BACKGROUND Adolescence is the transitional phase of growth and development between childhood and adulthood. Menstruation, which is a milestone event in a girl's reproductive life begins during this period and it is also one of the major causes of stress in this stage. Adequate knowledge and good menstrual practices can help in addressing this stress and also in preventing reproductive tract infections to a great extent. This study tries to assess the awareness with regard to menstrual practice and its determinants among adolescent girls in a rural area of Central Kerala. The study also aims to explore the social taboos related to menstrual practices. METHODS This cross-sectional study was conducted at two high schools in Thrissur district of Central Kerala. The study methodology involved visiting the selected schools and questions about menstrual practices were put to students individually ensuring adequate privacy, with the aid of a semi-structured interview schedule. 196 adolescent girls participated in the study. The data was coded and entered into MS excel. Further analysis was done using the software SPSS 16.0 version. RESULTS The percentage of girls using sanitary pad is 32.1 %, clothes were used by 12.2 % girls, and 55.6 % used either cloth or sanitary pad. Most of them disposed their sanitary pads by burning them (75.6 %), but 16.3 % threw their pads / clothes in the general waste, some flushed them in the toilet (8.1 %). 64.3 % of them washed and exposed their undergarments in the sun but 35.7 % washed and kept them inside their house. 84.7 % of girls were aware about menstruation at the time of menarche. In 58.7 % of cases the source of information was their mother. Regarding social taboos during menstruation, the most common one was inability to attend social or religious functions during menstruation (76 %) followed by restrictions in going out (9.7 %), and 7.7 % in food preparation. 7 % of girls had to sleep in a corner of the room while they were menstruating. Maternal education, family income and awareness regarding menstruation had statistically significant association with usage of sanitary pads. CONCLUSIONS Majority of the adolescent girls had awareness regarding menstruation. However, there were some who followed less than ideal practices when it comes to disposal of sanitary napkins / clothes and care of undergarments. The wrong concepts like menstruation is a ‘disease of impurity’ and menstruation occurs when ‘bad blood’ collects is still prevalent among the adolescent girls. It is of concern that the social taboos regarding menstruation are still widely embraced by the society. KEYWORDS Menstrual Practices, Menstrual Awareness, Kerala, Menstruation

Background: Asymptomatic bacteriuria (ASB) in pregnancy is a significant risk factor for developing upper urinary tract infection and pyelonephritis which is associated with significant maternal and fetal risks. The aim of this study was to know the prevalence of asymptomatic bacteriuria in pregnancy, to identify the organisms and their antibiotic susceptibility patterns and to formulate a single or combined rapid screening method as an acceptable alternative to urine culture.Methods: A total of 375 pregnant women aged between 18 to 45 years were included in this study. Clean catch mid-stream urine samples were collected. Screening tests done were gram staining of uncentrifuged urine, pus cell count, nitrite test and leukocyte esterase test. Identification of pathogens and antibiotic sensitivity tests were performed as per standard urine culture and sensitivity methods.Results: Out of the 375 pregnant women, 31 (8.4%) had significant bacteriuria. High percentage of women with ASB were primigravidas (51.38%) and in 2nd trimester (43.86%). The most common organism isolated was E.coli (56.14%). In screening tests, gram staining of uncentrifuged urine had a sensitivity of 85.71%. Sensitivity of 71.42% was found in Nitrite and leucocyte esterase tests. However, the combination of these two tests, with either test positive, showed sensitivity and negative predictive value of 90.47% and 99.09% respectively.Conclusions: Early detection and treatment of ASB in pregnancy can prevent complications. ASB can be identified by simple and combined rapid screening methods and urine culture along with antibiogram. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy newborn.

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Background: Misoprostol is a prostaglandin E1 analogue, a methyl-ester of prostaglandin E1 additionally methylated at C-16. Misoprostol is an effective myometrial stimulant of pregnant uterus, selectively binding to prostanoid receptors. The objective of the study was to compare the efficacy of vaginal and oral misoprostol for the induction of labour in women with intra-uterine foetal death (IUFD).Methods: A prospective randomised clinical trial, comparing 50µg oral and 50µg vaginal misoprostol, six hourlies for a maximum of four doses for the induction of labour in women with IUFD. All patients with IUFD after 28 weeks without previous uterine surgeries, without contraindications for prostaglandins are included in the study. The study was conducted in the Department of Obstetrics and Gynecology MVJ Medical College and Research Hospital, Hoskote. Bangalore from June 2012 to June 2015. It is a tertiary institution serving predominantly rural population. The primary outcome measure was the induction to delivery time, secondary all complications were noted.Results: Twenty-five women were randomised to the vaginal route and twenty-five to the oral route. The induction to delivery time was longer with vaginal misoprostol 10.5±4.03 compared to oral misoprostol (9.58±4.9). There was no significant difference in the amount of misoprostol needed to achieve successful induction in the two groups. 3 patients needed oxytocin augmentation to complete the induction of labour. There were no cases of failed induction. The systemic side effects (shivering, diarrhoea, vomiting and pyrexia) were more common with oral misoprostol (44.5%) compared to vaginal misoprostol (20%).Conclusions: Oral misoprostol achieved successful induction of labour in women with IUFD in a shorter time than vaginal misoprostol. Both routes are equally effective in termination of pregnancy. Sublingual route is easy to administer, patient compliant, no need for internal examination, less chance of labour dysfunction, less chance of post-partum sepsis.

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