Hysteroscopy in evaluation of intrauterine causes of AUB

Background: Abnormal uterine bleeding is the most common gynecological problem comprising more than 30-50% of gynecological OPD patients. There are various causes of AUB from hormonal dysfunction to endometrial cancer. In order to manage effectively it is important to diagnose accurately the cause of abnormal bleeding. This study outlines the place of hysteroscopy and its role in evaluation of intrauterine causes of AUB.Methods: This is a Retrospective cross sectional observational study conducted in department of Obstetrics and Gynaecology at CCM Medical College, Durg, Chhattisgarh. 350 Patients between 20-70 years age presenting to general gynae OPD with abnormal uterine bleeding at CCM medical college over a period of 2 years between 1st January 2015 to December 2016 were studied. All patients were subjected to thorough clinical evaluation followed by sonography and hysteroscopy. Data collected from medical records, analysed and various intrauterine causes of AUB were studied.Results: Mean age of patients in our study was 45 years with majority of patients in 40-50 year age group. predominant complaint reported was menorrhagia (52%) followed by menometrorrhagia (18.86%) and polymenorrhoea (18.58%). USG detected abnormality in 65.6 % of cases and 34.4% were normal on USG but majority of these were fibroids and ovarian cysts. However, diagnosis of specific intrauterine pathology was made in only 12.8%. Hysteroscopy detected intrauterine abnormality in 60% cases. Most common being polyp in 94 patients (26.8%) followed by hyperplastic endometrium in 74 (21.1%). 18 (5.1%) patients had polypoidal endometrium which is also type of hyperplastic endometrium. 17 (4.85%) had submucous fibroid, 4 (1.1%) had atrophic lining and 3 (0 .85%) had intrauterine adhesions. Diagnostic accuracy of hysteroscopy was found better in polyps and submucous myomas which were missed by usg and also can be missed by traditional D and C only.Conclusions: Hysteroscopy allows exclusion of intracavitary pathology as well as treatment of them in same sitting with proper tissue biopsy from the abnormal area which can be of help in proper treatment planning. Though hysteroscopy helps in diagnosing cause of AUB their proper management will depend on final histology, age of patient and fertility goals

Incidence of antepartum haemorrhage in pregnancy and its maternal-fetal outcome in admitted antenatal patients in tertiary care centre, Bhilai Durg, Chhattisgarh

Background: Antepartum haemorrhage has always been one of the deadliest complications in obstetrics. Antepartum haemorrhage (APH) complicates about 2-5% of pregnancies. Maternal and perinatal morbidity and mortality associated with APH can be reduced significantly by aggressive expectant management. The present study was conducted to assess maternal and fetal outcome in patients with antepartum haemorrhage. Aims and objectives were to study the incidence of antepartum haemorrhage at SSIMS hospital. To highlight the importance of early diagnosis and treatment. To study the maternal and fetal outcome in antepartum haemorrhage. To study the associated risk factors contributing to maternal and fetal morbidity and mortality.Methods: The study was conducted in Shri Shakaracharya Institute of Medical Sciences, Bhilai, Durg, Chhattisgarh during the period of January 2020 to December 2020 after getting approval from the institutional ethical committee. 31 cases of APH with gestational age ≥28 weeks were included. They were distributed according to type of APH into abruptio placentae (AP), placenta previa (PP). Causes of APH were noted and maternal as well as perinatal outcome observed.Results: In the present study it was observed that incidence of APH was 2% out of 1503 deliveries. Out of 31 cases, 54.83% was AP followed by PP 45.16%. Abruption was the commonest cause of APH with its associated maternal morbidity and perinatal mortality and morbidity. Anemia was the most common complication in APH. Prematurity of the neonate was a serious complicating factor in APH. No maternal mortality was seen in this study.Conclusions: Overall incidence of APH has remained high. Though maternal morbidity is reduced with modern management of APH, but timely diagnosis and intervention is necessary. Perinatal morbidity can be reduced with good neonatal intensive care facilities

Incidence of hypertensive disorders of pregnancy and it’s maternal-fetal outcome in admitted antenatal patients in tertiary care centre, Bhilai, Chhattisgarh, India

Background: Pre-eclampsia refers to any new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive, non proteinuric women. Hypertension is a very common medical complication of pregnancy. It is one of the leading causes of maternal and fetal mortality and morbidity worldwide. Early detection, close surveillance and timely delivery are necessary to reduce complications and improvement in maternal and fetal health and outcome. To determine the incidence, risk factors and maternal and fetal outcomes in women with hypertensive disorders of pregnancy in all pregnant women attending Obstetrics and Gynaecology department, Shanakaracharya Institute of Medical Science, Bhilai.Methods: This is a retrospective record-based observational study conducted over a period of one year from January 2020-December 2020 after getting approval from the institutional ethical committee. Patients diagnosed with hypertensive disorders of pregnancy were evaluated and data was collected and analyzed.Results: Of the 1503 deliveries in the hospital during the period under review, 131(8.7%) were managed for hypertensive disorders of pregnancy. Pre-eclampsia was the commonest type of hypertensive disorder of pregnancy (69.3%) with the majority presenting with severe disease. Women of all age group were affected with highest incidence among 21-30years of age (69.4%). The incidence was maximum among primigravida (67.2%) compared to multipara 100 (32.8%). Intra uterine deaths were recorded among 12.2%, while a major share of fetus (41.2%) were diagnosed to have intrauterine growth retardation. Most common maternal complication in our study was abruption (7.6%), followed by HELLP (2.2%). Two maternal deaths were recorded, giving a case fatality rate of 1.5%.Conclusions: Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality. Regular antenatal follow up will help in early diagnosis and timely intervention of the cases. Also, special consideration and close surveillance of those women with early-onset disease is important. There is need for strengthening of communication and referral systems in the healthcare

Laparoscopic management of adnexal masses in admitted patients at tertiary care centre, Bhilai, Chhattisgarh, India

Background: Laparoscopy is most widely accepted procedure in gynaecological cases both for diagnostic and operative purposes. It is associated with early recovery, shorter hospital stay and significant patient satisfaction. This study has been conducted to evaluate the effectiveness and safety of laparoscopy in the management of adnexal masses. Our Primary aim was to find out indications, intraoperative findings and different interventions to deal with adnexal mass. The objective of the study was to determine laparoscopic management of adnexal mass in all women attending Obstetrics and Gynaecology department, Shanakaracharya Institute of Medical Science, Bhilai, Chhattisgarh.Methods: This is a retrospective record-based observational study conducted over a period of one year from March 2020 to March 2021 after getting approval from the institutional ethical committee. Patients diagnosed with adnexal mass were evaluated and data was collected and analyzed.Results: Of the 130 cases of adnexal mass admitted in the hospital during the period under review, 43 cases (33%) were diagnosed as ovarian cyst among which simple cystic ovarian cyst was found to be most common etiology followed by ectopic pregnancy (41 cases). Majority of cases were managed laparoscopically with a good success rate, better outcome and short hospital stay. Conversion rate to laparotomy was 3.8% mainly seen in cases with complex ovarian mass or dense adhesions.Conclusions: Diagnosis of adnexal mass is important and it may affect females of any age group. Laparoscopy is a better approach to deal with adnexal masses (except malignancy) as it has better paronamic vision with less complications, less post-operative pain, shorter hospital stay. Careful patient selection should also be taken into account. Current study is an overview in favor of laparoscopic management of adnexal mass

Incidence of anemia in pregnancy and its maternal-fetal outcome in admitted ANC patients in tertiary care center, Bhilai, Chhattisgarh, India

Background: Anemia in pregnancy is an important public health problem in developing countries like India. Anemia results in poor pregnancy outcome and also affects fetal outcome. The present study was conducted to asses maternal and fetal outcome in relation anemia. Aim and objectives of the study was to determine incidence, risk factors and maternal-fetal outcome of anemia in the admitted pregnant women attending obstetrics and gyanecology department, shanakarcharya institute of medical sciences, Bhilai.Methods: This is retrospective observational study conducted among pregnant women admitted in labor room over a period of one year after getting approval from the institutional ethical committee.Results: Out of total 1503 delivery during study period 675 patients were found to be anaemic which gives incidence of 44.5%. Most the pregnant women were moderately anaemic i.e. 50.96% followed by mild (45.04%) and severe (4%) repectively. Among the pregnant women most common type of anaemia is Iron deficiency anaemia (69.65%) followed by Sickle cell anaemia (15.4%). In the present study,90.4% of subject received oral iron, 26.9% received parenteral iron and 19.4% received blood transfusion. Common maternal outcome related to anemia found to be low birth weight (25.2%) followed by premature delivery (22.96%) and fetal outcome in anemic mother in the form of preterm (22.9%) followed by NICU admission (14.37%) and FGR (8.6%).Conclusions: Anemia being one of the most important cause of poor feto maternal outcome should be treated preconceptionaly. There is a need of health education programmes and adequate intake of iron rich diet during pregnancy, to be strengthened for safe maternal and foetal outcomes

Assessing cesarean section trends in a tertiary care teaching hospital using robson’s ten group classification

Background: Rising caesarean section rates are a matter of great concern for all.In order to understand the reasons and take measures to reduce this WHO has suggested that all health care facilities should do periodical audit of their institutional caesarean sections using the Robson's ten group classification. This classification helps to identify which group of patients and indications are contributing maximum to the caesarean sections in the institute and what measures can be taken to reduce the rate in each group.Aim: When we study each group and its contribution to cesarean section rates we can formulate guidelines to reduce the rates.Methods: This is a retrospective cross sectional study conducted for a period of 1 year at a tertiary care medical college hospital in Chhattisgarh.All women who delivered here in between December 2019 to November 2020 were included in study these were classified into 10 groups according to Robsons 10 group classification and caesarean delivery rates were calculated in each category and analysed. Contribution of each group to overall caesarean section rate and caesarean percentage in each group was calculated.Results: Out of total of 1586 women who delivered during the study period 972 women had undergone caesarean section with an overall C section rate of 61.2 %.in our hospital. Group 5 contributed to highest C-sections followed by group 2 and 1.Together these 3 groups contributed to 75% of CS rates. Groups 6,7 and 9 did not contribute much to overall C-sections but CS rates in this group of patients is above 90% reaching close to 100% in group 6. Conclusion: Robson 10 group classification provides for an easy, simple way of collecting and comparing information about C section rates in an institution. detailed analysis of each groups can help to detect causes of increased CS rates in each group at our institution .measures to reduce CS rates can be reducing primary C-sections,increasing VBAC in previous section cases, judicious use of ECV, partogram,EFM and modification in criteria for non-progress of labor,Fetal distress can all contribute to reduce CS rates

Analysing laparoscopic management of adnexal masses in the adolescent females- A retrospective clinical trial in central indian population

Background: Adnexal masses affect approximately 5-10 percent of females and carry a risk of undergoing surgery at least once in a lifetime for ovarian masses. They are seen in females of all ages and can affect females in their older age from their adolescence to early fetus life.Aims: The present trial was carried out to assess histopathological findings, surgical procedure, and pre-operative diagnosis in adolescent females who were managed for adnexal masses by laparoscopic surgical procedure.Materials and Methods: The demographic data of 84 adolescent females were recorded and additional data obtained from the medical records were chief complaint, menstrual history and normalcy, radiographic size of the cyst detected on the ultrasound, pre-operative assessment, time of the surgery, surgical procedure, histopathological findings, and serum tumor markers. The collected data were subjected to the analyzation and the results were formulatedResults: The adnexal mass diameter in present study ranged from 2.5cm to 36cm. The mass of ˂10cm were recorded in 67.85% (n=57) of study subjects, and 5 subjects among these 57 had increased values of assessed tumor markers in serum. 6 (7.14%) masses among 84 subjects were greater than 15 cm diameter. HPE showed hemorrhagic cyst (9.52%, n=8), simple cyst (28.57%, n=24), or paratubal cyst (13.09%, n=11), polycystic ovary (2.38%, n=2), dermoid cyst (14.28%, n=12), cystadenoma, corpus luteal cyst (13.09%, n=11), hydrosalpinx (2.38%, n=2), and endometriotic cyst (1.19%, n=1).Conclusion: Laparoscopic management is an effective and safe technique for managing adnexal masses in adolescent females including large size cysts as most masses encountered during adolescence are benign