Clinical analysis of gynecological diseases in postmenopausal women in tertiary care centre

ABSTRACTBackground: Menopause is a natural step in ageing process represents the period end of menstruation after last menstrual period in previous 12 months. Gynaecological disorder in older women differs from those who are younger. Disorders peculiar to ageing are pelvic organ prolapse, urinary incontinence, genital infections and malignancies. Present study is contemplated with a view to assess the magnitude of postmenopausal gynaecological morbidity. The goal of this study was to assess the age of onset of menopause and the spectrum of different gynaecological diseases, their incidence, diagnosis and treatment modality in postmenopausal females.Methods: A Prospective observational study of postmenopausal females attending Gynecology OPD or admitted in Sultania Zanana Hospital, Bhopal was carried out between July 2014 to June 2015. Total 401 postmenopausal females were included. Age of menopause and detail of all gynecological problems were recorded using predesigned proforma.Results: The study population was drawn from both rural (41.4%) and urban (58.8%) areas. Mean age of onset of menopause was 48.01 years in study population. In all, 28.4% had pelvic organ prolapse, 26.6% had genital malignancies, 25.5% had urogenital infections and 17.7% had benign disorder like senile endometritis, fibroid uterus etc.Conclusions: Menopausal health has been one of the neglected area in our country and needs timely vital attention as they are at risk of developing various genital malignancies. This emphasises the need for a screening programme for Indian women in our scenario

Role of hysterolaparoscopy in the evaluation of female infertility in a tertiary care centre

Background: Infertility is one of the most important and underappreciated reproductive health problems in developing countries. Inability to conceive bears a social stigma which causes societal repercussion and personal suffering. The advent of hysterolaparoscopy have redefined the evaluation and treatment of infertile women. Study aimed to assess the role of hysterolaparoscopy in the evaluation of female infertility.Methods: This prospective observational study was done in the department of obstetrics and gynaecology, Gandhi Medical College, Sultania Zanana Hospital, Bhopal, during the period between 1st December 2016 to 30th November 2017. 104 infertile patients either with primary or secondary infertility were included after thorough evaluation.Results: Out of 104 infertile patients, 82(78.8%) women had primary infertility and rest 22(21.1%) women had secondary infertility. In primary infertility group, most common laparoscopic finding was PCOD in 24(29%) women and in secondary infertility group, tubal blockage was seen in 9(40%) women. The most common pathology seen in hysteroscopy was submucous fibroid in 6(7.3%) women with primary infertility, whereas in secondary infertility group, synechiae was found in 2(9%) patients and septum was seen in 1(4.5%) patient. Out of 104 patients, 33 (31.7%) patients underwent various interventions. The most common intervention was ovarian drilling for PCOS in 21(63.3%) patients followed by hysteroscopic cannulation in 5(15.5%) patients.Conclusions: Hysterolaparoscopy is a very useful tool that can detect various structural abnormalities in multiple sites like uterus, tubes, ovaries and peritoneal cavity in the same sitting. When done by experienced hands and proper selection of patients, hysterolaparoscopy can be considered as a definitive investigative procedure for evaluation of female infertility

A study to evaluate the causes of stillbirths according to the ReCoDe classification

Background: Foetal death or stillbirth is a major obstetrical complication and a devastating experience for the pregnant patients and relatives. Worldwide an estimate of at least 3.2 million stillbirths occurs each year. There are intensified demands on medical, political and epidemiological ground for proper determination and classification of causes of perinatal death. The aim of this study was to test a new classification system- Re. Co. De. Classification (Relevant Condition at Death) for stillbirths to improve our understanding of the main causes and conditions associated with foetal deaths.Methods: This study was a hospital based Prospective study conducted in department of obstetrics and Gynaecology, SZH, Bhopal. The study included 463 women who were admitted with Intra Uterine Foetal Demise. All cases were evaluated and after delivery the stillborn baby, the placenta and cord were examined. The causes were classified according to Re. Co. De. System.Results: The analysis of the new classification system Re. Co. De. Allowed attributable causes to about 90.72% of causes of still births explained where 9.28% were unexplained. The commonest cause was found to be class F4-Toxaemia of pregnancy (13.17%) followed by class A7- IUGR (10.58%), class C1-Abruptio placentae (10.36%), class E3-Obstructed labour (9.8%) and class A1- Lethal congenital malformations (8.42%).Conclusions: The Re. Co. De. Classification system gives us a better understanding of antecedents of stillbirths and the clinical practices, which need to be addressed to reduce perinatal mortality and have a better obstetric result in the next pregnancy

Intrapartum amnioinfusion in meconium stained amniotic fluid at term pregnancy

Background: In our country a major cause of perinatal mortality and morbidity is meconium aspiration syndrome (MAS) in new-born. The aim of this study is to assess feto-maternal outcome following intrapartum amnioinfusion in patients with meconium stained amniotic fluid and the rate of ceaserean deliveries following intrapartum amnioinfusion in patients with meconium stained amniotic fluid.Methods: This prospective observational study was conducted on 252 patients with pregnancy at or beyond 37 weeks in active labour with moderate to thick meconium stained amniotic fluid following spontaneous rupture or ARM. In such cases amnioinfusion was performed. Continuous electronic FHR monitoring was performed. Emergency LSCS was done when fetal Bradycardia was recorded or in case of non-progress of labor. Fetomaternal outcome will be noted.Results: In present study most, women had normal vaginal delivery 157 (62.30%) followed by LSCS 93 (36.91%) followed by forceps/vaccum delivery 02 (0.07%). No maternal complication was seen in 230 women (91.26%). Accidenatal hemorrhage was seen in 01 (0.39%) which was managed by emergency LSCS. Out of 252 neonates, 183 asymptomatic neonates at birth, 69 needed resuscitation and in which 52 neonates recovered and shifted back to mother and 17 neonates referred and admitted in NICU for MAS in which 07 were recovered and 10 neonates (3.96%) died due to MAS.Conclusions: Intrapartum amnio infusion in meconium stained amniotic fluid by diluting the meconium and by decreasing the cord compression decreases the incidence of foetal distress and there by decreases the rate of caesarean section, these all leads to decrease the incidence of maternal and perinatal morbidity and mortality

Clinical analysis of gynecological diseases in postmenopausal women in tertiary care centre

ABSTRACTBackground: Menopause is a natural step in ageing process represents the period end of menstruation after last menstrual period in previous 12 months. Gynaecological disorder in older women differs from those who are younger. Disorders peculiar to ageing are pelvic organ prolapse, urinary incontinence, genital infections and malignancies. Present study is contemplated with a view to assess the magnitude of postmenopausal gynaecological morbidity. The goal of this study was to assess the age of onset of menopause and the spectrum of different gynaecological diseases, their incidence, diagnosis and treatment modality in postmenopausal females.Methods: A Prospective observational study of postmenopausal females attending Gynecology OPD or admitted in Sultania Zanana Hospital, Bhopal was carried out between July 2014 to June 2015. Total 401 postmenopausal females were included. Age of menopause and detail of all gynecological problems were recorded using predesigned proforma.Results: The study population was drawn from both rural (41.4%) and urban (58.8%) areas. Mean age of onset of menopause was 48.01 years in study population. In all, 28.4% had pelvic organ prolapse, 26.6% had genital malignancies, 25.5% had urogenital infections and 17.7% had benign disorder like senile endometritis, fibroid uterus etc.Conclusions: Menopausal health has been one of the neglected area in our country and needs timely vital attention as they are at risk of developing various genital malignancies. This emphasises the need for a screening programme for Indian women in our scenario