International Journal of Infertility & Fetal Medicine

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2011 | September-December | Volume 2 | Issue 3

EDITORIAL

Editorial

[Year:2011] [Month:September-December] [Volume:2] [Number:3] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/ijifm-2-3-v  |  Open Access |  How to cite  | 

REVIEW ARTICLE

Sabaratnam Arulkumaran, Vikram Sinai Talaulikar

Labor Admission Test

[Year:2011] [Month:September-December] [Volume:2] [Number:3] [Pages:7] [Pages No:89 - 95]

PDF  |  DOI: 10.5005/jp-journals-10016-1025  |  Open Access |  How to cite  | 

Abstract

Labor admission test (LAT) is performed at the onset of labor to establish fetal well-being in low-risk pregnancies and identify those fetuses who either may be hypoxic, needing delivery or at risk of developing hypoxia during labor so that additional measures of fetal surveillance can be instituted to prevent adverse outcomes. We searched the literature in Medline, Cochrane Library and PubMed using the words— cardiotocograph, cardiotocogram, nonstress test, vibroacoustic stimulus (VAS), amniotic fluid index (AFI), Doppler, labor admission test, labor admission cardiotocography (CTG) and reviewed four randomized controlled trials (RCTs) and three systematic reviews to summarize the current evidence regarding use of LAT. Although the existing RCTs and systematic reviews do not favor admission testing, we have critically reviewed the methodology used in some of these major studies. There is a need for robust RCTs with adequate sample size to evaluate the effectiveness of LAT. In clinical practice, while a normal admission CTG reassures the mother and the clinician about the health of the baby, an admission CTG with nonreassuring FHR pattern leads to careful review which may reveal a growth restricted or compromised fetus before onset of active labor when the risk of fetal hypoxia is higher with increasing frequency and duration of uterine contractions. Like in other obstetric interventions, the woman should be offered the choice of LAT after providing appropriate information and her informed decision should be respected.

RESEARCH ARTICLE

Hema Divakar, Issac Manyonda

Battling with Rising Prevalence of Gestational Diabetes Mellitus: Screening and Diagnosis

[Year:2011] [Month:September-December] [Volume:2] [Number:3] [Pages:5] [Pages No:96 - 100]

PDF  |  DOI: 10.5005/jp-journals-10016-1026  |  Open Access |  How to cite  | 

Abstract

Introduction

Gestational diabetes affects 2 to 4% of all pregnancies, with an increased risk of developing diabetes for both the mother and the child. The prevalence of gestational diabetes mellitus (GDM) in India varied from 3.8 to 21% with the geographical locations and diagnostic methods used.

Objective

To study the differences in the type of tests and timing of tests; failure to screen and diagnose; this could explain the varying prevalence reported from different centers indicating that there could be an underestimation due to missed diagnosis.

Materials and methods

A 15-question online survey (www.abcofobg.com) was developed to assess providers’ knowledge; practices and attitudes related to the screening and management of GDM. All data were entered into an electronic database without personal identifiers, to maintain confidentiality. The data was analyzed by using SPSS version 16.0.

Results

A total of 584 respondents were participated in the survey. Overall, 82.14% of doctors screened all their antenatal patients for GDM. A total of 65.48% of them ordered for a blood glucose test during first antenatal visit even in first trimester. During screening, 39.29% of doctors preferred 50 gm glucose challenge test and 26.19% of doctors preferred 75 gm glucose and 2-hour reading. When the test was positive, 47.62% of doctors ordered for 100 gm oral glucose tolerance test (OGTT) and 38.1% for 75 gm OGTT. A total of 40.48% of doctors used C and C criteria, 26.4 % used National Diabetes Data Group (NDDG) criteria and 32.14% took 140 at 2 hours for 75 gm OGTT criteria of cutoff to diagnose the GDM.

Conclusion

Preventive measures against type 2 diabetes (T2DM) should start with proper screening and diagnosis during pregnancy. Many tests with varied criteria are in use. There is an urgent need to institute uniform standards for the timing and type of tests done for identifying the cases of GDM. This is crucial to reduce the burden of T2DM in India for now and for generations to come.

RESEARCH ARTICLE

Rutvij Jay Dalal, Nandita P Palshetkar, Akanksha P Mishra

Intracytoplasmic Morphologically selected Sperm Injection vs Intracytoplasmic Sperm Injection: A Retrospective Analysis

[Year:2011] [Month:September-December] [Volume:2] [Number:3] [Pages:5] [Pages No:101 - 105]

PDF  |  DOI: 10.5005/jp-journals-10016-1027  |  Open Access |  How to cite  | 

Abstract

This study was conducted to determine the efficacy of using the technique of intracytoplasm morphologically selected sperm injection (IMSI) as compared to the conventionally used intracytoplasmic sperm injection ((ICSI) procedure. IMSI, as the name suggests, is the technique of selecting the most normal looking sperm by magnifying it to about 7200 times. A total of 192 patients who underwent the treatment of in vitro fertilization (IVF) with us by either one of the two procedures of IMSI or ICSI over a period of 18 months were included in the study. Out of these 92 were included in the IMSI group while 100 others in the ICSI group according to our inclusion and exclusion criteria. The pregnancy rate among patients who underwent IMSI was found to be significantly higher (52.1%) as compared to those with ICSI (36%). Furthermore, even the implantation rates were higher in the IMSI group (30.12%) than the ICSI (19.93%) group.

RESEARCH ARTICLE

Reshma Sultana, Lakshmi Rathna Marakani, Sirisha Rao Gundabattula

Abdominal Fat Distribution, Insulin Resistance and Cardiovascular Risk Profiles in Women with Polycystic Ovary Syndrome

[Year:2011] [Month:September-December] [Volume:2] [Number:3] [Pages:3] [Pages No:106 - 108]

PDF  |  DOI: 10.5005/jp-journals-10016-1028  |  Open Access |  How to cite  | 

Abstract

Aim

To determine potential associations of abdominal fat distribution with insulin resistance and cardiovascular risk in women with polycystic ovary syndrome (PCOS).

Methods

Cross-sectional study that included detailed clinical examination, body mass indices (BMI), waist-hip ratio, insulin resistance and cardiovascular risk scores for 350 women registered between August 2008 and December 2009. Biochemical analysis included fasting blood glucose level, serum insulin level, triglycerides, total cholesterol and HDL cholesterol. Primary outcomes of interest included insulin resistance and cardiovascular risk score.

Results

The mean age of the subjects was 25.77 years. Oligoovulation was present in 99% of the women. Eighty-two (23.43%, 95% CI: 19.21%, 28.08%) women were obese and 100 (28.57%, 95% CI: 24.02%, 33.47%) women had android obesity. Insulin resistance was present in 136 (38.86%, 95% CI: 33.85%, 44.05%) women and 107 (30.57%, 95% CI: 25.91%, 35.55%) women had a cardiovascular risk >1. Women with a waist-hip ratio >0.85 were more likely to have insulin resistance (OR 2.70, 95% CI: 1.68, 4.35, p < 0.001) and at increased risk for cardiovascular events (OR: 1.82, 95% CI: 1.12, 2.97, p = 0.02). Obese women were more likely to have insulin resistance (OR 2.53, 95% CI: 1.53, 4.19, p < 0.001) and at increased risk for cardiovascular events (OR: 2.17, 95% CI: 1.30, 3.63, p = 0.003).

Conclusion

Long-term health hazards of PCOS have to be considered as these may be prevented to some extent by early identification and interventions, such as changing the lifestyle of the individual.

RESEARCH ARTICLE

Tarakeswari Surapaneni, Manisha Dudlani

Is Advanced Paternal Age associated with Fetal Growth and Adverse Neonatal Outcomes? A Case-Control Study

[Year:2011] [Month:September-December] [Volume:2] [Number:3] [Pages:5] [Pages No:109 - 113]

PDF  |  DOI: 10.5005/jp-journals-10016-1029  |  Open Access |  How to cite  | 

Abstract

Aim

To determine associations of advanced paternal age with fetal growth and adverse neonatal outcomes.

Methods

A hospital-based unmatched case-control study with random selection of controls. Fetal growth was determined by serial ultrasound measurements and growth was classified at birth by a neonatalogist based on the Lubchenco charts. Advanced paternal age was explored using two cutoffs (35 and 40 years). Likelihood ratios, unadjusted and adjusted odds ratios and the 95% confidence intervals around point estimates are presented.

Results

The study covered 218 pregnant women that included 137 (63.72%) pregnant women who delivered a live AGA/LGA baby and 78 (36.28%) pregnant women who delivered a live small for gestational age baby and 45 (20.64%) fathers with advanced paternal age based on a cutoff of ≥ 40 years and 73 (33.49%) fathers with advanced paternal age based on a age cutoff ≥ 35 years. Although advanced paternal age (both ≥ 35 and ≥ 40 years) was protective for small for gestational age babies in a bivariate analysis, the association was not significant in a multivariate regression model that adjusted for maternal age, parity, diabetes and gestational age at delivery. Advanced paternal age (both ≥ 35 and ≥ 40 years) did not show a clinically meaningful positive or negative likelihood ratio with other adverse neonatal outcomes.

Conclusion

Paternal age does not seem to be associated with fetal growth or adverse neonatal outcomes; however, a prospective cohort study is necessary to provide further evidence after controlling for potential confounders.

CASE REPORT

Korula George, Vaibhav Londhe, K Muthukumar

Fertility Preservation: A Case Series

[Year:2011] [Month:September-December] [Volume:2] [Number:3] [Pages:4] [Pages No:114 - 117]

PDF  |  DOI: 10.5005/jp-journals-10016-1030  |  Open Access |  How to cite  | 

Abstract

Improvement in survival rates of cancer patients has lead to a shift in focus toward fertility issues, especially in young survivors. Male fertility preservation is well established. Embryo cryopreservation remains most successful female fertility preservation option. Other female fertility preservation procedures like oocyte/ovarian tissue cryopreservation either have limited efficacy or in experimental stages. We have highlighted not uncommon clinical scenarios where the fertility preservation option was exercised. There is an urgent need to spread awareness among clinicians and patients regarding the various available fertility preservation measures. Timely referral will help in improving the quality of life of cancer survivors.

CASE REPORT

Sunita Pawar Shekokar, Tasneem Shah, C Chandana

Phocomelia: An Extremely Rare Congenital Disorder involving the Limbs (Dysmelia)

[Year:2011] [Month:September-December] [Volume:2] [Number:3] [Pages:3] [Pages No:118 - 120]

PDF  |  DOI: 10.5005/jp-journals-10016-1031  |  Open Access |  How to cite  | 

Abstract

Phocomelia—phoco(seal), melia(limbs)—is a rare congenital deformity in which hands or feet are attached close to the trunk, the limbs being grossly underdeveloped or absent. The babies are born with limbs that look like flippers on a seal. The two main etiological factors of phocomelia are genetic inheritance and use of the drug thalidomide. Here, we present a case of phocomelia in second gravida without exposure to thalidomide.

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