International Journal of Infertility & Fetal Medicine

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2019 | May-August | Volume 10 | Issue 2

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Mariyadhas Irina Jishala, Pavithra Kannan, Krishnaveni Kandasamy, Shanmugasundaram Rajagopal, Sambathkumar Ramanathan

Evaluating the Effectiveness of Mother's Education in Terms of Knowledge, Attitude, and Practice Regarding Pubertal Awareness among School-going Prepubertal Girls

[Year:2019] [Month:May-August] [Volume:10] [Number:2] [Pages:6] [Pages No:15 - 20]

   DOI: 10.5005/jp-journals-10016-1181  |  Open Access |  How to cite  | 


Aim: Evaluating the effectiveness of mother's education in terms of knowledge, attitude, and practice regarding pubertal awareness among school-going prepubertal girls. Materials and methods: A descriptive cross-sectional study was conducted among prepubertal girls studying in the middle school (6th, 7th, and 8th standard). A predesigned questionnaire, which consists of questions to evaluate the knowledge, attitude, and practice on pubertal changes were used for data collection. Information on demographic variables, which include age, class, type of family, education of parents, and sources of information was collected from the participants. In total 450 prepubertal girls, 150 each from state board school, matriculation board school, and central board school, were included in the study. Results: Study resulted that for 52.6% of state board school respondents, the major source of information was siblings, and for 64.6% of matriculation board and 68% of central board respondents, the major source of information was mothers. For state board participants, the mean average level of knowledge was 10%, attitude 23.5%, and practice 16.2%; for matriculation board participants, the mean average level of knowledge was 32.7%, attitude 58.3%, and practice 42.6%; and for central board participants, the mean average level of knowledge was 47.4%, attitude 59.6%, and practice 53.8%. Conclusion: Most of the participants from central board school have good knowledge, attitude, and practice regarding pubertal changes when compared with the state board and matriculation board. The result demonstrated that based on parent's literacy, the knowledge of girls on puberty increases. Creating awareness regarding puberty through health education is very essential to help the adolescent girls to handle sexuality-related issues confidently.



Aishwarya P Pargaonkar, Rukmini Talagadadeevi, Venkatachalam D Parvathi

Genetic Counseling in Reproductive Issues: Emphasis on the Genetic Aspects

[Year:2019] [Month:May-August] [Volume:10] [Number:2] [Pages:7] [Pages No:21 - 27]

   DOI: 10.5005/jp-journals-10016-1182  |  Open Access |  How to cite  | 


Aim: To provide information regarding contributing genetic factors and emphasize the importance of genetic counseling in reproductive issues. Background: Genetic counseling is a communication process, where a trained genetic counselor helps educate the client about the genetic background and comprehend the options available to deal with the risks and guides them to choose an appropriate line of action that is relevant in their perspective. A client could be indicated for genetic counseling for reproductive issues such as recurrent spontaneous abortions or infertility (primary and secondary infertility or subfertility). There are various etiological factors responsible for these issues, regarding the pregnancy itself or the environment, but genetic factors are a major cause and account for approximately 5% of pregnancy loss. Conclusion: There is poor awareness and knowledge with regard to the role that genetics plays in reproductive issues, which could cause miscarriages, recurrent abortions, or fertility issues. Obviously, there is a requirement for generalized education of communities and targeted interventions at the primary level itself, but in the clinical setting, it is the responsibility of the genetic counselor to counsel in a nondirective and nonbiased way so that the client has authority to make a decision in complete autonomy. Clinical significance: Out of all the clinically recognized pregnancies, 10–15%, globally, end in a miscarriage and the recurrence risk increases with each consecutive pregnancy loss. Chromosomal abnormalities account for around 50–66% of all miscarriages. Infertility is also a major problem in India and it affects 10–14% of Indian population. In order to clearly understand the causes of reproductive issues in the Indian context, all the above factors need to be further investigated.



Papa Dasari, Ashraf M Ali, T Chitra

Uterine Torsion Associated with Previable Preterm Premature Rupture of Membranes Diagnosed at Cesarean Section

[Year:2019] [Month:May-August] [Volume:10] [Number:2] [Pages:3] [Pages No:28 - 30]

   DOI: 10.5005/jp-journals-10016-1184  |  Open Access |  How to cite  | 


Background: Torsion of gravid uterus is a rare and sporadic event, and its association with previable preterm premature rupture of membrane (PPROM) is not reported in literature. Case description: A 35-year-old third gravida with previous two early pregnancy losses was managed conservatively following previable rupture of membranes at 20 + 6 weeks of gestation. Torsion of gravid uterus to 180° was diagnosed at elective cesarean section performed at 32 + 2 weeks in view of Breech presentation with severe oligoamnios and tubular cervix. An alive baby of 1.48 kg with good APGAR score was extracted through a low vertical incision given on anterior surface of uterus after detortion. Discussion: Torsion is diagnosed when uterus rotates itself on its long axis 45° or more, and the etiology may be fibroid uterus adhesions and ovarian cysts. Preoperative diagnosis is rare except when magnetic resonance imaging is performed. Most of the cases reported in the literature are diagnosed at cesarean section undertaken for fetal distress or nonprogress of labor. In the case presented here, there were no predisposing factors except that she was on prolonged bed rest due to PPROM, and there was a cornual implantation of placenta. Conclusion: Conservative management of maternal position may predispose to uterine torsion, and in such cases, vigilant monitoring and timely termination can save the fetus. Clinical significance: Presence of a tubular cervix with mal-presentation is one of the clinical features to suspect torsion during pregnancy and labor.



Sanjivani Wanjari

Transfusion-related Acute Lung Injury in a Case of Ruptured Ectopic Pregnancy

[Year:2019] [Month:May-August] [Volume:10] [Number:2] [Pages:3] [Pages No:31 - 33]

Keywords: Ectopic pregnancy, SpO2, Transfusion-related acute lung injury, Transfusion reactions

   DOI: 10.5005/jp-journals-10016-1185  |  Open Access |  How to cite  | 


Aim: To highlight an uncommon complication of blood transfusion, which can be detected early based on suspicion, especially when the presentation is mild or atypical. Background: Transfusion-related acute lung injury (TRALI) is a rare complication of blood transfusion which can be life-threatening. TRALI is most commonly associated with plasma-containing blood products. The transfusion components can be fresh frozen plasma (FFP), whole blood platelet concentrates, and apheresis platelets and packed red blood cells. TRALI is thought to be caused by activation of recipient neutrophils by donor-derived antibodies targeting human leukocyte antigen (HLA). Case description: We are herewith presenting the case of a 26-year-old lady who was admitted with the diagnosis of ruptured ectopic pregnancy and a hemoglobin of 5.6 g%. Exploratory laparotomy was done, and she received three transfusions intra and postoperatively. After a few hours, we noticed that she was not maintaining SpO2 at room air. Chest X-ray showed infiltrates, and ECHO was normal. With the diagnosis of TRALI, she was started on nasal oxygen and was investigated. She responded well to injection hydrocortisone and diuretics and recovered within 72 hours. Conclusion: TRALI is a clinical diagnosis that should be considered in all patients who have respiratory difficulty and pulmonary insufficiency during or after transfusion. Timely recognition and adequate treatment are crucial in its management. Clinical significance: The classical presentation of TRALI includes onset of dyspnea and tachypnea within 6 hours of a transfusion. TRALI should be differentiated from transfusion-associated circulatory overload (TACO) and other transfusion reactions and also from cardiac conditions and pulmonary embolism. In mild cases, nasal oxygen administration is sufficient to achieve clinical improvement. In severe cases, mechanical ventilation may be necessary. Our patient responded well to hydrocortisone and diuretics and oxygen inhalation at 2 L/minute.



Swati Agrawal, Kiran Aggarwal, Manvi Dua

Severe Ovarian Hyperstimulation Syndrome in a Patient of Polycystic Ovarian Syndrome, Necessitating Paracentesis, with Successful Pregnancy Outcome: A Case Report

[Year:2019] [Month:May-August] [Volume:10] [Number:2] [Pages:3] [Pages No:34 - 36]

Keywords: Assisted reproductive techniques, Cabergoline, Case report, Complication, Ovarian hyperstimulation syndrome, Paracentesis, Polycystic ovarian syndrome, Pregnancy

   DOI: 10.5005/jp-journals-10016-1186  |  Open Access |  How to cite  | 


Background: Severe ovarian hyperstimulation syndrome (OHSS) is a serious complication of controlled ovarian stimulation which requires a multipronged management to achieve a favorable outcome. Case description: A 24-year-old infertile lady with polycystic ovarian syndrome (PCOS) presented with the complaints of vomiting, abdominal pain, and abdominal distension following ovulation induction with follicular-stimulating hormone. Ultrasound suggested bilateral enlarged ovaries with moderate free fluid in the Pouch of Douglas. A diagnosis of OHSS was made, and oral cabergoline with prophylactic anticoagulation was initiated along with supportive management. However, the patient continued to deteriorate and was shifted to intensive care unit and started on human albumin infusion. Despite all measures, the patient developed tachypnea with tense ascites and oliguria which necessitated ultrasound-guided abdominal paracentesis twice. The patient started improving following paracentesis, was diagnosed to have quadruplet pregnancy, and discharged in stable condition. Two of four embryos did not thrive, and eventually, the patient delivered two healthy babies by cesarean section. Conclusion: Management of severe OHSS requires multimodality treatment. Surgical intervention in the form of paracentesis should be strongly considered in patients with tense ascites, leading to respiratory compromise and oliguria, which is refractory to medical management. Clinical significance: The case report highlights the need for extreme caution during controlled ovarian hyperstimulation in patients with PCOS. The case also aims to guide in the management of a case of severe OHSS, which may require a combination of therapies including paracentesis for a favorable outcome.


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