Histopathological evaluation of endometrial sampling in perimenopausal women with abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is one of the common symptoms in the gynaecology outpatient department. About one third of women are affected at some time in their lives. The perimenopausal women show significant number of underlying organic pathology. The evaluation of endometrium and/or organ histopathology has the dual advantage of finding the cause of AUB and to rule out endometrial cancer or the potential for cancer in future like endometrial hyperplasia with atypia. The aim of the study was to determine the histopathological pattern of endometrial sampling in perimenopausal women with AUB and to follow them up for a period of six months after the procedure.Methods: The prospective observational study was conducted at the department of obstetrics and gynaecology at Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, Kerala, for a period of one year from December 2019 to December 2020. The study was conducted on 116 perimenopausal women 41-52 years who presented with AUB and had undergone endometrial sampling. These ladies were subsequently followed up for six months post procedure to assess the response to medical treatment or the need for any surgical intervention like hysterectomy.Results: A total 39.65% patients had heavy and prolonged menstrual bleeding and 18.16% patients had irregular bleeding. 14.65% patients had prolonged flow, 8.6% had heavy flow, 6.8% had infrequent with prolonged flow, 6% had prolonged, infrequent with heavy bleeding. Non-structural (COEIN) causes contributed to about 60.4% of AUB in perimenopausal women and 39.6% had structural (PALM) causes. 49% cases were secretory endometrium. 29.3% had disordered proliferative endometrium, 4.3% had proliferative endometrium, 5.2% each had polyp or hyperplasia without atypia. 18 (15.5%) cases underwent hysterectomy, 3 patients who had adenocarcinoma underwent staging laparotomy, 2 patients had LNG IUS insertion and 40 patients were on follow up requiring either no treatment and 53 (45.68%) patients were given antifibrinolytics or hormonal therapy.Conclusions: Heavy and prolonged menstrual bleeding was the most common presenting symptom. COEIN contributed to about 60.4% of cases. Evaluation of the endometrium showed that, secretory endometrium was commonest (49%) followed by disordered proliferative endometrium (29.3%). On follow up for six months, 15.5% patients underwent hysterectomy, 2 patients had insertion of levonorgestrel IUD, 45.68% patients had medical management with antifibrinolytics or hormones and were on follow up. The responsibility of gynaecologist in the management of AUB in perimenopausal women is to exclude hyperplasia of endometrium and endometrial cancer

Prospective study of maternal outcomes in primigravida with gestational diabetes mellitus in a tertiary care centre Venjaramood, Thiruvananthapuram

Background: The prevalence of Gestational diabetes mellitus (GDM) is on the rise. Understanding the various outcomes of it is essential to face this challenge. The aim of the study was to understand the maternal outcomes of GDM in primigravida and to compare the maternal outcomes in primigravida with GDM and without GDM.Methods: This prospective study was conducted in the department of obstetrics and gynaecology at Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, on 180 primigravida mothers,90 with and 90 without gestational diabetes. GDM was diagnosed with IADPSG criteria using 75 g Oral glucose tolerance test (OGTT).Results: A total of 180 primigravida with singleton gestation, 90 with GDM and 90 without GDM were followed from pregnancy to delivery after fulfilling criteria during study period. 65.6% GDM mothers had good compliance with Medical nutrition therapy (MNT) and exercise.  88.8% of GDM mothers required induction of labour, 13.3% had pregnancy induced hypertension, 12.2% had vulvovaginal candidiasis and 10% had postpartum hemorrhage. Thus, women with GDM on MNT or MNT with insulin had a higher risk of adverse maternal outcomes but was comparable to normoglycemic mothers if they had good compliance to MNT or insulin.Conclusions: Women with GDM had a higher but comparable risk of adverse maternal outcomes as compared to normoglycemic pregnant mothers, if they strictly adhere to MNT with or without insulin reflecting the importance of good treatment compliance.