Association of thyroid dysfunction with abnormal uterine bleeding

Background: Abnormal uterine bleeding is a common complaint for women being referred to the gynaecologist and is associated with an array of symptoms. The objective of this study was to detect association of thyroid dysfunction in patients with menstrual irregularitiesMethods: This non-interventional prospective study was done over a period of one and half years in a private medical college in Mangalore. All patients in age group of 15-55 years who presented with history of menstrual disturbances were enrolled and evaluated in the study. Patients with structural causes of AUB or using IUCDs or hormonal steroids were excluded. Total of 85 patients were hence evaluated. These 85 patients were subjected to routine investigations like Hb, BT, CT and platelets (to rule out coagulation defects) along with TSH, T3, T4 estimation. Ultrasound abdomen and pelvis with endometrial thickness was done to rule out structural causes.Results: The most common menstrual disturbance was menorrhagia (47 patients: 55.3%). Thyroid abnormalities were found in 29 of the 85 patients with AUB (34.11%). Of the 29 patients with thyroid dysfunction, 24 were hypothyroid and 5 patients were found to be hyperthyroid.Conclusions: Thyroid abnormalities are frequently associated with menstrual irregularities. Hence Thyroid Function Tests are extremely valuable in patients with provisional diagnosis of AUB and should be made mandatory to avoid unnecessary hormonal or surgical treatment in such patients

Elective induction versus spontaneous labor at term: prospective study of outcome and complications

Background: This study aims at identifying the association between inductions of labor in nullipara and multipara to caesarean delivery and other associated maternal and neonatal outcomes.Methods: The study subjects were divided into two groups, elective induction group and spontaneous labor group. They were matched for maternal age, parity and gestational age. Duration of first and second stage of labor, mode of delivery, if caesarean section, indication for caesarean section and its relation to Bishop score, maternal age, birth weight was analyzed. Maternal intrapartum and post-partum complications and fetal outcome were also analyzed.Results: Out of the 400 women in the study, 200 were induced and 200 were those who went into spontaneous labor. The rate of cesarean section rate among induced group is 31% and was statistically significant. But the analysis of the same after excluding risk factors like nulliparity, Bishop score 3.5 kg it was found that the rate of cesarean section is 37.1%, but was statistically not significant when compared to the spontaneous group.There was significant decrease in the duration of second stage of labor in the induced primipara group with p value of 0.038. There was no significant difference in the maternal and neonatal complications.Conclusions: This study concludes that elective induction in carefully selected low risk population, excluding the above-mentioned risk factors does not pose any increased risk of cesarean section. Elective induction does not cause any increased risk to mother and fetus

Contraceptive practices among reproductive age group of women in Justice K. S. Hegde Medical College Hospital, Mangalore

Background: India’s population as per 2011 census was 1.21 billion second only to china in the world, and is estimated to overtake china by 2050. India was the first country to launch National Family Planning Program in 1952. Even though various measures have been taken to encourage the usage of contraception but, the achievement in this field was not to the extent expected due to various social and cultural factors.Methods: It was a cross sectional study conducted in out patients and inpatients of department of obstetrics and gynecology, Justice K. S. Hegde medical college hospital, Mangalore. The study constituted 705 subjects. It was an interview based study. The study was aimed to know the awareness, acceptance and prevalence of temporary and permanent contraceptive methods among the study group and various factors affecting the contraceptive usage.Results: A total of 705 women in the age group between 18-45 years were studied.  671 (95.2%) were aware of one or multiple methods of contraception, 615 (87.2 %) accepted the contraceptive practices, and 495 (71.2%) followed or are following contraception at the time of study. Of 705 women, 366 (51.9%) followed or used temporary methods, 227 (32.2%) followed permanent methods of contraception.Conclusions: Awareness about the contraception is not sufficient enough to use contraception in the community, also shows that more programs are required to combat the influence of various factors on contraception usage, and emphasizing on the positive effects of the use of contraception

A clinical study of primary caesarean section at a tertiary care hospital in coastal city: an observational study

Background: Caesarean section represents the most significant operative intervention in obstetrics and its development and application has saved the lives of countless mothers and infants. However there has been a steady increase in the rate of caesarean sections worldwide. In this study, we aim to find the primary caesarean section rates and strategies to cut it down.Methods: This was a prospective observational study done from January 2018 to June 2019 at Justice K. S. Hegde Charitable Hospital, Deralakatte, Mangaluru which included 379 cases of primary cesarean sections. All patients undergoing primary caesarean section with gestational age >28 weeks confirmed by dates, clinical examination and ultrasound were included in this study. Patients who had undergone previous caesarean section or were less than 18 years of age or were less than 28 weeks of gestation were excluded from the study.Results: In this study the rate of primary caesarean section was found to be 14.5% and the majority of the study subjects belonged to the age group of 18-27 years (62.3%). With respect to parity, primigravida were high in number (71.2%), followed by multigravida. The number of emergency caesarean sections were (79%) more than elective (21%). The most common intra-operative complication was post-partum haemorrhage (PPH) in 2.8% and the most common postoperative complication was wound gape in 2.1%.Conclusions: Maximum efforts should be made to allow progression of vaginal delivery in primigravida which helps us to bring down the primary caesarean rate

A case of ovarian Sertoli-Leydig cell tumor with multiple endocrine gland involvement

Sertoli-Leydig Cell Tumors (SLCT) comprises an uncommon and heterogeneous group of ovarian neoplasms within sex-cord stromal category. Retiform type accounts to about 10-15% of all SLCTs and they are less androgenic than other variants. We present to you a 20 year old lady who came to us with features of virilisation and abdominal mass. Intra-operatively, mass arose from left ovary. Left salpingo-oophorectomy was done. Histopathological diagnosis was SLCT with retiform pattern and with a foci of heterologous elements. Interestingly, patient had undergone hemithyroidectomy at the age of 9 for thyroid adenoma. As a part of pre-operative work up, computed tomography revealed an incidental finding of adrenal adenoma but overnight dexamethasone suppression test was negative. There have been reports of association of thyroid conditions with SLCT but here we are reporting association of two endocrine glands (thyroid and adrenal) in the same patient

Role of uterine artery doppler at 18-22 weeks in the prediction of pre-eclampsia: a prospective study

Background: Pre-eclampsia is the most common pregnancy complication associated with serious maternal and fetal morbidity. Uterine artery Doppler reflects the impaired trophoblastic invasion of the uterine spiral arteries, which is involved in the aetiology of preeclampsia. Thus, uterine artery Doppler was proposed as a screening test for pre-eclampsia.Methods: A prospective cohort study of 100 singleton pregnancies was conducted in a tertiary centre and the study population were subjected to uterine artery Doppler study at 18-22 weeks gestation. Uterine artery Doppler indices of pulsatility index (PI), resistance index (RI) and persistence of diastolic notch was obtained and the outcome of pre-eclampsia was studied.Results: Out of 100 women, 14 women developed pre-eclampsia in which the resistance index showed a sensitivity of 21.4%, specificity of 91.8%, positive predictive value of 30% and negative predictive value of 87.7% and pulsatility index showed sensitivity of 35.7%, specificity of 90.6%, positive predictive value of 38.4% and negative predictive value of 89.6%. Diastolic notch had a sensitivity of 35.7%, specificity of 98.8%, positive predictive value of 83.3% and a negative predictive value of 90.4%.Conclusions: The high negative predictive values, indicated that women with normal Doppler velocimetry were unlikely to develop preeclampsia. Uterine artery Doppler, being non-invasive can be included during routine sonography to identify patients at risk of developing pre-eclampsia. Early, screening for pre-eclampsia will help in individualized antenatal surveillance and initiation of prophylactic therapy, early to reduce the adverse maternal and foetal complications of preeclampsia

Association of thyroid dysfunction with abnormal uterine bleeding

Background: Abnormal uterine bleeding is a common complaint for women being referred to the gynaecologist and is associated with an array of symptoms. The objective of this study was to detect association of thyroid dysfunction in patients with menstrual irregularitiesMethods: This non-interventional prospective study was done over a period of one and half years in a private medical college in Mangalore. All patients in age group of 15-55 years who presented with history of menstrual disturbances were enrolled and evaluated in the study. Patients with structural causes of AUB or using IUCDs or hormonal steroids were excluded. Total of 85 patients were hence evaluated. These 85 patients were subjected to routine investigations like Hb, BT, CT and platelets (to rule out coagulation defects) along with TSH, T3, T4 estimation. Ultrasound abdomen and pelvis with endometrial thickness was done to rule out structural causes.Results: The most common menstrual disturbance was menorrhagia (47 patients: 55.3%). Thyroid abnormalities were found in 29 of the 85 patients with AUB (34.11%). Of the 29 patients with thyroid dysfunction, 24 were hypothyroid and 5 patients were found to be hyperthyroid.Conclusions: Thyroid abnormalities are frequently associated with menstrual irregularities. Hence Thyroid Function Tests are extremely valuable in patients with provisional diagnosis of AUB and should be made mandatory to avoid unnecessary hormonal or surgical treatment in such patients