Abstract

Objectives: To review the limitations, major complications, and conversion rates associated with non-descent vaginal hysterectomy (NDVH); and develop a scoring system to predict the possibility of successful NDVH.

Methods: The risk analysis of conversion rates from vaginal to abdominal route while attempting NDVH was applied to formulate a scoring system for the assessment of successful NDVH. Parameters were selected based on Kovacs guidelines to determine the route of hysterectomy.

Results: From April 2005 to December 2008, NDVH was attempted in 364/1,378 women undergoing hysterectomy for benign conditions (Gp-I). Eight out of 364 cases (2.1 %) either had to be converted to the abdominal route or had major complication. Endometriosis and repeated sections had the highest risk. Scoring system was developed based on the risk analysis. Validity of this scoring system was tested in 1,177 women from January 2009 to September 2012 (Gp-II). 460 women with a score of 16 or less underwent NDVH successfully with a conversion rate of 0.2 %.

Conclusion: Careful assessment by a simple scoring system can help in deciding the feasibility of performing NDVH.

Abstract

Purpose of the Study: To compare the quantitative assessment of blood flow and vascularization of ovaries in polycystic ovary syndrome patients and normal women using three-dimensional power Doppler ultrasonography.

Methods: This cross-sectional quantitative study was conducted on women of reproductive age group (15–45 years) attending Gynaecology OPD AIMSR, Bathinda, Punjab. Thirty women were enrolled in polycystic ovarian syndrome (PCOS) group and 30 healthy women in control group. Women were categorized as polycystic ovary syndrome according to Rotterdam’s criteria. The women with PCOS underwent transvaginal USG Doppler on day 6 of the cycle using 3D power Doppler USG equipment (GE Voluson E8), and vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were measured.

Results: The mean values of VI, FI and VFI measured by power Doppler ultrasonography were significantly increased (P value = 0.000) in women with PCOS when compared with healthy women.

Conclusion: This study suggests that blood flow and vascularization measured by 3D power Doppler ultrasonography in ovaries of polycystic ovary syndrome patients were significantly more than the ovaries of normal women.

Abstract

Objectives: To study prevalence of lower genital tract infections (LGTI) (bacterial vaginosis, trichomoniasis, and candidiasis) in HIV-seropositive women and correlation with CD4 counts and antiretroviral therapy (ART).

Methods: Cross-sectional study conducted in 200 HIV-1- seropositive women (18 to 45 years) attending ART clinic of PGIMS, Rohtak. Vaginal samples sent for laboratory diagnosis of bacterial vaginosis, trichomoniasis, and candidiasis, CD4 count determined and data analyzed using Chi-square method.

Results: Prevalence of bacterial vaginosis, candidiasis, and trichomoniasis was 47.7, 43.2, and 8.8 % respectively, 30 % women with CD4 counts \200 cells/ll had LGTI, and 17.4 % women with CD4[200 Cell/ll had LGTI. Of 70 women not on ART, 18.6 % had LGTI and 30 of 130 on ART had LGTI.

Conclusions: HIV-seropositive women had higher prevalence of LGTI especially at lower CD4 counts and women on ART did not have a lower prevalence of LGTI and should be screened for LGTI to decrease HIV transmission.

Abstract

Purpose: Present study aims to examine the relationship of the bone mineral density (BMD) with body mass index (BMI) in an apparently healthy premenopausal and postmenopausal north Indian female population.

Methods: Two hundred and fifty-five apparently healthy women were evaluated by a detailed questionnaire including all possible factors that could affect the BMD. The height and weight of all the subjects were recorded and BMI was calculated. Bone mineral density was measured by DXA (Dual Electron X-ray Absorptiometry) at L1-L4 Lumbar spine (LS) and femur neck (FN) by using the Prodigy DXA system (software version:8.50) manufactured by GE medical systems LUNAR.

Results: The population was divided into pre and postmenopausal groups. The BMD at all sites increased with BMI in both groups. In a multiple regression model, the attributability of BMI and age to variation in LSBMD and FNBMD was 10.3 and 13.9 %, respectively. In postmenopausal women, age, BMI, and a previous history of fracture together attributed to a variance in BMI of 40.1 and 27.6 % at lumbar spine and femur neck, respectively. BMI was found to be significantly associated with low BMD at both sites in premenopausal women, while the association was lost in postmenopausal females.

Conclusion: BMI is an important determinant of BMD in Indian females. However, the association is not present in postmenopausal women with osteopenia. In addition, the effect of increase in BMI on BMD has a ceiling effect, and moderate to morbid obesity might not actually be a preventive factor for osteopenia.

Abstract

Introduction: The timeline between a decision made and delivery of the baby is termed decision delivery interval (DDI). According to current recommendations, an emergency caesarean section must be performed within 30 min of the decision. The present study was conducted with an objective to assess DDI in a busy obstetric unit in India and its impact on obstetric outcome.

Material and Method: A total of 480 women with indications of category I (emergency): Immediate threat to life of woman or foetus (n = 66), and category II (urgent): Maternal or foetal compromise but not immediately lifethreatening (n = 414), were studied in the context of DDI and composite adverse perinatal outcomes including fresh stillbirth, 5-min Apgar score < 7 and NICU admission.

Result: Recommended DDI of\30 min could be achieved in 30% cases of emergency CS only. Sixty-three per cent with prolapsed cord could be delivered within 30 min. The composite neonatal outcomes were not significantly increased up to DDI of 60 min for category I (emergency) (except in prolapsed cord) and up to 90 min in category II (urgent) caesarean sections.

Conclusion: Authors propose reconsideration of the present recommendations of DDI in categories I and II, while Crash CS (cord prolapse or catastrophic antepartum haemorrhage) should be a separate group with recommended DDI of 30 min. For the remaining cases in the present emergency CS group, the suggested DDI of 60 and, for urgent group, 90 min may be made following further studies to prevent this DDI yardstick from becoming a rod at our back.

Abstract

Introduction: Hypertension in pregnancy is one of the potential causes of maternal and fetal morbidity and mortality. It complicates 7–10% of pregnancies. As of today, prediction of pregnancy hypertension is not possible.

Aim and Objectives: Evaluation of pregnancy associated plasma protein-A (PAPP-A), free b-human chorionic gonadotropin, tumor necrosis factor-a (TNF-a) and interferon gamma (INF-c) in establishing a biomarker or combination of biomarkers for the early identification of pregnancy hypertension.

Methodology: This prospective study was carried out in two phases. Phase I was a cohort study in which 2000 pregnant women were enrolled in their first trimester (11 ? 0 to 13 ? 6 weeks of gestation) and followed till delivery. Women who developed hypertension were compared with normotensive cohort (women who remained normotensive till term). Phase II was a case–control study. The women who were diagnosed with hypertension in phase I were cases and their controls were matched for gestational age and sample storage time from normotensive cohort population. Two additional proinflammatory markers TNF-a and INF-c were evaluated in this case–control population.

Results: Out of 2000 women, 199 women developed hypertension and 1454 women remained normotensive throughout their pregnancy. Among 199 hypertensive women, 151 (9.13%) cases had gestational hypertension, 45 (2.72%) had preeclampsia (PE) and 3 (0.18%) had eclampsia (E). First trimester mean arterial pressure (MAP) (p < 0.001) and body mass index (BMI) (p < 0.001) were found significantly higher in hypertensive women when compared with normotensive women. Maternal serum levels of PAPP-A (p< 0.001) were significantly low in hypertensive women as compared to normotensive women, while free b-hCG (p = 0.59) was high, but the difference was not statistically significant. TNF-a (p < 0.001) and INF-c (p = 0.014) both were high in hypertensive women. When all biomarkers were combined we found the positive predictive value (PPV) of 51.6% an negative predictive value (NPV) of 71.4%.

Conclusion: Increased levels of proinflammatory cytokines suggest the role of underlying inflammation in pathogenesis of pregnancy hypertension, and low PAPP-A may be attributed to impaired implantation. Combining biomarkers may improve the prediction of pregnancy hypertension in the early stages of gestation. NPV of 71.4% depicts that if woman has all biomarkers in normal ranges during first trimester, she will have 71.4% chances of remaining normotensive during pregnancy.

Abstract

Background and Objectives: Preeclampsia is a challenging disease of human pregnancy that affects the mother and her foetus. It is a common obstetric syndrome of undefined aetiology affecting 7–10% of pregnant women. This study aimed to investigate the total antioxidant capacity (TAC), superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities, malondialdehyde levels, uric acid, vitamin C, and vitamin E levels in serum and saliva of preeclamptic and normotensive pregnant women with and without periodontitis.

Methods: Sixty pregnant women, divided into four groups, preeclamptic women with and without periodontitis, and normotensive pregnant women with and without periodontitis, were recruited between 26 and 36 weeks of gestation from the Outpatient Department of Obstetrics and Gynaecology, KS Hedge Hospital, Mangalore. Pocket depth, clinical attachment loss, and gingival index were measured in all subjects. Saliva and serum levels of TAC, SOD, and GPx activities, malondialdehyde levels, vitamin C, vitamin E, uric acid were determined using spectrophotometer.

Results: Comparison of sociodemographic variables among the study groups showed no significant differences. Salivary malondialdehyde levels were highest (p = 0.025), levels of antioxidants vitamin C (p = 0.027) and uric acid (p = 0.013) being significantly lower in preeclamptic women with periodontitis. This group also had significantly lower serum levels of vitamin C (p = 0.041) and SOD (p = 0.004).

Conclusions: The results of our study show that periodontal disease may be potential risk factor for severity, progression, and even initiation of preeclampsia because of reduced antioxidant capacity or increased oxidative stress.

Abstract

Objective: To compare the efficacy and safety of mifepristone followed by misoprostol with misoprostol alone in the management of early pregnancy failure (EPF).

Study Design: A randomized double-blind placebo-controlled clinical trial.

Methods: Ninety-two women with EPF B12 weeks were recruited and randomly allocated to receive either mifepristone 200 mg (n = 46) or placebo (n = 46). Fortyeight hours later, patients in both the groups were given 800 lg misoprostol per-vaginum. If no expulsion occurred within 4 h, repeat doses of 400 lg misoprostol were given orally at 3-hourly interval to a maximum of 2 doses in women <= 9 weeks by scan and 4 doses in women > 9 weeks by scan.

Results: Pre-treatment of misoprostol with mifepristone significantly increased the complete abortion rate (86.7 vs. 57.8%, p = 0.009) and, hence, reduced the need for surgical evacuation (13.3 vs. 42.2%, p = 0.002), induction to expulsion interval (4.74 ± 2.24 vs. 8.03 ± 2.77 h, p = 0.000), mean number of additional doses of misoprostol required (0.68 vs. 1.91, p = 0.000), and side effects.

Conclusion: Use of mifepristone prior to misoprostol in EPF significantly improves the efficacy and reduces the side effects of misoprostol alone.

Abstract

Purpose of the Study: To assess the efficacy of hysteroscopy in diagnosis of AUB.

Method: A total of 56 women in reproductive and perimenopausal age group (20–50 years) with complaints of abnormal uterine bleeding were enrolled in the study. All the patients underwent hysteroscopic examination followed by biopsy/histopathological evaluation. Hysteroscopic findings were compared against histopathological findings. Sensitivity, specificity, PPV, NPV and accuracy of hysteroscopy were calculated.

Results: Mean age of patients was 36.4 ± 7.6. Majority (60.7%) presented within 6 months of complaints. Clinically, 66.1% were diagnosed as menorrhagia, 30.4% polymenorrhoea and 3.6% intermenstrual bleeding. Hysteroscopically 53.6% presented with abnormal pathology, it diagnosed polyps in 16.1%, calcification in 12.5%, submucous fibroma in 10.7%, necrotic mass in 7.1%, adhesion and forgotten IUCD in 5.4% cases each. However, on histopathology, 33 (58.9%) cases had normal/proliferative/ atrophic endometrium, 12 (21.4%) had hyperplasia, 7 (12.5%) had calcified endometrium, and 12 (21.4%) had polyp. No significant difference between two modalities was observed with respect to number of normal/  proliferative/atrophic endometrium (p = 0.185). Histopathology diagnosed hyperplasia in significantly higher proportion of patients as compared to hysteroscopy (p = 0.042). Hysteroscopy diagnosed significantly higher proportion of patients with submucous myoma (p = 0.012) and necrotic mass (p = 0.042). Statistically, no significant difference between two modalities was observed with respect to other pathologies (p[0.05). Overall agreement between two modalities was 62.5%. For pathological abnormalities in general, hysteroscopy had sensitivity, specificity, PPV, NPV and accuracy values of 78.3, 63.6, 60, 80.8 and 69.6%, respectively.

Conclusion: Hysteroscopy provided additional information for some of the pathologies, otherwise remaining undiagnosed by HPE.

Abstract

Purpose of the Study: To assess the efficacy of hysteroscopy in diagnosis of AUB. 

Method: A total of 56 women in reproductive and perimenopausal age group (20–50 years) with complaints of abnormal uterine bleeding were enrolled in the study. All the patients underwent hysteroscopic examination followed by biopsy/histopathological evaluation. Hysteroscopic findings were compared against histopathological findings. Sensitivity, specificity, PPV, NPV and accuracy of hysteroscopy were calculated.

Mean age of patients was 36.4 ± 7.6. Majority (60.7%) presented within 6 months of complaints. Clinically, 66.1% were diagnosed as menorrhagia, 30.4% polymenorrhoea and 3.6% intermenstrual bleeding. Hysteroscopically 53.6% presented with abnormal pathology, it diagnosed polyps in 16.1%, calcification in 12.5%, submucous fibroma in 10.7%, necrotic mass in 7.1%, adhesion and forgotten IUCD in 5.4% cases each. However, on histopathology, 33 (58.9%) cases had normal/proliferative/ atrophic endometrium, 12 (21.4%) had hyperplasia, 7 (12.5%) had calcified endometrium, and 12 (21.4%) had polyp. No significant difference between two modalities was observed with respect to number of normal/  proliferative/atrophic endometrium (p = 0.185). Histopathology diagnosed hyperplasia in significantly higher proportion of patients as compared to hysteroscopy (p = 0.042). Hysteroscopy diagnosed significantly higher proportion of patients with submucous myoma (p = 0.012) and necrotic mass (p = 0.042). Statistically, no significant difference between two modalities was observed with respect to other pathologies (p[0.05). Overall agreement between two modalities was 62.5%. For pathological abnormalities in general, hysteroscopy had sensitivity, specificity, PPV, NPV and accuracy values of 78.3, 63.6, 60, 80.8 and 69.6%, respectively.

Conclusion: Hysteroscopy provided additional information for some of the pathologies, otherwise remaining undiagnosed by HPE.

Abstract

Background: This study aims to compare the value of the Bishop score and cervical length measurement by transvaginal ultrasonography in predicting active labor within 6 h, induction- to-delivery interval, and the duration of active labor and to estimate the most useful cutoff points for the two methods.

Methods: This is a prospective comparative study of Bishop score and cervical length measured by transvaginal sonography on 62 nulliparous subjects who underwent induction of labor. Results The Bishop score of the subjects ranged from two to seven (2–7). The mean Bishop in this study population was 4.37 ? 1.23. The mean cervical length in this study was 25.59 ? 6.07. Bishop score was highly significant (P value < 0.0001) in predicting active phase of labor as compared to cervical length (P = 0.004). The best cutoff value for Bishop score to predict induction of labor within 6 h was more than 4 with sensitivity of 69% and specificity of 79%. Similarly, best cutoff value for cervical length to predict induction of labor within 6 h was less than or equal to 25 mm with sensitivity of 51% and specificity of 70%. Bishop score was more significant (P = 0.001) in predicting induction-todelivery interval within 12 h as compared to cervical length (P = 0.01).

Conclusion: The Bishop score was superior in predicting the response to induction as compared to the cervical length measured by transvaginal ultrasonography.

Abstract

Purpose: To look for endocrine abnormalities like thyroid disorders, hyperprolactinemia, hyperandrogenism and PCOS among adolescents with menstrual disorders and to compare the above endocrine status with those without menstrual disorders.

Methods: This was a case–control study carried out in adolescent girls aged 10–19 years in gynecology outpatient department of a tertiary care hospital. Sample of venous blood (5 ml) was taken for hormonal studies as clinically indicated—thyroid function test, serum prolactin, total testosterone, which were analyzed by chemiluminescence system.

Results: Oligomenorrhea was the most common menstrual abnormality in our study, the prevalence being 61.0% in cases followed by primary amenorrhea (16.4%). Thyroid dysfunction was found in 13.6% girls with menstrual disorders compared to 3.5% in those without menstrual disorders, and this was statistically significant (p = 0.006). Biochemical hyperandrogenism was seen in 9.04% cases compared to 0.7% controls (p = 0.001). The overall prevalence of hyperprolactinemia was 0.94%, and there was no statistically significant difference in girls with and without menstrual disorders. The prevalence of PCOS was 12.4% in the study population and 22.6% cases. Oligomenorrhea and PCOS were the most prevalent phenotypes in 52.5% of PCOS girls. No endocrine abnormality was detected in cases of polymenorrhea, hypomenorrhea and intermenstrual bleeding.

Conclusions: Although immaturity of hypothalamic pituitary ovarian axis is considered to be the most common cause of menstrual irregularities in adolescent girls, endocrine abnormalities, namely thyroid dysfunction and hyperandrogenism, may be responsible in some cases, thus warranting further evaluation.

Abstract

Introduction: Intrauterine insemination (IUI) is one of the most commonly performed procedure of assisted reproductive technology, for the treatment of infertility. Controlled ovarian hyperstimulation is an important first step while performing IUI. This study aims at establishing a relationship between stimulation protocol and pregnancy outcome following IUI.

Methods: This is a retrospective study of 1001 cycles of IUI in which the patients were divided into two groups: Group A Clomiphene citrate (CC only) and Group B Clomiphene citrate and Gonadotropin or Gonadotropin alone(CC?GN OR GN alone). The primary outcome assessed was clinical pregnancy rates (CPRs), and the secondary outcomes were miscarriage rate (MR), multiple pregnancy rates (MPRs), follicle numbers and endometrial thickness (ET).

Results: Significantly, higher CPR was observed in Group B in comparison with Group A (14.55 vs. 7.82%; p = 0.05). MR was much higher in Group A in comparison with Group B, (14.29 vs. 5.43%; p = 0.94), but it was non-significant. The follicle number and the ET of the Group A versus Group B are (1.54 ± 0.69 vs. 1.90 ± 1.04; p = 0.0003) and (8.56 ± 1.33 vs. 8.39 ± 1.29; p = 0.1784), respectively; and for subgroups, Group B1 and Group B2 are 1.92 ± 0.99 versus 1.65 ± 0.92; p = 0.0008 and 8.32 ± 1.27 vs. 8.69 ± 1.24; p = 0.0004, respectively.

Conclusion: GN, either alone or the combination with CC, gives a higher CPR and a lower abortion rate following IUI, thus increasing the multiple pregnancy rate.

Abstract

Aim: To compare obstetric and perinatal outcomes of early and late teenage pregnancies of Omani nulliparous women with singleton pregnancies cared for and delivered at a tertiary teaching hospital.

Method: In this retrospective study, we reviewed obstetric and perinatal outcomes of early teenage pregnancies (14–16 years), (n = 20) delivered at Sultan Qaboos University Hospital, Muscat, Oman, between 1 July 2006 and 30 June 2013 and compared their outcomes with outcomes of late teenage pregnancies (17–19 years), (n = 287) delivered at the same hospital during same period.

Results: When compared with late teenage pregnant women, early teenagers were found to have no significant differences in prevalence of very preterm delivery< 32 weeks (P = 0.62), preterm rupture of membranes (P =>0.99), and anemia (P = 0.34). When compared to late teenagers, early teenagers had similar cesarean sections rates (P =[0.99), instrumental delivery rates (P = 0.56) and spontaneous vaginal delivery rates (P>0.99). Both groups had similar birth weights (P = 0.87), low birth weights, (P = 0.55), and very low birth weights babies (P = 0.56 %). Perinatal mortality rate was similar in both groups.

Conclusion: We may conclude that early teenage pregnant Omani women are not at increased risk of obstetric and perinatal complication compared to older teenagers.

Abstract

Purpose of the Study: The aim of the study was to determine the prevalence and risk factor for vitamin D deficiency in our pregnant population.

Method: A total of 418 healthy primigravida with single live pregnancy and sure of dates attending the antenatal clinic between October 2011 and April 2013 were recruited. Women were excluded if they had history of current or past chronic medical disease. Women were also excluded if they had history of medication with drugs interfering with calcium and vitamin D metabolism.

Results: The prevalence of vitamin D deficiency during pregnancy has been found to be 391 (93.5 %). Severe vitamin D deficiency among pregnant patients was 34.44 % (144/418). The levels of serum 25(OH)D and serum calcium were significantly lower in severe deficient group than the adequate group [7.10 ± 1.49 vs. 38.90 ± 4.22 ng/ml (p = 0.001) and 7.13 ± 1.41 vs. 9.39 ± 0.88 ng/ml (p = 0.001)], respectively. Maternal education, husband education, socioeconomic status, serum calcium, serum phosphorous, and season were significant factors associated with vitamin D deficiency. Significant independent variables for severe vitamin D deficiency were low serum calcium, serum alkaline phosphatase, and serum phosphorus (OR 39.41, 95 % CI 10.30–150.85, p < 0.01), (OR 18.03, 95 % CI 3.95–82.44, p < 0.01), and (OR 8.40, 95 % CI 2.47–28.61, p < 0.01).

Conclusion: Vitamin D deficiency is highly prevalent among pregnant women in Northern India, and these raises concern about the health consequences for the mother and the offspring.

Abstract

Background: Antenatal diagnosis of the invasiveness of a placenta percreta helps in planning the surgical approach, reducing blood loss and morbidity. Doppler sonography is the mainstay diagnostic modality with a sensitivity of 80–95 %. With the advent of high magnetic field MRI techniques, there has been recent interest in evaluation of placenta by MRI. On an extensive PUBMED search, we could not find any citations describing imaging, ultrasound, or MRI features to evaluate vesical wall invasion by placenta percreta.

Purpose: We attempt to evaluate transmyometrial vesical wall invasion by placenta percreta using chemical shift artifact as a marker of intact bladder-myometrial interface on steady-state MRI sequences.

Materials and Methods: This is a prospective observational study, conducted at a university hospital. We have compiled clinico-radiological criteria for diagnosis of invasive placentae based on the existing body of evidences, in four patients. We further go on to analyze a specific proposed sign on a newly introduced MR imaging sequence i.e., loss of chemical shift artifact (India ink line) on steady-state GRE sequence (TrueFISP), to diagnose transmyometrial vesical invasion in placenta percreta.

Results: Though the sample size is small, the sensitivity, specificity, positive, and negative predictive value of the proposed sign for the purpose was 100 %.

Conclusions(s): Loss of chemical shift artifact (India ink line) on steady-state GRE sequences at the vesico- myometrial junction in case of invasive placentae confirms vesical wall invasion, a prospective diagnoses of which can help in planning the surgical protocol and preventing potentially fatal blood loss.

Abstract

Objectives: To assess the preoperative serum levels of CA 125 with its diagnostic role and to evaluate the p53 expression in patients of primary ovarian neoplasms. We also wished to judge their relationship with other parameters like clinical staging and histopathologic tumor type.

Materials and Methods: The present study was conducted on 86 patients during the study period of 2.5 years. Preoperative CA 125 levels were evaluated by an automated immunoassay analyzer. p53 expression was judged immunohistochemically with pre-diluted monoclonal antibody. An objective scoring was done depending on distinct nuclear immunopositivity.

Results: Median value of preoperative CA 125 levels was 32 U/mL in benign surface epithelial-stromal tumors (BSEST), 53 U/mL in borderline surface epithelial-stromal tumors (BOT), 346 U/mL in malignant surface epithelial-stromal tumors (MSEST) and 560 U/mL in serous adenocarcinomas (SAC). Most of ovarian tumors were in the FIGO stage I (64 cases, 74.4%), but higher stages (II, III, IV) were observed mostly in MSESTs. SACs displayed the maximum p53 expression. Considering the cut-off value of more than 35 U/mL in CA 125 levels, the sensitivity to diagnose MSESTs was 94.7%. Preoperative CA 125 levels strongly and positively correlated with FIGO staging and p53 expression. Similarly p53 expression strongly and positively correlated with FIGO staging and histopathological categories.

Conclusion: Higher values of preoperative CA 125 levels and higher expression p53 are associated with MSESTs and BOTs especially of serous type. They strongly correlate with each other and with tumor stage. But there is no serum CA 125 concentration that can clearly differentiate benign and malignant ovarian masses.

Abstract

Objective: To study the prevalence of thyroid disorders and its correlation with menstrual disorders.

Methods: 100 women aged between 15 and 45 years who attended gyne OPD in Kasturba Hospital, Delhi, were included for this cross-sectional study. The study group comprised 50 patients presented with menstrual complaints. The control group consisted of 50 women of same age group with complaints other than menstrual disorders. Thyroid function tests, anti-TPO antibody estimation, and endometrial sampling were done in all patients.

Results: In patients with menstrual disorders, 44 % had thyroid disorders in which subclinical hypothyroidism was prevalent in 20 %, overt hypothyroidism in 14 %, and overt hyperthyroidism in 8 %of the women. Autoimmune thyroid antibodies were present in 30 % patients of women with menstrual disorders. On endometrial sampling, hypothyroid patients mainly had proliferative endometrium (42.85 %) whereas hyperthyroid had atrophic endometrium (60 %).

Conclusions: Thyroid dysfunction is an important causative etiology of menstrual abnormalities. Assessment of thyroid function should be done in all patientswithmenstrual disorders to avoid unnecessary interventions like curettage and hysterectomy.

Abstract

Pregnancy is affected by maternal age from conception till delivery. Various studies have been conducted globally to study this effect; few in developing countries. Maternal age is increasing in developing countries as well, so we have conducted this study.

Method: This was a prospective observational study consisting of 1,263 women booked at Jehangir hospital during a period of 2 years, fulfilling inclusion criteria and consenting for the study. They were divided into two groups; women aged 35 years and above and women less than 35 years of age. Pregnancy outcomes were studied in terms of antepartum, intrapartum and postpartum complications. Neonatal outcomes were studied in terms of birth weight and NICU admissions. Data was analyzed statistically using statistical package for social sciences version 17, by applying Chi square test and Fisher exact test. A p value below 0.05 was considered significant.

Results: Women aged 35 years and above constituted 9.63 % of the total study population. Most were multigravidae. Rate of assisted conception was significantly higher among women aged 35 years and above; early pregnancy loss was also high in this group. Pre-eclampsia and abruption were significantly higher among them. Neonatal outcomes were comparable.

Conclusion: Women with advanced maternal age are at higher risk of complications from conception till delivery and should be provided close supervision for better pregnancy outcome.

Abstract

Purpose: To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and transvaginal sonography (TVS).

Method: In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I–IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I–IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I–IV).

Results: Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS (p = 0.440) and interdelivery interval (p = 0.062) had no statistically significant correlation with thickness of LUS.

Conclusions: Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.