Rekha Bharti

Risk assessment for psychological disorders in postmenopausal women.

INTRODUCTION Psychological symptoms are common & bothersome in post menopausal women. Hence, screening these women for risk factors for psychological disorders is an important measure to improve their health. OBJECTIVE To study the risk assessment for psychological disorders in postmenopausal women Material & Methods: This was a prospective and observational study conducted in the Department of Obstetrics and Gynecology of a North Indian tertiary care hospital. It included a cross-section of 200 postmenopausal women attending gynecology OPD and menopausal clinic. RESULT Psychological symptoms were present in 32% postmenopausal women while sleep disturbance and decreased concentration were reported by nearly 34%. Irritability, nervousness and depression were the presenting complaints in 31.5%, 28.5% and 23.5% women respectively. Mild depression was present in 41.5%, whereas 3% women suffered from clinical (moderate to severe) depression. Depression was significantly associated with vasomotor symptoms (p=0.000), past history of depression (p=0.048) and psychosocial stressors (p=0.000). CONCLUSION Women during postmenopausal years are at increased risk of psychological disorders; hence assessment of mental health and address of related issues should be an integral part of comprehensive evaluation of these women.

To Evaluate the Effect of Perceived Stress on Menstrual Function

INTRODUCTION Menstrual irregularities affect 2-5% of childbearing women, a number that is considerably higher among females under constant stress during a cycle. AIM To study the effect of perceived stress on cycle length, regularity and dysmenorrhoea. MATERIALS AND METHODS A cross-sectional study was conducted on 100 female undergraduate students of a medical college. A questionnaire along with the Perceived Stress Scale (PSS) and Pictorial Blood Assessment Chart (PBAC) was provided to the students. The menstrual pattern was then correlated with the PSS using the chi- square test and the Fishers Exact test for statistical analysis. OBSERVATIONS AND RESULTS Out of the 100 undergraduate medical students, 30 students had a PSS score >20 while 70 had a score ≤20. An association was established between high stress levels (PSS >20) and menstrual irregularity. No association was found in students with PSS >20 with hypomenorrhoea, menorrhagia, dysmenorrhoea, long cycle length and short cycle length. CONCLUSION High stress levels (PSS >20) was associated with only menstrual irregularities and not with duration, amount of flow or dysmenorrhoea. Hence, other causes should be looked for in young women complaining of menstrual problems before stress is assumed to be the cause.

Clinical Outcome of Postplacental Copper T 380A Insertion in Women Delivering by Caesarean Section.

INTRODUCTION Short interconception period after caesarean section and its associated risk of increased morbidity, mortality and surgical interventions could be avoided by postplacental IUCD insertion during the procedure. Despite the safety reports on intracaesarean IUCD insertion, obstetricians are still hesitant to extend the benefit of this long acting reversible contraception to women undergoing operative delivery. OBJECTIVE To study the clinical outcome (safety, efficacy, expulsion and continuation rates) of postplacental Copper T 380A insertion in primiparous women undergoing caesarean section. MATERIALS AND METHODS This study was a prospective observational study, carried out in the Department of Obstetrics and Gynaecology, Safdarjung hospital, which is a tertiary care hospital of Northern India. Primiparous women who delivered by caesarean section over a period of six months (July 2012 to December 2012), willing for postplacental intracaesarean IUCD insertion, and willing to comply with the study protocol, were recruited for the study. All these subjects fulfilled the WHO Standard Medical Criteria for PPIUCD insertion; follow up visits were scheduled at 1, 3, 6 and 12 months. RESULTS A total of 300 primiparous women underwent postpartum intracaesarean insertion of Copper T 380A. The mean age of women included in the study was 23.12 ± 2.42 years. Most common postinsertion complication observed in the immediate postoperative period was febrile morbidity (2%). Majority of women (94.33%) had hospital stay of less than 4 days. The common adverse events observed during follow-up of 12 months were menstrual complaints, excessive vaginal discharge and persistent pelvic pain. At the end of one year, there were 16 expulsions, 21 removals, and 2 pregnancies with gross cumulative expulsion, removal, failure and continuation rates of 5.33%, 7%, 0.67% and 91%, respectively. CONCLUSION Postplacental intracaesarean Copper T 380A insertion in primiparous women is a safe and effective method of reversible contraception, with low expulsion and high continuation rates.

Non-visualisation of strings after postplacental insertion of Copper-T 380A intrauterine device

Aim To assess the incidence of visible strings of intrauterine contraceptive devices (IUDs) after postplacental insertion following vaginal or caesarean delivery and to establish a management protocol of follow-up visits when strings are not visualised. Methods This was a prospective study of a cohort of 348 women who underwent postplacental insertion of Copper-T 380A IUDs following vaginal or caesarean delivery, conducted at a hospital in New Delhi, India. Women were followed up at 6 weeks, 3, 6 and 12 months after IUD insertion and were questioned about IUD expulsion or removal at each visit. The cervix was inspected to visualise the IUD strings. All women whose IUD strings could not be visualised at the cervical os at any given follow-up were identified. We analysed the cumulative incidence of visible strings and of procedures performed to locate the IUD when strings were not visible. Results At 1 year follow-up, the IUD was in situ in 313/348 (89.9%) women. There were eight (2.3%) expulsions and 15 (4.3%) IUD removals. Among women with IUDs in situ, the strings were not visible in 73 (21%) cases. Pelvic ultrasound confirmed intrauterine position of the IUDs in these cases. At 1 year, string visibility was significantly lower after intra-caesarean insertions as compared to vaginal insertions (72.4% vs 98.1%; p<0.05). Conclusions Visualisation of strings after postplacental vaginal insertion is more common than after intra-caesarean insertion. Pelvic ultrasonography can be used to verify the presence of the device in cases of missing strings.

Retained Intra-uterine Foetal Bones Resulting in Secondary Infertility: A Case Report

Termination of pregnancy (abortion) is a reasonably safe procedure when properly performed. However, even after being performed with due precautions, complications may occur. Retention of fetal products following a mid-trimester abortion is a rare complication of abortion which can then result in secondary infertility. We are here presenting the case of a young woman who underwent an abortion in the 15th week of gestation due to anencephaly in the fetus and who then failed to conceive for the next five years. Transvaginal ultrasonographic examination suggested the presence of bone-like structures in the uterine cavity which were removed hysteroscopically. The patient was able to conceive after the hysteroscopic removal of bony fragments. Retained bony fragments from a previous mid-trimester abortion should thus be kept in the list of differentials of secondary infertility.

Feto-maternal Outcome Using New Screening Criteria of Serum TSH for Diagnosing Hypothyroidism in Pregnancy

INTRODUCTION Evidence suggests that by using the classical non pregnant reference range for serum TSH (STSH), one might miss hypothyroidism in pregnancy. Therefore, upper normal cut off value of S TSH should be taken as <2.5 mIU/L in the first trimester and <3mIU/L in the second and third trimester. However, two Indian studies have reported higher trimester specific reference ranges in the Indian pregnant women. OBJECTIVES To assess the maternal and fetal outcomes using new screening criteria with upper S TSH cut off as >3mIU/L, for diagnosing hypothyroidism in pregnancy. MATERIALS AND METHODS This study was a cross sectional study, carried out in the Department of Obstetrics and Gynaecology of a tertiary care hospital, in collaboration with the Department of Endocrinology. Pregnant women with ≤ 20 weeks gestation, attending antenatal OPD from December 2010 to January 2012 were included in the study. On the basis of S TSH level, women were divided into Study Group with S TSH level between 3.1 to 6.2 mIU/L, (new range to be studied) and an equal number of age and parity matched Control Group with S TSH levels between 0.4 to 3 mIU/L. The maternal and fetal outcomes were compared between study and control groups. RESULTS During the study period, a total of 66 women had S TSH between 3.1-6.2 mIU/L. Maternal and fetal outcomes in both the groups were comparable. There was no difference in the mode of delivery between study and control groups. CONCLUSION The lower S TSH cut off recommended for diagnosing hypothyroidism in pregnancy may not be applicable to pregnant Indian women.

Leiomyosarcoma of the Broad Ligament - a Case Report

Primary leiomyosarcoma of the broad ligament (LBL) are extremely rare tumours with no defined risk factors. They are mostly reported in postmenopausal women with only 3 case reports of tumor developing before 40 years of age. Diagnosis is difficult as signs and symptoms are nonspecific. None of the reported cases so far have been diagnosed preoperatively. In view of very few documented cases, there are no guidelines for the management of this rare tumor. We report a case of primary leiomyosarcoma of broad ligament with its management.