OBJECTIVE: To determine the effect of exercise stress test (EST) through brisk walking on the cardiotocogram tracings (CTGs) and the association of the tracings to neonatal outcomes.

METHODOLOGY: This one-group pretest-post test experimental study involved 65 term pregnant women (mean age = 25.94 + 4.66 years) who underwent brisk walking exercise using a motorized treadmill for 30 minutes, following American College of Obstetricians and Gynecologists (ACOG) guidelines for exercise among pregnant women. Pre- and post- walk CTGs were assessed, with presence of post-walk decelerations taken to mean a positive EST. Sensitivity (positive EST in sick / meconium-stained / cord coil babies), specificity (negative EST in well babies), positive predictive value (PPV) (probability of sick / meconium-stained / cord coil babies given positive EST) and negative predictive value (NPV) (probability of well babies given negative EST) were computed.

RESULTS: A significant difference in the proportion of subjects with pre- and post- walk decelerations was noted (p-value = 0.000) wherein 18 subjects (28.13%) without decelerations in the baseline CTG had decelerations in the post-walk CTG. These decelerations were significantly associated to having sick, meconium-stained, or cord coil babies (p-values < 0.05). EST had 80% sensitivity, 75% specificity, 21.1% PPV and 97.8% NPV for detecting sick babies; 75% sensitivity, 77.2% specificity, 31.6% PPV and 95.7% NPV for detecting meconium-stained babies; and 75% sensitivity, 85.7% specificity, 63.2% PPV and 91.3% NPV for detecting nuchal cord.

CONCLUSION: Exercise stress testing is a complementary way of assessing fetal well-being due to manifestation of decelerations in the post-walk CTG which could have gone undetected if only the resting CTG was done. The EST had high sensitivity for detecting sick / meconium-stained / cord coil babies and has the advantage of reinforcing a reassuring fetal condition due to its high NPV for detecting well babies.

Human ; Female ; Adult ; Cardiotocography ; EXERCISE TEST ; Heart Rate, Fetal

In Vitro Fertilization (IVF) is generally accepted as the most effective treatment for infertility. Its success depends on the correct and meticulous implementation of each stage in the procedure. The process of systematically examining embryos is standardized through the use of internationally recognized criteria. On the other hand, the evaluation of oocyte quality continues to be conducted more arbitrarily. A morphologically good quality mature human oocyte is universally described as one that shows a homogeneous cytoplasm, has a single polar body (PB), an approprate zona pellucida (ZP) thickness and a proper perivitelline space (PVS). An abnormality in one or more of these features are very common in IVF cycles and may be related to several factors that are extrinsic and intrinsic to the patient. There has been extensive speculation over whether specific anomalies in the structure of oocytes can suggest a reduced developmental capacity. The most notable among the dysmorphisms of oocytes are the severe morphological deviations, such as smooth endoplasmic reticulum clusters, cytoplasm granularity, and giant oocytes that are related to genetic abnormalities, and extra-cytoplasmic parameters such as PB morphology, the PVS and ZP abnormalities that may indicate oocyte ageing. This paper acknowledges the significance of oocyte morphology grading as an important and practical predictor of a successful IVF outcome and it can serve as a supplementary measure to embryonic assessment in order to optimize efficacy of assisted reproductive technology (ART). It discusses the fundamental knowledge that infertility specialists and embryologists should possess to enable its routine application in the ART laboratory.

Fertilization In Vitro ; Sperm Injections, Intracytoplasmic ; Reproductive Techniques, Assisted ; Embryonic Development ; Meiotic Spindle ; Spindle Apparatus

OBJECTIVE: This single blind, randomized, controlled trial investigated the efficacy of the use of guava leaves as hot steam and wash for postpartum wound healing in women who underwent normal spontaneous delivery with episiotomy.
METHODS: A total of 127 women aged 18 to 45, from 37 to 41 weeks AOG, served as subjects in this study. They were allocated to three treatments arms (guava group, antibiotic group and guava + antibiotic group) through block randomization. The guava group used a solution from boiled guava leaves as hot steam and wash tid for 7 days while the antibiotic group took amoxicillin 500 mg tid also for 7 days. The 3rd arm used both treatments. Outcomes included pain score (measured using Visual Analog Scale) and wound healing (measured using REEDA Scale) at 24 hours, 3 days and 7 days postpartum.
RESULTS: Showed that mean pain scores and mean REEDA scores of the women in the three groups at 24 hours, 3 days and 7 days postpartum were not significantly different. Likewise, the risk of wound dehiscence was not significantly different for the three treatment arms. Therefore, this study revealed that guava leaves extract used as hot steam and wash is as effective as the standard oral antibiotic intake for postpartum wound care but no additional benefit is derived from combining guava leaves and oral antibiotic.
CONCLUSION: Guava leaves used as hot steam and wash may be recommended for postpartum wound care after normal spontaneous  vaginal delivery with episiotomy.

Human ; Female ; Adult ; Episiotomy ; Psidium ; Steam ; Amoxicillin ; Anti-bacterial Agents ; Pain Measurement ; Delivery, Obstetric ; Wound Healing ; Postpartum Period

BACKGROUND: Clomiphene citrate is used as the first line drug for anovulatory infertility treatment. When a woman fails to ovulate using clomiphene at maximum dose, letrozole is used as a second line drug.

OBJECTIVE: To determine association between a patient's age and body mass index (BMI) and their response to clomiphene citrate or letrozole in the treatment of anovulation-related infertility.

MATERIALS AND METHODS: The authors reviewed 147 patient records from January 2011 to August 2016 and investigated the age, BMI and response of patients when given clomiphene or letrozole for ovulation induction.

RESULTS: Ninety-nine (99) patients received clomiphene citrate while the other 118 patients received letrozole. Those who responded positively to clomiphene were at least 35 years old (72.2%) or had above normal BMI (61.5%). Patients who responded positively to letrozole were at least 35 years old (95%) and were categorized with above normal BMI (82.9%). The authors found that patients who are older than 35 years of age are more likely to respond to letrozole compared to younger patients.

CONCLUSION: This study found no significant association between BMI and response to either Letrozole or Clomiphene. Patients who are more than 35 years old are more likely to respond to letrozole, compared to younger patients. 

Human ; Clomiphene ; Body Mass Index