Hysteroscopy in one hundred cases of postmenopausal uterine bleeding, in the detection of uterine cancer and atypical endometrial hyperplasia

Background: Evaluation was done in 100 women presenting with postmenopausal bleeding, (PMB), to discuss the utility of hysteroscopy combined guided endometrial curettage in the diagnosis of uterine cancer and endometrial hyperplasia, and, treat benign lesions, like polyps, synechiae at the same sitting. At MGMH during the years, 2002 to 2006, there were 57 women, and at care, 40 women with PMB during 2011 to 2013, and three in a nursing home, Hyderabad, were investigated.Methods: Evaluation was done in 100 women presenting with PMB by hysteroscopy and curettage to diagnose the cause of PMB and benign lesions like polyps, synechiae were managed by operative hysteroscopy. Bettocchi 5 mm hysteroscope, monopolar instruments and glycine was used for excision of polyps.Results: In one hundred women with PMB, 19% had cancer. Endometrial adenocarcinoma in 14, endocervical carcinoma in 2, uterine carcinosarcoma in 3 cases. All 3 cases of uterine carcinosarcoma on hysteroscopy were large polyps measuring 5×5-6 cm size. Atypical hyperplasia endometrium in 7% and simple hyperplasia in 17%, was reported on histopathology, in cases with hyperplastic endometrium on hysteroscopy. Benign polyps in 41% were managed at the same sitting by operative hysteroscopy.Conclusions: Women with postmenopausal bleeding must have USG, trans vaginal sonography (TVS), endometrial thickness (ET) measurement, preferably endometrial echo complex (EEC). In women with PMB, the risk of uterine cancer would be 19%, i.e., 1 out of 5 women. Atypical hyperplasia in 7%. Hysteroscopy guided curettage, with histopathology, is the gold standard protocol in cases of PMB

HELLP syndrome on the rise: a major cause of maternal deaths

Background: In the recent years, 2021 to 2022, there has been a sudden rise in the number of HELLP syndrome cases admitted to Modern Government Maternity Hospital, (MGMH) / Osmania Medical College. There were maternal deaths due to complications secondary to HELLP syndrome. Complications like placental abruption, DIC, PPH, PRAKI, pulmonary edema, were responsible for maternal deaths. The need for blood products has increased enormously. In our earlier study of eclampsia and imminent eclampsia from the same Institute, during 2004 to 2007, we did not find HELLP syndrome to be a major cause of maternal deaths. Hence, we proceeded with in depth study of the complications, morbidity and mortality and some management issues related to HELLP syndrome. All 70 cases of HELLP in this study had associated Preeclampsia/eclampsia.Methods: This is a prospective analytical observational study of 70 cases of HELLP syndrome.Results: Recurrent preeclampsia was noted in 6÷45=13.33%. Cases of hypothyroidism were observed in 6÷45=13.33%. There were four sets of twins, 8.88%. Placental abruption was noted in 10/70 women with HELLP, 14.28%, DIC occurred in 15÷70=21.42%, PPH occurred in 11÷45 cases, 24.44%, PRAKI was recorded in 16/70 patients, 22.85%, Pulmonary edema occurred in 5/70, 7.14%, PPCM in cases with HELLP syndrome were 2÷70=2.85%, Abdominal delivery was needed in 53÷70=75.71%, Maternal mortality in the present study was10÷70=14.28%, The perinatal mortality was 21.33%. Blood products were needed in 22/45 cases, (9.136) units on the average.Conclusions: Dissemination of knowledge that immediate delivery should be planned in all cases of HELLP, irrespective of gestational age is the need of the hour. Postponing delivery would lead to complications