Background: Polycystic ovary syndrome (PCOS) is a heterogeneous hormonal disorder of reproductive aged women characterized by chronic anovulation, irregular menstrual cycles and hyperandrogenism. The present study aimed to investigate the effects of metformin and calcium-vitamin D on follicular maturation and regularity of menstrual cycles in patients with PCOS.Methods: A prospective, open-label, multiple arms, randomized clinical trial. Group 1 participants received 1,000 mg of calcium and 400 IU of vitamin D per day, orally, group 2 participants received 1,500 mg of metformin per day, orally and group 3 participants received combination of above drugs. The patients were treated for 3 months and followed up for a further 3 months. Menses regularity, number of dominant follicles (≥14 mm) and pregnancy rates were compared among the three groups.Results: A total of sixty infertile women with PCOS were recruited. Calcium-vitamin D plus metformin treated patients showed highest percentage improvement (50%) menstrual regularity as compared to other two groups (p<0.001) also showed significant follicular response (p<0.014). Calcium-vitamin D plus metformin treated group showed better follicular response in the second and third month of follow-up and 30% of women showed high quality dominant large (≥14 mm) follicles at the end of follow-up period.Conclusions: Calcium-vitamin D plus metformin combination is more effective in terms of follicle maturation and restoring menstrual disturbances as compared to individual drug treatment.
INTRODUCTIONPregnancy induced thyroid disorders, diabetes and hypertension are the common endocrine and cardiovascular disorders seen maternally either in early and late period of pregnancy. Maternal thyroid dysfunction contributes many risk factors which includes increase thyroglobulin levels, renal excretion of iodine due to increased rate of glomerular filtration, alterations in thyroid hormone peripheral metabolism and modifications in iodine transfer to placenta. 1 Iodine requirement increases by 50% during gestation period which can be compensate with synthesis and production of maternal thyroid hormones from gland and 10% increase in gland size is estimated. 2 Pregnancy is a stress factor for thyroid gland which resulting in hypothyroidism with dietary iodine deficiency and very limited thyroidal reserve women. Early pregnancy ABSTRACT Background: Pregnancy induced thyroid disorders, gestational diabetes mellitus (GDM) and gestational hypertension are common problems in women with gestational period. Published literate shows wide range of prevalence in pregnancy induced disorders in other states of India, and as of now the exact prevalence in our study population is not studied. Hence, there present study was aimed to know the prevalence of pregnancy induced disorders in pregnant women in South Indian population. Methods: A total of 120 subjects were followed-up at the time of recruitment to entire gestational period. Standard guidelines were followed for the assessment of thyroid hormone levels, glucose tolerance test (OGTT) and blood pressure values at different intervals and positions. Apart from detailed clinical history has been taken and routine basic and obstetrical investigations were done. Results: Prevalence of thyroid dysfunction (15.0%), gestational diabetes mellitus (11.7%) and gestational hypertension (9.2%) was reported in the present study population. Subclinical hypothyroidism was highest prevalence amount thyroid disorders. Gestational diabetes subjects have mean blood glucose levels of 230.68±17.48 mg/dL with OGTT test. Gestational hypertensive patients had SBP of 152.4±10.8 and DBP of 96.6±6.4; pre-hypertensive subjects had SBP of 134.2±5.48 and DBP of 6.8±4.6 respectively. Conclusions: Our study findings were slightly higher than normal prevalence's which are reported earlier by various authors. We suggested that early screening, diagnosis and treatment are warranted for the prevention of maternal and fetal complications in Indian population.
Introduction: Misoprostol is a synthetic prostaglandin E1 analogue widely used for cervical ripening and labour induction. However, misoprostol optimal dose required to induce labour is still controversial. Aim: To determine the efficacy and safety of 25 µg and 50 µg of intravaginal misoprostol for induction of labour at term and to evaluate maternal and neonatal complications. Materials and Methods: The present study was a prospective, randomised, double blind, single centre study carried out during March 2019 to December 2020. All the selected participants were randomised (1:1) to group 1 which received 25 µg of intravaginal misoprostol (n=70) and group 2 received 50 µg of intravaginal misoprostol (n=70). Based on the Bishop’s score, misoprostol was chosen as labour inducing agent. Number of misoprostol doses, mode of delivery, vaginal delivery duration, maternal and neonatal complications was recorded. Statistical significance among study groups were analyzed by using Chi-square test. Results: Postdatism was most frequently reported indication in both the study groups (57.1% and 52.9%). A total of 14 and 4 participants in group 2 and group 1 received only single dose of misoprostol (p<0.01). Participants who received misoprostol 50 µg (n=60, 85.7%) has slightly showed higher vaginal deliveries compared to misoprostol 25 µg (n=57, 81.4%). The mean duration of induction time in group 2 was 10.12 hours and group 1 women showed 13.56 hours (p<0.0001). Maternal and neonatal complications were slightly higher in 50 µg misoprostol group. Maternal complications such as uterine tachysystole (n=4), Postpartum Haemorrhage (PPH) (n=3) and uterine hyperstimulation syndrome (n=2). Neonatal complications with 50 µg misoprostol were Apgar <7 at 1 min (n=4), Apgar <7 at 5 min (n=3), Special Care Baby Unit (SCBU) admissions (n=2) and severe birth asphyxia (n=1). Misoprostol with 25 µg has showed Apgar <7 at 1 min (n=2), Apgar <7 at 5 min (n=2), SCBU admissions (n=1). Conclusion: The efficacy and safety results of 25 µg intravaginal misoprostol were comparable with 50 µg of intravaginal misoprostol for labour induction. The advantages of 50 µg misoprostol were it favours the vaginal deliveries, lesser active induction time and decrease number of misoprostol doses required to induce labour. However, higher dose of misoprostol showed higher frequencies of both maternal and neonatal complications.
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