were compared with controls. A statistically significant difference was not observed in serum AMH (P = 0.38) and AFC (P = 0.52). Conclusion: EFS is an uncommon event. Antagonist cycles have higher chances of empty follicle at ovum pickup. Looking at the profile of patients in this study, we conclude that EFS is not a manifestation of DOR.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Venus Dalal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanamail Perumal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Yadav V, Sharma JB, Kachhawa G, Kulshrestha V, Mahey R, Kumari R, Kriplani A. Obstetrical and perinatal outcome in pregnant women with extrapulmonary tuberculosis. Indian J Tuberc 2018; 66:158-162. [PMID: 30797275 DOI: 10.1016/j.ijtb.2018.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
Tuberculosis (TB) is a major health problem and a leading cause of illness and death from infectious disease. Tuberculosis in pregnancy has been associated with increased risks of prematurity and small for gestational age (SGA)infants.The present study is aimed to examine obstetrical and perinatal outcomes among women who had extra-pulmonary tuberculosis. MATERIAL AND METHODS It was retrospective study involving patient who presented with extra pulmonary tuberculosis over a period of ten years (2008-2017)was reviewed. Diagnosed women were compared with controls in the ratio of six controls for each case. Data included age, parity and complications in the antenatal, intrapartum and postpartum periods. The mean birth weights of infant and the frequency of small for gestation age, neonatal depression and still births were used for perinatal outcome. RESULTS During the period of study 30 pregnant women were booked for extra -pulmonary TB. 22/30(73.3%) were diagnosed having extra pulmonary -TB prior to pregnancy and were taking ATT (anti-tubercular therapy) during the pregnancy, in 8/30(26.6%) it was diagnosed during pregnancy. Age, parity were similar in two groups. There was significantly increased incidence of oligoamnios and preterm rupture of membrane (P = 0.001). Mean gestation age of delivery in TB cases was 36.15 ± 1.8 weeks as compared to37.5 ± 0.5 weeks in low risk patients (P = 0.001). The mean birth weight of the infants of mother with extra pulmonary TB was 2324.26 ± 379.5 grams and 2712.3 ± 635.7 for control group(P = 0.001). CONCLUSION This study emphasize on the need for early diagnosis and treatment of tuberculosis preferably before pregnancy, regular medical follow up and good perinatal care.
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Affiliation(s)
- Vikas Yadav
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - J B Sharma
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India.
| | - Garima Kachhawa
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | | | - Reeta Mahey
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynecology, AIIMS, New Delhi, India
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Goel T, Sharma J, Mahey R, Kachhawa G, Kriplani I, Kriplani A. Effect of Anti Tubercular Treatment on Laparoscopic Obstetrics and gynecology department at a hospital and Hysteroscopic Findings in Infertile Women with Genital Tuberculosis. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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