Gynecology Unit Research Articles

Physio-Anatomical complications in short and long surgical procedures with General Anesthesia. A comparative cross-sectional study

Background: The complication intensity of short- and long-term anesthesia during different surgeries depends upon the age, medical history and general lifestyle of a patient. Aims and objectives: The aims and objectives of present study were to evaluate the risks associated with general anesthesia during various surgical procedures. Methodology: Current comparative cross-sectional study was conducted in ICU, general surgery and gynecology units of Ghurki Trust and Teaching Hospital from July 2023 to February 2024. Total 100 patients of appendectomy and hysterectomy were selected as study subjects and divided into two groups. In Group-A (short surgery group) 65patients with appendectomy and in Group-B (Long surgery group) 35 women patients with hysterectomy were included. All of the clinical and demographic data were recorded on MS Excel and SPSS version 2024 were used to process, analyze, and distribute the data as needed and graph pad prism was used to plot graphical data representation. Results: The study identified a significant association between anesthesia duration and increased postoperative complications, notably in patients aged 51-55 years. Enhanced risks included postoperative pain, nausea, and respiratory distress, emphasizing the need for tailored anesthesia strategies based on surgical length and patient demographics. Conclusion: General anesthesia is largely safe but linked to some complications, necessitating innovative improvements and further research with larger sample sizes for enhanced safety.

To Assess Knowledge and Practice among Nurses Regarding Prevention of Catheter-Associated Urinary Tract Infection

Background:Catheter-associated urinary tract infections (CAUTIs) are a common healthcare-associated infection among patients with indwelling urinary catheters. The role of nursing staff is crucial in preventing these infections through proper knowledge and practices. Objective:To assess the knowledge and practices among nurses regarding the prevention of catheter-associated urinary tract infections in a tertiary hospital in Lahore, Pakistan. Methods:This descriptive cross-sectional study was conducted among 164 nurses from various departments, including medical, surgical, and gynecological units. Nurses with more than one year of experience were included, while student nurses and head nurses not directly involved in patient care were excluded. Data were collected through a survey assessing knowledge and practices related to CAUTIs. The sample size was determined using Solvin's formula. Ethical approval was obtained, and participants gave informed consent. The data were analyzed using IBM SPSS Statistics Version 25.0 for descriptive statistics, including frequencies and percentages. Results:The majority of participants were female (85.4%), and most were aged between 31 and 35 years (50%). About 51.2% of the nurses had 6 to 10 years of experience, and 46.2% had received prior information or training on catheter-related urinary tract infections. The majority of participants (92.8%) knew that CAUTIs result from prolonged catheter use, and 95.7% were aware that aseptic technique with sterile equipment is crucial for catheter insertion. However, only 67.4% used a sterile technique for insertion, and 79.3% did not perform daily catheter care. The overall knowledge level was low for 29.3% of participants, moderate for 43.5%, and high for 16.3%, while the practice level was poor for 52.2% and good for 37%. Conclusion:Nurses demonstrated moderate knowledge but poor practices in preventing catheter-related urinary tract infections, indicating the need for targeted interventions and educational programs to bridge the gap and enhance patient care.

Prevention of Uterine Inversion by Using Ultrasonographic Confirmation During Placental Delivery in Dr. Ruth K.M Pfau Civil Hospital Karachi

Objective: To determine the prevention of uterine inversion by using ultrasonographic confirmation duringplacental delivery.Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Gynecology Unit II, Dr. Ruth K.MPfau Civil Hospital Karachi, Pakistan from June 2022 to June 2023.Methods: In this research, the total of 180 patients were included with transvaginal deliveries. To preventuterine inversion during placental delivery, regular ultrasonographic was implemented. The placental deliverywas performed with ultrasonographic confirmed placental detachment. The frequency of uterine inversionduring placental delivery was compared before and after the introduction of ultrasonographic images. Inaddition, a comparison was made between the ultrasonographic group and the non-ultrasonographic groupregarding the amount of blood loss during transvaginal delivery and the length of the third stage of labor. TheDescriptive statistics were applied to all parameters Using SPSS Version 26.Results: A total of 180 patients who had transvaginal deliveries, mean age 29 ± 9 years. One hundred and eighty women had transvaginal deliveries before and after the introduction of ultrasonography. Following theultrasonographic confirmation, there was a significant decrease in the frequency of uterine inversion whencompared to the pre-introduction period (43.3% vs. 56.7%, p = 0.001). Due to a number of limitations, theactual rate of ultrasonography performed even after it was introduced ultrasonography was 46.1%.Conclusion: In our investigation, we concluded that with the help of ultrasonographic confirmation of placentaldetachment uterine inversion may be prevented. How to cite this: Abbasi TS, Kubra K, Zarrar T, Tasneem M, Gul P. Prevention of Uterine Inversion by Using Ultrasonographic Confirmation During Placental Delivery in Dr. Ruth K.M Pfau Civil Hospital Karachi. Life and Science. 2024; 5(2): 204-209. doi: http://doi.org/10.37185/LnS.1.1.563

Inflammatory Markers in Prior Loop Electrosurgical Excision Procedure (LEEP) as a Prognosis Factor in the Recurrence of Cervical Intraepithelial Neoplasia.

To investigate the relationship between preoperative inflammatory markers and recurrence of CIN after loop electrosurgical excision procedure (LEEP). A retrospective historical cohort study was conducted at gynecologic oncology unit, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Thailand. Data was collected from medical records of CIN cases from year 2016 to 2021. Inclusion criteria were subjects who were diagnosed of CIN and underwent LEEP with pathologic confirmation and followed up for two years (at 6 months, 1 year, and 2 years). Preoperative complete blood count (CBC) was obtained within one month for calculation as systemic inflammatory values. One hundred and ten cases of CIN were enrolled. Mean age of participants was 48.1 years old. Three-fourths (83/110) of the participants had histological confirmation as CIN2/3. Sixteen (18/110) and twenty (22/110) percentage of cases had recurrence of disease at 1 and 2 years, respectively. Monocytes /lymphocytes ratio (MLR) and systemic inflammation response index (SIRI) could predict recurrence of CIN within 2 years. MLR more than 0.16 and SIRI more than 0.57 gave the sensitivity and negative predictive value (NPV) at percentage of 77.3/ 81.8 and 91.8/ 90.2, respectively. Combination of MLR and SIRI had sensitivity and NPV at 90.5 and 95.4 percent, respectively. MLR and SIRI could not predict marginal involvement, glandular involvement, and LEEP confirmed CIN 2/3. Pretreatment MLR and SIRI were statistically significant in predicting the recurrence in CIN after post LEEP procedure within 2 years follow up.

A comparative retrospective analysis on robot-assisted laparoscopic surgery compared to conventional laparoscopy in case of myomectomy: experience in a third-level hospital of Southern Italy

Uterine myomas are the most common gynecological disease in reproductive-aged women, present several symptoms, and require effective medical and/or surgical strategies. This study aimed to compare robotic-assisted laparoscopic myomectomy (RALM) with laparoscopic myomectomy (LM) in terms of operative times, intraoperative estimated blood loss, pre- and post-hemoglobin levels drop, and length of hospital stay. Data from 50 clinical records (25 RALM in Group A and 25 LM in Group B) of patients with uterine fibroids were collected from December 2022 to December 2023 at Gynecological Unit of DAI Materno-Infantile Federico II in Naples, Italy. Patients aged 30–49 years with symptomatic fibroids were included. Data on peri-operative outcomes, including operative time for myomectomy (OTM), overall operative time (OOT), intraoperative estimated blood loss (EBL), pre- and post-operative hemoglobin levels, and length of hospital stay were analyzed. The OTM in the presence of > 5 myomas was 59 [52–65] vs 69 min [61–96] (p < 0.001) for RALM and LM groups, respectively. Moreover, also in presence of ≤ 5 myomas, a difference was observed in the RALM group 48[43–55] compared to the LM group 53[50–61] min (p = 0.07). The OOT was also statistically significant for Group A compared to Group B (83[65–93] vs 72[56–110] min, p < 0.001). There were no significant differences between the two groups in terms of pre- and post-operative hemoglobin levels and EBL (p = 0.178). Group A demonstrated a notably shorter hospital stay 1.2 [1–2] days compared to Group B 2.9[3–3.75] days (p = 0.007). Our study suggests potential advantages of RALM over LM in terms of reduced operative times and shorter hospital stays. The standardized approach and extensive surgical experience likely contributed to the favorable outcomes of RALM.

Validation of Sinhala and Tamil translations of the motherisk: Pregnancy unique quantification of emesis (PUQE) scoring system

Aims: Nausea and vomiting in pregnancy (NVP), where there are no other underlying causes, is one of the most common symptoms in the early part of the pregnancy. It is responsible for up to 80% of pregnant population. By using PUQE score system, it is very convenient to categorize pregnant women with nausea and vomiting come to outpatient department (OPD) or general practice into those who can manage in community setting or those who need inpatient treatments. Objectives: Validation of PUQE instrument to assess NVP and hyperemesis gravidarum (HG) women in Sri Lanka. Methods: Descriptive cross-sectional study conducted among 160 pregnant women presented to the Gynecology Unit of Teaching Hospital Anuradhapura (ATH) during three months duration. Translated self-administered PUQE questionnaire was applied to the patients with signs and symptoms with emesis in pregnancy. All study participants were undergoing clinical judgment as a confirmation test. Diagnostic test accuracy methods were used to assess criterion validity of the experimental tool. Data were analyzed by using SPSS statistical software version 25.0. Results: Study population has a mean age of 27.96 (SD 5.31). Majority of study participants were Sinhalese and according to the parity majority were primigravida pregnancies. Majority of study participants were diagnosed as NVP Stage II (N=134:53.8%) by the PUQE scoring system. According to the clinical judgment Stage II of NVP was diagnosed among 127 (79.4%) study participants. Mean score of the PUQE scale was 9.08 (SD=2.35). Reliability assessment of the PUQE scoring system was reported as an excellent level (Cronbach alpha=0.804). Five types of management strategies were detected among study participants. Significantly high percentage of study participants were given first line antiemetics and oral rehydration solutions. Calculated sensitivity of the PUQE scoring system to diagnose Stage I of NVP was 69.56% and specificity was 96.35%. Calculated sensitivity of the PUQE scoring system to diagnose Stage II of NVP was 100% and specificity was 78.78%. All pregnant women who were clinically detected as Stage II NVP patients were detected as Stage II NVP patients by the PUQE scoring system also. None of the false positives and false negatives regarding Stage II of NVP detected by the PUQE scoring system. Conclusion: First line antiemetics and oral rehydration solutions are usually used for treating pregnancy-related nausea and vomiting. Stage II NVP conditions were detected with a higher prevalence when NVP status was diagnosed clinically and with PUQE scoring system. Specificity of PUQE scoring system appeared higher while detecting NVP Stage I and for NVP Stage II, sensitivity of PUQE scoring system appeared high. For Stage III NVP, clinical judgments and PUQE scoring system values were completely compatible. Management strategies used for treating pregnancy-related hyperemesis status should be further studied. Conducting these studies at different study settings may help to achieve more successful results. Pregnancy unique quantification of emesis tool can be used to diagnose NVP status more descriptively. Also, this PUQE tool is a valid tool which can be effectively used for patient management. Application of PUQE scoring system should be published by planning and implementing staff awareness programs for both curative sector and public health sector.

Molecular typing and virulence characteristics of Escherichia coli strains isolated from hospital and community acquired urinary tract infections.

The main causes of hospital- and community-acquired urinary tract infections (UTIs) are a group of Escherichia coli (E. coli) strains with multiple virulence factors known as uropathogenic E. coli. One hundred E. coli isolates from the urine specimens of hospital- and community-acquired UTI patients were characterized based on their virulence factors and genetic relatedness using PCR and RAPD‒PCR, respectively. Among all, the traT (71%), sitA (64%), ompT (54%), malX (49%), ibeA (44%), tsh (39%), hlyD (18%) and cnf1 (12%) genes had the highest to lowest frequencies, respectively. There was no significant difference between the frequency of tested virulence genes in E. coli isolates from inpatients and outpatients. The frequency of the hlyD gene was significantly greater in E. coli isolates from patients hospitalized in gynecology, dermatology and intensive care unit (ICU) wards than in those from other wards. Eight virulence gene patterns were common among the isolates of inpatients in different wards of the same hospital, of which five patterns belonged to the isolates of inpatients in the same ward. More E. coli isolates with similar virulence gene patterns and greater genetic similarity were found in female patients than in male patients. The analysis of the RAPD‒PCR dendrograms revealed more genetic similarities among the E. coli isolates from inpatients than among those from outpatients. Our findings indicate the presence of a wide variety of virulence factors in E. coli isolates and the possibility of spreading the same clones in different wards of the hospital.

Frequency of different causes of thrombocytosis among patients presenting to tertiary care hospital.

Objective: To assess the prevalence and underlying causes of thrombocytosis among patients seeking medical attention at a prominent tertiary care facility located in Lahore. Thrombocytosis, characterized by an elevated platelet count, can signify an array of underlying health conditions, and this research seeks to unravel the frequency of these causes within the study population. Study Design: Cross-sectional. Setting: Department of Pathology, Allama Iqbal Medical College and Jinnah Hospital. Period: November 2019 to May 2020. Methods: A total of 150 patients were carefully selected from diverse medical specialties, including but not limited to medical, surgical, gynecological, obstetric, gastroenterological, nephrological, and intensive care units. The diagnostic criteria for thrombocytosis were aligned with the operational definition provided by the World Health Organization (platelet count exceeding &gt;450 x 10^9/L) during the stipulated study period. Statistical analysis of gathered data was performed using SPSS version 17.0. Results: The findings of the study showcased that infections and iron deficiency emerged as the predominant contributors to thrombocytosis among the adult patient cohort. These factors were trailed by conditions like chronic infections, trauma accompanied by blood loss, and instances of splenectomy. Interestingly, instances of primary thrombocytosis, notably essential thrombocythemia, constituted a mere 2% of the overall sample size, signifying its rarity within this adult population. Conclusion: In the realm of thrombocytosis, the research highlights a notable prevalence of secondary thrombocytosis, while primary thrombocytosis remains a considerably infrequent occurrence among adults. The study emphasizes the significance of infections and iron deficiency anemia as the leading triggers for secondary thrombocytosis. Such insights contribute to an improved understanding of the spectrum of conditions associated with elevated platelet counts and may aid clinicians in effectively diagnosing and managing these underlying causes.

Validation of a Predictive Model of Vaginal Birth after Caesarean Section in Pakistani Women.

To determine the frequency of successful trials of vaginal birth after Caesarean section (VBAC) using the Flamm and Geiger model. Observational study. Place and Duration of the Study: Obstetrics and Gynaecology Unit II of Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to January 2023. Women with singleton pregnancy having cephalic presentation, previous one lower segment caesarean section (LSCS), and without any contraindication for vaginal delivery were included. Women bearing foetus having estimated weight >3.5kg, morbid obesity, multiple pregnancies, non-cephalic presentation, placenta praevia, abruptio placentae, uncontrolled maternal comorbidities, or had previous two or more Caesarean sections were excluded. Flamm and Geiger score was applied to record observations of successful and unsuccessful trials. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the score were calculated by ROC curve, along with its area under the curve (AUC) and Youden's index curve, with 95% confidence interval. This study included 258 participants. Successful vaginal delivery was possible in 125 (48.4%) participants, whereas 133 (51.6%) underwent emergency Caesarean section. Cervical dilatation and effacement were the main factors assessing the success. The Flamm and Geiger score of >5 had an area under the curve of 0.813 (0.762-0.864). The score's sensitivity was 75% (67-82%), specificity 76% (68-82%), and PPV of 75% with an accuracy of 76%. The Flamm and Geiger score of >5 demonstrated high sensitivity, specificity, PPV, and accuracy in predicting later successful vaginal birth. It is recommended as a promising and valuable tool for assessing VBAC's success in low-resource countries. Vaginal birth after caesarean, Flamm and Geiger Model, Indication of caesarean, trial of labour after caesarean, VBAC risk scoring criteria.

Prenatal insomnia disorder may predict concurrent and postpartum psychopathology: A longitudinal study.

While insomnia symptoms may be a risk factor for mental disturbances, few studies evaluated "Insomnia Disorder" and its relationship with perinatal psychopathology. Pregnant women were recruited during their last routine assessment before being hospitalized for delivery during the 3rd trimester at the Gynaecological Unit of the University Hospital of Ferrara and Udine, Italy, from January 2022 to January 2023. Our assessment included baseline evaluation (T0), and evaluations at 1 month (T1) and 3 months (T2) in the postpartum period, with specific questionnaires for insomnia disorder, such as Sleep Condition Indicator, mood and anxiety symptoms and psychosocial functioning, such as Edinburgh Postnatal Depression Scale, Mood Disorder Questionnaire, State-Trait Anxiety Inventory, Work and Social Adjustment Scale. At T0, 181 pregnant women were included. Insomnia disorder affected 22.3% at T0, 23.5% at T1 and 16.2% at T2. Women with insomnia disorder at baseline were significantly more affected by concurrent anxiety and depressive symptoms, had higher bipolar diathesis and poorer psychosocial functioning in the perinatal period. Prenatal insomnia disorder predicted anxiety (T0: odds ratio 4.44, p << 0.001; T1: odds ratio 4.009, p = 0.042) and depressive symptoms (T0: odds ratio 2.66, p = 0.015; T1: odds ratio 11.20, p = 0.001; T2: odds ratio 12.50 p = 0.049) in both the prenatal and postnatal period. It also predicted poor psychosocial function during the prenatal (odds ratio 3.55, p = 0.003) and postpartum periods (T1: odds ratio 2.33, p = 0.004). Insomnia disorder is emerging as an important prenatal factor that may contribute to concurrent and postpartum psychopathology.

Comparative Analysis of Perceptions of Doctors, Management, Nurses and Patients on the Use of the Enhanced Recovery After Caesarean Surgery Method Based on the Concept of Perceived Value

In this era of modernization, several companies, one of which is hospitals, are adopting E-Service Quality because currently patients prefer services that are quickly accessible wherever and whenever they are, so this adds to the main function of a service. One of the services of the Obstetrics and Gynecology unit, especially the delivery service using the ERACS (Enhanced Recovery After Caesarean Surgery) method, is a surgical procedure that increases profits for hospital Agencies. So, it can influence consumer value perceptions, perceived quality and hospital imAge and patient satisfaction. The aim of this research is to analyze differences in perceptions between the components of doctors, management, nurses and patients based on perceived value in implementing ERACS actions. This research method uses a quantitative research approach, survey method and the type of research is hypothesis testing with descriptive analysis and comparative analysis. The sampling technique used was a saturated sampling technique. The number of samples used was 50 respondents. The research results show that the Mann Whitney test analysis on the combination of all components which compares benefits and costs, shows that the p-value is 0.000 (p &lt; 0.05), meaning there is a significant difference between benefits and costs on the combination of all components. It can be concluded that there is a significant difference between benefits and costs in the doctor, management, nurse and patient components.

Measuring the Levels of AMH, FSH, LH, TSH, Progesterone, Estrogen, Vitamin D, Calcium, and Magnesium in Women with Premature Ovarian Insufficiency

This research was designed to study some hormonal and physiological aspects of women with Premature Ovarian Insufficiency (POI). Blood samples were collected from the Infertility and Gynecology Unit at Al-Batoul Teaching Hospital in Baqubah and private women's clinics, including ages between 20 and 40. The study took place from 12/1/2022 until 5/1/2023, and informed consent was obtained from all patients. The study included 45 women with premature ovarian insufficiency. It was compared to a control group that consisted of 45 healthy women after confirming their fertility, at ages ranging from 20 to 40 years. The study investigated the effects of specific physiological and biochemical parameters on the disease. This was done by examining hormone levels and various biochemical levels in women with premature ovarian insufficiency. Some of the hormones examined were anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), progesterone, and thyroid hormone. The levels of vitamin D, calcium, and magnesium were also measured. The results of the current investigation showed that the age groups had a significant difference (P\(&lt;\)0.05) with the study groups. (patients and healthy people). The age groups 31-35 and \(&gt;\)35 years recorded the highest percentages (33.3% and 31.1%) in female patients compared to the groups \(&lt;\)20-25 and 26-30 years, which recorded the lowest percentages (15.6% and 20.0%), respectively. The outcomes of the current investigation regarding the concentration of reproductive hormones showed a significant difference. (P\(&lt;\)0.05) between the AMH, FSH, and LH hormone levels in the two study groups (patients and healthy individuals). The levels of FSH and LH were higher in patients (6.780 \(\pm\) 15.54 and 5.44 \(\pm\) 12.40) compared to healthy individuals (4.75\(\pm\) 6.51 and 4.04 \(\pm\) 0.94), respectively. On the other hand, AMH levels were lower in patients (0.18 \(\pm\) 0.42) compared to healthy individuals (0.92 \(\pm\) 3.15). In terms of TSH, E2, and Progesterone hormone levels, there were no significant differences (P\(&gt;\)0.05) between the two study groups. About the physiological investigation that included measuring the concentration of magnesium, calcium, and vitamin D, the current study demonstrated a significant difference (P\(&lt;\)0.05) in the concentration of magnesium between the two groups. (patients and healthy people). The level of magnesium was low in patients (0.29 \(\pm\) 0.75) compared to healthy people (0.30 \(\pm\) 2.07). There was also a statistically significant difference (P\(&lt;\)0.05) in the level of calcium concentration between the two study groups (patients and healthy people). The calcium level was high in patients (0.45 \(\pm\) 8.33) compared to healthy people (0.58 \(\pm\) 8.02). Also, significant differences (P&lt;0.05) in the levels of vitamin D were observed between the two groups of study (patients and healthy individuals). The levels of vitamin D were low in the patients (8.62 \(\pm\) 18.88) compared to the healthy people (11.53 \(\pm\) 44.15).

Implementing Enhanced Recovery After Surgery for hysterectomy in a hospital network with audit and feedback: A stepped-wedge cluster randomised trial.

To evaluate the effectiveness of implementing the Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing elective hysterectomy in a network of regional hospitals, supported by an intensive audit-and-feedback (A&F) approach. A multi-centre, stepped-wedge cluster randomised trial (ClinicalTrials.gov NCT04063072). Gynaecological units in the Piemonte region, Italy. Patients undergoing elective hysterectomy, either for cancer or for benign conditions. Twenty-three units (clusters), stratified by surgical volume, were randomised into four sequences. At baseline (first 3 months), standard care was continued in all units. Subsequently, the four sequences implemented the ERAS protocol successively every 3 months, after specific training. By the end of the study, each unit had a period in which standard care was maintained (control) and a period in which the protocol, supported by feedback, was applied (experimental). Length of hospital stay (LOS), without outliers (>98th percentile). Between September 2019 and May 2021, 2086 patients were included in the main analysis with an intention-to-treat approach: 1104 (53%) in the control period and 982 (47%) in the ERAS period. Compliance with the ERAS protocol increased from 60% in the control period to 76% in the experimental period, with an adjusted absolute difference of +13.3% (95% CI 11.6% to 15.0%). LOS, moving from 3.5 to 3.2 days, did not show a significant reduction (-0.12 days; 95% CI -0.30 to 0.07 days). No difference was observed in the occurrence of complications. Implementation of the ERAS protocol for hysterectomy at the regional level, supported by an A&F approach, resulted in a substantial improvement in compliance, but without meaningful effects on LOS and complications. This study confirms the effectiveness of A&F in promoting important innovations in an entire hospital network and suggests the need of a higher compliance with the ERAS protocol to obtain valuable improvements in clinical outcomes.

Girls referred for amenorrhea: analysis of a patient series from a specialist center.

Among adolescents, amenorrhea is a common reason for medical consultation. Despite the variety of underlying etiologies, the prevalence of the causes is incompletely understood. This study aimed to assess the demographic and etiological factors among patients with amenorrhea treated in a single specialist unit of adolescent gynecology. Retrospective register study. Medical records of 438 girls evaluated for primary or secondary amenorrhea in a single tertiary care center between 2015 and 2019 were retrospectively reviewed. In all, 423 patients-171 with primary amenorrhea and 252 with secondary amenorrhea-were included in the study. Data on underlying conditions, anthropometric variables, and selected hormonal markers were analyzed. Functional hypogonadotropic hypogonadism was the most frequent reason for primary (56%) and secondary (78%) amenorrhea. It was mostly explained by lifestyle-related functional hypothalamic amenorrhea caused by disordered eating, intense exercise, energy deficiency, psychological stress, and their combinations. Menstrual pattern is a significant indicator of overall health and well-being among adolescent girls and young women. Functional reasons behind primary and secondary amenorrhea are important to recognize. Treatment often requires long-term lifestyle modifications. The frequency of functional causes also implies that most amenorrhea cases are preventable.

Laparoscopic Modified Radical Hysterectomy for Severe Endometriosis: A Single-Center Case Series

Study objectiveThe main objective is to describe the feasibility and report a single centre experience of a standardized laparoscopic modified radical hysterectomy technique among patients with severe endometriosis and pouch of Douglas obliteration. DesignA single-center case series of laparoscopic modified radical hysterectomy performed at the Poissy Hospital between December 2012 and May 2021. SettingsSingle-center, gynecology unit (level III) with a focus on endometriosis. PatientsPatients with severe endometriosis (stage 4 AFS) and pouch of Douglas Obliteration. Measurements and Main ResultsFifty-two patients with severe endometriosis underwent the surgical procedure.Out of these patients: 23.1% underwent a rectal shaving (n= 12), 1.9 % a discoid resection (n= 1) and 17.3% a rectal resection (n= 9), including a protective ileostomy in one case. Ureterolysis was performed on 82.7% of patients (n= 43). The average hospital stay was 3.3 days (1-12). Seven patients required intermittent self-catheterization (13.5%). Minor complications (Clavien-Dindo grade 1 and 2) occurred to 25.9% of the patients and severe complications to 3.8% of them (Clavien-Dindo grade 3, no grade 4). Two patients (3.8%) were reoperated: one for a postoperative occipital alopecia (balding) and the other for vaginal dehiscence with evisceration. About 50 patients (96.2%) had a complete resection of endometriosis. The median follow-up was 14 months (interquartile range 6-23 months) with 94.3% of them improved (much and very much) and 3.8% minimally improved. ConclusionIn our experience, laparoscopic modified radical hysterectomy is a reliable procedure with a low rate of severe complications. This technique needs to be assessed by other surgeons and others centers across the country and abroad, in order to determine the likehood of it succeeding.

Place Of First Trimester Ultrasound at The University Teaching Hospital of Bogodogo (UTH-B) in Burkina Faso

Objective: To describe the experience of the UTH-Bogodogo obstetrics and gynecology department in ultrasound determination of fetal sex in the first trimester of pregnancy. Patients and methods: This was a prospective descriptive study conducted over a 30-month period from February 1, 2021 to June 30, 2022 in the gynecological and obstetric ultrasound unit of the UTH-Bogodogo in Ouagadougou. The study sample consisted of 311 fetuses. The sample included all pregnant women who came for an obstetrical ultrasound scan in a non-emergency situation, whose gestational age was between the 11th and 14th week of amenorrhea, and who expressed a wish to know the fetal sex. The methods described by Mazza and Efrat were used to determine fetal sex. Patients were followed until delivery, after clinical verification of the sex of their newborns. Data were collected using an individual data collection form. Participation in the study was conditional on patients signing an informed consent form. Results: Fetal sex determination was possible in 280 of 311 fetuses, for a feasibility rate of 89.7%. In the remaining 31 cases, it was not possible to determine the fetal sex, as the position of the fetus did not allow a clear view of the genital bud. In terms of reliability, of the 238 fetuses monitored, fetal sex determination was correct in 204 fetuses, for a success rate of 85.7%. Accuracy was better when sex determination was performed after 12 weeks of amenorrhea. There was no significant difference in measurements between single and multiple fetuses. Conclusion: ultrasound determination of fetal sex at first birth could be an effective, simple, available and inexpensive option in developing countries.

PLACE OF FIRST TRIMESTER ULTRASOUND AT THE UNIVERSITY TEACHING HOSPITAL OF BOGODOGO (UTH-B) IN BURKINA FASO

AbstractObjective: To describe the experience of the UTH-Bogodogo obstetrics and gynecology department in ultrasound determination of fetal sex in the first trimester of pregnancy.Patients and methods: This was a prospective descriptive study conducted over a 30-month period from February 1, 2021 to June 30, 2022 in the gynecological and obstetric ultrasound unit of the UTH-Bogodogo in Ouagadougou. The study sample consisted of 311 fetuses. The sample included all pregnant women who came for an obstetrical ultrasound scan in a non-emergency situation, whose gestational age was between the 11th and 14th week of amenorrhea, and who expressed a wish to know the fetal sex. The methods described by Mazza and Efrat were used to determine fetal sex. Patients were followed until delivery, after clinical verification of the sex of their newborns. Data were collected using an individual data collection form. Participation in the study was conditional on patients signing an informed consent form.Results: Fetal sex determination was possible in 280 of 311 fetuses, for a feasibility rate of 89.7%. In the remaining 31 cases, it was not possible to determine the fetal sex, as the position of the fetus did not allow a clear view of the genital bud. In terms of reliability, of the 238 fetuses monitored, fetal sex determination was correct in 204 fetuses, for a success rate of 85.7%. Accuracy was better when sex determination was performed after 12 weeks of amenorrhea. There was no significant difference in measurements between single and multiple fetuses.Conclusion: ultrasound determination of fetal sex at first birth could be an effective, simple, available and inexpensive option in developing countries.

Preeclampsia in Ghana: A study on the prevalence and risk factors of postpartum readmission in the Ashanti Region

AbstractBackgroundDespite significant improvements in its management, preeclampsia continues to be one of the frequent causes of postpartum readmission. Increased awareness of the risk factors for postpartum readmission is required to reduce its incidence and related complications. This study determined the prevalence and associated risk factors for postpartum readmission among women with preexisting preeclampsia in a Ghanaian population.MethodsThis hospital‐based retrospective study was conducted at the obstetrics and gynaecology units of Komfo Anokye Teaching Hospital in Ghana. We reviewed the medical records including sociodemographic and obstetric characteristics of preeclampsia patients. Statistical analyses were performed using Statistical Package for Social Sciences Version 26.0 and GraphPad Prism version 8.0. p‐Value &lt;0.05 was considered statistically significant.ResultsA total of 208 preeclampsia patients were considered in this study. The rate of postpartum readmission for a hypertensive disorder among women with preeclampsia was 46%. After adjusting for multiple confounders in the multivariate logistic model, having a family history of hypertension [aOR = 3.512, 95% CI (1.669–7.394), p = 0.0028] was associated with increased odds for postpartum readmission. However, being nulliparous [aOR = 0.321, 95% CI (0.116–0.887), p = 0.0028] was independently associated with a reduced odd for postpartum readmission.ConclusionThe rates of postpartum readmission are significantly high among preeclampsia women. Our findings highlight the importance of continued efforts to improve the health outcomes of both mother and newborn, including heightened monitoring of at‐risk patients in the Ghanaian population.

Unravelling the Histomorphological Features of Kidney: An Autopsy-based Study

Introduction: Renal failure and End-stage Renal Disease (ESRD) are one of the leading causes of mortality. The presence of co-morbidities like Diabetes Mellitus (DM), Hypertension (HT), pregnancy, liver diseases, and various infections accelerates renal failure. Understanding the pathophysiology of Acute Renal Failure (ARF) is necessary to interpret and correlate the spectrum of morphologic changes associated with it. Aim: To study the aetiopathological causes of renal failure and evaluate the histopathological features associated with them. Materials and Methods: A cross-sectional autopsy-based study was performed in the Department of Pathology, Topiwala National Medical College, Mumbai, Maharashtra, India over three consecutive years. A total of 650 adult autopsies were studied. Clinical and laboratory details were obtained from hospital records. Gross and histopathological examinations were performed with a special focus on the kidneys. Special stains were performed wherever required to highlight any characteristic features. Results: It was found that males (n=460) were more affected than females (n=190). The age range was 13-90 years. The majority of autopsies were performed within 24 hours of hospital stay. Acute febrile illness was found to be the most common cause of ARF. Maximum number of cases were from medical units (n=520, 80%), followed by surgical (n=94, 14.5%) and gynaecological units (n=36, 5.5%). Features of Acute Kidney Injury (AKI) were seen in (n=374) 57.6% of cases, while Advanced Renal Disease (ARD) was noted in 10.9% of cases. Incidental findings at autopsy included two cases of renal cortical adenoma, one case each of renal cell carcinoma and medullary fibroma. Conclusion: Acute febrile illness does not just a reflect ion of co-existent pathologies but also directly contributes to mortality, possibly due to the risk of non renal complications like bleeding and sepsis. In the present study, the majority of cases were from medical units, in a young age group with a male predominance. Maximum cases had a short hospital stay. Several characteristic histopathological features in the kidney were identified in different clinical settings, aiding in pinpointing the cause of death. Autopsy findings of the kidney are indeed a treasure untouched and needs to be explored and warrants meticulous investigation.

The Incidence and Fetal Outcome of Threatened Miscarriage at a Tertiary Health Centre in Sub-Saharan Africa

Background: Threatened miscarriage or pregnancy-related vaginal bleeding in the first half of pregnancy without cervical dilatation, is associated with adverse pregnancy outcomes and its incidence varies from one centre to another. Objective: The main objective was to determine the incidence and fetal outcome of threatened miscarriage at the Benue State University Teaching Hospital (BSUTH), Makurdi. Methodology: This was a cross-sectional study of 90 consecutive, eligible pregnant women presenting with threatened miscarriage at the Obstetrics and Gynaecology unit of Benue State University Teaching Hospital over a two-year period. After discharge, they were followed up at the antennal clinic to determine the fetal outcome of their pregnancies. Data was analyzed using SPSS version 25.0 Results: There were 504 gynaecological admissions with 90 threatened miscarriages giving an incidence of 17.9%. The mean age of the subjects was 28.8 (±5.93) years. The mean gestational age at presentation was 10.93 (±3.68) weeks. Seventy-five-point six (75.6%) percent of the cases presented in the first trimester. Fever, due to malaria and UTI, was the major risk factor for threatened miscarriage, occurring in 28.9% of the subjects. Fifty (55.6%) of the subjects progressed to the age of viability whereas 44.4% subjects miscarried prior to the age of viability. Forty-eight (96.0%) delivered at term whereas 2(4%) had preterm delivery at 34 and 35 weeks respectively. The main route of delivery was SVD (84%). The mean birth weight was 3.02 (±0.32) kg. There was no neonatal intensive care unit (NICU) admission. Conclusion: The incidence of threatened miscarriage (17.9%) in this study was high. Seventy-five point six (75.6%) of the cases occurred in the first trimester. Fifty-five point six (55.6%) progressed to the age of viability and the fetal outcome was favourable. Close follow up is imperative in maximizing a favourable outcome for cases of threatened miscarriage.