Evaluation of the diagnostic accuracy of transvaginal sonography versus hysteroscopy in detection of submucous myomas in peri and postmenopausal women with abnormal uterine bleeding

Background: Abnormal uterine bleeding is a very common gynaecological condition that affects all age groups. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation. Aim was to evaluate the diagnostic accuracy of transvaginal sonography versus hysteroscopy in detection of submucous myomas in peri and postmenopausal women with abnormal uterine bleeding.Methods: The present study was prospective cross sectional study conducted in the Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child Indira Gandhi Medical College Shimla for period of one year w.e.f. 1st May 2018 to 30th April 2019. The study was started after hospital ethical committee approval. 76 patients peri and post-menopausal women were enrolled in the study after taking written consent.Results: On TVS- all the study subjects underwent TVS examination, submucous fibroid was detected in 10 subjects (n= 76) i.e. 13.1% (all perimenopausal). On hysteroscopy submucous fibroid was detected in 11 (14.4%) subjects, on histopathology it was confirmed in 11 subjects (14.4%). Out of 11, 8 patients underwent hysterectomy, 1 myomectomy, 2 patients had hysteroscopic removal of fibroid. 1 subject with AUB-LSM was wrongly diagnosed as AUB-P. Sensitivity, specificity, positive and negative predictive values of transvaginal sonography versus hysteroscopy was 90.09%, 100%, 100%, 98.5% respectively.Conclusions: TVS is an important initial modality for evaluating the patient of AUB. It is quick, simple, painless, least invasive, less expensive and readily available procedure and does not need full bladder like TAS. On the other hand, hysteroscopy has a better diagnostic accuracy as it provides the option of see and treat which is recommended for peri and post-menopausal women with AUB

Huge fibroid uterus mimicking an ovarian malignancy

Leiomyoma of the uterus is the most common benign tumor arising from uterine smooth muscle. This is a case of a woman with an exophytic uterine leiomyoma mimicking an ovarian neoplasm. The potential for uterine leiomyomas to grow to an extreme size before causing symptoms is quite remarkable. This is likely due to the relatively large volume of the abdominal cavity, the distensibility of the abdominal wall and the slow growth rate of these tumors. In our case report, despite a fibroid of size reaching up to 34 weeks of gestation, our patient had minimal symptoms except for abdominal discomfort. There were no symptoms related to abnormal uterine bleeding or abnormal bowel or bladder habit. Also, the history and clinical examination of the patient favored a diagnosis of ovarian malignancy

Giant uterine cervical polyp: a case report

Cervical polyps are benign growths, usually protruding from the surface of the cervical canal. Two out of three women with cervical polyps present asymptomatically. However, symptomatic women usually present with abnormal uterine bleeding, such as heavy menstrual bleeding, intermenstrual bleeding, or postmenopausal bleeding, as well as vaginal discharge. Giant cervical polyps often are misdiagnosed as malignant in view of their appearance, however most of them are benign in nature. They are also confused with uterine prolapse and uterine inversion. Proper evaluation and diagnosis should be provided so as to ensure complete care to the individual and adequate management

Prospective study to evaluate management of ectopic pregnancy in a tertiary care centre

Background: To study the pattern of management of ectopic pregnancy in a referral Centre in North India.Methods: This prospective study was conducted over a period of one year in the department of obstetrics and gynecology, in a tertiary care Centre in North India. Total number of cases who reported to hospital with ectopic pregnancy during the study period were 110. All the cases were analyzed and managed either with conservative, medical or surgical treatment depending on the condition of cases at the time of presentation to the hospital. Frequencies of different variables were compared by chi square test using Graphpad Prism 9, p value less than 0.05 was considered statistically significant.Results: The incidence of ectopic pregnancies reported in present study was 18.62 per 1,000 deliveries. Total of 110 cases with ectopic pregnancy reported to hospital during the study period. Mean age of the cases was 28.72 years. Out of 110 cases, laparotomy was performed in 100 cases and medical management in 10 cases. Medical management failed in one case and necessitated surgery in that case. There was no maternal mortality during the study period.Conclusion: Most of the cases presented late to the hospital due to lack of awareness, topographically tough terrain in Himachal with limited transport facilities which delayed management of ectopic pregnancy and precludes conservative management either in the form of medical management or conservative surgery. Screening of high-risk cases, early diagnosis, early referral and early intervention reduces the maternal mortality and morbidity. So awareness at the primary health care level is the necessity of the hour

Evaluation of serum lactate dehydrogenase in hypertensive disorders of pregnancy and its comparison with normal pregnancy

Background: Hypertensive disorders of pregnancy and their complications rank as one of the major causes of maternal morbidity and mortality. The objective of the study was to compare the level of serum LDH in normotensive and hypertensive pregnant women and to correlate the levels with maternal and foetal outcome.Methods: Study was conducted in department of obstetrics and gynecology Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla w.e.f. 15th July, 2014 to 14th July, 2015. Pregnant women enrolled in the study were divided into following groups: - Group 1- Age and parity matched 202 normotensive pregnant women. Group 2- 202 women with hypertensive disorders of pregnancy as per the inclusion and exclusion criteria. Subjects were also divided according to the serum LDH levels into following groups: LDH 800IU/L. The maternal and foetal outcome was correlated with the serum level of LDH. One-way analysis of variance (ANOVA) and the chi-square test were used to compare the results. Differences were considered significant when p800 IU/L as compared with those who had lower levels.Conclusions: Lactate dehydrogenase is a useful biochemical marker that reflects the severity of and the occurrence of complications of preeclampsia and eclampsia. Identification of high-risk patients with elevated levels of lactic dehydrogenase, their close monitoring, and prompt, correct management may prevent these complications, with a subsequent decrease in maternal foetal morbidity and mortality

Comparative study of fetal outcomes in pregestational and gestational diabetes mellitus

Background: Diabetes mellitus is an emerging health problem worldwide and is now seen in increased frequency during pregnancy. Pregestational DM and GDM have an impact on the fetal outcome in terms of the baby weight, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome and other complications in the fetus. This study was designed to study these effects in a comparative way between these two groups so as to equip ourselves better and provide better materno-fetal care. Method: This was a prospective observational study conducted during a period of one year.All pregnant females attending the antenatal OPD were screened for diabetes mellitus. Those fulfilling the ADA criteria belonged to the pregestational diabetes mellitus group and those fulfilling the DIPSI criteria belonged to the GDM group. A proforma containing general information on demographic characteristics and neonatal outcome in terms of the baby status, baby weight, l, hypoglycaemia, hyperbilirubinemia, and respiratory distress syndrome was maintained. The whole data collected was then analyzed. Results: The fetal outcome for Group DM was more adverse in comparison to the Group GDM. There was an increased incidence of macrosomia (27.9% vs. 8.25%), hyperbilirubinemia (87.1% vs. 53.1%), hypoglycemia and fetal wastage. Conclusions: Pregnancy complicated with diabetes mellitus is a high risk pregnancy and the type of diabetes plays a crucial role in the fetal outcome of that pregnancy. An understanding of this can help provide better perinatal care and outcome

Krukenberg tumor

Krukenberg tumor is a rare form of metastatic ovarian cancer which accounts for less than 2% of all ovarian tumor. Krukenberg tumor mostly occurs after the age of 40 years and is rarely found in younger age group. It usually presents with bilateral involvement of ovaries. It presents when the primary is already advanced. Here we are presenting a rare case of Krukenberg tumor in a 22 years old female with primary from stomach

Prevalence and associated risk factors of abnormal pap smear in pregnant women

Background: The Papanicolaou test is a method of cervical screening used to detect pre-cancerous and cancerous processes. The incidence of cervical cancer in India is alarmingly high and is the leading cause of cancer in women in India accounting for 147 deaths per lakh women. Cervical cytological abnormalities are found in up to 5% of all pregnancies. In Indian settings, published data on abnormal Pap smear in pregnancy is lacking. The present study was designed to know the prevalence of abnormal Pap smear in pregnant women and its associated risk factors.Methods: This prospective study included 450 pregnant and 450 non-pregnant women who fulfilled the inclusion criteria. After a detailed history, clinical examination and investigations, Pap smear was collected as per conventional method and reported using 2014 Bethesda system.Results: 53.6% pregnant and 44.6% non-pregnant subjects had abnormal Pap smear. Out of the abnormal smears in pregnant women, 31.18% had inflammatory cytology, 15.37% had bacterial vaginosis, 4.01% had Trichomonal and 3.34% Monilial pathology. No epithelial cell abnormality was seen. Rural residence, lower class, age at first intercourse less than 21 years and having more than one sexual partner were important risk factors observed in our study and were statistically significant.Conclusions: Bacterial vaginosis, the most common infection detected on Pap smear is strongly associated with previos preterm labour and delivery. This opportunity for screening of cervical cancer and counselling should not be missed in the antenatal period

Can serum homocysteine predict hypertensive disorders of pregnancy?: an evidence from a case control study in a North Indian tertiary health care institution

Background: Hypertensive disorders of pregnancy are a major cause of both maternal and foetal morbidity and mortality. Although pregnancy induced hypertension (PIH) is still regarded as a disease of theories and unknown etiology, elevated homocysteine level has been hypothesized as a key risk factor. Abnormally raised homocysteine has been significantly associated with increased risk of PIH, abruption, intrauterine growth restriction, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present case control study was conducted among 180 pregnant women (90 cases and 90 controls) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of ascertaining the role of homocysteine in pregnancy related hypertensive disorders. Socio-demographic, clinical, biochemical including homocysteine level, laboratory and ultrasonographic parameters of all the participants were documented.Results: The mean homocysteine level of cases (18.30±10.81) was significantly higher than the controls (8.70±2.64).  About 62.2% cases had abnormally raised homocysteine level (>15 µmol/L), while only 1.1% controls had such level. The odds of a case having abnormally elevated homocysteine level were 146.6 (CI: 19.52-1101) times to that of controls. Eclamptics had the highest homocysteine level followed by preeclamptics and controls.Conclusions: The present study significantly associates the abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and demands much needed robustly designed studies to further explore the phenomenon. A simple intervention like estimating the much neglected homocysteine levels prior to pregnancy can definitely aid in predicting and preventing perinatal outcomes

Ectopic pregnancy and unsupervised abortion pills: the hidden truth

Background: Aim of the study was the indiscriminate use of self-consumption of abortion pills and its association with complication like ectopic pregnancy reporting to a tertiary care center.Methods: The study was a prospective observational study conducted in the department of obstetrics and gynecology, Kamla Nehru State hospital for mother and child, Indira Gandhi medical college Shimla w.e.f. 1st July 2018 to 30th June 2019. A total of 27 women reported to the hospital who were diagnosed of having ectopic pregnancy after intake of abortion pills.Results: A total of 27 cases presented to the hospital who were diagnosed to have ectopic pregnancy. Maximum 18 (67%) cases were in 21-30 years of age group. Married women constituted 21 (77%) cases. The 14 (52%) belonged to rural area while 13 (48%) belonged to urban area. The chemist was found to be source of procurement in 19 (70%) cases, private practitioner in 6 (22%) cases and only two consumed pills after consultation with registered doctor.Conclusions: This study shows urgent need for legislation and restriction of drugs used for medical termination of pregnancy. Drugs should be made available via health care facilities under supervision to reduce maternal mortality and morbidity due to indiscriminate use of these pills.