Ahanthem Santa Singh

Vaginal pH: A marker for menopause

Introduction: Menopause is suspected with age, cessation of menstruation for more than a year and presence of symptoms. The diagnosis of menopause is confirmed by follicle stimulating hormone (FSH) levels >40 IU/L. Few studies have focused on vaginal pH for menopausal diagnosis. It is a simple, non-invasive and inexpensive method for this purpose. Aim of the Study: The following study is to correlate the serum follicle stimulating hormone (FSH) level with vaginal pH estimation in menopause. Materials and Methods: This is a cross-sectional descriptive study conducted in 173 women aged 31-60 years with menopausal symptoms who attended the Menopausal Clinic of our hospital from January 2012 to January 2013. Vaginal pH was measured using pH micro-meter strips and serum FSH levels were measured using immunoassay methods. The data obtained was then analyzed using Statistical Package for the Social Sciences software (version 17) and results were evaluated statistically by the Chi-square and Kappa tests. P ≤ 0.05 was considered to be statistically significant. Results: According to our study of the 173 women studied, mean FSH level was 46.5 IU/L and mean vaginal pH was 5.3. If the menopausal hallmark is considered to be vaginal pH >4.5 and serum FSH ≥40 IU/L, the sensitivity of vaginal pH for menopausal diagnosis was 84.9% and of serum FSH is 77.4%, respectively. Conclusion: Vaginal pH is a simple, accurate and cost-effective tool that can be suggested as a suitable and better alternative to serum FSH estimation for the diagnosis of menopause.

Dysmenorrhea due to a rare müllerian anomaly

Müllerian duct anomalies may produce reproductive failure like abortion and preterm birth, or obstetric problems like malpresentation, retained placenta, etc., or they may be asymptomatic. Unicornuate uterus with a noncommunicating functional rudimentary horn is a type of müllerian anomaly that results in obstruction to menstrual blood flow, leading to endometriosis and dysmenorrhea. Though the majority of cases of dysmenorrhea in adolescents are primary in nature and require only reassurance and symptomatic management, it is important to be aware of rare causes such as müllerian anomalies so that these cases can be properly managed. Hence, we present this case report, with interesting illustrations, so as to increase awareness regarding these anomalies.

Steroid cell tumor: A rare virilizing ovarian tumor.

Steroid cell tumors of the ovary account for less than 0.1% of all ovarian tumors. These tumors may present at any age with presentations related to the hormonal activity and virilizing properties of tumor. We present a case report of a young girl with ovarian steroid cell tumor, who had a complete and dramatic response to surgery alone.

Pelvic tuberculosis and shock in the puerperium.

Pelvic tuberculosis (TB) in pregnancy and puerperium is rare. Its atypical presentation as puerperal shock is more rare. We describe a case of pelvic TB that manifested as shock in a teenager who was two weeks postpartum. She failed to respond to antibiotics. Ziehl-Neelsen staining of aspirated pus from the left fossa collection in the abdominal cavity was positive for mycobacterium TB. Prompt treatment with antitubercular therapy could save patients from this life-threatening condition.

Acute abdomen with hemoperitoneum in a postmenopausal woman.

Gynecological emergencies may be encountered in postmenopausal ladies like that of ruptured ectopic pregnancy in the reproductive age group. We report a case of ruptured granulosa cell tumor in a 70-year-old woman who presented with acute abdomen and hemoperitoneum.

A prospective study on the efficacy and safety of ferric carboxymaltose in correcting anaemia in patients with heavy menstrual bleeding

According to WHO reports, anaemia is one of the most common and wide spread disorders in the world affecting about 2 billion people and resulting in an estimated global prevalence of about 25%. In developing countries, anaemia affects more than half of school children and women and this incidence is at least 30-40% in developed world.1 Among the several causes of anaemia, iron deficiency is undoubtedly the most common cause and oral iron is the first mode of therapy with iron deficiency anaemia (IDA) but its ability to replenish iron store is limited by patient compliance problems due to gastrointestinal side effects. Treatment with parenteral iron could present some advantage over oral iron by leading to a rapid and higher increase of hemoglobin levels and body iron stores.2

An Audit of primary ovarian pregnancy in a tertiary care hospital

Intrauterine contraceptive devices (IUCD) and fertility treatments remain important associated risk factors. Risk factors like previous ectopic pregnancy, pelvic inflammatory disease (PID), and endometriosis have been implicated in the pathogenesis. These pathologies cause damage to epithelial lining of the fallopian tubes that impairs the normal ovum migration. The criteria for diagnosis of primary ovarian pregnancy were originally provided by Spielberg in the year 1878.

Metachronous Cancer of Breast and Adenocarcinoma of Cervix: A Rare Case Report

The occurrence of a second primary cancer in a cancer survivor is well documented. It may be synchronous or metachronous. Incidence of metachronous cancer involving cervix is 0.82% to 1.33%. One such metachronous cancer is that of breast and cervix. We present a case of a woman who received tamoxifen for invasive ductal cancer of breast following a modified radical mastectomy and subsequently developed adenocarcinoma of cervix after six month of tamoxifen therapy. The role of tamoxifen in pathogenesis of cervical cancer and that of human papillomavirus infection in pathogenesis of both cancer of cervix and breast cancer has been well recognized. In our patient, the adenocarcinoma of cervix (rare occurrence) which is likely due to six month of tamoxifen therapy is a perplexing question. Women diagnosed and treated for breast cancer need to be followed up for development of other metachronous gynecological cancers.

Spontaneous Perforation of Pyometra

Pyometra is collection of purulent material which occurs when there is interference with its normal drainage. It is an uncommon condition with incidence of 0.1 to 0.5% of all gynecological patients. Spontaneous rupture of uterus is an extremely rare complication of pyometra. A 65-year-old lady presented with pain abdomen and purulent vaginal discharge. Preoperative diagnosis of pyometra was made by magnetic resonance imaging (MRI). Laparotomy followed by peritoneal lavage and repair of perforation was performed. Although spontaneously perforated pyometra is rare, the condition must be borne in mind with regard to elderly women with acute abdominal pain. Preoperative diagnosis of perforated pyometra is absolutely essential. Computed tomography (CT) and MRI are diagnostic tools. In selected cases conservative approach at surgery can be opted.