Shikha Pasrija

Prospective study of saline infusion sonohysterography in evaluation of perimenopausal and postmenopausal women with abnormal uterine bleeding

Aim:  To evaluate saline infusion sonohysterography as an investigative modality in abnormal uterine bleeding in perimenopausal and postmenopausal women.

Teenage pregnancies and their obstetric outcomes.

This study was conducted to evaluate the obstetric performance of teenage women in India. In total, 13,210 women were included in the study, of whom 840 were teenagers (<19 years) and 12,370 were > 20 years. Antepartum, intrapartum and postpartum events were recorded and comparative analysis was done. We found that teenage women were at a significantly higher risk for development of severe anaemia (relative risk [RR] 1.61, P value < 0.02), eclampsia (RR 1.95, P value < 0.05), preterm labour (RR 1.25, P value < 0.001), intrauterine growth retardation (RR 2.29, P value < 0.001) and low birth weight (RR 1.24, P value < 0.001). Assisted delivery (11.78% versus 2.23%, P value < 0.001) was significantly more common and caesarean delivery (9.64% versus 17.18%, P value < 0.001) was significantly less common in teenagers. Moderate anaemia, mild pregnancy-induced hypertension, preeclampsia, premature rupture of membranes, antepartum haemorrhage and post dates were all significantly higher in ≥ 20 years group. To conclude, we found that teenage women are a high-risk group, which is aggravated by social and cultural factors. Special attention is required to educate these women for more positive outcomes.

Maternal and perinatal outcome in patients with severe anemia in pregnancy.

Anemia is a major health problem among women of reproductive age particularly in developing countries. The prevalence of anemia among pregnant women is 55.9% worldwide and varies between 35% and 100% in developing countries. Anemia is responsible for 15% to 20% of total maternal mortality. This study assesses maternal and perinatal outcomes among women who were severely anemic in their third trimester of pregnancy with a hemoglobin concentration less than 5 g/dL. The 130 women admitted with severe anemia during the study period represented 9% of all hospital admissions. Such a high prevalence in an urban setting where obstetric services are freely available emphasizes the need to look into the deeper causes of the condition. (excerpt)

A rare case of vesicovaginal fistula following illegal abortion.

It is estimated that 50-60 million induced abortions take place annually in the world and 19 million are still performed illegally. According to WHO about one quarter to one third of maternal deaths are due to complications of induced abortion. The morbidity and mortality related to criminal abortions is due to complications like haemorrhage perforation sepsis shock and visceral injuries. Bladder injuries due to instrumental perforation of the uterus have been reported but development of a urinary fistula without any instrumentation in induced abortion is rare. We came across such a presentation. A 35-year P/5A/1L/5 illiterate woman presented with continuous dribbling of urine per vaginum following an illegal abortion at 3 months of gestation by a quack 7 months back. According to her some paste was applied in the vagina following which she aborted spontaneously and noticed watery discharge per vaginum. She consulted a doctor for persistent vaginal discharge and was diagnosed as a case of vesicovaginal fistula. Earlier Obstetrc history was uneventful. Her menstrual cycles were normal however following abortion she developed amenorrhoea. Abdominal examination was unremarkable. Speculum examination showed a blind vagina about 6 cm long. Cervix could not be visualized. A small opening (6 mm in diameter) about 4.5 cm from the urethral meatus was seen at the vault. On bimanual examination vagina ended blindly with cicatrization in upper part cervix could not be felt. The margins of the fistula were fibrosed and irregular. On per rectal examination uterus and cervix could not be appreciated properly instead a transverse band was felt. (excerpt)

A case of autoimmune myopathy in pregnancy

Autoimmune diseases are not found frequently with pregnancy in clinical practice. Polymyositis Dermatomyositis have a prevalence of 2.4-10.7/ 100,000 in general population. This is further low in pregnant women. It is associated with 57% perinatal morbidity and increased maternal and fetal mortality. Literature suggests that pregnancy outcomes are poorer if it manifests early in gestation while development or exacerbation in second or third trimester is associated with a better fetal prognosis. Not many case reports are published where the disease was diagnosed in third trimester. We present a case detected in third trimester, which was initially mistaken as a case of allergic reaction, however timely diagnosis and adequate management resulted in good fetal and maternal outcome.

Clinical profile of women with severe anaemia in the third trimester of pregnancy

Anaemia, the most common medical disorder associated with pregnancy, is a silent killer. Most severely anaemic pregnant women are asymptomatic and present late in the third trimester with medical and obstetric complications.

Asymptomatic bladder rupture in a primigravida: late manifestation and delayed diagnosis.

© 2005 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 45: 533–537 535 chorionic plate consistent with vasculitis. The umbilical cord showed no evidence of infection or inflammation. The cultures showed a light growth of Enterobacter. The mother had an uneventful post-partum period without evidence of infection. Twins 1 and 2 stayed in special care nursery for 55 and 37 days, respectively. Both had normal Apgar scores at birth. Neither of them developed respiratory distress or sepsis. Both required IV fluids in the first 4 days of life. After delivery of twin 2, lactation was established and the mother was able to breastfeed her babies at the time of discharge.

Prong sign: a simple measure to enhance safety of laparoscopic sterilization.

SUMMARY Laparoscopic female sterilization is widely practiced and is very safe. However, mesosalpingeal tears and mesosalpingeal haematomas are common complications especially when performed by an inexperienced surgeon. It was found that the observation of a simple ‘prong sign’ could prevent these complications and possibly reduce failure rates.

Copper intrauterine devices in the management of secondary amenorrhea

Secondary amenorrhea has always been a challenge for the gynecologist. The incidence is reported to be between 1.4% and 3% in the general population [1,2], and its causes can be hypothalamic (62%), pituitary (15%), ovarian (12%), or anatomical (7%). Intrauterine devices have been used to treat Asherman syndrome. Lately, copper intrauterine devices have been proposed to treat secondary amenorrhea [3]. As in the treatment of Asherman syndrome, their effect is probably related to the release of prostaglandins in the endometrium. Prostaglandins affect homeostasis through their effect on vascular tone and platelet aggregation, and thus lead to an increased blood flow [3]. This preliminary study was carried out to evaluate