Comparative study of hysteroscopy, hysterosalpingography and transvaginal sonography in evaluation of the female infertility

Background: One of the most important and underappreciated reproductive health problems in developing countries is that of infertility. Objective of this study was to evaluate HSC (hysteroscopy), HSG (hysterosalpingography) and ultrasonography in infertility.Methods: This study was conducted among 100 infertile patients over a period of two years. The patients were questioned for the detailed history including socioeconomic status, medical history and previous history of taking any medications and supplements. The recruited patients had to undergo.Results: Transvaginal sonography and clinical examination were done. Transvaginal sonography detected abnormality in 40% of women. 65 women had normal hysterosalpingography findings whereas the rest 35 women had abnormal hysterosalpingography findings. Thirty nine percent (39%) had normal hysteroscopic findings while sixty one percent (61%) had abnormal findings. The study depicts that hysteroscopy has sensitivity (95%) and negative predictive value NPV (92%) whereas that of TVS is 48.9% and 44.9% respectively. Hysterosalpingography has sensitivity 68.3% and NPV 40.3%. Specificity (100%) and positive predictive value PPV (100%) of all the three modalities are the same.Conclusions: The results of the present study showed that each modality provided useful information but no single modality provided complete information for evaluating infertile women. Thus, a combination of all three modalities- TVS (transvaginal sonography), HSG (hysterosalpingography) and hysteroscopy is necessary to evaluate infertile women

Clinical and ultrasonological features of adenomyosis and its histopathological correlation

Background: Adenomyosis is a common gynaecological condition that affects the menstruating women. Uterine enlargement, dysmenorrhoea and HMB are regarded as the cardinal clinical symptoms of adenomyosis. Classically it was thought, compared with ultrasonography, when adenomyosis is suspected, MRI enables more accurate diagnosis of the disease.Methods: 78 subjects were enrolled after an informed consent that had complaints of HMB, Dysparenuia, dysmenorrhea, and chronic pelvic pain. Detailed history of the enrolled subjects was taken, followed by a clinical examination. These patients were then subjected to TVS where myometrial echo texture, presence of myometrial cysts, blurring of endomyometrial junction was noted. After hysterectomy, histopathological diagnosis was obtained.Results: 78 subjects enrolled in the study. The mean age was 44.2 years. 43.5% had parity of 4 or more. HMB was present in 97.8% and dysmenorrhea in 93.48 % of HPE positive patient. Transvaginal sonography had a sensitivity of 89.13%, specificity of 90.62%, positive likelihood ratio of 9.51, negative likelihood ratio of 0.12, positive predictive value of 93.18%, negative predictive value of 85.29% and a diagnostic accuracy of 89.74%.Conclusions: Thus adenomyosis has a prevalence of 30.23%. HMB with dysmenorrhoea and chronic pelvic pain helps in diagnosis. TVS is both sensitive and specific in diagnosing adenomyosis without need for additional diagnostic tool. Endomyometrial junction blurring is the sensitive and specific criteria on TVS

Maternal vitamin D levels in hypertensive disorders of pregnancy

Background: Current study was conducted with the objective to evaluate maternal vitamin D levels in patients with hypertensive disorders of pregnancy.Methods: The present prospective observational study was conducted among 200 pregnant women attending gynaecological OPD of Subharti medical college, Meerut, over a period of two years and satisfying the inclusion criteria were enrolled. On admission, patient demographic profile, complete history was recorded, and comprehensive clinical examination was done. In all the patients, blood samples for routine examination along with LFT, RFT, random blood sugar, serum electrolytes, serum uric acid and serum vitamin D were drawn, and serum levels of these biochemical parameters were determined according to standard laboratory procedures. Subjects were classified into three categories according to serum vitamin D level i.e. >20 ng/ml (mild), 10-20 ng/ml (moderate deficiency), <10 ng/ml (severe deficiency).Results: Insignificant difference was found between case (hypertensive) and control (normotensive) group when compared in relation to age, education, parity and socioeconomic status. The mean vitamin D level of women with HDP was 5.7+2.99 ng/ml as compared to 17.34+5.79 ng/ml in normotensive women with statistically significant difference as p<0.001. No correlation was found between severity of vitamin D deficiency and maternal complications (p=0.318).Conclusions: The results of the present study concluded that women with hypertension had significantly lower vitamin D level as compared to normotensive women