Histopathological examination of emergency obstetric hysterectomy specimens

Background: Obstetric hysterectomy is done as a lifesaving procedure in very trying circumstances of life threatening severe hemorrhage. The study was undertaken with the aim to evaluate the relative frequency of hysterectomy done for obstetric indication among the hysterectomy specimens and also to assess the histopathological findings in the hysterectomy specimens.Methods: The study was conducted at a tertiary care center over a period of two and half years. Consecutive specimens of hysterectomy done for obstetrical indication were included. Gross and microscopic findings noted and data analysed. The study was approved by the Institute Ethical Committee.Results: Of the total hysterectomy specimens received obstetrical hysterectomy comprised only 1.3%(12/915) of all the hysterectomies. Patient’s age ranged from 20-36 years; mean 28.6 years. Parity ranged from 1 to 5; mean 2. More multiparous women 91.7%(11/12) had hysterectomies as compared to primiparous 8.3%(1/12) cases                         (p value <0.0001). All patients had single pregnancy. All (100%) patients underwent surgery through abdominal route with subtotal hysterectomy with preservation of the bilateral adnexae undertaken in most (11/12; 91.7% cases). About 5(41.6%) cases hysterectomies were performed after previous caesarean section and had abnormal placentation. Histopathological examination revealed adherent placenta in 33.4%(4/12), endometritis in 25%(3/12), rupture in 25%(3/12) and histologically unremarkable in 16.6%(2/12) cases.Conclusions: Obstetric hysterectomy is an emergency lifesaving procedure done in situations of uncontrolled post-partum hemorrhage. In recent years with more number of caesarean sections the incidence of abnormal placentation has drastically increased, thus making adherent placenta as the most common histopathological finding

Prevalence and predictors of metabolic syndrome among women above 35 years of age: a cross sectional study from northern India

Background: In India, as more and more people are adopting sedentary lifestyle the prevalence of metabolic syndrome is increasing. Metabolic syndrome (MS) is a cluster of risk factors for future development of type 2 diabetes mellitus and cardiovascular diseases. The objectives of the study was to determine prevalence of metabolic syndrome among women above age of 35 years in northern India attending a gynecological outpatient department of a tertiary hospital and to find out predictors of metabolic syndrome.Methods: Premenopausal and postmenopausal women above 35 years of age attending gynecological outpatient department were screened for the presence of metabolic syndrome, according to the criteria of modified NCEP-ATP III (National Cholesterol Education Program). Data was collected and analyzed. A p-value <0.05 was considered statistically significant.Results: The prevalence of metabolic syndrome was 49.3% among women above 35 years of age. In the logistic regression analysis it is found that body mass index and menopausal status were two variables which significantly affected occurrence of metabolic syndrome.Conclusions: The present study shows a high prevalence of metabolic syndrome amongst women above 35 years of age. The prevalence was higher in postmenopausal women than in premenopausal women. In logistic regression analysis it was found that menopause and body mass index are independent predictors of metabolic syndrome

Perception and correlates of excessive vaginal discharge in rural women

Background: Vaginal discharge is one of the most common symptoms of gynecological morbidity. Vaginitis is the most prevalent cause. Gynecological disorders have substantial impact on female health and behaviour. Recent evidence suggests that the association between the complaint of vaginal discharge and the presence of Reproductive Tract Infections is weak. Women who are overanxious, introspective or suffering from fears of venereal disease and cancer tend to exaggerate the complaint of vaginal discharge into something pathological. The objective of the study was to study rural women’s perception and health care seeking behaviour regarding excessive vaginal discharge. To study various psychological and biological correlates of excessive vaginal dischargeMethods: This was a community based cross sectional study, conducted in the rural field practice areas under the Department of Community Medicine, Christian Medical College, Ludhiana. House to house surveys were conducted with semi-structured questionnaire and GAD 7 (Generalised Anxiety Disorder) scale, using systematic random sampling.Results: 160 rural women were interviewed to collect data. Of them, 27.5% reported having excessive vaginal discharge. There was no association observed between menstrual hygiene methods and excessive vaginal discharge (p= 0.77). Association couldn’t be observed with selection of barrier and other non-barrier methods of contraception (p= 0.09) either. Statistically significant association was observed between presence of anxiety and vaginal discharge (p=0.01).Conclusions: All vaginal discharges are not pathological. Causative factor of excessive vaginal discharge may not be infections always. There was a statistically significant association between anxiety and perceived vaginal discharge

Prevalence and predictors of metabolic syndrome among women above 35 years of age: a cross sectional study from northern India

Background: In India, as more and more people are adopting sedentary lifestyle the prevalence of metabolic syndrome is increasing. Metabolic syndrome (MS) is a cluster of risk factors for future development of type 2 diabetes mellitus and cardiovascular diseases. The objectives of the study was to determine prevalence of metabolic syndrome among women above age of 35 years in northern India attending a gynecological outpatient department of a tertiary hospital and to find out predictors of metabolic syndrome.Methods: Premenopausal and postmenopausal women above 35 years of age attending gynecological outpatient department were screened for the presence of metabolic syndrome, according to the criteria of modified NCEP-ATP III (National Cholesterol Education Program). Data was collected and analyzed. A p-value &lt;0.05 was considered statistically significant.Results: The prevalence of metabolic syndrome was 49.3% among women above 35 years of age. In the logistic regression analysis it is found that body mass index and menopausal status were two variables which significantly affected occurrence of metabolic syndrome.Conclusions: The present study shows a high prevalence of metabolic syndrome amongst women above 35 years of age. The prevalence was higher in postmenopausal women than in premenopausal women. In logistic regression analysis it was found that menopause and body mass index are independent predictors of metabolic syndrome

Uterine prolapse: Should hysterectomy specimens be subjected for histopathological examination?

Context: Uterine prolapse accounts for one of the common gynecological problems in India. The excised uterus is not expected to have any pathological finding other than atrophic endometrium and may be an ulcer because of the prolapse. Aims: The aim of this study is to assess the hysterectomy specimen for unsuspected pathology. Subjects and Methods: The study is done over two and half years at a tertiary care hospital. Hysterectomy specimens done with a clinical indication of prolapse were included in the study. Histopathological examination done, findings noted, and data analyzed. Statistical Analysis Used: Descriptive analysis was used in this study. Results: Of the total hysterectomy specimens, 55 (6%) were done for uterovaginal prolapse. Patients age ranged from 32 to 78 years; mean 51.1 ± 11.9 years. Majority (46; 83.6%) of the patients were above 40 years of age, whereas only (9; 16.4%) were < 40 years of age (P < 0.0001) Vaginal hysterectomy was done in most 38 (69.1%) cases as compared to abdominal hysterectomy in 17 (30.9%) cases (P < 0.001). Adnexae were removed in only 3 (5.5%) cases as compared to 52 (94.5%) cases, in which adnexae were preserved (P < 0.001). Chronic cervicitis was seen in 100% of cases. Majority (18:32.7%) of the endometrium was in atrophic phase, secretory in 8 (14.5%), cystic regressive hyperplasia and chronic endometritis in 4 (7.2%) each. Myometrium was unremarkable in 43 (79%) cases, whereas focal adenomyosis in 12 (21%) cases. All the adnexa received were histologically unremarkable. Conclusions: Grossly unremarkable specimens can have unsuspected histopathological lesion which could be potential premalignant or malignant lesions. Therefore, all hysterectomy specimens should be subjected to the histopathological examination for accurate diagnosis and proper categorization of lesions

Prevalence and Association of Physical Activity with Obesity: An Urban, Community-Based, Cross-Sectional Study

Aim: To study levels of physical activity and various measures of obesity and their association in an urban population. Study Design: Cross sectional. Materials and Methods: One thousand and forty-seven individuals between the ages 25-64 years systematically sampled from a community-based population database were contacted through a house-to-house survey. We adopted the WHO STEPS guidelines for conducting this study. Anthropological measures collected were height, weight, and waist and hip circumference. Results: Physical Activity (PA) levels declined with age and the decline was greater among females. The Pearson′s correlation coefficient for age against PA among males was found to be negative and weak (r = -0.104) and that among females was found to be similar (r = -0.206). The prevalence of obesity was higher among females (28.8 %) than among males (13.3 %) and the difference was statistically significant. There was a progressive increase in abdominal obesity with age in both genders. The prevalence of overweight and obesity was higher among individuals with low levels of PA as compared to those with high levels of PA. Conclusion: Sedentary behavior is prevalent in more than half of the current study sample. This was more so with increasing age, female gender and increasing obesity. PA is an important component on long-term weight control, and therefore adequate levels of activity should be prescribed to combat the obesity epidemic. Habitual moderate physical activity may be beneficial in preventing excess accumulation of fat

Community health volunteer for blood pressure control in rural people with stroke in India: Pilot randomised trial

Objective To test the hypothesis that an Accredited social health activist (ASHA), a community health volunteer in a task-sharing model can help in sustained control of systolic blood pressure (BP) in rural people with Stroke and hypertension at 6 months follow up. Methods In this randomized trial two rural areas (Pakhowal and Sidhwan bet) with 70 and 94 villages respectively were screened for people with stroke and hypertension. They were assigned to either ASHA-assisted BP control in addition to standard-of-care (Pakhowal-intervention Group) or standard-of-care alone (Sidhwan bet- Control Group). Assessors blinded to intervention conducted the baseline and 6 months follow-up visits to measure risk factors in both the rural areas. Results A total of 140 people with stroke with mean age of 63.7 ± 11.5 years and 44.3% females were randomised. The baseline systolic BP was higher in the intervention group (n = 65,173.5 ± 22.9 mmHg) compared to the control group (n = 75,163 ± 18.7 mmHg, p = 0.004). The follow-up systolic BP was lower in the intervention group compared to the control group 145 ± 17.2 mmHg and 166.6 ± 25.7 mmHg respectively (p < 0.0001). According to the intention-to-treat analysis a total of 69.2% of patients in the intervention group achieved systolic BP control compared to 18.9% in the control group patients (OR 9, 95% CI 3.9-20.3; p < 0.0001). Conclusion Task sharing with ASHA a community health volunteer can improve BP control in rural people with stroke and hypertension. They can also help in the adoption of healthy behaviour