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

Primary amenorrhea: a clinical review

Primary amenorrhoea is a symptom with an extensive list of underlying causes, the majority of which are rare. According to the definition it should present in adolescence, although some conditions are diagnosed in childhood may present with failure of menstruation. Many causes of secondary amenorrhoea can also present with primary amenorrhoea if they arise very early in life. A systematic, compartment based approach will cover the commoner causes of primary amenorrhoea and recommend a pragmatic but cost-effective approach to achieve correct diagnosis. Treatment must be directed at the specific cause but has often wider implications for life long wellbeing like weight management, hormone replacement, sexual health and fertility

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

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

Combined hysterolaparoscopy as an early option for initial evaluation of female infertility: a retrospective study of 135 patients

Background: The aim of this study was to find out different causes of female infertility with diagnostic approach using laparoscopy and hysteroscopy.Methods: This retrospective study was done in the Department of Obstetrics and Gynecology of MGMCRI, Puducherry. 135 infertile women aged 19-40 years were enrolled retrospectively for combined laparoscopy and hysteroscopy. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Patient with active genital tract infection and any contraindication to hysterolaparoscopy procedure were excluded. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interventions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized. Data was statistically analyzed using SPSS software version 15; a result of P <0.05 was considered as significant.Results: Out of 135 cases, 65% patients had primary and 34.8% patients had secondary infertility. As a whole pelvic pathology were confirmed in 54.5% and intrauterine pathology in 20.7% patients by hysterolaparoscopy. The most common laparoscopic abnormality detected was tubal pathology 40%, followed by pelvic inflammatory disease 18.5%, ovarian pathology 8.1% pelvic endometriosis 4.4%, and uterine pathology 4.4% in infertile patients. In hysteroscopy, the incidence of uterine anomaly was 9.6% and intrauterine septum is the most common anomaly with a mean incidence of approximately 84% in both the group of infertile patients.Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable abnormalities in pelvis, tubes and the uterus which are usually missed by other imaging modalities.

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

Histomorphological analysis of placental changes of pre-eclampsia patients in a tertiary care hospital of Puducherry, India

Background: Placenta is a dynamic tissue synthesized physiologically to serve as a nutrient source for developing fetus it is exposed to several changes in reaction to many toxemic conditions associated with pregnancies. Studies had proved that placental changes observed on histomorphology is directly proportional to reaction to hemodynamic compensatory mechanisms, thereby aiding the obstetricians to manage the sequelae of complications. Objective of this study was to study the placental histomorphology in pregnancies associated with pre-eclampsia and to quantitate the observed placental changes.Methods: The study comprised on 101 placental specimens obtained from department of obstetrics and gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry. Toxemia of pregnancies were divided into mild, severe preeclampsia and eclampsia based on blood pressure. The 101 cases were divided as 4 groups: Group 1 (control group); Group 2 (mild preeclampsia); Group 3 (severe preeclampsia); Group 4 (eclampsia).Results: Among the 101 cases, 38 placentas were from uncomplicated full-term deliveries which constitutes the control group. The rest 63 placenta were from toxemia of pregnancies which constitutes the study group.Conclusions: The incidence of toxemic pregnancies and pre-eclamptic cases are on higher margin than assumed. Histomorphology examination of placenta plays a vital role in assessing etiopathogenesis and mechanism of toxemic pregnancies. This aids the obstetrician to further manage subsequent sequelae and fix the complication to significant proportion

Paraurethral leiomyoma in a woman: a case report

Paraurethral leiomyomas are rare, benign smooth muscle tumours of the urogenital tract. Most para-urethral tumours occur in the reproductive age group. Its etiology is uncertain and its presentation is variable. Here we present a 45 year old multiparous lady, who approached the out-patient department, with complaints of profuse foul-smelling discharge and a mass per vaginum for 10 days

Prevalence and clinico-mycological profile of vulvovaginal candidiasis in a tertiary care hospital

Background: Vulvovaginal candidiasis is an infectious condition caused by Candida and its species remains a global health morbidity among females especially in the reproductive age group. Vulvovaginal candidiasis has been associated with variable clinical profile and being a potential relationship with obstetric morbidities, the prevalence still remains high. The emergence of Non albicans species and its diagnosis at laboratory levels remains a challenge to the pathologists often warranting a supportive diagnostic modalities. The present study had been aimed to monitor the prevalence of vulvovaginal candidiasis in our tertiary care hospital and correlate the clinic-mycological profile with pathological findings on light microscopy.Methods: All patients presented with specific clinical symptoms of reproductive age group were included. With few exclusion criteria, the clinical history was obtained and high vaginal smears were collected and stained with Papanicalou stain and pathological interpretation was documented. In few available and indicated cases, culture procedure was performed. The data obtained were compared and correlated with clinical and laboratory diagnostic findings.Results: Among 125 cases studies, 62 positive cases for Candidiasis were reported with an approximate incidence of 50%. Further speciation identification showed C. albicans positivity in 45 cases and 17 cases for non albicans species. Women of second and third decade were predominantly affected by vulvovaginal candidiasis with abdominal pain and pruritis being a common clinical presentation. Conclusions: The prevalence of vulvovaginal candidiasis is on higher margin especially among reproductive age group. Clinical profile must be further correlated with laboratory data for speciation, thereby guiding in prompt and appropriate treatment modalities on best patient care

Spontaneous utero-rectal fistula formation following reconstructive genital tract surgery: An interesting case report

A genital fistula is an abnormal communication between uterus with either urinary tract or gastrointestinal tract. Although genitourinaryfistula is a common entity, rectovaginal or even uterorectal fistula is relatively uncommon. The etiology of fistula is usually due toan obstetric cause in a developing country, whereas, it is gynecological in the developing country. Whether etiology is obstetricalor gynecological, this develops following days of the procedure. Here, we present the case of a 17-year-old girl, who underwentvaginoplasty for cervical atresia and develop uterorectal fistula one and a half year following the first surgery. She was finallymanaged with hysterectomy