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Sociocultural and behavioral factors are associated with decision to use and the selection of a contraceptive method, continuation of use and reasons for discontinuation of a contraceptive. This paper tries to distinctly outline the determinants of discontinuation of the intrauterine contraceptive device (IUCD), especially in the Indian context. Data on medical reasons for discontinuation are available through clinical trials. However, sociodemographic studies provide one with a wider spectrum to analyze the factors associated with the discontinuation of IUCDs. Information on service providers can be used to improve the quality of family planning services in the country. In India, a thorough review of birth spacing methods, especially the IUCD, is needed since the surveys show a high rate of discontinuation. The emphasis in this paper is upon compilation of reasons for discontinuation of the IUCD and research thereof. The review of the literature is directed towards giving a new direction to assessment of family planning programs, especially in India where population control is largely dependent upon permanent methods. Delineation of factors is important to improve the family planning program. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of sublingual (S/L), oral and vaginal routes of misoprostol administration for cervical priming before suction evacuation (SE) under local anaesthesia. Methods: In a prospective randomised clinical trial, 200 women in the first trimester of pregnancy were randomised into four groups of 50 each. Patients in control group did not receive any medication before SE while other treatment groups received 400 microg of misoprostol three hours prior to SE either by sublingual/oral or by vaginal route. Main outcome measure was basal cervical dilatation while the secondary outcome measures were operative blood loss, time duration of surgery, patient satisfaction, pain perception and adverse effects. Results: Sublingual group had a higher dilatation (9.9 +/- 2.1 mm; P < 0.001) and lower time duration of surgery (3.6 +/- 1.0 min; P < 0.01) as compared to oral (8.2 +/- 2.6 mm, 4.9 +/- 1.7 min) or vaginal routes (7.6 +/- 2.6 mm, 5.2 +/- 1.8 min). Mean pain score of the sublingual group was significantly lower (2.4 + 1.3; P < 0.001) as compared to oral (3.4 +/- 1.3) or vaginal routes (3.6 +/- 1.2). Patient acceptability was higher for sublingual (53 of 150) and oral routes (62 of 150) as compared to vaginal (35 of 150) route. Conclusion: Sublingual route was significantly more effective than oral or vaginal administration of misoprostol for cervical dilatation. To the best of our knowledge, this is the first study to simultaneously compare the efficacy of sublingual, oral and vaginal routes of misoprostol for cervical priming before SE. [ABSTRACT FROM AUTHOR]

To increase the sensitivity and reliability of immunodiagnostic assay for direct detection of chlamydial genital infection, we developed monoclonal antibodies (MAbs) that recognize the major outer membrane protein (MOMP) of all serovars of Chlamydia trachomatis. ELISA and dot-ELISA were used to select hybridomas that produced anti-C. trachomatis MAbs. Four MAb clones--A12.6, B serogroup specific; C1.5, C serogroup specific; G10.2, species specific; and E9.1, genus specific--were characterized by SDS-PAGE and immunoblot and were reactive with MOMP of C. trachomatis. The species-specific MAb G10.2 had a molecular mass of 40 kDa. The reactivity of developed species-specific monoclonal antibody for detection of C. trachomatis antigen in endocervical specimens was compared with the commercially available DFA test. We found that developed antibody had high sensitivity (97.22%) compared to DFA for detection of chlamydial infection in endocervical samples. It can be used as a reliable method in laboratories for the diagnosis of chlamydial infections. [ABSTRACT FROM AUTHOR]

Most of the studies on 60-kDa and 10-kDa chlamydial heat shock proteins (HSPs) to date have been carried out with blood lymphocytes or serum antibody responses, which do not provide a clear picture of the actual pathogenesis as they do not differentiate primary infection from recurrent infection. Thus, in the present study induction of the immune response was evaluated by studying lymphoproliferation of both cervical and peripheral lymphocytes to synthetic peptides of cHSP60, cHSP10 and major outer membrane protein (MOMP) antigen. In addition, cervical antibody prevalence to MOMP antigen, cHSP60 and cHSP10 and cytokine levels in cervical washes was also determined. Positive proliferative responses of cervical lymphocytes to cHSP10 peptide were significantly higher ( P < 0·05) in women with recurrent infections and that to MOMP antigen were significantly higher in primary infection. On proliferation of PBMCs with the above antigens, no significant difference was observed between primary and recurrent infection. Prevalence of cervical IgG and IgA antibodies to Chlamydia trachomatis was significantly higher ( P < 0·05) during primary infection than recurrent infections. In contrast, prevalence of IgG and IgA antibodies to cHSP10 and IgG antibodies to cHSP60 was higher during recurrent infections than primary infections. Interferon (IFN)-γ levels were significantly higher in cervical washes of women with recurrent infection and correlated strongly with cHSP60 antibody titres. Our data thus suggest that mucosal responses are more appropriate in understanding the pathogenesis of chlamydial infection and IFN-γ could be involved in the modulation of immune responses towards chlamydial infection directly, by causing acute inflammation, or indirectly through modulation of HSP expression. [ABSTRACT FROM AUTHOR]

Objective: To evaluate by ultrasonography, the lower uterine segment thickness of women with a previous cesarean delivery and determine a critical thickness above which safe vaginal delivery is predictable. Methods: A prospective observational study of 71 antenatal women with previous cesarean delivery and 50 controls was carried out. Transabdominal and transvaginal ultrasonography were used in both groups to evaluate lower uterine segment thickness. The obstetric outcome in patients with successful vaginal birth and intraoperative findings in women undergoing cesarean delivery were correlated with lower segment thickness. Results: The overall vaginal birth after cesarean section (VBAC) was 46.5% and VBAC success rate was 63.5%, the incidence of dehiscence was 2.82%, and there were no uterine ruptures. There was a 96% correlation between transabdominal ultrasonography with magnification and transvaginal ultrasonography. The critical cutoff value for safe lower segment thickness, derived from the receiver operator characteristic curve, was 2.5 mm. Conclusion: Ultrasonographic evaluation permits better assessment of the risk of scar complication intrapartum, and could allow for safer management of delivery. [ABSTRACT FROM AUTHOR]

Objectives: To screen and treat chlamydial infection in pregnant women in order to assess the effects of therapeutic intervention on the outcome of Chlamydia trachomatis-infected pregnancy. Methods: Enrolled in the study were 350 women in the first to third trimesters of pregnancy. Endocervical swabs were collected for C. trachomatis diagnosis by DFA and PCR. A few STD infections, viz.: Neisseria gonorrhoeae, Candida spp., bacterial vaginosis, Trichomonas vaginalis and Treponema pallidum were ruled out. After excluding 22 patients infected with other sexually transmitted infections, a cohort of 328 pregnant women comprised the study population. Anti-chlamydial treatment (viz.: oral therapy with erythromycin stearate, 500 mg 4 times daily for 7 days) was given to 17 women (group I) and their partners. Fifteen patients of group I were retested by DFA and PCR assay for C. trachomatis infection 2 weeks following therapy. Other Chlamydia-positive patients (n=42) who were lost to follow-up were classified as untreated positive cases (group II) while group III included C. trachomatis negative cases (n=269). Data on obstetric outcome were recorded in a total of 164 cases. Statistical comparison of the data were done using the χ2-test and means were compared using Student''s t-test. Results: Among the 350 pregnant women enrolled initially for the study, C. trachomatis positivity was found to be 18.8% (n=66) in the endocervix by DFA and PCR assay. Co-infection with Candida spp., bacterial vaginosis, T. vaginalis and T. pallidum was 2.0%, 1.7%, 1.7% and 0.5%, respectively. None of the pregnant women was infected with N. gonorrhoeae. Pregnant women at an increased risk of chlamydial infection included those who had multiple births and were in second trimester of pregnancy. Fifteen patients of group I became Chlamydia-negative following treatment. Data on obstetric outcome were recorded in 11, 26 and 127 patients of groups I, II and III, respectively. The mean duration of gestation for premature deliveries was found to be significantly higher in group I in comparison with group II [35.5 vs. 33.1 weeks (P<0.05)], thereby showing an improved effect of treatment on pregnancy outcome. The mean of low birth weight births was higher in group I compared with group II (2200.0 vs. 2113.3 g), however, this was statistically non-significant. Stillbirths were significantly higher among group II in comparison with group III [11.5% vs. 4.7% (χ2=1.79; P<0.5)]. No stillbirths were recorded in patients who had taken anti-chlamydial treatment. Conclusions: Our findings suggest that routine screening and treatment of C. trachomatis infection in pregnant women, especially those in high risk groups, should be mandatory to reduce the adverse effects on obstetric outcome. [Copyright &y& Elsevier]

Presents a letter to the editor about a case of spectinomycin resistant Neisseria gonorrhoeae Isolate in New Delhi, India.

An imbalance between angiogenic and anti-angiogenic factors has been hypothesized to have a major role in hypertensive disorders during pregnancy, which account for significant morbidity and mortality for the mother and neonate in India. There is a paucity of information on soluble vascular endothelial growth factor receptor-1 (sVEGFR-1, anti-angiogenic factor) concentrations in different subgroups of pregnancy-induced hypertensive (PIH) disorders particularly in gestational hypertension (GH) and eclampsia during pregnancy. This cross-sectional study was conducted in order to test the above hypothesis and to get more insight into the role of sVEGFR-1 in these disorders. The concentrations of sVEGFR-1 in serum were measured from women with 22-39 weeks of gestation in the control (n=180) and gestationally matched hypertensive (n=360) pregnant mothers by ELISA. These sVEGFR-1 concentrations were found to be significantly elevated in the study groups as the severity of disease increases from GH to eclampsia (24 076 pg ml−1; 42 000 pg ml−1, P=0.0001) as compared with controls (3360 pg ml−1). According to Receiver operating characteristic curve analysis, at 34 weeks, the concentration cutoff, sensitivity, specificity for sVEGFR-1 in differentiating GH, pre-eclampsia and eclampsia were 7619.2 pg ml−1, 75%, 75%; 16 726.6 pg ml−1, 89.1%, 89.1%; 26 222.8 pg ml−1, 91.6%, 91.6%, respectively. The gradual upregulation of sVEGFR-1 concentrations in these groups may be due to its intimate involvement in the etiopathogenesis of severity of various hypertensive disorders by antagonizing effects of VEGF during the placental development. These observations indicate the clinical utility of sVEGFR-1 in differentiating PIH disorders and also will be helpful for the evaluation of increased monitoring system for successful pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Risk of malformations in children of women with epilepsy -- 5 years data from prospective, control study. Methods: All pregnant women, including women during preconception, who attended our hospital during years 2002-2007 were screened for women with history of epilepsy (WWE) and were enrolled for prospective study after obtaining due consent. Pregnant women, including women during preconception, who had neither history of epilepsy nor taking any anti epileptic drug (AED), but matched for age, parity and period of gestation were enrolled as control group. All women were given 5 mg of folic acid daily after enrolment, if not taking already, Women were followed up every trimester till delivery and children were followed up to early neonatal period. Details of malformations were noted in both groups. Results: 2.75, 598 pregnant women, attending our hospital, were screened during years 2002-2007 for history of epilepsy or intake of AED. There were 530 pregnant women with epilepsy (0.2%) and 8 other women were taking AED for reasons other than epilepsy. 8 WWE were excluded from study because of severe co morbid conditions or induced abortion for personal reasons other than fetal status. 522 WWE and 474 controls were recruited in the study. Outcome was known in 424 WWE and 387 controls. There were 395 live births (93.5%) in WWE and 378 (97.7%) in control group. Congenital malformations were seen in 13 children of WWE (3.0%) and in 7 children of control group (1.8%) and the difference was not statistically significant (P value 0.249). There is no significant difference in the type of malformations between the groups. AED intake as mono therapy or no AED intake during pregnancy in WWE showed no significant difference in the risk of malformations in children of WWE (Odds ratio 1.20 and 95% C.I. 0.91-1.57). But, intake of AED as poly therapy increased the risk of malformations (10.4% Odds ratio 4.87 95% C.I. 1.36-17.41). Use of carbamazapine was not associated with any malformation in the present study. Conclusions: More than 90% women with epilepsy delivered normal children. Risk of malformations did not show any significant increase over controls. AED monotherapy did not increase risk of malformations. Long duration of epilepsy and Polytherapy with multiple AED significantly increased risk of malformations in WWE. Use of Carbamazepine did not result in any malformation in the present study. [ABSTRACT FROM AUTHOR]

Objective: To assess the risk of abortions/stillbirths in women with epilepsy Methods: in a prospective, control study, pregnant women with epilepsy (WWE) and control group of pregnant women, who had neither history of epilepsy nor history of intake of antiepileptic drugs, but matched for age, parity and period of gestation were followed up till delivery to assess the risk of abortions/stillbirths. Women with severe comorbid conditions or women, who opted for medical termination of pregnancy for reasons unrelated to status of fetus were excluded from study. Results: 424 WWE and 387 controls were followed up till delivery. 29 WWE [6.8%] and 9 women in control group [2.3%] had abortion or stillbirth [P value 0.01]. Presence of generalized tonic clonic seizures during first trimester [14.7% vs 6.2% P value 0.05] and polytherapy with antiepileptic drugs [14.5% vs 5.4% P value 0.03] increased the risk of abortions/stillbirths in WWE. Use of antiepileptic drugs as monotherapy did not increase the risk of abortions or stillbirths in WWE. Conclusions: WWE had three times increased risk of abortions or stillbirths as compared to control group. Presence of generalized tonic clonic seizures during first trimester and use of polytherapy increased the risk in WWE, but antiepileptic drug use as monotherapy did not increase the risk of abortion or stillbirth in WWE. [ABSTRACT FROM AUTHOR]

With 2 figures and 2 tables Apoptosis plays a central role in organ development, homeostasis and immune defence in multicellular organisms and is strictly controlled in part by members of Bcl-2 family. The Bcl-2 is a pro-survival molecule identified through its involvement in B-cell lymphomas. The aim of the study was to evaluate the incidence of apoptosis in the human placenta at different stages of pregnancy and to correlate it further with Bcl-2 expression. A total of 96 placental samples from first trimester, mid-trimester and uncomplicated term pregnancies were collected ( n = 32 + 32 + 32). M30 cyto death monoclonal antibody was used to identify apoptotic cells. The apoptosis index of first trimester placentae was 2.33 ± 1.70, mid- trimester was 1.77 ± 1.36 and term placenta was 1.15 ± 0.21. Bcl-2 protein was found immunolocalized in the cytoplasm of syncytiotrophoblast. Apoptosis index was significantly reduced in term cases as compared with first trimester ( P < 0.002) and mid-trimester placentae ( P = 0.01). On the contrary, Bcl-2 expression was significantly higher at term cases than in first trimester ( P < 0.0001) and mid-trimester cases ( P < 0.001). The present study divulges the importance of apoptosis in permitting normal physiological turnover of villous trophoblast and also exhibits the contribution of bcl-2 in maintaining syncytial integrity throughout normal pregnancy. [ABSTRACT FROM AUTHOR]

Abstract: Little is known about genital mucosal immune response to chlamydial infection in women with or without sequelae (Chlamydia positive women with or without fertility disorders as infertility and multiple spontaneous abortions). Cervical lymphocytes were stimulated with chlamydial EBs and cytokine secretion was determined by ELISA, RT-PCR and ELISPOT assays. Stimulated cervical cells from women with fertility disorders (FD) secrete significantly (P <0.05) higher levels of IL-1β, IL-6, IL-8 and IL-10 and cells from fertile women secrete significantly higher levels of IL-12 and IFN-γ compared to other groups. RT-PCR analysis showed similar results for IFN-γ and IL-12. For IL-10 and IL-4, mRNA expression levels were significantly higher (P <0.05) in cells obtained from women with FD compared to other groups. Results for ELISPOT assay were similar as those of RT-PCR. The results suggest that cytokine secretion profile of cervical cells may decide whether infection does not hamper fertility or will develop fertility disorder. [Copyright &y& Elsevier]

The mobilization of myeloid dendritic cells (mDCs) and plasmacytoid dendritic cells (pDCs) to the cervix during chlamydial infection is not fully understood, and the role of these cells in immunopathogenesis is largely unknown. As an effective vaccine to control chlamydial infection is currently unavailable, understanding the regulation of the local immune response becomes a necessity. Therefore, mDC and pDC populations were analysed in peripheral blood and cervical samples of controls and Chlamydia-positive women, with or without mucopurulent cervicitis (MPC). Cervical cytokines and C-reactive protein levels in serum were quantified by ELISA and the chlamydial infectious load by culture. Chlamydia trachomatis infection mobilized both mDCs and pDCs to the cervical mucosa. pDCs were recruited more often in women with MPC (p <0.05) and they correlated significantly with the chlamydial load, C-reactive protein levels and cervical interleukin-8 (IL-8) levels. Upregulation of surface expression of co-stimulatory molecules (CD80, CD83 and CD86) on cervical mDCs and pDCs was observed during chlamydial infection but was significant only for mDCs. Significantly higher levels of IL-1β, IL-6 and IL-8 were observed in Chlamydia-positive women with MPC; however, after therapy, IL-8 levels decreased significantly. Median numbers of mDCs after therapy were significantly higher in the cervix and blood of infected women as compared to the numbers of pDCs, which were found to be lower in the cervix after therapy. These results thus suggest that during chlamydial infection, both mDCs and pDCs are recruited to the cervix, but their number and possible immunological functions may differ with the pathological condition. pDCs were associated more often with MPC and inflammatory factors, suggesting that they may possibly be involved in the immunopathogenesis of infections due to Chlamydia. [ABSTRACT FROM AUTHOR]

Human genital infection caused by C hlamydia trachomatis is thought to be immunologically mediated, resulting in local recruitment of lymphocyte subsets and inducing the production of cytokines. Little information is available about the role of lymphocyte recruitment and the regulation of cytokine production in the genital tract of C. trachomatis positive infertile women. We have evaluated the recruitment of lymphocyte subsets in the genital tract and production of Th1/Th2 cytokines in cervical secretions and laparoscopic specimens from the fallopian tubes of C. trachomatis positive infertile women ( n = 17) and compared them with controls, viz. C. trachomatis negative infertile women ( n = 20) using ELISA and flow cytometry. None of these patients were found to be infected either with Candida sps., bacterial vaginosis, Trichomonas vaginalis, Neisseria gonorrhoeae, Mycoplasma hominis or Ureaplasma urealyticum in the cervix. Flow cytometric analysis of cervical secretions in Chlamydia positive women revealed recruitment of both CD4 and CD8 lymphocytes to the genital tract was up-regulated and a variation in the production rates of different cytokines in cervical secretions and fallopian tube was observed. We found that the immune responses in cervical secretions were of Th0 type, since all the analysed cytokines, viz. IFN- γ, TNF- α, IL-10 and IL-12 were up-regulated. As, both CD4 and CD8 cells contribute to the production of IFN- γ and IL-10, these results suggest that along with CD4 cells, CD8 lymphocytes also may be important for local regulation of Th1/Th2 responses in the genital tract during C. trachomatis infection. [ABSTRACT FROM AUTHOR]