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1.
J Adolesc Young Adult Oncol ; 10(1): 71-77, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-32456519

RESUMEN

Purpose: Recommendations from the American Society of Clinical Oncology (ASCO) emphasize the critical need to understand current trends in fertility preservation (FP) among the two sets of primary health care providers involved in oncofertility: the oncologists and the gynecologists. This study is aimed at understanding the health care providers' knowledge, attitudes, and barriers in oncofertility across India. Methods: An 18-item oncofertility survey was designed and directed to 77 oncologists and 214 gynecologists across India. The responses were analyzed by using descriptive statistical methods, and the oncofertility trends between the two groups were studied. Results: The total response rate was 34%, with 49 of 214 oncologists (23%) and 49 of 77 gynecologists (64%) participating in the survey. The awareness of ASCO FP guidelines among oncologists and gynecologists was 53% and 59.5%, respectively. About 48% of oncologists felt knowledgeable about sperm banking, whereas 52% knew about oocyte freezing but not about other options. On the other hand, among gynecologists, 38% reported inadequate knowledge of testicular or ovarian tissue cryopreservation. About 85% of oncologists reported routine referral of cancer diagnosed patients for FP, whereas 75% of gynecologists reported routine FP discussion with patients. Health care providers from both groups perceived the major barriers in oncofertility to be, "financial burden on the patient" (73%-86%) and, "lack of patient awareness" (71%-79.5%). Conclusion: Effective collaboration between oncologists and gynecologists is essential to establish a successful FP program. Economic burden on the patient and lack of patient and physician awareness are limiting factors that need to be overcome.


Asunto(s)
Preservación de la Fertilidad , Neoplasias , Oncólogos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Neoplasias/terapia , Encuestas y Cuestionarios
2.
J Interpers Violence ; 31(3): 515-30, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25381267

RESUMEN

To reduce the many adverse health outcomes associated with intimate partner violence (IPV), high-risk groups need to be specifically targeted in the fight against domestic violence in India. This study aims to examine the prevalence and correlates of IPV in HIV-positive and HIV-negative women from India. A convenience sample of HIV-positive and HIV-negative women responded to questionnaires to assess their experience and perception of violence. Multivariate logistic regression analysis was used to model the association between IPV and age, education, employment status, contraception use, age at first marriage, and HIV status. Although adjusting for age, education, employment status, contraception use, age at first marriage, and HIV status, women who are employed were 3.5 times more likely to suffer IPV (confidence interval [CI] = [1.5, 8.5]), women aged 18 or above at first marriage are 0.3 times less likely to face IPV (CI = [0.1, 0.6]), and women who use contraception are 7 times more likely to suffer IPV (CI = [1.4, 30.2]). Also, HIV-positive women are 3 times more likely to face sexual violence compared with HIV-negative women (CI = [1.1, 7.6]).


Asunto(s)
Mujeres Maltratadas/estadística & datos numéricos , Infecciones por VIH/epidemiología , Violencia de Pareja/estadística & datos numéricos , Adulto , Factores de Edad , Causalidad , Intervalos de Confianza , Anticonceptivos , Empleo/estadística & datos numéricos , Femenino , Humanos , Relaciones Interpersonales , Matrimonio/estadística & datos numéricos , Persona de Mediana Edad , Oportunidad Relativa , Pobreza/estadística & datos numéricos , Factores Socioeconómicos , Adulto Joven
4.
J Hum Reprod Sci ; 3(2): 102-4, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-21209755

RESUMEN

Endometrial osseous metaplasia is an uncommon clinical entity with the presence of bone in the endometrium. Most of the cases clinically present with secondary infertility following an abortion. Various theories have been proposed and the most accepted theory is metaplasia of the stromal cells into osteoblastic cells that produce the bone. It is important to distinguish this condition from the mixed mullerian tumor of the endometrium to avoid hysterectomy. Removal of these bony bits leads to spontaneous conception. We present one such case in a 25-year-old female patient presented with secondary infertility.

5.
J Matern Fetal Neonatal Med ; 22(1): 24-8, 2009 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19089777

RESUMEN

OBJECTIVE: To investigate the side effects of 600 microg oral misoprostol given for the mother and the newborn to prevent postpartum hemorrhage (PPH). METHODS: One thousand six hundred twenty women delivering at home or subcentres in rural India were randomised to receive misoprostol or placebo in the third stage of labour. Women were evaluated for shivering, fever, nausea, vomiting and diarrhea at 2 and 24 h postpartum. Newborns were evaluated within 24 h for diarrhea, vomiting and fever. Symptoms were graded as absent, mild-to-moderate or severe. RESULTS: Women who received misoprostol had a significantly greater incidence of shivering (52%vs. 17%, p < 0.001) and fever (4.2%vs. 1.1%, p < 0.001) at 2 h postpartum compared with women who received placebo. At 24 h, women in the misoprostol group experienced significantly more shivering (4.6%vs. 1.4%, p < 0.001) and fever (1.4%vs. 0.4%, p < 0.03). There were no differences in nausea, vomiting or diarrhea between the two groups. There were no differences in the incidence of vomiting, diarrhea or fever for newborns. CONCLUSIONS: Misoprostol is associated with a significant increase in postpartum maternal shivering and fever with no side effects for the newborn. Given its proven efficacy for the prevention of PPH, the benefits of misoprostol are greater than the associated risks.


Asunto(s)
Misoprostol/administración & dosificación , Misoprostol/efectos adversos , Hemorragia Posparto/prevención & control , Población Rural , Administración Oral , Diarrea Infantil/inducido químicamente , Diarrea Infantil/epidemiología , Femenino , Fiebre/inducido químicamente , Fiebre/epidemiología , Humanos , Incidencia , India/epidemiología , Recién Nacido , Intercambio Materno-Fetal/efectos de los fármacos , Náusea/inducido químicamente , Náusea/epidemiología , Oxitócicos/administración & dosificación , Oxitócicos/efectos adversos , Placebos , Embarazo , Características de la Residencia , Tiritona/efectos de los fármacos , Vómitos/inducido químicamente , Vómitos/epidemiología
6.
J Matern Fetal Neonatal Med ; 21(8): 559-64, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18609354

RESUMEN

OBJECTIVE: The main objective of this study was to identify factors associated with variation in the rate of acute postpartum hemorrhage (PPH), defined as blood loss >or= 500 mL within 2 hours of delivery, observed in a randomized clinical trial of misoprostol for the prevention of PPH, conducted in rural India. Although the women in the misoprostol group had a significantly lower probability of having a PPH, we also noted a reduction in the rate of PPH in the placebo group over the course of the study. We hypothesized that this was due to the changing skills of the auxiliary nurse midwives (ANMs) over the course of the study. METHODS: We conducted a post-hoc analysis examining variation in PPH rates over the duration of the trial among the women randomized to the placebo arm (n = 808). Descriptive, correlation analysis and generalized estimating equations (GEE) were used to predict PPH rates. With no direct measure of ANM skills, we used proxy measures, including: (1) the ANM's point of entry into the study (original ANMs at the initiation of the trial were less skilled than replacement ANMs); (2) the study duration, representing exposure of the ANM to ongoing training and monitoring; and (3) duration of the second stage of labor as a measure of improved delivery practices. RESULTS: As the study duration increased, the duration of the second stage of labor decreased (-0.12, p = 0.001) and as the duration of the second stage of labor decreased, the rate of PPH decreased (0.0282; 95% CI 0.0201-0.0363). For each 10-minute increase in the duration of second stage labor increased PPH odds by 7.1% and each 30-day duration of the trial decreased PPH odds by 3.4%. Additionally, a patient delivered by an original ANM was 3.14 times more likely to have a PPH compared to a patient delivered by a replacement ANM. CONCLUSIONS: Declining PPH rates were associated with improved skills and delivery practices that decreased duration of the second stage of labor. These improvements appeared to be consistent with the introduction of the more skilled replacement ANMs as well as ongoing training and monitoring for all ANMs over the duration of the trial.


Asunto(s)
Misoprostol/administración & dosificación , Hemorragia Posparto/prevención & control , Adulto , Parto Obstétrico/estadística & datos numéricos , Femenino , Humanos , Recién Nacido , Segundo Periodo del Trabajo de Parto/efectos de los fármacos , Asistentes de Enfermería/educación , Asistentes de Enfermería/provisión & distribución , Oxitócicos/administración & dosificación , Embarazo , Competencia Profesional , Factores de Tiempo , Resultado del Tratamiento
7.
Int J Gynaecol Obstet ; 101(1): 94-9, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18291401

RESUMEN

OBJECTIVE: Postpartum hemorrhage (PPH), a major cause of maternal mortality and morbidity in low-income countries, can occur unpredictably. This study examined the sociodemographic, clinical, and perinatal characteristics of low-risk women who experienced PPH. METHODS: This analysis was conducted using data on 1620 women from a randomized trial testing oral misoprostol for prevention of PPH in rural India. RESULTS: Of the women, 9.2% experienced PPH. No maternal or sociodemographic factors and few perinatal factors differed between women with PPH and those without, other than treatment with misoprostol. Having fewer than 4 prenatal visits and lack of iron supplementation increased the risk for PPH (P<0.001 and P=0.037, respectively). Several factors unknown until the second stage of labor (perineal tear and birth weight) were also associated (P=0.003). CONCLUSIONS: Among women at low risk for PPH, there were few factors associated with further risk. Given that PPH can occur without warning, rural communities should consider ways to increase both primary prevention (iron supplementation, AMTSL) and secondary prevention of PPH (availability of obstetric first aid, availability of transport, and availability of emergency obstetric care).


Asunto(s)
Hemorragia Posparto/epidemiología , Hemorragia Posparto/etiología , Atención Prenatal , Adulto , Femenino , Humanos , India/epidemiología , Mortalidad Materna , Misoprostol/administración & dosificación , Oxitócicos/administración & dosificación , Hemorragia Posparto/tratamiento farmacológico , Embarazo , Factores de Riesgo , Población Rural
8.
Lancet ; 368(9543): 1248-53, 2006 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-17027730

RESUMEN

BACKGROUND: Postpartum haemorrhage is a major cause of maternal mortality in the developing world. Although effective methods for prevention and treatment of such haemorrhage exist--such as the uterotonic drug oxytocin--most are not feasible in resource-poor settings where many births occur at home. We aimed to investigate whether oral misoprostol, a potential alternative to oxytocin, could prevent postpartum haemorrhage in a community home-birth setting. METHODS: In a placebo-controlled trial undertaken between September, 2002, and December, 2005, 1620 women in rural India were randomised to receive oral misoprostol (n=812) or placebo (n=808) after delivery. 25 auxiliary nurse midwives undertook the deliveries, administered the study drug, and measured blood loss. The primary outcome was the incidence of acute postpartum haemorrhage (defined as > or =500 mL bleeding) within 2 h of delivery. Analysis was by intention-to-treat. The trial was registered with the US clinical trials database (http://www. clinicaltrials.gov) as number NCT00097123. FINDINGS: Oral misoprostol was associated with a significant reduction in the rate of acute postpartum haemorrhage (12.0% to 6.4%, p<0.0001; relative risk 0.53 [95% CI 0.39-0.74]) and acute severe postpartum haemorrhage (1.2% to 0.2%, p<0.0001; 0.20 [0.04-0.91]. One case of postpartum haemorrhage was prevented for every 18 women treated. Misoprostol was also associated with a decrease in mean postpartum blood loss (262.3 mL to 214.3 mL, p<0.0001). Postpartum haemorrhage rates fell over time in both groups but remained significantly higher in the placebo group. Women taking misoprostol had a higher rate of transitory symptoms of chills and fever than the control. INTERPRETATION: Oral misoprostol was associated with significant decreases in the rate of acute postpartum haemorrhage and mean blood loss. The drug's low cost, ease of administration, stability, and a positive safety profile make it a good option in resource-poor settings.


Asunto(s)
Misoprostol/uso terapéutico , Oxitócicos/uso terapéutico , Hemorragia Posparto/prevención & control , Administración Oral , Femenino , Parto Domiciliario , Humanos , India , Partería , Misoprostol/administración & dosificación , Misoprostol/efectos adversos , Oxitócicos/administración & dosificación , Oxitócicos/efectos adversos , Áreas de Pobreza , Salud Rural
9.
Int J Gynaecol Obstet ; 94 Suppl 2: S135, 2006 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29644694
10.
Int J Fertil Womens Med ; 49(2): 91-6, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15188836

RESUMEN

BACKGROUND: Maternal mortality rates in India are estimated at 560/100,000 live births and postpartum hemorrhage (PPH) accounts for 35-56% of these deaths. Given that 50% of births in rural India occur at home, oral Misoprostol administered by minimally trained midwives may be an effective uterotonic agent for preventing PPH when the use of other uterotonics is not feasible. While the import for testing the effectiveness of this intervention may be readily obvious, the elements essential for the conduct of a scientific study in rural areas served by indigenous health workers may not be as evident. METHODS: We present the design as well as the preparation and development of an ongoing NICHD sponsored U.S.-Indian collaborative randomized, placebo-controlled, clinical trial (RCT) conducted in four Primary Health Center areas of Belgaum District, Karnataka, India. The primary goal of the trial is to assess the effectiveness of Misoprostol 600 microg orally in reducing the incidence of acute PPH (> or = 500 mL) in women delivering at home or in neighboring sub-centers. 1600 pregnant women will be randomized to receive Misoprostol or placebo immediately post-delivery of the infant. However, beyond testing the scientific merit of the RCT, this study also tests the feasibility of having indigenous midwives regularly using Misoprostol in rural areas as well as the willingness of these communities to accept this intervention. In addition, this paper also explores the international and community collaborations necessary for the conduct of this study. FINDINGS: It is necessary to have several critical elements in place, including international collaboration between the Indian and US research sites, funding through a private/public collaboration and trained scientists, as well as commitment from the community for the successful conduct of such a study. In the development and implementation of a RCT, careful attention must be paid to the training of field personnel involved in the delivery process and developing a data collection and monitoring system to ensure that information gathered is valid. CONCLUSIONS: A joint U.S.-Indian collaboration to test the efficacy and the feasibility of an innovative method to reduce PPH can serve as collaborative model to develop additional interventions to improve maternal mortality and morbidity. If Misoprostol is shown to be sufficiently safe and efficacious in the prevention of PPH, the appropriate government agencies will be encouraged to make the drug available to midwives (ANMs) and rurally located physicians for whom parenteral medications are either not permitted or impractical and/or unavailable. Such a project can serve as a model applicable to rural settings throughout the developing world for improving delivery practices and reducing maternal mortality and morbidity. These are important public health concerns in India and other developing nations.


Asunto(s)
Cooperación Internacional , Partería , Misoprostol/uso terapéutico , Oxitócicos/uso terapéutico , Hemorragia Posparto , Salud Rural , Estudios de Factibilidad , Femenino , Directrices para la Planificación en Salud , Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , India , Servicios de Salud Materna/normas , Mortalidad Materna , Partería/educación , Partería/normas , Hemorragia Posparto/tratamiento farmacológico , Hemorragia Posparto/prevención & control , Embarazo , Estados Unidos
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