Vidushi Kulshrestha

All India Institute of Medical Sciences, New Delhi, NCT, India

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Publications (16)21.58 Total impact

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    ABSTRACT: Background & objectives: Uterine myoma is a common indication for hysterectomy in India. An effective medical treatment option may reduce hysterectomy associated morbidity. This study was undertaken to evaluate efficacy and safety of low dose mifepristone in medical management of myoma and to compare two doses - 10 vs. 25 mg/day. Methods: In this randomized clinical trial, women with symptomatic myoma or myoma>5cm were included. Uterine size >20 wk, fibroids >15 cm were excluded. Pictorial blood loss assessment chart (PBAC) score was used to assess menstrual-blood-loss and visual analog scale (VAS) for other symptoms. Haemogram, liver function test, ultrasound with doppler and endometrial histology was performed. Patients were randomized and were given oral mifepristone as 25 mg/day in group 1 and 10 mg/day in group 2 for 3 months. Patients were followed at 1, 3 and 6 months. Results: Seventy patients in group 1 and 73 in group 2 completed treatment. Mean PBAC score reduced from 253 to 19.8 and from 289.2 to 10.4 at 1 and 3 months in groups 1 and 2, respectively. At 3 months, 67 of 70 (95.7%) patients of group 1 and 66 of 73 (90.4%) of group 2 developed amenorrhoea which reverted after median 34 (range 4-85) days. Mean myoma volume decreased by 35.7 per cent (from 176.8 to 113.7cm 3 ) and 22.5 per cent (from 147.6 to 114.4 cm 3 ) at 3 months in groups 1 and 2, respectively. Side effects seen were leg cramps in 7 of 70 (10%) and 5 of 73 (6.8%) and hot-flushes in 5 of 70 (7.1%) and 5 of 73 (6.8%) in groups 1 and 2, respectively. Repeat endometrial-histopathology did not reveal any complex hyperplasia or atypia in either group. Interpretation & conclusions: Mifepristone (10 and 25 mg) caused symptomatic relief with more than 90 per cent reduction in menstrual blood. Greater myoma size reduction occured with 25 mg dose. Amenorrhoea was developed in 90-95 per cent patients which was reversible. It can be a reasonable choice for management of uterine leiomyoma as it is administered orally, cost-effective and has mild side effects.
    The Indian Journal of Medical Research 06/2013; 137(6):1154-62. · 2.06 Impact Factor
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    ABSTRACT: To study the efficacy, safety, and functional outcomes of laparoscopic-assisted uterovaginal anastomosis with placement of a silicone tube as stent in congenital cervical atresia. Descriptive study (Canadian Task Force classification II-3). Tertiary care referral hospital. Fourteen consecutive patients (mean [SD] age, 15.2 [2.0] years) with congenital absence of a uterine cervix, associated with partial or complete vaginal aplasia. Laparoscopic-assisted uterovaginal anastomosis with placement of a silicone stent was performed to treat cervical agenesis. In cases with associated vaginal aplasia, modified McIndoe vaginoplasty was performed concomitantly. Follow-up assessment was performed at 1, 3, and 6 months, and then yearly. Of 14 patients with congenital cervical anomalies, cervical dysgenesis was observed in 5 (35.7%), and cervical agenesis in 9 (64.2%). All patients with cervical agenesis also had a partial or complete noncanalized vagina. The procedure was successfully completed in all patients. Main outcome measures were functional capability and postoperative complications. Mean (SD) follow-up after surgery was 3.8 (1.2) years. Postoperatively, all but 1 patient (92.8%) experienced regular menses, with complete relief of cyclical abdominal pain. One patient underwent hysterectomy because of genital infection and re-stenosis. Concomitant vaginoplasty was performed in 9 patients (64.2%) with associated vaginal aplasia, and vaginal length was 6.5 (1.2) cm at 6-month follow-up. Five patients (35.7%) are sexually active, and report it to be satisfactory. Pregnancy has been achieved in 3 of the 5 patients (60%). Laparoscopic-assisted uterovaginal anastomosis may be considered the treatment of choice in patients with cervical agenesis, and radical treatment such as hysterectomy can be averted. The procedure is successful insofar as resumption of menstrual function. However, long-term reproductive outcome in these young girls will require further follow-up.
    Journal of Minimally Invasive Gynecology 07/2012; 19(4):477-84. · 1.61 Impact Factor
  • Alka Kriplani, Divya Awasthi, Vidushi Kulshrestha, Nutan Agarwal
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    ABSTRACT: To evaluate the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) in reducing menstrual blood loss (MBL) in myoma-related menorrhagia and to assess the effect of the LNG-IUS on uterine and leiomyoma volume. A prospective comparative study investigated the effect of LNG-IUS use in women with myoma-related menorrhagia (n=54) and women with idiopathic menorrhagia (n=50). The outcome was assessed in terms of reductions in MBL and in myoma and uterine volume. Within 1 month of LNG-IUS insertion, the Pictorial Blood Loss Assessment Chart score in the myoma group fell by 86.8% (P<0.0001). At 3, 12, 24, 36, and 48 months, the MBL was reduced by 92.1%, 97.4%, 97.4%, 99.5%, and 99.5%, respectively, similar to the effect seen in the idiopathic menorrhagia group. The mean uterine volume was significantly reduced in both groups, but the reduction was greater in the group with leiomyomas (idiopathic menorrhagia, P=0.038; myoma-related menorrhagia, P=0.012). There was no statistically significant reduction in the myoma volume (P=0.409). Use of the LNG-IUS appears to lead to a significant reduction in the uterine volume of women with menorrhagia, as well as reducing the MBL in women with uterine leiomyomas.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 09/2011; 116(1):35-8. · 1.41 Impact Factor
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    ABSTRACT: To compare modalities for diagnosing genital tuberculosis (GTB) and to assess fertility outcome after antitubercular therapy (ATT). Infertile women underwent endometrial aspiration (EA) and peritoneal washing (PW) for histopathologic examination, PCR, and acid-fast bacilli (AFB) smear and culture of Mycobacterium tuberculosis; laparoscopy and hysteroscopy were also performed. Women with a positive laboratory test and/or laparoscopic finding classified as definitive/probable received ATT for 6 months. Of 196 women recruited, 187 underwent laparoscopy. Genital tuberculosis was diagnosed in 118 (60.2%). In 41.3%, EA PCR was positive; PW PCR was positive in 7.6%. The remaining laboratory tests were positive in a small number. Laparoscopy indicated definitive GTB in 9.1% and probable GTB in 37.4%. Among the 118 women treated for GTB, 22.9% conceived without in vitro fertilization; of these women, 74.1% had a positive EA PCR and 59.3% had a positive laparoscopy finding. A quarter of the women received ATT solely on the basis of the PCR result and 31.0% of these women conceived. No single test can detect all instances of GTB. A combination of tests is needed to increase the detection rate. Treatment given solely on the basis of a positive PCR result can result in conception.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 03/2011; 113(3):229-34. · 1.41 Impact Factor
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    ABSTRACT: This study was designed to test the utility of mRNA-based RT-PCR to detect viable bacilli, indicating active tubercular involvement, and DNA-PCR to detect present or past infection in the diagnosis of active female genital tuberculosis (TB) infection. A total of 200 subjects with complaints of infertility were enrolled in the study. Multiple sampling was done. One hundred and forty-three endometrial aspirate (EA), 94 peritoneal fluid/peritoneal washing (PF/PW) and six cornual biopsy (CB) specimens were collected for diagnosis using microscopy, culture, RT-PCR and DNA-PCR and results were compared with laparoscopic findings. RT-PCR and culture were concordant [positive in four (2.8%) EA specimens] signalling sampling from the site of active infection. Smear microscopy showed a poor detection rate while DNA-PCR showed high positivity. Sixty-one (44.85%) EA specimens, nine (9.57%) PF/PW specimens and two (33.33%) CB specimens were positive by DNA-PCR. Genital TB causing infertility (localized or secondary to TB elsewhere) can be picked up early by DNA-PCR, when it can be completely cured prior to the appearance of florid disease.
    Journal of Medical Microbiology 12/2010; 60(Pt 4):486-91. · 2.30 Impact Factor
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    ABSTRACT: A prospective randomized trial was conducted to compare efficacy of a drospirenone-containing combined oral contraceptives (COC) with desogestrel-containing COC in women with polycystic ovary-syndrome (PCOS) not desirous of child-bearing. Sixty women were randomized into study group [ethinylestradiol (EE) 30 mcg+drospirenone 3 mg] and control group (EE 30 mcg+desogestrel 150 mcg), treated for 6 months and followed up at 1 month, 3 months, 6 months, during treatment and 3 and 6 months post-treatment. Acne and hirsutism scoring, bodyweight, body mass index (BMI), blood pressure (BP), ultrasound parameters, lipid profile, glycemic profile and hormonal profile were compared. Cycles were regular in both groups during treatment. Effect of regular cycles persisted in 44.83% (13/30) vs. 17.24% (5/30) in study vs. control group at 6 months post-treatment with 33.3% decreased hirsutism score in the study group (versus no change in control group) even at 6 months after stopping treatment. With treatment, BMI fell by 0.52 kg/m(2) in the study group; systolic and diastolic BP fell in the study group while it rose in the control group. Low-density lipoprotein significantly decreased and high-density lipoprotein was elevated in the study group (p<.05). The study group showed a significant fall in fasting/postprandial blood sugar and insulin and total testosterone against a rise in the control group. In women with PCOS, a drospirenone containing COC has better outcome in terms of persistent regular cycles, antiandrogenic effect, fall in BMI and BP, better lipid profile, favorable glycemic and hormonal profile than desogestrel-containing COC.
    Contraception 08/2010; 82(2):139-46. · 3.09 Impact Factor
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    ABSTRACT: To evaluate the efficacy of mifepristone to reduce intermenstrual bleeding in levonorgestrel intrauterine system (LNG-IUS) users. In this prospective, open-label, comparative study, 36 women using the LNG-IUS for menorrhagia received 100mg of mifepristone every 30 days for 3 months (group 1). Fifty age-matched LNG-IUS users who did not receive any drugs were used as the comparison group (group 2). Menstrual bleeding days, pictorial blood loss assessment chart (PBAC) score, and intermenstrual bleeding/spotting days were compared between the 2 groups at 3 months (during treatment) and at 6 months (3 months post treatment). Baseline characteristics were comparable between the groups. At 3 months, median duration and episodes of intermenstrual bleeding/spotting were significantly lower in group 1 compared with group 2 (6 vs 12.5 days, P=0.01; 2.5 vs 3, P=0.05, respectively). More women were satisfied with the LNG-IUS in the mifepristone group compared with the control group (75% vs 44%; P=0.004). At 6 months, the median duration of intermenstrual bleeding/spotting was significantly lower in group 1 compared with group 2 (6 vs 15 days; P=0.008). Mifepristone was effective in reducing the number of episodes and duration of intermenstrual bleeding/spotting in LNG-IUS users.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 03/2010; 109(2):128-30. · 1.41 Impact Factor
  • Nutan Agarwal, Vidushi Kulshrestha, Alka Kriplan
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    ABSTRACT: Combination of placentrex injection with antimicrobial therapy is a better option for treating pelvic inflammatory disease (PID) than only antimicrobial therapy; which also gives more sustained effect and lesser recurrences. Improvements in symptoms continue despite stopping therapy. Addition of placentrex leads to marked improvement in dyspareunia, less fornix tenderness and better uterine mobility suggesting better effect on adnexal tissues and parametrium. As placentrex decreases adnexal inflammation to significant level in comparison to antimicrobials alone, it can be a good option- specially to reduce the risk of tubal damage, infertility and formation of adnexal mass. In a study of 100 cases of PID, 50 in group I and II each; 42 in group 1 and 32 in group II completed the study. Marked reduction in various symptoms was observed in study group I (27-59%) where as in group II where only antimicrobial was given, reduction was found in range of 12-48%. Thus overall, group I had better as well as sustained effect of therapy on relieving dyspareunia, fornix tenderness and uterine restricted mobility which was statistically significant. In other symptoms and signs, there was marginal efficacy except in cervical erosion where no improvement was observed.
    Journal of the Indian Medical Association 02/2010; 108(2):117-8, 122.
  • S. Lal, A. Kriplani, N. Agarwal, V. Kulshrestha
    Journal of Minimally Invasive Gynecology - J MINIM INVASIVE GYNECOL. 01/2010; 17(6).
  • N. Agarwal, V. Kulshrestha, A. Kriplani
    International Journal of Gynecology & Obstetrics 10/2009; 107. · 1.84 Impact Factor
  • V. Kulshrestha, A. Kriplani, N. Agarwal, U. Singh, T. Rana
    International Journal of Gynecology & Obstetrics 10/2009; 107. · 1.84 Impact Factor
  • International Journal of Gynecology & Obstetrics 10/2009; 107. · 1.84 Impact Factor
  • Alka Kriplani, Vidushi Kulshrestha, Nutan Agarwal
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    ABSTRACT: To assess the efficacy and safety of ormeloxifene (centchroman) in the medical management of menorrhagia. Forty-two women with menorrhagia were recruited for the study. Ormeloxifene was given to each patient 60 mg twice a week for 3 months and then once a week for 1 month. Patients were followed up at 2 and 4 months of therapy, then at 3 and 6 months after treatment was stopped. Menstrual blood loss (MBL) was measured objectively by a pictorial blood loss assessment chart (PBAC) score and subjectively by a visual analog scale (VAS). The pretreatment median PBAC score was 388 (range 169-835). Eighteen patients (42.9%) had amenorrhea with the therapy. Median PBAC reduced to 80 (range 0-730) and 5 (range 0-310) at 2 and 4 months, respectively (P-value <0.001); thus, the percentage reduction was 97.7% at 4 months. Seven patients (16.7%) had no response and three (7.1%) discontinued treatment before 4 months. During the 10-month study period, 21% of the patients underwent hysterectomy. Adverse effects included ovarian cyst (7.1%), cervical erosion and discharge (7.1%), gastric dyspepsia (4.8%), vague abdominal pain (4.8%) and headache (4.8%). Ormeloxifene is an effective and safe therapeutic option for the medical management of menorrhagia.
    Journal of Obstetrics and Gynaecology Research 08/2009; 35(4):746-52. · 0.84 Impact Factor
  • International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2009; 105(1):63-4. · 1.41 Impact Factor
  • V. Kulshrestha, N. Agarwal, S. Lal, S. Kochar, A. Kriplani
    International Journal of Gynecology & Obstetrics - INT J GYNECOL OBSTET. 01/2009; 107.
  • A Kriplani, V Kulshrestha, N Agarwal, S Diwakar
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    ABSTRACT: Currently, tranexamic acid (TXA) is used as 4 g/day in menorrhagia This prospective randomised study included 100 cases to assess efficacy and safety of 2 g/day TXA in dysfunctional uterine bleeding (DUB) vs cyclical 10 mg twice-daily medroxyprogesterone acetate (MPA) for 3 cycles. Follow-ups were made monthly for 3 months during therapy, then 3 months after. Mean pictorial blood loss assessment chart (PBAC) score decreased from 356.9 to 141.6 in the TXA group and from the pre-treatment 370.9 to 156.6 with MPA and mean reduction of blood loss was 60.3% with TXA and 57.7% with MPA after 3 months (p < 0.005 in both groups). Lack of response during treatment was seen in three patients (6.1%) TXA and in 13 patients (28.9%) with MPA (p = 0.003). In patients who reported 3 months after stopping the treatment, 66.7% in TXA group and 50% in MPA had recurrence of menorrhagia, (p = 0.155). During the 6 months study period more hysterectomies were performed in the MPA than in the TXA group (17.8% vs 4%; p = 0.002). We conclude that TXA in 2 g/day dosage is an effective and safe option in DUB.
    Journal of Obstetrics and Gynaecology 10/2006; 26(7):673-8. · 0.55 Impact Factor