Gynecology OPD Research Articles

Thyroid disorders in reproductive age presenting with abnormal uterine bleeding

Abnormal uterine bleeding (AUB) is a frequently encountered clinical presentation in gynecological OPD. They are not life threatening but can cause social, psychological and occupational disturbances. As thyroid hormones play a major role in the menstrual and reproductive function of women, studying for thyroid disorder in patients with AUB should be a logical step.This is a prospective observational study conducted in Kalinga Institute of Medical Sciences, BBSR, Odisha. Two hundred and eighty patients of age group 18 to 45 years presenting with AUB were included in this study. All were subjected to routine investigations along with thyroid function tests.Out of 280 patients, 56 patients (20%) had thyroid abnormality. Among which 26 were diagnosed as subclinical hypothyroidism, 24 had hypothyroidism and 6 patients had hyperthyroidism. The frequent menstrual symptom associated with hypothyroidism and subclinical hypothyroidism was menorrhagia. Oligomenorrhea was seen in 50% of hyperthyroid patients.Any type of menstrual disorder should be considered as a possible presenting symptom of thyroid dysfunction and thyroid assessment deemed necessary in such cases, so that we can treat patients at the earliest and prevent morbidities in later life.

Estimation of incidence of Aerobic vaginitis in women presenting with symptoms of vaginitis

Vaginitis is found to be quite common among women who present in Gynecology OPD. Aerobic vaginitis is one of the causes of vaginitis which is typically marked by either an increased inflammatory response or by prominent signs of epithelial atrophy or both. The main aim of the study was to analyze the signs, symptoms and laboratory investigations among women presenting with symptoms of vaginitis. The study consisted of 155 cases of women presenting with symptoms of vaginitis. Brief general, systemic and detailed gynecological examinations were done and analysed. The incidence of Aerobic vaginitis in the study group was observed to be 7.74%. All cases of Aerobic vaginitis had unusual vaginal discharge as the presenting symptom. It was observed that 50% of cases had additional complaints of pruritus vulvae and vaginal irritation while 25% cases had complaints of dysuria and dyspareunia. pH of vaginal smears of these cases varied from 6 to 10, average being 7.75. On Gram staining, there were moderate to plenty number of pus cells and few to moderate number of epithelial cells. Organisms grown included Coagulase negative Staphylococci; Streptococci and Klebsiella species. Other causes of vaginitis included Candida - 14.19%, Trichomoniasis - 6.45% and Bacterial vaginosis 7.09%. The study concluded that the incidence of Aerobic vaginitis in the present study was less as compared to other studies. It is advisable to do culture with an antimicrobial sensitivity to find out the cause of vaginitis especially in cases presenting with recurrent symptoms of vaginitis. The type of antibiotics used to treat vaginitis must be very selective in order not to kill the beneficial bacteria that help in preservation of vaginal health and ecosystem.

How Common are Depressive-Anxiety States, Body Image Concerns and Low Self-Esteem in Patients of PCOS?

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age with increased incidence of emotional disturbances and other psychopathology. We undertook this research to study the prevalence and severity of depression and anxiety as well as understand body image disturbances and self-esteem of the women of PCOS. We studied the relationship of depressive symptoms with self-esteem and body image disturbances. A total of 105 patients diagnosed as PCOS were recruited from gynecology OPD after informed consent and ethics approval. A proforma along with Beck's Depression Inventory, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Body Image Concern Inventory and Rosenberg' s Self-Esteem Scale were administered to patients for further assessment. In total, 54 (51.43%) patients of PCOS had depression on BDI, 12( 11.43%) patients had body image disturbances an d 23 (21.90%) patients had a low self-esteem. A total of 21 patients( 20%) had mild and moderate depression while 5% had severe depression. Majority 53 (50.48%) of our patients had mild anxiety whereas severe to extreme anxiety was seen in about 31% of patients. Body image disturbances were seen in only 12(11.43%) patients and low self-esteem was present in 23 patients. No statistically significant correlation of depression was seen with body image or self-esteem. The results of this study indicate that there is a high prevalence of depression and anxiety in patients of PCOS than body image concerns and low self-esteem. Prognosis for patients would improve by liaison between gynecologist and psychiatrist.

Analysis of the Prescribing Pattern of Antihypertensive Drugs in Obstetrics /Gynecology OPD in A Tertiary Care Hospital

Analysis of the Prescribing Pattern of Antihypertensive Drugs in Obstetrics /Gynecology OPD in A Tertiary Care Hospital

Role of PCR in Rapid Detection Group B Streptococcus in Pregnant Females in Al-Quwayiyah General Hospital, Riyadh, Saudi Arabia

Background: Group B streptococcus is one of the most common causes of severe neonatal infections.
 Aim: To detect the prevalence of group B. Streptococcus and their antimicrobial susceptibility and to assess the role of PCR as a rapid method of its detection.
 Place and Duration of the Study: A cross sectional and prospective cohort study was carried out from September 2019 to February 2020 in Gynaecology and Obstetrics OPD and inpatient units in Al- Quwayiyah General hospital, Riyadh, Saudi Arabia
 Methodology: Paired rectal/vaginal specimens were collected from 540 pregnant females with gestational age 35 or more, Each swab was inoculated into selective medium, Todd Hewitt, One swab is streaked onto blood agar plates incubated in 5% CO2 for 24h at 36ºC. β-hemolytic colonies growth is identified by Gram’s stain, colony morphology and CAMP test. The confirmation and antimicrobial susceptibility were done by Vitek II machine, The second swab was used for PCR to identify atr gene.
 Results: Out of 540 pregnant women 87 (16.1%) were colonized with GBS isolates. The positive GBS women aged 25 (22-34) and negative GBS women aged 23 (24-35) with no statistical difference. Patients aged more than 35 years old has the higher rate of positive GBS, 46.2%. No significant association detected between GBS and gestational age at delivery, antenatal visits, BMI and gravidity. The GBS strains isolated from pregnant women was 100% susceptible to linezolid and vancomycin followed by ampicillin (93.1%) and tobramicin (83.9%) then gentamicin (81.6%) and levofloxacin(78.2%) and showed least antibiotic susceptibility to erythromycin (26.4%). The PCR was positive in 145 (26.9%). Using culture as gold method, PCR sensitivity was 100% (95% CI: 91.62-100), while specificity was 83.2% (95% CI: 82.61-91.02). Negative and positive predictive values were 100% and 61% respectively. Kappa between the two methods was 0.71, which indicate major agreement.
 Conclusion: The GBS prevalence among the pregnant females in Al Quwayiyah General Hospital was 16.1%. Detection of GBS using new PCR technique was found to have high sensitivity and faster results, allowing efficient management of GBS and reduction in newborn morbidity and mortality however the cost is high for some laboratories. Further studies should be assessed to be both low cost and accurate rapid screening.

Maternal Outcome among Women Having Cardiac Disease at Tertiary Care Hospital

Aim: To determine the maternal outcome among women presented with cardiac disease at tertiary care hospital. Study design: Prospective study. Place and duration of study: Department of Obstetrics & Gynaecology, Liaquat University of Medical and Health Science Jamshoro from 1st April 2019 to 31st March 2020. Methodology: Fifty-seven women after 24 weeks of alive pregnancy and having cardiac diseases were included. The subjects were seen in the Gynaecology OPD every two weeks till 34-36 weeks, as per institutional protocols and after that every week by obstetrician. Cardiologists saw subjects in each trimester and delivery schedule were developed and medications were adapted with collaboration. The anaesthetic scheme of the subject was also reviewed with the cardiac anaesthetist. All the maternal outcome data was recorded. Results: Most of the patients 89.5% had age group of 25-32 years. Multiparous women were commonest 43.3% and 53.7% patients underwent normal vaginal delivery. 35.8% patients had congenital heart disease, 32.8% had cardiomyopathy and 16.4% had Rheumatic heart disease. According to the maternal outcome anemia was most common among 85.1%, pre-eclampsia 41.8%, pulmonary edema 35.8%, IUGR 20.9%, birth asphyxia 26.9%, preterm 38.8% and maternal mortality 14.9%. Abruption placenta and preterm birth were significantly associated with congenital heart disease and cardiomyopathy p=0.047 and p=0.002 respectively. Pulmonary edema was higher among patients of cardiomyopathy (p=0.027). Birth asphyxia was higher among patients of rheumatic heart disease. While anemia, IUGR and maternal mortality were equally found among cardiac diseases, p-values were quit insignificant. Conclusion: Cardiac disease showed adverse maternal outcome during pregnancy with mortality rate of 14.9%. Keywords: Pregnancy cardiac disease, Maternal outcome, Mortality rate

Study of Pap Smear as Cervical Cancer Screening: A Prospective Study at a Periurban Tertiary Care Centre

Background: Cancer cervix is fourth most common cancer in the world and second most common in India. In India, cervical cancer is the leading cause of mortality and morbidity amongst women. Methodology:This prospective study was conducted among 200 women undergoing Pap Smear Test at gynecology OPD between January-June 2020. Pap smear test was classified as per Bethesda system. Result: Abnormal pap smear report was seen among 25.5% women. Higher proportion of abnormal pap report was seen among women aged 21-30 years (41.17%), with a duration of married life between 10-20 years 33.3%. The common abnormal pap smear report finding were inflammatory changes and vaginosis. Epithelial cell abnormalities were found among 18 (9%) women. Conclusion: Pap smear test is a simple, affordable, effective, and practical screening test for early detection of cervical cancer, and it decreases morbidities and mortalities due to cervical cancer.

ROLE OF CBNAAT IN DIAGNOSIS OF GENITAL TUBERCULOSIS IN WOMEN

Objective: Female genital TB referring to TB of the uterus,fallopian tubes and/or Ovaries.It poses a diagnostic dilemma because of its varied presentations and lack of sensitive and specific methods of diagnosis,though CBNAAT gives rapid result. India is a country sharing one fourth of the global incidence of tuberculosis. It is much easier to diagnose pulmonary cases, but challenges are with extrapulmonary cases. Genital tuberculosis is considered as an important cause of infertility in young females in India and difficult to diagnose.It requires incorporation of different modalities that should correctly,timely and rapidly diagnose the case.Methods:This study was conducted prospectively from October 2016 to June 2018 on 200 endometrial samples from reproductive age group females attending Obstetrics and Gynaecology OPD in obstetrics and gynaecology department of SSH, BHU. Nucleic acid amplification technique was done and their sensitivity in diagnosis of genital tuberculosis was ascertained. Results: Out of 200 samples, 1 samples were found positive with CBNAAT.Unlike Pulmonary TB, role of CBNAAT in the diagnosis of female genital TB is limited. Conclusion: Infertility in young female per se is usually heart breaking and distressing. Therefore, it is essential to diagnose and treat the cases of genital tuberculosis before irreversible damage of tube may happen. Although, advancement in diagnostic field is there from microscopy to molecular method,but still diagnosis of genital tuberculosis is challenging. Correct diagnosis prevents young female from mental trauma and toxicity of anti-tuberculosis drugs given on suspicion in high prevalence country like India.

English

BACKGROUND We wanted to analyse the clinical profile of polycystic ovarian syndrome (PCOS) women with history, examination and ultrasonogram and correlate hirsutism with biochemical markers as free testosterone, dehydro-epiandrosterone sulphate (DHEAS), sex hormone binding globulin (SHBG), free testosterone, DHEAS, and SHBG. METHODS This study is a prospective observational study conducted from 2011 to 2013 in the Department of Obstetrics and Gynaecology, Shree Balaji Medical College and Hospital, Chrompet in patients attending Gynaecology OPD. 100 women visiting the OPD were taken as control and 100 women were taken for PCOS study. RESULTS Hyperandrogenism was studied and all the biochemical markers were significantly higher in polycystic ovarian syndrome patients than in controls (P < 0.0001). The highest AUC-ROC was found for bioavailable testosterone (0.852) followed by free androgen index (0.847) and free testosterone (0.837). Lower AUC-ROC was found for androstenedione, total testosterone and SHBG (0.706, 0.799 and 0.76, respectively). When free androgen index of 4.97 was taken as a cut off value, sensitivity was 71.4 % and specificity was 85.2 %. A cut off of 0.78 nmol / L for bioavailable testosterone had even higher sensitivity of 75.9 %, but slightly lower specificity of 83.3 %. Bioavailable testosterone and free androgen index correlated significantly (all P < 0.05) with DHEAS, LH / FSH ratio, androstenedione and total testosterone. In addition, bioavailable testosterone, free androgen index, and free testosterone correlated significantly with follicle count, ovarian volume, and hirsutism scores. CONCLUSIONS White women have about 20 % of excess of dehydro-epiandrosterone sulphate (DHEAS) and black women have 30 % excess of dehydro-epiandrosterone sulphate (DHEAS) in those having poly cystic ovaries patients. There is an age-associated decline in DHEAS levels which is similar in both control and poly cystic ovaries women, regardless of the race which was seen in this study. KEY WORDS Free Testosterone, Dehydro–Epiandrosterone Sulphate (DHEAS), Sex Hormone Binding Globulin (SHBG)

ROLE OF USG FINDINGS AS A PREDICTIVE MARKER IN THREATENED ABORTION

Background: The Centers for disease control and prevention, and the World Health Organization all define abortion as pregnancy termination before 20 week gestation or with fetus born weighing <500g [1]. Early pregnancy USG parameters: - fetal crown-rump length (CRL), the presence/absence of sub-chorionic hematoma and Fetal Heart Rate (FHR) are good predictors of outcome.
 Material and Methods: The study was conducted in the Department of Obstetrics and Gynaecology, S.P. Medical College Bikaner& associated Group of Hospital, Bikaner, Rajasthan. This is a hospital based prospective comparative study. The study group comprise of pregnant females attending Obstetrics and Gynaecology OPD. A total of 200 pregnant women are examined in this study. We divided these patients into 2 groups i.e group A and group B. Group A consists of 100 pregnant females with threatened abortion and group B with 100 normal pregnant female.
 Results: FHR at 115bpm is 76.32% sensitive, 90.32% specific in predicting abortion with 82.86% positive predictive value and 86.15% negative predictive value. While CRL at 11 mm is 50% sensitive, 69.35% specific in predicting abortion with 55% positive predictive value and 69.35% negative predictive value. 
 Conclusion: FHR is best predictive marker followed by presence or absence of sub-chorionic hematoma and CRL in threatened abortion which results in loss of pregnancy.
 Keywords: Pregnancy, Abortion, Threatened, USG

STUDY TO EVALUATE EFFECTS OF MIFEPRISTONE 25mg IN MANAGEMENT OF UTERINE FIBROIDS

Background: In India, the uterine broid is a common indication of hysterectomy. An effective option for medical treatment may decrease the morbidity associated with hysterectomy. Objectives: We aimed to evaluate the effect of mifepristone (25 mg), progesterone antagonist, on uterine broids in perimenopausal women. Material And Methods: Fifty perimenopausal women having symptomatic uterine broids were selected from Gynaecology OPD and given 25 mg mifepristone once daily continuously for 2–4 cycles of 3 months each. Variables such as baseline broid size, position, and haemoglobin were measured and followed at 3, 6, 9, and 12 months. The data were entered in MS EXCELspreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. APvalue of <0.05 was considered as statistically signicant. Results: Majority were intramural broids (70%) followed by submucosal in 18%. Size of broids ranged from 7 cm; the majority of broids were in 5–7 cm size. No signicant association of location with the size of broid was found. Out of 50 cases included in the study, change in size in uterine broids was observed in 95.14% cases. There was an increase in haemoglobin, from 8.6 g% at baseline to 9.5 g% at 12 months. Conclusion: Mifepristone resulted in a reduction in uterine broids size and an increase in haemoglobin at the end of 12 months. It may be an option for uterine leiomyoma treatment, as it is given orally, cost-effective and has minimal side effects.

To study the outcome of vaginal reconstructive surgery for isolated rectocele

Aim: To study the symptomatic relief of local and bowel symptoms after vaginal reconstructive surgery for isolated rectocele. Introduction: Isolated posterior compartment defect as isolated rectocele is on the raise due to multi parity and chronic constipation, sedentary and faulty lifestyle. The term rectocele means herniation of rectum into vaginal canal. The posterior wall defect presented with difficult defecation, constipation, incomplete evacuation, pressure in recto vaginal area, manual vaginal replacement during evacuation.The cases with isolated rectocele were evaluated and relief of local and bowel functions before and after the pelvic repair were assessed. Materials and Methods: A prospective study was done between August 2016-August 2018, for the period of 2 years at IIMSR, Dasauli, dept. of OBG, Lucknow wherein cases with isolated rectocele were identified and pelvic repair of the rectocele was done by repair of pararectal fascia without mesh along with pelvic floor repair wherein the medial fibres of levator ani was approximated. Out of 426 cases presenting to the gynaecology OPD with mass per vagina, local pressure symptoms, after detailed history and examination, 25 cases of isolated rectocele were included in the study. Result: A total of 25 cases out of 426(5.86%) were with isolated rectocele.25 cases underwent pelvic repair of the rectocele by repair of pararectal fascia without mesh,excision of redundant vagina along with pelvic floor repair with approximation of medial fibres of levator ani muscles. There was significant association between isolated rectocele, chronic constipation and multi parity. The statistical analysis was done using chi square and pvalue. Keywords: Isolated rectocele, Chronic constipation, Pelvic repair.

Cell pattern abnormalities in cervical pap smear in correlation with age and demography at a Tertiary care centre.

Introduction: Carcinoma Cervix is common all around the globe and ranked third amidst allmalignancies among women. The cervical mucosa undergoes morphologic variation with age andpractising cytopathologists is aware of these difference to make an accurate diagnosis. This studyaimed to detect abnormal cervical epithelial cell patterns in a rural population and compare lesionsor abnormal cell patterns among different age groups. Materials and Methods: This is a cross-sectional, descriptive study conducted in a tertiary care centre at the Department of Pathology over6 months. 408 women were included in the study. Data were entered in Microsoft Excel andanalyzed in SPSS software. Results: Out of 408 women included in the study, the most commonage group of the presentation was 31 to 40 years (36%), followed by 20 to 30 years (24%). NILM-Inflammatory was the most common finding (50%), followed by NILM (36%). The most commonsymptoms of presentation were Menstrual abnormalities (21%), White discharge and pruritus(18%). Findings in younger women were most commonly NILM-Inflammatory & NILM whereas in thepost-menopausal age group, ASCUS, LSIL & HSIL. Conclusion: All women above 30 years of ageshould undergo routine cervical cancer screening, and should continue screening even in theperimenopausal and postmenopausal age. Most women who visited the gynaecology OPD were notaware of cervical cancer screening. Hence the general population has to be educated about thebenefits of pap smear test through medical camps and awareness programs.

Clinico-pathological Analysis of Cervical Pap Smear in Patients Attending Gynecology OPD of a Medical College

Background: Cervical cancer ranks the most common cancer among Nepalese women. Cervical and vaginal infections constitute the most common gynecological problems. Through Pap smear screening, early diagnosis, follow up and treatment, morbidity and mortality can be reduced by 70% and 80% respectively. 
 Methods: This retrospective study was conducted to know the incidence of abnormal cervical epithelial lesions and cervico-vaginal infections. It was carried out in the Outpatient Department of Gynecology at Chitwan Medical College from April 2018 to March 2019. The data were collected and standard statistical analysis done using Microsoft Excel 2007. 
 Results: The most prevalent cervical epithelial cell abnormality was atypical squamous cells of undetermined significance (3.43%) whereas the least common was low grade squamous intraepithelial lesion (0.21%). The most prevalent cervical vaginal infection was Bacterial vaginosis (12.30%) whereas the least prevalent was Trichomoniasis (0.29%). The majority of the women with epithelial cell abnormality were in the age group of 31-40 years whereas the lowest number in the age group less than 20 years. The highest prevalence of cervical vaginal infection was in the reproductive age group (31-50 years) and the lowest in the age above 51 years. Most of the patients had multiple symptoms like vaginal discharge, genital itching, whereas only (20.17%) visited for routine screening. 
 Conclusion: Atypical squamous cells of undetermined significance and Bacterial vaginosis were the most common finding in Pap smear test representing abnormal cytology of cervix and cervicovaginal infection respectively.

Antifungal profile of vulvovaginal candidiasis in sexually active females from a tertiary care hospital of Western Rajasthan.

Introduction:Vulvovaginal candidiasis (VVC) is the commonest form of sexually transmitted infection especially in sexually active females. Various species of Candida i.e., Candida albicans and non-albicans Candida are associated with VVC. More than 75% of women experiences vulvovaginal candidiasis at least once in their lifetime and 10% of it can lead to recurrent VVC. So, this study was planned to evaluate the clinico-mycological profile and antifungal profile of VVC in sexually active female attending tertiary care hospital.Materials and Methods:The present two months study was conducted in sexually active females attending Obstetrics –gynecology OPD with VVC in tertiary care hospital. Two high vaginal swabs were taken and fungal culture was done on SDA agar by standard methods. Identification and antifungal susceptibility testing of candidial isolates were done by standard mycological methods.Results:Most of the patients belonged to younger age group between 18 and 29 years (55%). Lower abdominal pain was the most common symptom after vaginal discharge followed by burning sensation and pruritis. Candida glabrata (15) with 58% of all the isolates was the most common Candida species associated with VVC in this study, followed by Candida albicans (5, 19%). Highest antifungal resistance was observed to itraconazole (81%) followed by amphotericin B (35%) and fluconazole (31%). 81% resistance to itraconazole among Candida glabrata and Candida albicans. Voriconazole was maximum susceptible to all Candida species.Conclusion:This study highlights the incidence of VVC among sexually active females of reproductive age group as its recurrence may result into obstetric complications and even infertility and also enlightens the common Candida species and their antifungal profile, which would help the treating clinicians to formulate local antifungal treatment policy for VVC.

High Class and Special Thorax Nourishing Carry Out Between Mothers: A Clinic Centred Research and Evaluation

Background: Majority of the women do not give exclusive breast feed to their children and waste colostrum. The objective of this study was to assess practices of exclusive breast feeding among mothers less than 5 year children attending a tertiary care hospital outpatient. There is a decline in proper breast feeding practices in Pakistan Methodology: A cross sectional study was carried out on 258 mothers, who presented to Gynaecological and Obstetrical OPD or ward and had at least one child between the age of 1 to 5. Questions regarding their demographic profile and breast feeding practices were asked. Results: Among them 110/250 (44%) practiced exclusive breast feeding and the rest either used formula milk or cow’s milk along with breast milk. Only 41/250 (16%) women had given colostrum to their children, 153/250 (61%) had given Ghurti (a traditional pre-lacteal feed, mainly honey). Women who were uniparous, housewives, lived in joint families, belonged to middle class families and had vaginal mode of delivery had better breast feeding practices than others. When grading and categorization of breast feeding practices were done 41/250 (18.5%) had excellent practice, 69/250 (31%) had good and 111/250 (50%) had poor practice.221/250 (88.4%) women had breast fed their children and 29/250 (11.6%) had not. Conclusion: The study emphasizes that there is a need to improve exclusive breast feeding and colostrum giving practices.

Impact of two intervention packages on the health and fitness of ante - and post-natal women attending in a teaching hospital.

Introduction:Pregnancy brings about many changes in mothers' body which continue even after the baby is born. After a vaginal delivery, taking good care of the mother is an essential part of postpartum care and to maintain overall fitness.Objective:The purpose of this research was to evaluate the effect of a physiotherapeutic intervention to improve the maternity fitness of Indian women.Methodology:It was a three-group RCT (randomized controlled trial). The target population consisted of women in ante and postnatal stage, 50 participants (58 were included in the end) in each group, randomly selected from Obstetrics and Gynecology OPD of a tertiary care hospital in North India. The study was carried out in the department of PRM (Physiotherapy). A total of 174 participants was included in the study and was divided into three groups, two intervention groups, and one control group. The target population consisted of women in ante and postnatal stage, randomly selected from ANC (Antenatal clinic) and PNC (Post-natal clinic). The study was conducted over a period of 4 years (2014–2018). They were advised to do exercise, postural correction, regular walking, and electrotherapy modalities and six follow-ups throughout their pregnancy. Outcome measures like (Visual Analogue Scale = VAS): Low and upper back pain relief (n = 158), Leg cramps (n = 41), Coccyx pain (n = 36), Sacro-iliac joint pain (n = 26) was considered.Results:The impact of the intervention package on both ante-natal and post-natal women with fitness-related health problems showed significant improvement.Conclusion:Pain, leg cramp and heaviness in the lower limb, coccyx pain, etc., during pregnancy are common complaints that start early in pregnancy and may persist throughout life if treatment does not start early in the pregnancy.

Effect of Vitamin B6 and Acupressure on Vomiting Symptoms in Pregnant Women with Hyperemesis Gravidarum

Introduction: Hyperemesis Gravidarum (HG) is a common early pregnancy syndrome that usually occurs around 6 weeks of pregnancy. The patient may cause dehydration, electrolyte metabolism disorders and abnormal fat metabolism, causing increased risk of pregnancy-induced. Objective: The effects of vitamin B and acupressure application combined with psychological adjuvant therapy on vomiting symptoms and mental health in pregnant women with severe vomiting. Methods: Study Type: Randomized Control Trial Duration of Study: Twelve Months from January 2019 to December 2019 Sampling Technique: The data has been collected from the subject index coming to the gynecology OPD of Gulab Devi Teaching Hospital, Lahore, Pakistan. Control group: aged 20 to 37 years, with an average of (26.12±2.44) years; 8 to 17 weeks of gestation, with an average of (9.18±1.77) weeks. Sample Selection Inclusion Criteria: All persons who have 1) meet the diagnostic criteria for HG; 2) 20 to 40 years of age; 3) both signed informed consent. Exclusion Criteria: vomiting caused by medical diseases such as hydatidiform mole, gastrointestinal disease, viral hepatitis, cholecystitis. This study was approved by the Medical Ethics Committee of Gulab Devi Teaching hospital. Pregnant women who were enrolled were divided into control group and experimental group according to the random number table method, with 48 cases in each group. Study Tools: Questionnaire and Interview Sample size (n)=96. Results: After 7 days of treatment the effective percentage rate in the experimental group was higher as compare to the control group in terms of clinical efficacy, SAS and SDS scores, antiemetic and hospitalization time and cost was much lower and within limits in the experimental group as compare to control group. Discussion: In addition to physiological treatment such as fluid replacement, psychological treatment should not be ignored. Conclusion: vitamin B6 and acupressure application combined with psychological adjunctive treatment of HG had a significant effect and could significantly relieve pregnant women Anxiety, depression and promote the recovery of pregnant women.

Study of gynecological problems of adolescent girls attending gynaecology outpatient department at tertiary care center

Background: The most striking change in adolescent girls is the onset of menstruation. After menarche, common menstrual abnormalities that the female adolescent may encounter include premenstrual syndrome, dysmenorrhea, prolonged menstrual bleeding, and emotional disturbances, In present study, we evaluated gynaecological problems of adolescent girls attending outpatient gynaecology department at tertiary care centre. Material and Methods: Present study was prospective, observational study, conducted in adolescent girls (10-19 years age) attending to the outpatient department of Obstetrics and gynaecology suffering from various gynaecological problems, willing to participate. Results: During study period, total 396 adolescent girls visited gynaecology outpatient department were considered for present study. Most cases belonged to 17-19 years age (52.8 %) followed by 14-16 years age (37.4 %) In study cases, menstrual complaints (67.7 %) were most common indication to visit OPD, followed by complaints like irregular cycles (48.5 %), pain in abdomen (29.8 %), abnormal vaginal discharge (13.9 %), acne and hirsutism (13.6 %) and obesity (11.4 %). Other less common complaints were delayed puberty (4.5 %), Bartholin cyst/abscess (3.3 %), breast diseases (2.8 %), mass per abdomen (0.8 %) and urogenital malformations (0.8 %). On basis of history and relevant investigations, menstrual cycle related gynaecological problems such as dysmenorrhea (24.7 %), oligomenorrhoea (19.7 %), menorrhagia (16.9 %), metrorrhagia (14.9 %) and hypomenorrhea (11.4 %) were noted. Amenorrhea was noted in 9.8 % cases, 1.5 % had primary amenorrhea while 8.3 % cases had secondary amenorrhea. Other problems were anaemia (28.8 %), urinary tract infection (19.7 %), PID (12.4 %), teenage pregnancy (2.3 %) and ovarian cyst (1.0 %). Conclusion: In present study menstrual cycle related gynaecological problems (dysmenorrhea, oligomenorrhoea, menorrhagia, hypomenorrhea, amenorrhea), anemia, urinary tract infection and PID were common in adolescent girls attending gynaecology OPD.

Colposcopic evaluation of cervix in symptomatic women and its correlation with Pap smear. A prospective study at a tertiary care centre.

Introduction:Back in India, cervical cancer is the second most frequent cancer in women (aged 15–45 years) following breast cancer, accounting for nearly 14% of all female cancer cases. The aim of this study is to yell the findings of pap smear with colposcopy and directed biopsy (if needed) and to evaluate the usefulness of colposcopy in discovering the premalignant and malignant lesions of the cervix.Methods:This is a prospective observational analysis of 150 symptomatic women attending the gynecology OPD of Indira Gandhi Institute of Medical Sciences, Patna, for a period of one year from 2019 to 2020. Assessment of symptomatic women was completed with a pap smear, colposcopy, and biopsy in selected instances.Statistical Analysis Used:MS Excel spreadsheet application, SPSS v23 (IBM Corp.), was used for data analysis.Results:The expression age (years) has been 34.68 ± 8.05. The sensitivity and specificity of pap smear were 91.7% and 45.45%, respectively, whereas the sensitivity and specificity of colposcopy were 83.3% and 72.72%, respectively, in the present study.Conclusions:Pap smear had low specificity as compared to colposcopy. Hence simultaneous use of colposcopy has shown to rise in the rate of carcinoma cervix discovery in symptomatic women.