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Clomiphene citrate (CC) has been the drug of choice for the treatment of anovulatory subfertility in women with polycystic ovarian syndrome (PCOS) for a long time. Despite high ovulation rate of CC, its pregnancy rate is low. Letrozole, an aromatase inhibitor has been considered as an alternative of CC but its effectiveness is yet controversial. Our aim was to compare the efficacy and side effects of Letrozole over CC. This randomized control clinical trial was conducted in Diabetic Association Medical College and Hospital, Faridpur, Bangladesh from January 2018 to December 2019. A total of 160 women diagnosed as PCOS by Rotterdam criteria seeking treatment of subfertility were included in the study. Participants were randomly divided into two groups. Group A got Letrozole and Group B got CC as treatment. Transvaginal ultrasonogram (TVS) was performed on 12 to 13th day of the cycle to see the details of the follicles and the endometrium. The demographic information of the participants and the side effects of the drugs were recorded. Successful pregnancies were followed up for 12 weeks. Ovulation rate was almost similar among the participants of both of the groups. But monofo licular development and pregnancy rate were significantly higher among the Letrozole group (p = 0.004 and p = 0.008 respectively). Multifo licular development, multiple pregnancy, and abortion rate were significantly higher in the CC group. Patients who took Letrozole had significantly higher endometrial thickness than CC group. Both of the groups reported relatively similar incidence of side effects. Due to the higher pregnancy rate and lower incidence of abortion or multiple pregnancy, Letrozole can be an effective alternative to CC for the treatment of anovulatory subfertility of the PCOS patients. Faridpur Med. Coll. J. 2020;15(2): 69-73

Postmenopausal estrogen deprived state causes various types of vasomotor symptoms, urogenital symptoms, and long-term health hazards. Among the postmenopausal women, this study was aimed to determine the prevalence of urogenital complaints, epidemiological studies relating with recurrent UTI, and to observe the changing pattern of bacterial resistance to commonly used antibiotics for UTI. This cross-sectional study was conducted in Faridpur, Bangladesh, from January-December 2019. Total 244 postmenopausal women attending the clinic with various complaints were selected as the study population. In-depth history, clinical examination, and relevant investigations were done. Urinary culture and sensitivity were done to isolate the causative organism and to identify the current antibiotic resistance and sensitivity pattern. Among the study population, 94.7% had urinary complaints as their first concern. However, upon query, 85.2% of them revealed that they had other postmenopausal syndromes. Among the study population, 43.4% had recurrent UTI. Burning micturition was the most common (79.2%) urinary complaint. On urinary culture, 57.5% cases had no growth; among the rest, the most common organism was E. coli (19.8%) followed by Proteus (12.3%) and Klebsiella (10.4%). In Proteus and Klebsiella isolates, a high number of resistances for Nitrofurantoin have been found (75% and 66.7% accordingly). Urinary complaints are the most common presentation of postmenopausal women attending the gynecology clinic. They are seeking treatment not to improve the quality of life with hormone replacement therapy (HRT), but getting rid of the pain of recurrent UTI. Faridpur Med. Coll. J. 2020;15(2): 85-91

Antimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. To better understand routes of AMR transmission to newborns, we aimed to characterize the frequency of and risk factors for AMR colonization of mothers and newborns during hospitalization for delivery. We enrolled 177 pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh, during February-October 2020. We collected vaginal and rectal swabs from mothers on presentation and after delivery as well as rectal swabs from newborns. We also collected swabs from the hospital environment proximal to the patients. Swabs were plated on chromogenic agars selective for extended-spectrum-beta-lactamase producing organisms (ESBL) and carbapenem-resistant organisms (CRO). We performed univariable and multivariable analyses to determine factors associated with ESBL/CRO colonization. Prior to delivery, 17% of mothers had vaginal colonization and 71% had rectal colonization with ESBLs; 4% had vaginal colonization and 13% had rectal colonization with CROs. Seventy-nine percent of women underwent cesarean deliveries (C-section). Ninety-eight percent of women received prophylactic antibiotics during hospitalization. Following delivery, nearly 90% of mothers and newborns were colonized with ESBLs and over 70% with CROs. Of the 290 environmental samples, 77% were positive for ESBLs, and 69% were positive for CROs. Maternal and newborn colonization at discharge were both associated with C-section (RR for maternal 1.4; 95% CI 1.0-1.8 and newborn 1.3; 95% CI 1.1-1.7). Facility-based deliveries increase exposure to AMR organisms, likely driven by intense use of antibiotics and frequent C-sections. Greater attention should be given to the use of perinatal antibiotics, indications for C-sections, and infection prevention practices to reduce the high prevalence of colonization with antibiotic resistant bacteria.

It is commonly believed that if the first child of a mother is born by normal vaginal delivery, all the subsequent deliveries will follow the same. As a result, such multiparous mothers often neglect routine antenatal check ups and intranatal care which may cause poor delivery outcome. For these reasons, attention should be given to analyze the indication of caesarean section (CS) in women who had history of previous vaginal delivery. Our objective was to know the indications and outcome of CS in multigravid women having a child previously delivered vaginally. This observational cross-sectional study was carried out in the Department of Obstetrics and Gynaecology in Diabetic Association Medical College Hospital, Faridpur. One hundred and ten multigravid women who had undergone elective as well as emergency CS for various indications were included in this study. Most common indication of CS was fetal distress (33.64%). Others were obstructed labour (10.9%), breech presentation (10.9%), and pre-eclampsia (9.09%). In the postpartum period, 75.5% patients were healthy. Others developed sepsis (10.9%) and URTI (8.2%). Most of the babies (95.5%) were alive. Understanding these insights may help both the mother and the caregiver an idea about the associated risks and what actions should be taken for a safe delivery outcome. Faridpur Med. Coll. J. Jul 2019;14(2): 86-89

Peripartum cardiomyopathy (PPCM) is a rare, life-threatening heart disease of unclear origin and is characterized by heart failure of sudden onset between the final weeks of pregnancy and 5 months after delivery. Incidence varies over geography and ethnicity. Risk factors include advanced maternal age, multiparity, preeclampsia, multiple pregnancy, anaemia, and so many other causes. PPCM is often not diagnosed until late in its course, because of its clinical manifestations are highly variable and a heart disease may not be suspected at first. Frequent presenting symptoms of PPCM, such as lassitude, shortness of breath on mild exertion and coughing are often initially misinterpreted as evidence of pneumonia or as physiological accompaniments of pregnancy and delivery. The clinical picture of PPCM corresponds to a dilated cardiomyopathy (DCM) with signs of severe heart failure. Medical management is similar to other causes of systolic heart failure, except for the ACE inhibitors and angiotensin receptor blockers are avoided in pregnancy. As there are lots of physiological changes during pregnancy and immediately after delivery, it is usually difficult to measure PPCM effectively. Complications include cardiac arrhythmia, thromboembolism, and refractory heart failure. Maternal deaths are not uncommon. Recently the role of abnormal prolactin metabolism and resulting myocardial toxicity have been explored and bromocriptine has shown promise as a potential treatment option. Faridpur Med. Coll. J. Jul 2018;13(2): 93-96

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder responsible for subfertility in young women. The aim of the study was to compare the efficacy of Letrozole over Clomiphene citrate (CC) for ovulation induction in patients with PCOS. It was a prospective randomized trial in a private practice setting. The study period was 3 years, which includes 240 sub fertile patients with PCOS. Patients were divided into two groups. Group-A: 120 patients got Letrozole (2.5 mg) tab, 2 tabs once daily from D2-D6 for 3 cycles. Group-B: 120 patients took tab. Clomiphene citrate (50mg), 2 tabs once daily from D2-D6 for 3 cycles. Trans-vaginal ultrasound was done on D12-D13 to document number of follicles, measurement of dominant follicle and endometrial thickness. Ovulation and pregnancy rate was measured. Results showed that Letrozole have significantly better effect on endometrial thickness (Let 9.2 mm vs CC 8.1mm) and pregnancy rate (Let 44% vs CC 24%). In CC, multiple follicles were found (CC 44% vs Let 30%). Ovulation occurred in 65% with Letrozole group and 64% in CC group without a significant statistical difference. The study concluded that Letrozole have better effect for induction of ovulation in PCOS patient in comparison to CC. Faridpur Med. Coll. J. Jul 2018;13(2): 78-81

Female genital fistula is a serious medical condition in which a perforation develops most commonly between bladder and vagina (VVF). Although the majority of genitourinary fistulas can be closed surgically, the successful closure depends on many factors. In this retrospective study, the records of 30 women with a mean age of 23.8 years were assessed; 13% of the VVF occurred after abdominal hysterectomy, 67% after Caesarean section, and 20% after difficult vaginal delivery. Six (20%) women had previous repair. The median duration of the VVF was 5.9 months. Of the 30 patients of VVF, 24 were high and 6 were low. Twenty seven had single fistula opening and 3 had two fistulous openings. An abdominal approach was used in 24 patients and vaginal approach in 6 patients. At a mean follow up of 24 months, the VVF was cured in 90% patients. In conclusion, surgical correction of the VVF is more successful when done earlier, probably in the first 6 months. Abdominal approach seems to be more successful technique and recurrent VVF being associated with lower success rates than primary repair. High variety also has good result. Faridpur Med. Coll. J. Jul 2018;13(2): 85-88

Iron deficiency is the most common nutritional deficiency state of women in childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. An effective management is needed to prevent adverse outcomes. Current options for treatment are limited; these include oral iron supplements, which are usually ineffective and poorly tolerated, and whole blood transfusion, which carries an inherent risk, should be avoided during pregnancy. Intravenous ferric carboxymaltose is a new treatment option and it is better tolerated with a good result. The study was designed to assess the safety and efficacy of intravenous ferric carboxymaltose for correction of IDA in pregnant women in third trimester. It was a prospective study; 260 anaemic pregnant women received Injection ferric carboxymaltose, as a total dose of 500-1000 mg between 28 to 36 weeks of pregnancy. Safety was assessed by analyzing adverse drug reactions. Ferric carboxy maltose significantly increased Hb level (p

Background Antimicrobial resistance (AMR) is a global health threat that disproportionately affects low- and middle-income countries. An ongoing study of childhood mortality in Bangladesh revealed a common cause of death among neonates is sepsis from Gram-negative multi-drug-resistant organisms. Methods To ascertain factors leading to neonatal exposure, we enrolled 100 women presenting for delivery to Faridpur Hospital during February-March 2020. We collected vaginal and rectal swabs from mothers on presentation and at least 24 hours after delivery as well as rectal swabs from newborns. Swabs were plated on chromogenic agars selective for extended-spectrum-beta-lactamase-(ESBL) producing organisms and carbapenem-resistant Enterobacteriaceae (CRE). Results Eight-five percent of women underwent C-section. Prior to delivery, ESBL organisms were isolated from 15% of vaginal and 63% of rectal swabs. CRE was detected in 2% of vaginal and 8% of rectal swabs. Following delivery, colonization exceeded 90% (ESBL) and 70% (CRE) in both swab sets. Similarly, among newborns, 85% were colonized with ESBL and 67% with CRE. Maternal AMR colonization on admission did not correlate with income, education, parity, prenatal care, or prior antibiotic use, but was associated with hospitalization during pregnancy (rectal CRE OR 11.9, p< 0.01). Maternal colonization at discharge was positively associated with membrane stripping (vaginal ESBL OR 9.0, p< 0.01; rectal CRE OR 5.0, p=0.03), C-section (OR 4.0-15.4, p< 0.05), and administration of third-generation cephalosporins (OR 5.0-10.1, p< 0.05). Newborn colonization correlated with maternal colonization on discharge (p< 0.005) but not on admission. Among newborns delivered by C-section, there was an 8-9-fold increased risk of ESBL and CRE colonization (p< 0.01). Conclusion These results demonstrate that AMR is driven by nosocomial factors in the perinatal setting, and invasive procedures and perinatal antibiotic use increase risk of AMR colonization. These findings emphasize the urgent need for enhanced antibiotic stewardship and infection prevention and control practices to preserve the benefits of hospital-based deliveries. Disclosures All Authors: No reported disclosures

not available Faridpur Med. Coll. J. Jul 2018;13(2): 56-57

Placenta previa is a life threatening pregnancy complication where placenta partially or completely covers the internal cervical os causing serious adverse consequence for both mother and baby. History of cesarean delivery is an important risk factor for placenta previa. Which have a increased chance of cesarean hysterectomy and bladder injury because of an associated accrete syndrome. The objective of this study is to analyze the outcome of placenta previa with history of cesarean section. This is a prospective study done in Faridpur Medical College Hospital, Bangladesh from 01.01.2013 up to 31.12.14. Total 18 (study group) patients had undergone cesarean delivery with placenta previa and history of previous cesarean section. Among 18 patients maternal age range was 25- 40, parity 1-4, emergency hysterectomy was done in 11, average blood transfusion 2-8 and other morbidity like urinary bladder injury was 4. So we decided to conduct the study to evaluate the frequency of the placenta previa and morbidity related to number of previous cesarean deliveries.Faridpur Med. Coll. J. Jul 2015;10(2): 52-54

Preeclampsia is a pregnancy specific, multi-system disorder of unknown etiology characterized by new onset of elevated blood pressure & proteinuria after 20 weeks of gestation. Globally preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. But the exact pathophysiology is yet to be explored. It was a case control study and was conducted during the period of January 2010 - December 2010 in the department of Obs & Gynae DMCH and dept. of Biochemistry of BSMMU. The main objective of the study was to evaluate the association of serum ferritin and iron in preeclampsia & eclampsia. A total 100 pregnant women were included in this study. Of them 50 preeclamptic or eclamptic, nonanaemic patients not in labour (26-40weeks) were taken as case and 50 normotensive pregnant women were taken as control. Mean Serum ferritin level in case and control group was 100.03 ± 123.52 ?gm/L and 31.53 ± 20.86 ?gm/L respectively which is highly significant (P< 0.001). Out of 50 cases ferritin level was raised in 10 cases (20%). In 80% cases ferritin level was below the cut-off value that is normal or below normal but in 100% of controls had ferritin level below the cut off value. DOI: http://dx.doi.org/10.3329/fmcj.v8i1.16892 Faridpur Med. Coll. J. 2013;8(1): 18-21

Removal of uterine myoma during caesarean section (CS) is not commonly done due to fear of severe haemorrhage which may lead to hysterectomy. Contradicting the previous belief many studies have been showing that myomectomy during caesarean section is a safe procedure without significant increase of risk. The objective of this study is to analyze the safety and clinical outcome of caesarean myomectomy. This is a prospective study carried out in different hospitals of Faridpur district, Bangladesh from 01.01.10 up to 31.12.12. Total 16 (study group) patients had undergone caesarean myomectomy. Operation time, peroperative blood loss, post operative complications and length of hospital staying was compared with that of 32 women (control group) with caesarean section alone. The result shows that peroperative blood loss was average 350±100 ml in study group which is 50 ml more than control group. Operation time was 20 minutes more and length of hospital staying was 1 day more than control group. There was no post partum haemorrhage, no hysterectomy was done at the time of CS and there was no maternal or perinatal mortality. So, caesarean myomectomy is safe and convenient to patient and cost effective without increasing any extra risk. DOI: http://dx.doi.org/10.3329/fmcj.v8i1.16889 Faridpur Med. Coll. J. 2013;8(1): 07-10