A rare case of congenital vesico-uterine fistula

Herein we report the case of a patient with primary amenorrhea and cyclical menouria. The patient was a 20 years female with primary amenorrhea. Clinical examination revealed normal external genitilia. A mature female pubic hair pattern was present, and axillary development was normal. Breast was normally developed. Intraoperatively, a congenital vesico-uterine fistulous tract was observed. Repair was done. The patient has been regularly menstruating since the operation

Spontaneous uterine rupture in first trimester of pregnancy

This is a case of 30 years old female who presented in emergency at 11 weeks 3 days with acute abdomen and diagnosed as spontaneous uterine rupture. The defect was repaired and bilateral tubal ligation was done. This shows that uterine rupture can occur as early as that late first trimester and should be included in the differential diagnoses of acute abdomen

Identification and Modelling of Religious Tourism Supply Chain Enablers in Post-Covid Era Using ISM

Post-Covid-19 pandemic, the supply chains of all the trades faced a setback, but the tourism sector faced an extended jolt of this disaster. Religious tourism, which has been adding a sizeable revenue to Indian GDP, came to a downfall. This manuscript aims to identify and model the enablers of the religious tourism supply chain for reviving the economy in the post-Covid era. The research paper elucidates that post-shock of Covid-19, understanding religious tourism enablers will provide opportunities to all the stakeholders of this chain. Eleven enablers for the religious tourism supply chain were identified. The modelling of these enablers using ISM (Interpretive Structural Modelling), provides insight into their hierarchy and interdependence upon each other. The ISM model also illustrates that the enabler Pilgrims belief and value, a mandatory obligation is the most crucial enabler and influence all other enablers. Religious tourism supply chain stakeholders can employ this model to formulate strategies to overcome the post-pandemic challenges. Subsequently focusing upon the key enablers essential in reviving the tourism sector economy.

Holt-Oram syndrome: a rare case report

Holt-Oram syndrome is an inherited disorder that causes abnormalities of the hands, arms and heart. The diagnosis can be established clinically. The diagnostic criteria have been validated with molecular testing. An upper-limb malformation involving the carpal bone(s) and, variably, the radial and/or thenar bones-An abnormal carpal bone, present in all affected individuals and identified by performing a posterior-anterior hand x-ray, may be the only evidence of disease. 24 years unbooked Hindu female G2P1+0 presented in OPD at term. Her USG examination showed-small deformed upper limbs with poorly appreciable upper limb skeleton. Induction of labour was done and patient delivered vaginally a female baby with deformed upper limbs. This case emphasizes the importance of proper history taking (family history), early diagnosis of such anomalies and proper counseling the parents

Factors determining successful intrauterine insemination

Background: Infertility is defined as failure to conceive even after one year of regular, frequent and unprotected intercourse. Infertility can be attributed to male causes in approximately 25-40% cases, female causes in 40-50% cases, both in 10-20% and unexplained causes in 10-15% cases. Artificial insemination (Intrauterine Insemination) involves placement of processed sperms from husband (AIH – artificial insemination homologous) or from donor (AID – artificial insemination donor) into the female genital tract.Methods: Objectives of the study were to do sperm preparation to obtain normal good quality motile sperms, to perform intrauterine insemination using husband semen around the time of ovulation, to study factors responsible for successful pregnancy rates by this method. Out of 100 infertile females recruited for the study 34 underwent artificial insemination by IUI with controlled ovarian hyper stimulation. Sperms were washed by density gradient centrifugation or by a direct swim-up technique that does not involve centrifugation.Results: Overall pregnancy rate per patient for male factor infertility was 23.52%. None of the patients consented for more than three cycles of IUI. Maximum pregnancy was achieved in third cycle of IUI. Sperm motility >40% was related with pregnancy in 8 cases. Duration of infertility didn’t influence pregnancy rate. The majority of pregnancies were achieved in the age group of 25-29 years (50%). No pregnancy occurred with >15 years of infertility.Conclusions: This study concluded that intrauterine insemination after ovarian stimulation or controlled ovarian hyperstimulation is a successful and efficacious therapy for infertility

Posterior reversible encephalopathy syndrome: a case report

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinic radiological entity, characterized by variable associations of seizure activity, consciousness impairment, headache, visual abnormalities, nausea and vomiting and focal neurological signs. The global incidence of PRES is not known. It can develop in association with conditions like exposure to toxic agents, hypertension, infection and eclampsia was present in 7%. So, here I am presenting a case of our patient of 22 years primigravida, who presented with ante partum eclampsia at 28 weeks of gestation and delivered vaginally by induction of labor. Post-delivery she developed PRES which was diagnosed by MRI

Evaluation of abnormal uterine bleeding by transvaginal sonography, sonohysterography and correlation with endometrial histopathology

Background: Abnormal uterine bleeding (AUB) in reproductive-age women is common, leading to one-third of outpatient visits by this population and this proportion crosses the two-third threshold in peri or post-menopausal group. Annually 5-10% of women of reproductive age seek medical care for AUB, which negatively impacts quality of life. The aim of the present study was to study the role of transvaginal sonography (TVS) and sonohysterography (SHG) in abnormal uterine bleeding.Methods: The present study was carried out at Department of Obstetrics and Gynaecology, Era’s Lucknow Medical College, Lucknow in collaboration with Department of Radiology and Pathology, Era’s Lucknow Medical College, Lucknow. It was a prospective study carried out over a period of 1 year. Detailed history regarding their present complaints, menstrual history along with thorough examination was noted on the proforma designed for the study. Those with active and heavy bleeding underwent TVS and D&C for diagnostic and therapeutic purposes in the same sitting. However others without active bleeding underwent TVS, SIS in mid cycle and D&C in premenstrual period.Results: The present study was carried out at Department of Obstetrics and Gynaecology, Era’s Lucknow Medical College, Lucknow in collaboration with Department of Radiology and Pathology, Era’s Lucknow Medical College, Lucknow. It was a prospective study carried out over a period of 1 year. Detailed history regarding their present complaints, menstrual history along with thorough examination was noted on the proforma designed for the study. Those with active and heavy bleeding underwent TVS and D&C for diagnostic and therapeutic purposes in the same sitting. However others without active bleeding underwent TVS, SIS in mid cycle and D&C in premenstrual period.Conclusions: The findings in present study show a relative supremacy of SIS over TVS in diagnosis of uterine abnormalities in cases of abnormal uterine bleeding

Socio-demographic profile of reproductive tract infections and sexually transmitted diseases in reproductive aged women

Background: RTI including Sexually Transmitted Diseases (STD) are increasingly recognized as a major cause of morbidity in India. RTI have become widespread today because of the changing social fabric and unconventional sexual behaviors. The present study was done to assess the prevalence of RTI and STD in women aged 20-45 years and to correlate the socio-demographic factors with RTI & STD.Methods: Two hundred & fifty women in the age group of 20-45 years attending the outpatient department of Obstetrics and Gynecology of VPC & IMS, Lucknow were included in the study. Out of them 215 were symptomatic and 35 were asymptomatic. All of them were offered clinical and microbiological examinations. A pretested, semi-structured interview schedule was used.Results: In this study the prevalence of RTI/STD was higher among women aged 31-35years, rural population, illiterate & less educated (90.4-97%) females, in farm workers & in students. The females having toilet access in field & outside toilet and with poor personal and menstrual hygiene, had more prevalence of RTI/STD.Conclusions: Hence we as obstetricians should try to make public aware about the importance of RTI/STD prevention, early diagnosis and prompt and complete treatment to avoid long term squealae.

Characteristics of infertile couples attending OPD of a teaching hospital

Background: Infertility is defined as failure to conceive even after one year of regular, frequent and unprotected intercourse. Infertility has, in the last few years surfaced in society as a significant problem affecting as many as 15% of couples. This study aimed at identifying the characteristics of infertility among Indian couples.Methods: The present study was carried out on 100 infertile couples attending the OPD of upper India sugar exchange maternity hospital attached to GSVM medical college, Kanpur, other hospital and nursing homes of Kanpur. Both the partners were completely evaluated by taking proper history, examination and investigation to assess the cause of infertility.Results: Majority of female partners were between ages of 25-29. Female factors were found in 45% couples and male factors in 30 % couples. Among female factors, tuboperitoneal factor was found in 32% cases and ovulatory factor was found in 40% cases. Oligospermia was the commonest cause in male factor infertility.Conclusions: From this study we concluded that infertility is a public health problem in India and the main infertility pattern is a primary rather than secondary infertility

Impact of infertility on marital relationships among infertile couples attending OPD of a tertiary health care centre

Background: There is little empirical literature on the effects of infertility on marital relationships in India. This study was sought to examine the impact of infertility on the marital relationships of the couple at Eras Lucknow Medical College and Hospital.Methods: This is a descriptive cross-sectional design conducted on infertile women presenting in OPD (outpatient department) of Obstetrics and Gynecology Department of Era’s Lucknow Medical College and Hospital. A self-developed questionnaire was used for collecting data for the study. The questionnaire was divided into 5 sections: A to E. Data was presented in the form of descriptive statistics such as proportion and percentage.Results: This study revealed that infertility affected the sexual life of participants as it was reported that even though they still had regular sexual intercourse with their partners after realising they were infertile (64.5%), sex was only for the purpose of reproduction and not for mutual sexual satisfaction (13%). Sexual intercourse was reported to be unfulfilling as well as unenjoyable (16.4%). The psychological well-being of participants (29.60%) and stability within marital unions were also negatively affected by infertility, resulting in quarrels (13 %).Conclusions: Infertility has numerous negative implications for marital relationship. Thus, infertile persons should not be only physically examined and treated for infertility but should also be given counselling to lessen the psychological trauma attached to infertility