Labial hypertrophy as a cause for vulvae pruritis

Labia minora hypertrophy is a relatively uncommon surgical condition being popularised in the realm of vulvovaginal plastic surgeries. Apart from the unaesthetic appearance of the hypertrophied minora, these cases are also associated with itching, hygiene problem, pain while sitting down, sports activities, difficulty in wearing tight clothing, bleeding and discomfort while or after sexual intercourse, social embarrassment, insecurity and psychological diminution of confidence and self‐esteem. In a country like India, due to sociocultural reasons, patients hesitate to consult a doctor for such deformities. Most of the patients suffer in silence for years. Although common in the west, very few surgeons in the country perform this simple and rewarding surgery. Here, presenting a case of married women of reproductive age group presented to the study side with complains of severe vulvar itching, the cause of itching was labia minora hypertrophy

A rare case of Crigler-Najjar syndrome type II with pregnancy

Crigler-Najjar syndrome (CNS) has been rarely described during pregnancy with only few case reports available in literature, CNS is expressed in two forms, CNS type I and CNS type II; Type I CNS results in severe unconjugated hyperbilirubinemia and neurological impairment in newborn and is fatal. Type II CNS results in milder unconjugated hyperbilirubinemia responding to Phenobarbital treatment with better outcome

Evaluation of pelvic organ prolapse by standardized POP Q system for vaginal hysterectomy

Background: Uterovaginal prolapse is a common condition affecting women in reproductive and perimenopausal age groups. Evaluating pelvic organ prolapse in an objective, reproducible, easy to apply method is required for proper management. Aim of the study was preoperative and postoperative evaluation of pelvic organ prolapse by POP Q system in patients undergoing vaginal hysterectomy.Methods: In this observational study, 100 patients having pelvic organ prolapse, (average age 48±12 years), underwent elective vaginal hysterectomy at Lala Lajpat Rai Memorial Medical College Meerut during June 2015 to July 2016. POP Q was done preoperatively and after completion of surgery by the same surgeon.Results: The mean of genital hiatus preoperatively was 6.4 and post operatively it was 3.64 i.e. the genital hiatus was reduced by 2.76. The mean of total vaginal length pre-operatively was 8.07 and post operatively was 7.2. There was only 0.9 cm reduction in the vaginal length. The mean of perineal body pre-operatively was 2.64 and post operatively was 3.64. The points preoperatively were Aa 2.35, Ba 2.61, C 2.57, Ap 2.24, Bp 0.96, D-4.79 and post-operative the value of the points was -2.19, -2.04,-5.57,-2.98,-2.52 respectively and D point absent due to hysterectomy.Conclusions: The post-operative POP Q was analysed and the patients having grade 0 were 63 (optimum anatomical outcome) and patients having grade 1 were 36 (satisfactory anatomical outcome)

Effect of body mass index on maternal outcome in pregnancy

Background: Maternal body mass index during pregnancy is one of the important parameter which gives us the clue regarding maternal complications. The objectives of this study were to study distribution of antenatal patients in underweight, normal, overweight (and obese) categories according to booking BMI, to examine the association of BMI with obstetric outcomes in singleton pregnancies.Methods: This prospective Study was conducted over a period of 1 year from July 2019 to June 2020 on antenatal women attending OPD in the Department of Obstetrics and Gynecology in LLRM Medical College. The enrolled patients were divided into three equal groups (n=50) according to their BMI. In all the groups obstetric outcome was assessed.Results: In normal BMI group 12% patients had preterm vaginal delivery. While In group of underweight patients 32% patients landed up in preterm delivery which has three times higher incidence. In overweight group 48% patients had caesarean section, while in normal BMI group it is only18% patients i.e. 3 times higher caesarean rate in high BMI group. 10% of patients belonging to normal BMI group needed induction of labor while 26% of patients in overweight group required induction .Thus incidence of induction of labor is more than double in overweight group. While only 16% patients had PPH in normal BMI group, 44% patients had PPH in overweight group i.e. three times higher. The frequency of preeclampsia was 22% in the overweight category and <1% in the normal group.Conclusions: Higher prevalence of complications to the mother when BMI is not in the recommended normal range.

Comparing the safety and efficacy of intravenous iron sucrose and intravenous ferric carboxymaltose in treating postpartum anemia

Background: Anaemia is the most common hematological abnormality diagnosed during pregnancy. As per WHO, anaemia during pregnancy is defined as haemoglobin concentration of less than 11 gm% (7.45mmol/L) and haematocrit less than 33%. The objective of this study was to compare the safety and efficacy of intravenous iron sucrose and i.v. ferric carboxymaltose in treating postpartum anemia.Methods: This open label, interventional, prospective study was carried out in 200 postpartum patients with Anemia in the department of obstetrics and gynecology, LLRM Medical College, Meerut, Uttar Pradesh, India from November 2014 to November 2015. The subjects were randomized in 1:1 ratio of two groups. First approved receiving 500 mg of intravenous iron sucrose divided in three doses on alternate days (200 mg, 200 mg, and 100 mg).  Second receiving 500 mg of intravenous ferric carboxymaltose (Ferium, Emcure Pharmaceuticals).Results: Maximum number of patients of our study belonged to low socioeconomic group, significantly higher number of women achieved Hb >11gm/dl in FCM group.88 women in FCM group achieve Hb rise of 2 gm as compared to only 24 in iron sucrose group, which was highly significant (P value <0.001) mean size of Hb was 2.086 mg for FCM group and 1.766 gm for iron sucrose group, which was also significant. Serum ferritin, which is a marker of iron stores rise much higher 67.6 mg/ml in ferric carboxymaltose group as compared to 47.88 mg/ml for iron sucrose group.Conclusions: Ferric carboxymaltose is an efficient alternative to Iron Sucrose in treating postpartum anemia. It has an added advantage of single dose regime and lower incidence of side effects

Case series of abdominal sacral colpopexy

Background: Abdominal sacral colpopexy is a transabdominal procedure that suspends vaginal vault to the sacrum using natural or synthetic graft material. We can perform this procedure in patients who have Post hysterectomy vault prolapse. Primary indication of this procedure is to resuspend a prolapsed vaginal apex. Secondary indications include repair of the cystocele, posterior vaginal wall and apical segment descent. The goal of this study was to assess the complications of repair of post hysterectomy vaginal vault proplase with polypropylene mesh.Methods: This study was conducted on 8 patients scheduled to undergo abdominal sacral colpopexy in SVBP Hospital associated to LLRM Medical College, Meerut, UP, India from March 2011 to March 2016 who had vault prolapse after hysterectomy. When patients complained of something coming out of vagina, pelvic examination was done by consultant in OPD during valsalva manoeuvre and per speculum examination. Pelvic organ prolapse quantification classification was used to classify prolapse. Two consultants performed all operations based on a standardized surgical technique.Results: In our study, all patients were followed for up to one year (at 3 months, 6 months, one year) after surgery for following observations- recurrence of prolapse, mesh erosion, dyspareunia, lower abdominal pain, constipation. None of the patient had above complaints in the follow up period.Conclusions: Abdominal sacral colpopexy with polypropylene mesh is a safe, effective treatment in patients having post hysterectomy vaginal vault proplase. When done by experienced gynecologist, major post-operative complications seem to be very few in patients having normal BMI &amp; no major systemic illnesses

Effect of bilateral salpingectomy with hysterectomy on ovarian reserve

Background: Aim of the study was to evaluate the effect of salpingectomy with hysterectomy on ovarian reserve. Methods: This prospective case control study was done in the department of obstetrics and gynaecology from June 2020 to May 2021 on patients who underwent hysterectomy with or without salpingectomy were included in the study. Patients then divided into two groups of 30 in each group. In group A hysterectomy without salpingectomy were included. In group-B patients who underwent hysterectomy with salpingectomy were included, and then both groups were followed through Si-anti-Mullerian hormone (AMH), luteinizing hormone (LH), follicle stimulating hormone (FSH) and ovarian volume.Results: Baseline AMH levels were 1.20 ng/mL for group-A, 1.29 ng/mL for group-B with no statistical significance. It was seen that AMH levels for across the group but of no statistical significance at any given follow up-line point. Baseline LH levels were 7.22 IU/L and 7.27 IU/L for group-A and group-B patients respectively with no statistical significance. The average LH levels seen to increase in the follow up period in both groups, but it was of no statistic significant at any given follow up time point. Baseline FSH levels were 7.58 IU/L and 6.84IU/L for group A and group-B respectively with no statistical significance. The average FSH levels were seen to increase is the follow up period in both groups.Conclusions: The hysterectomy coupled with bilateral salpingectomy (BS) had minimal or no statistically significant impact on the ovarian reserve. Depends on patients’ profile and states of fallopian tube we should take decision of salpingectomy during surgery

Evaluating association between thrombocytopenia and hypertension in pregnancy and its fetomaternal outcome

Background: Hypertension in pregnancy is common complication of pregnancy with incidence 5-15% and associated with maternal and perinatal mortality and morbidity. Platelet count is most simple, rapid and economical method of prediction of pregnancy induced hypertension. The aim and objective of study was to corelate with severity of thrombocytopenia and its association with fetal and maternal outcome. Methods: This study was a case control study and was conducted in department of obsterics and gynecology, SVBP hospital attached to LLRM medical college, Meerut, from October 2020 To June 2022. Total number of 100 pregnant females out of which 50 pregnant females with hypertension as cases and 50 pregnant females without hypertension as control were included in study. Observations were tabulated, analysed and conclusions were drawn. Results: Out of 50 cases 43 patients developed preeclampsia thus giving incidence of 43 % and out of which 21 patients had mild thrombocytopenia,13 moderate thrombocytopenia and 4 severe thrombocytopenia. The mean age amongst cases was 26.73±5.19SD and the mean age amongst control was 28.09±4.83. There was very high significant relationship between the degree of thrombocytopenia with severity of hypertension during pregnancy (at p &lt;0.01). 24% fetuses had preterm birth, 8% had fetal growth restriction, 2% were IUD and 2% mortality. 2% of mothers had DIC,8% had post-partum hemorrhage, 6% had abruption ,4% had pulmonary edema and 6% mortality. Conclusions: Thrombocytopenia is most common and can be life threatening complication of pregnancy induced hypertension. Therefore, platelet count can be used as an early, easy, simple, most economical and rapid test to assess severity of preeclampsia and to prevent its progression to eclampsia, HELLP syndrome and DIC

The study of co-relation of pap smear with colposcopy and histopathology in sexually active woman with unhealthy cervix

Background: Unhealthy cervix is a group of cervical lesions, mostly chronic. Cervical cancer is the second most frequent cancer worldwide in women after breast carcinoma cervical cancer is a preventable and curable malignancy if identified and managed early. Primary objective was to study pap smear, colposcopy and histopathology in unhealthy cervix in sexually active woman with secondary objective to screen woman who have abnormal unhealthy, foul smelling cervical discharge.Methods: The present study was conducted in the department of obstetrics and gynecology L.L.R.M. medical College and associated SVBP hospital, Meerut from June 2019 to May 2020 with sample size of 70. Participant who fit the inclusion criteria were included in the study after taking a written and informed consent. The colposcopy finding was correlated with histopath findings of cervical biopsy that was undertaken.Results: Co relation of pap smear with colposcopy had sensitivity of 78% and specificity of 92% with positive predictive value of 52%and negative predictive value of 97%, p value less than 0.0001. The pattern of distribution of histopathological assessment with respect to the pap smear findings was significant statistically (p<0.0001). The proportion of patients with NILM on pap smear was significantly higher in the VILI negative category compared to the VILI Positive category (94.12% vs 77.78%, p=0.0525). In the present study, prevalence of CIN of any grade was detected in 8 (11.4%) cases. With CIN 1 in 5 (7.14%) and CIN2 in 2 (2.86%) and CIN3 in 1 (1.43%) case were seen.Conclusions: Several screening modalities are available of which pap smear is most widely used. colposcopy has been proven very useful to identify and guide the biopsy of dysplastic lesion

Vaginoplasty in mayer Rokitansky-Kuster-Hauser syndrome using amnion: a case series

Background: Congenital absence of both uterus and vagina is termed Mullerian aplasia, Mullerian agenesis, or Mayer-Rokitansky-Kuster-Hauser syndrome. In classical mullerian agenesis patients have a shallow vaginal pouch, only measuring 1 to 2 inches deep. In addition the uterus, cervix, and upper part of the vagina are absent. One treatment goal for most of these women is creation of an artificial vagina either conservatively or surgically. McIndoe procedure is the most commonly employed surgical approach for creation of neovagina. The neovagina thus created is lined with skin graft, amniotic membrane, cutaneous and myocutaneous flaps, buccal mucosa, and absorbable adhesion barrier.Methods: This study was conducted on 8 patients presenting with MRKH syndrome over a period of 3 years from 2012-2015. All the patients were admitted in SVBP hospital associated to LLRM Medical College, Meerut, (UP). McIndoe procedure was the surgical treatment common to all patients, where the neovagina created was lined by amniotic membrane. The surgery was performed by two consultants using the standardized surgical technique.Results: In our study, all patients were followed for preferably 6 months (1,4,8,12 weeks and if possible 6 months) after surgery for following observations-vaginal caliber, presence of any stricture, vaginal sloughing, failure of graft uptake any urogenital complaints. Except for complication in one patient, all the rest had excellent results.Conclusions: Vaginoplasty using amnion as a graft is a safe, effective treatment in patients of MRKH Syndrome. When done by experienced gynecologist, major post operative complications seem to be very few