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.

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

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

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

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

Clinical study of primary caesarean section in multiparous women in a tertiary care hospital

Background: The objective of this study was to find the incidence and indications of primary caesarean section in parous women and evaluate the maternal and perinatal outcomes there from.Methods: Prospective study of primary caesarean sections in parous women at our institute from June 2013 to May 2014 was done. Age, indications and the maternal as well as perinatal outcomes were analyzed. Data was expressed as number and percentage.Results: Out of 1124 caesarean deliveries, 68 primary caesareans in parous women were done.  The most common age group was 21-30 years. The majority of parous women who underwent primary caesarean section, were para 2. Booked cases constituted the maximum number of such women at 97.1 % (n=66). In parous women undergoing primary caesarean section, the number of spontaneous onset of labour was significantly more than those undergoing induction of labour. The most common indication for caesarean section in this group of patients was fetal distress. There was no neonatal mortality or adverse maternal outcome.Conclusions: Fetal distress was the most common indication for primary caesarean section in the parous woman, although malpresentation also contributed significant numbers. Primary caesarean sections in women with previous vaginal deliveries, were not associated with any significant neonatal or maternal complications

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

Efficacy and safety of serial membrane sweeping to prevent post term pregnancy: a randomised study

Background: Prolonged pregnancy is associated with increased perinatal mortality and morbidity. Elective induction of labor at 41 weeks gestation is practiced routinely to improve the outcome. Membrane sweeping is old and simple method to promote onset of labor. To improve the success rate of this method, multiple attempts of sweeping has been tried and found to be effective and safe. Our aim was to assess the safety and efficacy of serial membrane sweeping in prevention of post term pregnancies.Methods: Participants were randomly assigned to serial membrane sweeping every 48 hours starting from 40 weeks until the labour commencement   or up to 41 weeks of gestation. There was no intervention up to 41weeks in the control group.  Labor was induced in women of both the groups who continued pregnancy beyond 41 weeks. Outcome measures include spontaneous onset of labor, mode of delivery, need of oxytocin for augmentation and maternal and fetal complications.Results: Significant number of women had spontaneous onset of labor before 41 weeks (47/48) and delivered vaginally in contrast to control group (23/50). There is significantly less need of oxytocin in study group. The prevention remained consistent and not dependent on parity and bishop score. Significant number in control group had meconium stained liquor. No other maternal or fetal complications noted.Conclusions: Serial membrane sweeping is both safe and effective in the prevention of pregnancy beyond 41 weeks. Hence reduces the   post term pregnancy, need for induction of labour and related risks in low pregnancies

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