IntroductionUrinary tract infection (UTI) is a common health problem among women compared with men due to shorter urethra, closer proximity of the anus with vagina and pathogen entry facilitated by sexual activity. 1,2 It is estimated that one in three women of childbearing age contracts UTI, which may manifest symptoms or remain asymptomatic. 3 Pregnant women are more susceptible to UTI, owing to altered anatomical and physiological state during pregnancy. 2 Asymptomatic bacteriuria (ASB) is a presence of a significant quantity of bacteria in a properly collected urine specimen from a person without symptoms or signs of UTI. 4 Asymptomatic bacteriuria occurs in 2 to 7 percent of pregnant women. 5,6 It typically occurs during early pregnancy, with only approximately a quarter of cases identified in the second and third trimesters. 7 Factors that have been associated with a higher risk of bacteriuria include a history of prior UTI, pre-existing diabetes mellitus (DM), increased parity and low socioeconomic status. 8

Summary:Infertility has been classified with respect to a number of parameters; prominent amongst which are time, causes, treatment cost and socio-cultural implications. The most widely accepted practical classification distinguishes between primary and secondary infertilities with a further sub classification into 3 clearly defined groups that include ovulatory dysfunction, fallopian tube compromise and male factor alongside an ambiguous and controversial group labeled as "unexplained infertility". In infertility work-up various procedures can be carried out in isolation or in different combination, depending on the indication. Other complimentary procedures can be done when specifically required. So, with infertility in general the diagnosis of tubal infertility should be tailored to the individual patient. Here is a review on an evidence based approach to diagnose the tubal factors for infertility. Evidence Based Diagnostic Approach to Purpose of review:The investigation for potential tubal disease is an essential step in the work-up of infertility. This review article will provide an overview of evidence based diagnosis of tubal factor infertility. The different diagnostic tools will be described together with discussion of different minimal access surgical approaches. We intend to highlight the capital and central role of minimal access procedures playing in the diagnosis of tubal infertility as well as to demonstrate the positive impact it has in the fight against infertility; thus redefining the classification and pathology.(Birdem Med J 2014; 4(1): 33-37)

Background: Anemia during pregnancy is associated with adverse outcomes. Prevalence of anemia is thought to be high in developing countries. This study was aimed at determining the prevalence and socio-demographic and reproductive factors associated with anemia among a group of pregnant mother. Methods: This cross-sectional observational study was conducted on pregnant women who visited the antenatal clinic of Combined Military Hospital (CMH), Savar, Dhaka from January 2017 to December 2019. Hemoglobin level was measured in all these women to assess the presence of anemia and was categorized according to the World Health Organization (WHO) criteria. Demographic data and information on maternal age, gestational age, educational and income level, and socioeconomic status were collected from anemic pregnant women and were analyzed. Results: Out of 1500 pregnant women 525 (35%) were found to be anemic (Hemoglobin <11.0 g/dl). Among the 525 anemic women, 347 (66.1%) had mild anemia, 157 (29.9%) had moderate anemia and 21 (4.0%) women had severe anemia. Majority (48%) of the anemic women were less than 25 years old and majority (47%) had body mass index (BMI) <18.5 kg/m2. Most of the women (58%) presented in their second trimester of pregnancy. More than two thirds pregnant women were multigravida. More than 50% women had history of abortion and around one third had 2 or more abortions. Most of the women (56%) reported another pregnancy within 24 months of current pregnancy. Sixty four percent of the patients completed secondary education, 75% were homemaker and 56% lived in rural area. Most of the patients (80%) had a family income per month less than 20000 taka. Majority (58.4%) of the women did not receive any iron supplementation during this pregnancy. Conclusions: This study results show that more than one third of the pregnant women suffer from anemia irrespective of gestational week, but is more common in those presenting in second trimester of pregnancy, those who are younger, lean and thin, having history of previous pregnancy and bad obstetric history. Birdem Med J 2021; 11(1): 52-56

Background: Threatened abortion is the most common complication in the first half of gestation. Spontaneous abortion occurs in less than 30% of the women who experience threatened abortion. In order to prevent pregnancy loss several supportive therapies including hormonal therapy like human chorionic gonadotropin (hCG) or 17-alpha-hydroxyprogesterone (progesterone) have been advocated. The exogenous administration of hCG is aimed at stimulating and therefore optimizing progesterone production. Aim of this study was to compare the efficacy of supportive therapy with hCG and progesterone in women with threatened abortion. Methods: This prospective study was carried out in the department of obstetrics and gynecology of the CombinedMilitary hospital (CMH), Savar, Dhaka, Bangladesh from July 2016 to June 2017. One hundred pregnant patients admitted with the history of per vaginal bleeding before 20 weeks of gestation without having any other co-morbidity were included in this study. Patients were randomized to two treatment groups. The participants in group A (52, 52%) received injection hCG weekly while those in group B (48, 48%) received injection progesterone from recruitment up until 20 weeks of gestation. Further USG were performed one week and four weeks after recruitment to the study and again at 20 weeks and subsequently when indicated. The final outcome of pregnancy were recorded and analyzed.Results: Among 100 patients majority belonged to the 26-30 year age group. Mean age of the patients was 27.2±10.5 years. There was not much significant difference between the groups in terms of parity. More than 75% of patients in both the groups presented before 16 weeks of gestation with threatened abortion. In both the groups more than 75% of the patients had previous history of pregnancy loss. In terms of pregnancy outcome more patients in hCG group had live pregnancy than progesterone group (88.5% vs 66.7%) (p=0.012). Out of 46 live birth in hCG group, 4 (7.7%) were preterm labor between 31-35 weeks of pregnancy and one baby died in neonatal ICU, one died at 31 weeks of gestation which was delivered by vaginally. On the other hand out of 32 live birth in progesterone group, there was 3 (6.3%) preterm labor. Growth retardation was less in hCG group compared to progesterone group (9.6% vs 14.6%). However cesarean section rate was high in both the groups.Conclusion: Treatment with injection hCG has better pregnancy outcome than that of injection17-alphahydroxyprogesterone in early pregnancy with threatened abortion of unexplained cause.

Background: The trend of Caesarean section (CS) carried out is rising worldwide. One of the most common indications of CS is fetal distress which is based on the cardiotocograph (CTG) recording, abnormal fetal heart rate pattern and meconium stained liquor. The aim of this study was to carry out an audit of CS performed due to fetal distress in a tertiary care military hospital with a view to justify the methods for diagnosis of fetal distress to fetal outcome. Methods: This cross-sectional observational study was carried out over a period of 1 year and 6 months (July 2013 to January 2015) in the Combined Military Hospital (CMH), Dhaka. All pregnant women at or beyond 37 weeks of gestation who underwent CS for fetal distress were included. Neonatal outcome were assessed based on APGAR score and neonatal intensive care admission. Results: Among the 260 (100%) women who underwent CS due to fetal distress, mean age was 27.8 ± 5.3 years. More than half (54.6%) of the women were primigravida. Majority (48%) of the patients presented with spontaneous onset of labor and in 43% cases labor was induced by medical methods. In the majority (40%) of the patients, fetal distress was diagnosed by seeing abnormal patterns in CTG. During CS, signs of fetal distress was found in the majority (64.6%) of the patients (meconium stained liquor 42.3%, cord abnormality 13.5% and placental abnormality 8.8%). APGAR score of the newborn babies was abnormal (<7) in the majority (60%) cases. More than half of the newborn babies required admission in neonatal intensive care unit for different diagnosis. There was only 4 (1.5%) cases of neonatal death. Conclusion: The rate of CS for fetal distress in this study was comparable to other study findings and within recommendation of WHO. The high rate of identifiable causes of fetal distress as well as neonatal outcome justifies doing CS in these cases. Birdem Med J 2020; 10(1): 60-63