Infertility is defined as not being able to become pregnant after 12 months or more of unprotected sexual intercourse. Female infertility as a serious health issue can result from ovulation disorders, menstrual cycle problems, structural problems, and environmental factors. Ovulation occurs once a month between the time of menarche and menopause. The release of a mature egg from the ovary is controlled with the hypothalamic-pituitary-ovarian axis. Several hormones such as gonadotropin-releasing hormone (GnRH), FSH (follicle-stimulating hormone), LH (luteinizing hormone), estrogen, and progesterone play fundamental roles in the ovulation process. Both FSH and LH are the main treatment for women with ovulation disorders. Depending on the reasons for infertility, several different types of treatment are available for infertile women. Fertility drugs as an important part of treatment work like the natural hormones to treat infertility. Several fertility drugs can regulate ovulation and the release of an egg from the ovary in women with polycystic ovary syndrome (PCOS) or undergoing in vitro fertilization (IVF) treatment. This mini-review is about the FDA-approved prescription drugs that induce ovulation in women with ovulatory problems.

Mini review: The FDA‐approved prescription drugs that induce ovulation in women with ovulatory problems

Childbirth is perhaps, the most painful experience encountered by most women and just like other forms of pain, the experience of labour pain is unique to individual women, so it is only the woman in labour who can describe the extent of pain she is going through. This study assessed the perceptions, attitude, intention to use, also predict factors that influence intention to use epidural analgesia among pregnant women attending antenatal clinic. The study adopted a cross-sectional design and was conducted among 200 randomly selected pregnant women attending Ante-natal Clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Data were obtained using a structured questionnaire and were analyzed descriptively and inferentially. Statistical significance was determined at p < 0.05. The study revealed that majority (85%) of the respondents had good perception of epidural analgesia but majority (86%) displayed negative attitude toward epidural analgesia. More than half (56%) of the respondents got their information on epidural analgesia from nurses and midwives and 72.5% expressed their intention to use epidural analgesia (EA). Furthermore, there was significant relationship between ethnicity and attitude towards epidural analgesia (p= 0.001). Factors predicting intention to use EA include religion (B=0.99, p=0.016), perception of EA (B=-2.47, p=0.001), appropriate pain control (B=1.75, p=0.02), fear of pain procedure (B=-0.2, p=0.01). The study concluded that pregnant women in this setting have a desire to use EA for child birth. Factors that predict the use include perception, religion, and desire for pain control. Efforts should be intensity to improve on the negative attitude of the respondents as this will ensure prompt intervention which may result in positive birth outcome.

	Key words: Perception, attitude, epidural, analgesia, pregnant women.

Factors associated with intention to use epidural analgesia during labour among pregnant women attending antenatal clinic of a tertiary health institution in Southwestern Nigeria

Background: Various studies have debated intravenous paracetamol as analgesic agent However, there are no significant trials regarding comparison of paracetamol with other agents like Tramadol regarding analgesic effect on labor pain.
Objective: To compare the efficacy of intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labour analgesia.
Methodology: In this quasi experimental study, a total of 110 women with active phase of labour of term pregnancy, 18 to 40 years of age, were included. Duration and setting: May to November, 2019 at Department of Obstetrics and Gynaecology, Shaikh Zayed Hospital Rahim Yar Khan. In Group A, single 100 ml intravenous infusion containing 1000 mg of paracetamol while in Group B patients, tramadol hydrochloride 100 mg intramuscular, was given. All patients in both groups were evaluated by visual analogue scale and efficacy (yes/no) was noted. SPSS 20 was used for data analysis.
Results: The mean age of women in group A was 27.73 ± 5.35 years and in group B was 27.36 ± 5.61 years. The mean gestational age in group A was 39 ± 1.53 weeks and in group B was 38.95 ± 1.56 weeks. Parity was from 0 to 5 with mean parity of 2.46 ± 1.17. Efficacy (in terms of VAS score 0-3) was seen in 21 (38.18%) in group A (intravenous paracetamol infusion) and 09 (16.36%) in group B (intramuscular tramadol) with p-value of 0.010.
Conclusion: This study concluded that efficacy of intravenous paracetamol infusion is better than intramuscular tramadol as an intrapartum labour analgesia.

/pdf/efficacy-of-intravenous-paracetamol-infusion-versus-1mdlt2b9k2.pdf

Efficacy of Intravenous Paracetamol Infusion Versus Intramuscular Tramadol as an Intrapartum Labour Analgesia


 Background: The pain of labor is very severe. Most women prefer painless labor to routine labor if they are aware of the methods of analgesia. The aim of this study was to evaluate the effect of Dexmedetomidine intravenous infusion on labor pain management in primipar term pregnant women. Methods: In this Non-randomized clinical trial with control group, all primipar term pregnant women were enrolled in the study. In the intervention group, after the active phase of labor, Dexmedetomidine was given according to the protocol and continued until phase two of labor. The control group received no intervention to reduce pain. Patients in both groups were evaluated for, fetal heart rate, Apgar scores, vital signs, pain intensity and sedation score. Results: There were no significant difference in primary fetal heart rate, primary maternal hemodynamics, and mean Apgar scores of 1 and 5 minutes, between the two groups (p>0.05). There was no significant difference in the mean of fetal heart rate in different stages between two groups. Intra-group analysis in the intervention group showed that mean systolic and diastolic blood pressure were significantly decreased after drug administration but were in normal range. The active phase of labor in the intervention group was significantly shorter than the control group (p = 0.002). The mean VAS score after Dexmedetomidine administration decreased significantly from 9.25 at baseline to 4.61 after drug administration, 3.88 during labor and 1.88 after placental expulsion. The mean RSS score after Dexmedetomidine administration increased significantly from 1 at baseline to 2.05 after drug administration, 2.22 during labor and 2.05 after placental expulsion. Conclusion: Based on results, it seems that administration of Dexmedetomidine to manage labor pain with careful monitoring of mother and fetus is recommended. Due to limited studies, further larger and multicenter studies are needed to be performed.Trial registration: This study was registered on Iranian registry of clinical trials, identification number IRCT20161022030421N5, registered on February 2, 2019, https://irct.ir/trial/40134.

/pdf/evaluating-the-effect-of-dexmedetomidine-intravenous-1qlu5g1shz.pdf

Evaluating the Effect of Dexmedetomidine Intravenous Infusion on Labor Pain Management in Primipar Term Pregnant Women

Intravenous infusion of tramadol - a safe labour analgesia -

Background: Labour pain described as ‘the most horrible’ affects both physiological and psychological aspects of labour. Thus, the provision of labour analgesia is of paramount importance to better both maternal and neonatal outcomes. In our country, majority of obstetric services are in the hands of trained nurses and non-specialized doctors and thus awareness and acceptance of pain-relieving for women in labour virtually does not exist. Therefore, drugs like paracetamol and tramadol with advantage of easy availability, being inexpensive with no special technique of administration are a boon for labour analgesia.

Objective: To compare the role of intravenous paracetamol versus intravenous tramadol as an intrapartum labour

analgesic.

Materials and methods: A total of 273 primigravidae with term gestation with singleton pregnancy with vertex presentation in active phase of labour with cervical dilatation ≥ 4cm with spontaneous onset of labour were taken who satisfied the inclusion and exclusion criteria of the study. Group P (141 women) and Group T (132 women) received 100 ml intravenous infusion containing 1 gram of paracetamol single dose and 100 mg of tramadol hydrochloride diluted in 100 ml normal saline over 15 minutes respectively. Visual Analogue scale (VAS) was used to assess pain intensity, before administering drug, after 1 and 3 hours of drug administration. The primary outcomes measured were difference in VAS score in both groups. The secondary outcomes analysed were mode of delivery, duration of labour, drug-delivery interval, maternal side effects and neonatal outcomes in terms of birth weight, APGAR scores and NICU admissions.

Results: The mean VAS score decreased significantly to a greater extent in group P than group T and showed a significant statistical difference among both the groups (p < 0.001). In both the groups, the difference in the VAS score was statistically significant (p<0.05). The duration of labour was statistically shorter in group P (p< 0.0001). The participants in group T had more incidence of maternal side-effects and 7 NICU admission than in paracetamol group.

Conclusion: Intravenous paracetamol with better analgesic efficacy, shorter duration of labour and fewer maternal side effects is a more effective labour analgesic than tramadol.

A Randomized Controlled Trial of Intravenous Paracetamol and Intravenous Tramadol for Labour Analgesia

A Comparative Study of Letrozole Vs Clomiphene Citrate as First Line for Anovulatory Infertility– An Institutional Experience

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A Randomized Controlled Trial of Intravenous Paracetamol and Intravenous Tramadol for Labour Analgesia

A Comparative Study of Letrozole Vs Clomiphene Citrate as First Line for Anovulatory Infertility– An Institutional Experience