Stress and Coping Mechanism of Infertile Women Attending Infertility Clinic in Kathmandu

INTRODUCTION: Many women face problems related to infertility in various aspects of their life. Also, it is not comfortable to discuss on this issue. Because of this, the feelings and distress faced by women may not come out and the pent up emotions may lead to different stress related problems.   MATERIAL AND METHODS : A descriptive research design was adopted to assess the stress and coping mechanism of infertile women attending infertility clinic in Kathmandu Nepal. The study was conducted from October 2011 to January 2013. Purposive sampling technique was used and sample size was 100. Data was collected through semi- structured interview using; 'Perceived Stress Scale'(PSS) and 'Coping Check List' (CCL).   RESULTS: Regarding stress level of respondents, 40% were at very high level of stress and 35% with high level of stress. High level stress was found among the age group of 21-30 years. In relation to level of stress and coping strategies, 54.17% respondents with high stress used religious coping strategies, 50% of the respondents with very high stress also used religious coping, followed by 40% emotional coping and 37.5% problem focused coping and seeking social support strategies to overcome the stress.   CONCLUSION: It can be concluded that the  almost more than half of the respondents were under high level of stress and mostly were those who are under  treatment for more than 1-3 yrs of duration. The study also concluded that the higher the age the respondents were more stressed due to the infertility. It was also found that most of the respondents used religious coping as well as emotional focused coping during the stressful period.DOI: http://dx.doi.org/10.3126/jucms.v2i4.12039Journal of Universal College of Medical Sciences (2014) Vol.02 No.04 Issue 08Page: 24-28

Factors influencing endometrial thickness in postmenopausal women

Background:

Cut-off values for endometrial thickness (ET) in asymptomatic postmenopausal woman have been standardized. However, there are no comprehensive studies to document how various factors can influence the ET after the age of menopause.

Aim:

To study the various factors influencing the ET in postmenopausal women.

Subjects and Methods:

This was a prospective observational study. A total of 110 postmenopausal women underwent detailed history taking, clinical examination, and transvaginal scan for uterine volume and ovarian volume. The volumes were calculated by using ellipsoid formula: Width × thickness × height × 0.523. The variation in ET with respect to the influencing factors such as age, duration of menopause, parity, body mass index (BMI), medical illness like diabetes/hypertension, drugs like tamoxifen, presence of myoma, uterine volume, ovarian volume, and serum estradiol (in selected patients) were measured. Descriptive analysis was performed using SPSS software (version 16, Chicago II, USA) to obtain mean, standard deviation (SD), 95% confidence intervals (CIs) and inter quartile ranges. Comparison of means was carried out using analysis of variance.

Results:

The mean (SD) age of the patients was 55.4 (6.91) years (95% CI, 54.1, 56.7). The mean (SD) age at menopause was 47.95 (3.90) years (95% CI, 47.2, 48.7) and the mean (SD) duration of menopause was 7.27 (6.65) years (95% CI, 6.01, 8.53). The mean (SD) ET was 3.8 (2.3) mm (95% CI, 3.36, 4.23). Medical illness like diabetes and hypertension did not alter the ET. ET increased as BMI increased and it was statistically significant. The presence of myoma increased uterine volume significantly and was associated with thick endometrial stripe. Similarly, whenever the ovaries were visualized and as the ovarian volume increased, there was an increase in ET. When ET was > 4 mm (n = 37), they were offered endocel, of which 16 agreed to undergo the procedure. None were found to have endometrial cancer.

Conclusion:

This study suggests that parity, BMI, presence of myoma, tamoxifen usage, uterine volume, ovarian volume and serum estradiol influence the ET in postmenopausal women.

Severe rhizomelic chondrodysplasia punctata in a fetus due to maternal mixed connective tissue disorder

Maternal systemic lupus erythematosus and autoimmune diseases have been extremely rarely reported to cause rhizomelic chondrodysplasia punctata. We report on a fetus aborted spontaneously at 21 weeks of gestation due to complications of maternal mixed connective tissue disorder. The fetus had micrognathia, a depressed nasal bridge, flat nose, long philtrum, short columella and rhizomelia. Radiographic study showed stippling of carpal and tarsal bones, short humeri and coronal clefts in the vertebrae. Ossification centers were present at the lower end of the femora and upper end of the tibiae.

Unusual facial cleft in Fryns syndrome: defect of stomodeum?

Unusual facial cleft in Fryns syndrome: defect of stomodeum?: We report on a fetus with Fryns syndrome. The facial cleft was unusual. There was bilateral cleft lip with cleft palate. The intermaxillary segment was connected through the base of a mound in the midline to the lower lip. We believe this is an atypical facial cleft in Fryns syndrome and likely represents a defective stomodeum.

Preterm birth: mode of delivery and neonatal outcome

To evaluate the perinatal outcome of premature babies according to the mode of delivery. A total of 113 pregnant women and 124 neonates who delivered from 30 to 35 weeks of gestation were enrolled and outcomes of 70 neonates born vaginally were compared to 54 neonates born by caesarean. Neonatal mortality rate was 20 percent for infants in caesarean group as compared to 10 percent for vaginal group. There was no significant difference in the neonatal morbidity among both the groups. Caesarean delivery cannot be routinely recommended, unless there are obstetric indications.

Erythrocyte indicators of oxidative stress in gestational diabetes

Foetuses born to mothers with gestational diabetes are at increased risk of developing respiratory distress, foetal macrosomia, foetal anomalies and platelet hyperaggregability. High blood glucose level induces oxidative stress and decreases antioxidant defences. The present study discusses the possibility of lipid peroxidation and protein oxidation in both maternal and foetal erythrocytes as an indicator of oxygen radical activity. The level of lipid peroxidation and protein oxidation in erythrocytes was estimated in 20 mothers with gestational diabetes and their newborns. The maternal age varied between 19 and 42 y and foetal age ranged between 34 and 39 weeks. The proteolytic activities in the erythrocyte lysates obtained from mothers with gestational diabetes and their newborns were significantly greater [(mean +/- SD) 24.41 +/- 9.05 and 16.70 +/- 3.36 microM of amino groups/g haemoglobin, n = 20, respectively] than those from control group (10.18 +/- 4.84 and 14.64 +/- 6.21 microM amino groups/g haemoglobin, n = 15, respectively; p < 0.05 in both cases). Similarly erythrocyte malondialdehyde levels were significantly elevated in babies born to mothers with gestational diabetes (10.11 +/- 2.21 nM/g haemoglobin) when compared to controls (6.8 +/- 3.75 nM/g haemoglobin) (p < 0.05). In the erythrocytes of mothers with gestational diabetes, malondialdehyde levels correlated significantly with glycated haemoglobin levels (p < 0.01). The results of this study indicate that the oxidative stress induced by gestational diabetes manifests as increased lipid peroxidation and protein oxidative damage in the erythrocytes of both mothers with gestational diabetes and their newborn infants.

Symphysis fundal height curve--a simple method for foetal growth assessment

In this prospective study, symphisis fundal height (SFH) was measured in centimeters at different weeks of gestation from 20th week onwards in 100 healthy women with uncomplicated pregnancies. A curve was plotted based on the mean SFH measurements with standard deviation. Readings were also arranged on the basis of 10th, 50th and 90th percentiles. Percentile curve was similar to the curve based on mean with standard deviation. The rate of growth was 1 cm per week between 20-32 weeks. Thereafter, there was a slight fall in the rate of growth. SFH measurement is a simple method of foetal growth assessment which can be utilized even by paramedical workers to screen for small for gestational age babies. It is better to have a standard curve derived from the population as there is regional variation.

Energy expenditure and ventilatory responses during Siddhasana--a yogic seated posture

Reports of energy expenditure and ventilatory responses to yogic seated posture of Siddhasana are lacking in literature. Various cardio-ventilatory responses were studied in states of the horizontal supine, chair-sitting and Siddhasana. It was observed that sitting in Siddhasana posture was characterised by greater minute ventilation, larger tidal volume, higher oxygen consumption, greater CO2 elimination, higher heart frequency greater oxygen pulse and lesser as compared with other two postures. These observations suggest that Siddhasana is a mild type of exercise and may have its application in conditions of low cardio-respiratory reserves especially in individuals in whom heavy exercises are contra-indicated.

Energy expenditure and ventilatory responses during Virasana--a yogic standing posture

Energy expenditure and ventilatory responses to yogic standing posture of Virasana were studied on 10 healthy men (25-37 years of age). The results of various responses respectively to the horizontal supine, Chair-sitting and Virasana were: Minute Ventilation (VE) 7.64, 8.61 and 18.67 L/min; Respiratory Frequency (FR) 15.71, 15.70 and 21.45 Breath/min; Tidal Volume (VT) 0.496, 0.544 and 0.827 L/min; Oxygen consumption (VO2) 0.127, 0.234 and 0.573 L/min; Carbondioxide Elimination (VCO2) 0.127, 0.134 and 0.420 L/min; Respiratory Exchange Ratio (RER) 0.58, 0.57 and 0.69; Heart Frequency (FH) 65.2, 74.5 and 104.4 beats/min; Oxygen Pulse (O2P) 3.32, 3.17 and 5.45 ml/beat; Ventilatory Equivalent (VE-EQ) 36.78, 37.12 and 33.85; Multiple of Resting VO2 (METS) 0.96, 1.05 and 2.53 and Metabolic Cost (MC) 1.04, 1.13 and 2.76 Cal/min. Virasana posture was characterised by higher VE, FR, VT, VO2, VCO2, FH and O2P with lesser VE-EQ. The observations suggest that Virasana induces temporarily a hypermetabolic state characterised by enhanced sympathetic nervous system activity which gets inhibited during the adoption of resting supine shavasana posture.

Effect of yoga training on exercise tolerance in adolescents with childhood asthma

Forty six young asthmatics with a history of childhood asthma were admitted for yoga training. Effects of training on resting pulmonary functions, exercise capacity, and exercise-induced bronchial lability index were measured. Yoga training resulted in a significant increase in pulmonary function and exercise capacity. A follow-up study spanning two years showed a good response with reduced symptom score and drug requirements in these subjects. It is concluded that yoga training is beneficial for young asthmatics.

Severe abruptio placentae--still unpreventable

The management of abruptio placentae remains a problem, despite advances in medical science. This study analyses severity of abruption, resultant morbidity, and maternal and fetal mortality in 105 cases. Among the contributory factors, hypertension (44%) and grand multiparity (24%) were common. There was no maternal death among these cases, mainly because of liberal use of blood transfusion, prompt delivery, and careful fetal monitoring, but perinatal mortality remained high (73%). Factors responsible for this high perinatal mortality and its prevention are discussed.