Gynecological disorders in geriatric women regarding their frequency, diagnosis and management in the state of Himachal Pradesh, India

Background: Geriatric gynaecological problems have not received adequate attention in India. This study was undertaken to assess gynaecological disorders in geriatric women regarding their frequency, diagnosis and management in Himachal Pradesh, India.Methods: It was a prospective observational study of patients aged above 60 years, admitted in Gynecology ward, IGMC Shimla over one year. Spectrum of gynecological disorder, comorbidities, diagnosis and management were noted and analyzed.Results: 224 patients aged 60 years and above were admitted over a period of one year. The commonest presenting complaint was postmenopausal bleeding in 41.07% of patients. 80.80% patients had one or more comorbid conditions. Malignancy was the most frequent diagnosis 54% followed by uterovaginal prolapse in 30.35%. Ovarian cancer constituted 47.93% followed by cervical cancer 31.40%. 89.65% patients of ovarian cancer had surgical treatment whereas only 21.05% of cervical cancer patients underwent surgical treatment and rest were referred for radiation. In 62 out of 68 cases of pelvic organ prolapse had definitive surgical treatment.Conclusions: Pelvic organ prolapse and genital malignancy are the major gynecological causes of hospital admissions in the patients above 60 years. Ovarian and endometrial cancer are showing a rising trend in this age group. Cervical cancer was the second most common malignancy in this group and most of these patients presented at advanced stage. Therefore, recommendations to discontinue screening in older age groups must be viewed with caution

Intravenous leiomyomatosis

Intravenous leiomyomatosis is a rare benign smooth muscle tumour arising from a venous wall or a uterine leiomyoma. This case highlights that intra-cardiac leiomyomatosis should be considered as a differential diagnosis in addition to extended cancer or thrombus, in female patients, diagnosed with a right sided cardiac mass extending from the IVC. To prevent pulmonary embolism or sudden death in patients with intra-cardiac extension, complete surgical resection is necessary. One stage surgical removal has been recommended for complete resection

A rare case of pregnancy complicated by snake bite

Though snake bite is not common among pregnant women, however, the obstetrical consequences are severe and related to severity of envenomation. Little is known about the toxic effects and optimal management of snake envenoming because of rarity of cases. That was the main purpose of presenting this case

Consequences of antepartum hemorrhage and its maternal and perinatal outcome

Background: Antepartum haemorrhage, a life-threatening event, is defined as bleeding per vaginum occurring after the fetus has reached the period of viability, considered to be 20 weeks in developed countries and 28 weeks in countries with low resource settings. We evaluated the consequences of antepartum haemorrhage, their maternal and perinatal outcome so as to outline the proper management of patient in order to improve both maternal and perinatal morbidity and mortality.Methods: This one-year prospective study totaled 133 cases of APH fulfilling the inclusion criteria were studied. Data was recorded on the MS excel sheet for further analysis and processing.Results: Total 6693 deliveries were conducted out of which 133 presented as APH and incidence of APH was found out to be 1.98%. Placenta previa was most common. APH was commonly associated with multigravida and most cases were in age group of 26-30 years. Most of the PP and abruption cases were admitted at 34-37 weeks and 31-33 weeks respectively. High risk factors included previous LSCS and D and C, hypertension, multiple pregnancies and malpresentations. Most of the patients underwent preterm LSCS. Most fetal complications were due to prematurity. 58.6% patients were transfused blood. Overall perinatal mortality was 20.1% and maternal mortality was zero.Conclusions: Early diagnoses, timely referrals and transfusion facilities along with trained team of doctors with well-equipped ICU facility goes a long way in avoiding APH related maternak and fetal complications

Prevalence of gestational diabetes mellitus and its feto-maternal outcome in Kamla Nehru state hospital for mother and child, IGMC, Shimla, India

Background: Gestational Diabetes Mellitus (GDM) is defined as carbohydrate intolerance of variable severity with the onset or first recognition during pregnancy. It is a disease entity that adversely affects maternal as well as fetal outcome. DIPSI guideline having suggested one-time plasma glucose level has emerged as a simple, practical and cheap method to detect GDM. This study was done to evaluate the prevalence of gestational diabetes using Diabetes in Pregnancy Study Group India (DIPSI) criteria and further assess its feto maternal outcome in Kamla Nehru State Hospital for Mother and Child, IGMC, Shimla.Methods: This study was conducted in 500 patients between 24 and 28 weeks of gestation, attending the antenatal OPD. These patients were given 75g oral glucose irrespective of last meal and their plasma glucose was estimated at 2h. Patients with plasma glucose ≥140mg/dl were diagnosed as GDM and the rest as control or the non GDM group. The GDM patients were followed up and treated with medical nutrition therapy (MNT) and/or insulin therapy till delivery and maternal and fetal outcomes were then noted.Results: The prevalence of GDM in this study was 6%. Maternal and fetal complications were more in the GDM patients. Vaginal candidiasis and PROM were the common maternal complications, while hypoglycemia and hyperbilirubinemia were common in the fetuses.Conclusions: GDM adversely affects the mother as well as fetus. DIPSI guideline having suggested a single plasma glucose level test has emerged as a practical and economical method to detect GDM

Gynecological disorders in geriatric women regarding their frequency, diagnosis and management in the state of Himachal Pradesh, India

Background: Geriatric gynaecological problems have not received adequate attention in India. This study was undertaken to assess gynaecological disorders in geriatric women regarding their frequency, diagnosis and management in Himachal Pradesh, India.Methods: It was a prospective observational study of patients aged above 60 years, admitted in Gynecology ward, IGMC Shimla over one year. Spectrum of gynecological disorder, comorbidities, diagnosis and management were noted and analyzed.Results: 224 patients aged 60 years and above were admitted over a period of one year. The commonest presenting complaint was postmenopausal bleeding in 41.07% of patients. 80.80% patients had one or more comorbid conditions. Malignancy was the most frequent diagnosis 54% followed by uterovaginal prolapse in 30.35%. Ovarian cancer constituted 47.93% followed by cervical cancer 31.40%. 89.65% patients of ovarian cancer had surgical treatment whereas only 21.05% of cervical cancer patients underwent surgical treatment and rest were referred for radiation. In 62 out of 68 cases of pelvic organ prolapse had definitive surgical treatment.Conclusions: Pelvic organ prolapse and genital malignancy are the major gynecological causes of hospital admissions in the patients above 60 years. Ovarian and endometrial cancer are showing a rising trend in this age group. Cervical cancer was the second most common malignancy in this group and most of these patients presented at advanced stage. Therefore, recommendations to discontinue screening in older age groups must be viewed with caution

Профіль осіб, що звернулися з приводу проведення аборту в центр третього рівня району північних пагорбів, з розглядом медичного акту припинення вагітності в Індії

The aim of the present study was to investigate the socio-demographic and obstetric profile of pregnant women, seeking medical termination of pregnancy in accordance with the Medical Termination of Pregnancy (MTP) Act and the reasons for undergoing termination of pregnancy in the tertiary care center of the hilly region of Northern India and to further review the amendments in the Medical Termination of Pregnancy Act 1971 along with its future implications in legalizing abortions in India. Materials and Methods: A registry-based retrospective study was carried out among pregnant women, attending the gynecologic outpatient department for termination of pregnancy at the tertiary care teaching hospital and the referral center for Himalayan foothills in Northern India. The records of women, seeking termination of pregnancy during a 1-year period between October 2020 and September 2021, were reviewed and information on their demographic and obstetric profile, reason for undergoing termination of pregnancy, and acceptance of contraception, following termination of pregnancy was recorded in the data sheet. The information obtained was analyzed using SPSS version 20 (IBM, Chicago, USA) for descriptive statistics. Results: A total of 400 pregnant women underwent Medical Termination of Pregnancy between October 2020 and September 2021. 30.5 % (122/400) women between 26–30 years of age underwent termination of pregnancy, followed by 27.3 % women aged between 31–35 years. Social reasons for termination of pregnancy were more evident in women aged 26 years and above. 84.09 % pregnancies were terminated in the second trimester (>12 weeks) on eugenic ground, while 65.01 % pregnancies were terminated in the first trimester (6–12 weeks) on social grounds. Only 7.75 % (31/400) women opted for sterilization or family planning after MTP, out of which the majority opted for temporary methods of contraception. Conclusion: We conclude from the results of the present study that women in the peak reproductive age (26–30 years) are more likely to seek pregnancy termination and this group of women needs to be the focus of contraceptive counseling and family planning services. Timely ultrasound scans by an expert sonologist may be a step forward towards lowering the rates of late pregnancy termination. There is a need to educate women to avail and use contraceptive methods in an effective manner and to make them aware of utilizing sterilization services, once they complete their families to avoid unwanted pregnancies.Целью этого исследования было изучить социально-демографический и акушерский профиль беременных, обращающихся за медицинским прерыванием беременности в соответствии с Законом о медицинском прерывании беременности (МПБ) и причины прерывания беременности в центре третичной помощи холмистого региона Северной Индии для дальнейшего пересмотра поправок к Закону о медицинском прерывании беременности 1971 с его будущими последствиями для легализации абортов в Индии. Материалы и методы. Ретроспективное исследование на основе реестра было проведено среди беременных женщин, посещавших гинекологическое амбулаторное отделение для прерывания беременности при учебной больнице третьего уровня и реферальном центре Гималайских предгорий в Северной Индии. Были пересмотрены записи о женщинах, обратившихся за прерыванием беременности в течение 1 года с октября 2020 года по сентябрь 2021 года и опубликована информация об их демографическом и акушерском профиле, причине прерывания беременности и принятии контрацепции после прерывания беременности, что записано в паспорте данных. Полученную информацию проанализировали с помощью SPSS версии 20 (IBM, Чикаго, США) для описательной статистики. Результаты. В общей сложности 400 беременных женщин прошли медицинское прерывание беременности в период с октября 2020 года по сентябрь 2021 года. 30,5 % (122/400) женщин прерывали беременность в возрасте 26–30 лет, 27,3 % женщин в возрасте 31–35 лет. Социальные причины прерывания беременности были более яркими у женщин от 26 лет. 84,09 % беременностей было прервано во втором триместре (>12 недель) по евгенической причине, тогда как 65,01 % беременностей было прервано в первом триместре (6-12 недель) по социальным причинам. Лишь 7,75 % (31/400) женщин избрали стерилизацию или планирование семьи после MПБ, из которых большинство избрали временные методы контрацепции. Вывод. по результатам этого исследования мы делаем вывод, что женщины пикового репродуктивного возраста (26–30 лет) чаще стремятся к прерыванию беременности, и эта группа женщин должна быть в центре внимания консультаций по вопросам контрацепции и планирования семьи. Своевременное исследование экспертом-сонологом может стать шагом вперед к снижению частоты прерывания беременности на поздних сроках. Необходимо научить женщин выбирать и эффективно использовать методы контрацепции, а также проинформировать их об использовании услуг стерилизации после того, как они наполнят свои семьи во избежание нежелательной беременностиМетою цього дослідження було дослідити соціально-демографічний та акушерський профіль вагітних, які звертаються за медичним перериванням вагітності відповідно до Закону про медичне переривання вагітності (MПВ) та причини переривання вагітності в центрі третинної допомоги горбистого регіону Північної Індії для подальшого перегляду поправок до Закону про медичне переривання вагітності 1971 року разом із його майбутніми наслідками для легалізації абортів в Індії. Матеріали та методи. Ретроспективне дослідження на основі реєстру було проведено серед вагітних жінок, які відвідували гінекологічне амбулаторне відділення для переривання вагітності при навчальній лікарні третього рівня та реферальному центрі Гімалайських передгір'їв у Північній Індії. Були переглянуті записи про жінок, які звернулися за перериванням вагітності протягом 1 року з жовтня 2020 року по вересень 2021 року та опубліковано інформацію про їх демографічний та акушерський профіль, причину переривання вагітності та прийняття контрацепції після переривання вагітності, що записано в паспорті даних. Отриману інформацію проаналізували за допомогою SPSS версії 20 (IBM, Чикаго, США) для описової статистики. Результати. загалом 400 вагітних жінок пройшли медичне переривання вагітності в період з жовтня 2020 року по вересень 2021 року. 30,5 % (122/400) жінок переривали вагітність у віці 26–30 років, 27,3 % жінок у віці 31–35 років. Соціальні причини переривання вагітності були більш яскравими у жінок віком від 26 років. 84,09 % вагітностей було перервано в другому триместрі (>12 тижнів) за євгенічною причиною, тоді як 65,01 % вагітностей було перервано в першому триместрі (6-12 тижнів) за соціальними причинами. Лише 7,75 % (31/400) жінок обрали стерилізацію або планування сім’ї після MПВ, з яких більшість обрали тимчасові методи контрацепції. Висновок. за результатами цього дослідження ми робимо висновок, що жінки пікового репродуктивного віку (26-30 років) частіше прагнуть переривання вагітності, і ця група жінок повинна бути в центрі уваги консультацій з питань контрацепції та планування сім’ї. Своєчасне ультразвукове дослідження експертом-сонологом може стати кроком вперед до зниження частоти переривання вагітності на пізніх термінах. Необхідно навчити жінок обирати та ефективно використовувати методи контрацепції, а також поінформувати їх про використання послуг стерилізації після того, як вони наповнять свої сім’ї, щоб уникнути небажаної вагітност

Scholars Journal of Medical Case Reports ISSN 2347-9507 (Print) Unruptured Second Trimester Pregnancy in a Rudimentary Horn of Unicornuate Uterus: A Diagnostic Dilemma

Abstract: Unicornuate uterus with rudimentary horn is a rare mullerian anomaly of the uterus and pregnancy in a noncommunicating rudimentary horn is very rare. In most of the cases, it is ruptured before diagnosis in first and second trimester due to poor distensibility of the myometrium. Catastrophic hemorrhage results due to rupture which further results in increased maternal and perinatal mortality and morbidity. Diagnosis before rupture is a challenge due to diagnostic dilemma. Expertise in ultrasonography is required and early resort to surgical management is lifesaving in such cases. Here is a case of unruptured ectopic pregnancy in the rudimentary horn of gestation 17 weeks which was diagnosed by ultrasound and MRI and patient was operated before any symptoms appeared

Intravenous leiomyomatosis

Intravenous leiomyomatosis is a rare benign smooth muscle tumour arising from a venous wall or a uterine leiomyoma. This case highlights that intra-cardiac leiomyomatosis should be considered as a differential diagnosis in addition to extended cancer or thrombus, in female patients, diagnosed with a right sided cardiac mass extending from the IVC. To prevent pulmonary embolism or sudden death in patients with intra-cardiac extension, complete surgical resection is necessary. One stage surgical removal has been recommended for complete resection

A rare case of pregnancy complicated by snake bite

Though snake bite is not common among pregnant women, however, the obstetrical consequences are severe and related to severity of envenomation. Little is known about the toxic effects and optimal management of snake envenoming because of rarity of cases. That was the main purpose of presenting this case