A comparison of urine dipstick test with spot urine protein-creatinine ratio and 24-hour urine protein excretion in women with preeclampsia

Background: Measurement of protein excretion in a 24-hour urine collection and measurement of protein-creatinine (P/C) ratio in a spot urine sample have been standard investigations for evaluation of protein excretion. The urine dipstick method, a semi-quantitative method of proteinuria excretion, has long been used as a screening tool for the same purpose. The objective of this study was to assess the efficacy of test dipstick measurement of proteinuria in comparison with 24 hour urinary protein excretion and spot urine protein/creatinine ratio, as a screening test in pregnant patients with suspected preeclampsia, attending an obstetric outpatient service.Methods: We measured proteinuria in 75 patients attending the obstetric outpatient service at our University Hospital by test dipstick method, 24-hour urine protein excretion and spot urine protein/creatinine ratio and calculated the degree of correlation between the first with the other two standard tests.  Results: The correlation of the urine dipstick test values with the 24-hour urine protein excretion was strong (r = 0.634), while compared to the spot urine protein/creatinine ratio, it was moderate at best (r = 0.401). The 1 + level of urine dipstick demonstrated greater sensitivity, but at the 2 + level, dipstick was more specific in identification of significant proteinuria.  Conclusions: We conclude that test dipstick correlates better with 24 hour urine protein estimation than with the protein/creatinine ratio. Further, 1 + urine dipstick could be a good screening tool for identifying proteinuria in patients attending the obstetrics outpatient service. However, the 2 + level on the urine dipstick would be required to serve as be an alternative to the 24-hour urine collection for detection of significant proteinuria or calculation of spot urine P/C ratio.

Comparative study of saline infusion sonography and hysteroscopy for evaluation of uterine cavity in abnormal uterine bleeding

Background: Intra-cavitary uterine pathology is the commonest cause of abnormal uterine bleeding. Hysteroscopy is considered as the gold standard for uterine cavity examination. However, in resource limited set-ups saline infusion sonography is an effective alternative to hysteroscopy. The current study aims to compare the accuracy of saline infusion sonography with hysteroscopy in identifying intra-cavitary lesions in women with abnormal uterine bleeding.Methods: 52 patients with abnormal uterine bleeding underwent saline infusion sonography followed by hysteroscopy. The parameters studied were endometrial thickness, presence of sub-mucosal fibroid and endometrial polyp.  Results: Upon comparison of saline infusion sonography with hysteroscopy, for detecting endometrial hyperplasia the  sensitivity, specificity, positive and negative predictive value were 100%, 94%, 40% and 100% respectively. For endometrial polyp the sensitivity, specificity, positive and negative predictive values were 90.90%, 92.68%, 76.92% and 97.43% respectively. Similarly, the sensitivity, specificity, positive and negative predictive values for sub-mucosal fibroid were 86.36%, 83%, 79.16 % and 89.28% respectively.Conclusions: Saline infusion sonography is a less invasive alternative to hysteroscopy for diagnosis of intra-cavitary lesions in women with abnormal uterine bleeding.

Precocious puberty: a clinical review

Precocious puberty is defined as pubertal development occurring more than 2.5 standard deviations earlier than the average age. It may comprise of central or gonadotropin-dependent precocious puberty and peripheral or gonadotropin-independent precocious puberty. Variants of precocious puberty include premature thelarche, premature pubarche and isolated premature menarche which principally implies onset of menstruation without any other signs of sexual development. Precocious puberty may have long-term consequences including short stature later on in adulthood owing to premature epiphyseal fusion as also psychosocial problems. Evaluation includes a detailed history, physical examination, biochemical tests and imaging directed towards detecting the cause. Gonadotropin Releasing Hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the cause. Isolated variants are usually normal but should be closely monitored. Multi-speciality consultation with involvement of pediatricians and enocrinologists may improve treatment outcomes in these children, who otherwise pose significant challenges to the gynaecologist

Foreign body in vagina: a cause of persistent vaginal discharge in a prepubescent child

Vaginal discharge in prepubertal children is mainly due to hypoestrogenic state of vaginal mucosa making it thin and alkaline leading to mucosal invasion by pathogen. In paediatric case persistent foul smelling, blood stained discharge not responding to medical therapy should arouse suspicion of foreign body. Authors report an interesting case of 2 years old child who presented with persistent vaginal discharge and was found to have a retained foreign body in the vaginaneonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted

Effect of perineal massage in the second stage of labour, on the incidence of episiotomy and perineal tears

Background: This study aimed to investigate whether perineal massage during second stage of labour could decrease perineal trauma in the form of episiotomy and perineal tears.Methods: One hundred and fifty term antenatal women in labour were randomly assigned to two groups, one of which received perineal massage and the other received routine care during the second stage. Frequency of episiotomies, perineal tears, intact perineums, degrees of perineal tears, duration of second stage of labour and perineal pain after 24 hours was compared.Results: Perineal massage was efficient in reducing incidence of episiotomy, duration of second stage of labour and perineal pain assessed 24 hours after delivery. The frequency of perineal tears and intact perineums did not differ significantly. Perineal massage was protective against severe form of third degree perineal tears.Conclusions: Authors suggest that perineal massage can be routinely practiced by health professionals to improve quality of life in women post vaginal delivery

Foreign body in vagina: a cause of persistent vaginal discharge in children

Vulvovaginitis and vaginal discharge in pediatric patients, while not uncommon, is commonly believed to be due to such causes as absence of the protective effect on the vaginal mucosa. However, other causes need also to be kept in mind. We report a case of chronic vaginal discharge in a 5 yr old, who had retained a foreign body in her vagina for 6-7 months

A case of post-caesarean vesico-uterine fistula: A rare entity becoming common?

Vesicouterine fistula (VUF) is rare, with an incidence estimated at 1-4% of all genitourinary fistulas. We report a case of VUF which was referred to our institute on the 6th postoperative day following an emergency repeat lower section caesarean section (LSCS) at 39 weeks, with complaints of hematuria and watery discharge per vaginum for further management. Patient had stable vitals with slight abdominal distension and tenderness and watery discharge per vaginum having an ammoniacal odour. USG examination showed Foley’s bulb inside uterine cavity. CT abdomen confirmed the findings and showed presence of contrast inside uterine cavity. Patient was re-operated on 9th postoperative day in concurrence with urologists. Cystoscopy showed a 2 cm size fistulous opening. Intra-operative findings revealed a fistulous track between posterior wall of bladder and uterine incision. Appropriate reparative surgery was done. Obstetricians need to be aware of this condition particularly while operating on previous caesarean sections

Placenta percreta induced uterine rupture at 15 weeks of gestation: an unusual case

Spontaneous rupture of uterus during early pregnancy due to placenta percreta is a rare complication, which is potentially life-threatening to both mother & fetus and also difficult to diagnose. A 27 years old pregnant woman with history of previous one caesarean section 2 years back was referred to our emergency department with severe anaemia and breathlessness. On examination patient was in hypovolemic shock. Ultrasonography revealed massive fluid collection in peritoneal cavity, an intrauterine anomalous foetus of 15 weeks and low-lying placenta. Paracentesis was positive for blood. On laparotomy there was haemoperitoneum of about 3 litres with placenta perforating through the lower segment of uterus. Even after all measures to conserve uterus, due to uncontrolled bleeding hysterectomy was performed. Postoperative period was uneventful. Pathological analysis of the specimen confirmed our diagnosis of placenta percreta. Though uterine rupture is rare in early trimester, it may be considered in a patient with haemoperitoneum with a scarred uterus, which can be due to placenta percreta also

May–Thurner syndrome causing deep vein thrombosis in the postoperative patient

May–Thurner syndrome is a rare cause of left iliac deep vein thrombosis due to an anatomical variant in which right common iliac artery overlies and compresses left common iliac vein against lumbar spine. Patients with May–Thurner syndrome usually present in their 2nd to 4th decade of life. Pregnancy and intra-abdominal surgeries are known precipitating factors in acute May–Thurner syndrome. We report the case of a woman in her 3rd decade of life who presented with May–Thurner syndrome following total abdominal hysterectomy. This case report hopes to bring attention to the high variant of patient population with May–Thurner syndrome and the necessity for surgical intervention of stent placement to prevent recurrence

Maternal and neonatal outcome in newborns with nuchal cord loop: a comparative study

Background: To compare the maternal and neonatal outcome between the new-born with and without nuchal cord loop at the time of delivery.Methods: It is a prospective comparative study, conducted in Mahatma Gandhi Medical College and Research Institute, Pondicherry from August 2013 to May 2014. All the pregnant women, who fulfill the inclusion and exclusion criteria, were taken into account and allowed to have the normal course of labour. At the time of delivery all neonates born with nuchal cord loop were taken as the study group and without nuchal cord loop were included in the control group. Cord blood gas analysis was done using blood gas analyzer (Radiometer ABL5) for neonates with Apgar score <7 at 1 minutes. Outcomes measured were requirement of induction of labour, requirement of augmentation with oxytocin following spontaneous onset of labour, duration of labour, mode of delivery , amniotic fluid index, foetal heart rate irregularities, birth weight, meconium stained liquor, Apgar score, cord blood gas analysis like pH, PO2, PCO2 (neonatal parameters) in new-born with nuchal cord loop.Results: There were no statistically significant differences between the two groups in relation to  maternal outcome .As far as neonatal outcome concerned, although meconium stained liquor (15.3% vs. 10.6% ), foetal heart irregularities (20.9% vs. 11.5 %) and 1st minutes Apgar score <7 (13.2% vs. 7.2%, p=0.033)  are more  in the study group , the   difference is not significant.Conclusions: The study concluded that the presence of nuchal cord loop does not adversely affect the maternal outcome. Although it increases the meconium stained liquor, affect FHR irregularities and low 1st minute Apgar score, it does not increase the operative interference in mother.