Gynecology OPD Research Articles

Postural deviation in pregnancy: A significant debilitating balance problem which can be rectified by physiotherapeutic intervention.

The purpose of this study was to evaluate the effect of physiotherapeutic intervention to improve the deviated balance of pregnant women. A total of 174 subjects were included in the study out of which 62 had postural deviation. They were divided into three groups, two intervention groups and one control group. The target population consisted of women in the antenatal stage, randomly selected from Obstetrics and Gynecology OPD, PGIMER, Chandigarh. The study was conducted over a period of 3 years (2014-2017). They were advised exercises, postural correction, regular walking, and hot water fomentation. Six follow-ups were taken into consideration throughout the pregnancy and postnatal stage. The impact of the intervention package on both ante-natal and postnatal women with balance problems showed significant improvement. Postural deviations, pain, heaviness in the lower limb, incontinence, breathlessness, etc., are common complaints during and after pregnancy. The problem starts early in pregnancy and increased over time and may persist throughout life if treatment does not start early in the pregnancy. This intervention can be practiced in primary care setting after giving proper training to the health care workers by experienced physiotherapists.

Diagnostic laparoscopy findings in pelvic pain among the women attending Gynecology OPD at Dhulikhel Hospital

Aims: To evaluate the laparoscopic findings in women with pelvic pain.
 Methods: A prospective study conducted in Department of Obstetrics and Gynecology at Dhulikhel Hospital from March 2017 to December 2018. All women with pelvic pain, ultrasound evaluation and laparoscopic procedure at the hospital were taken. Data entered in SPSS 23 and analyzed using descriptive parameters.
 Results: Maximum number of cases of pelvic pain belonged to 21-30 years, most of them were parous with mean duration of pain of 16.48±4 months. The mean age and parity of the patients was 34±5 years and 1.74 respectively. The most common complaint was dysmenorrhea (33.3%) followed by abnormal vaginal discharge (31.7%). On clinical examination, pelvic tenderness was observed in majority (21.7%) of cases.
 On laparoscopic examination, normal finding were seen in 41.7% cases followed by pelvic inflammatory disease (19.2%), endometriosis (17.5%), pelvic adhesion (12.5%), retroverted uterus (2.5%). PCOS, pelvic congestion and fimbrial cyst were seen in 1.7% each. Pyosalphinx and twisted ovary were seen in 0.8% each.
 Conclusions: Laparoscopy serves as diagnostic as well as a therapeutic modality of management in chronic pelvic pain.

A COMPARATIVE EVALUATION BETWEEN CERVICAL CYTOLOGY AND VIRAL BIOMARKERS IN EARLY DETECTION OF CERVICAL INTRAEPITHELIAL LESIONS.

Cervical cancer is a public health problem in developing countries like India, so much so that India alone accounts for one-quarter of the worldwide burden of cervical cancers.[1] It is the one of the leading causes of cancer mortality, accounting for 17% of all cancer deaths among women aged between 30 and 69 years. Every year in India, 122,844 women are diagnosed with cervical cancer and 67,477 die from the disease.[2] Cervical cancer is a leading form of cancer among women living in low resource regions of the world and often kills women at young age when they are still raising families. Cervical cancer due to its slow progression from precancerous lesions to frank malignancy and easy accessibility to examination, is highly amenable to screening. The three screening modalities are Cervical Cytology Screening (Pap Smear), Visual Inspection, and HPV DNA test. Squamous intraepithelial lesions are viewed as precancerous lesions exhibiting many of the morphological characteristics of invasive carcinomas, identication of these entities is the focus of cervical screening. Persistence of high-risk HPV infection after initial infection is highly predictive of a lifetime risk of pre-invasive and invasive cervical neoplasia. The HPV genotype seems to be the most important factor in persistence, with HPV-16 and HPV-18 being the most likely to persist. The aim of this study was to evaluate concurrently the efcacy of Cervical cytology, HPV PCR methods for risk assessment in an attempt to dene the most efcient combination, so as to know which one is more applicable and accurate in cervical cancer screening strategies. The present prospective observational study was conducted in Department of Pathology, NSCB medical college and hospital, Jabalpur, M.P. from 1st February 2019 to 31st July 2020, with the primary aim of to assess cytomorphological incidence of various lesions of uterine cervix by Bethesda system and to study the biomarker HPV-DNA testing by PCR in case of abnormal cervical ndings and to correlate the ndings and results of cytology with the histopathology reports. This study had a total population of 140 women who attended the gynaecology OPD and fullled the inclusion criteria were enrolled in study. Per speculum examination was done and Pap smear examination was taken followed by colposcopy guided cervical biopsy in the symptomatic females. Out of 140 ,60 samples were tested for high HPV 16 and 18 using RTPCR. The maximum numbers of the patients were in third decade of life, followed by fourth decade. Maximum numbers of cases were reported as inammatory smear. ASCUS and HSIL was seen commonly in the age group of 31 to 40 years. Most common presenting complaint was white discharge 55.71 % .Erosive cervicitis (41.4%) was the most common histopathological nding. HPV DNAtesting showed only 6.7 % positivity. 16.67 % Of squamous intraepithelial lesions were positive for HPV and the most prevalent HPV genotype was found to be HPVtype 16. Conclusion: Pap smear evaluation and HPVtyping are most efcient combination for mass cervical screening programmes

Evaluation of colposcopy in screening of suspicious-looking cervix using swede score and its correlation with the histopathological findings

Background: Cervical cancer is a global health problem. It ranks as the fourth-most common leading cause of female cancer in the world and the second leading cause of female cancer in India. Different methods are used for its screening as it has a long latent phase. Colposcopy-guided biopsy of suspicious unhealthy-looking areas is taken as the gold standard in the diagnosis of intraepithelial lesions. However, a new scoring system of colposcopy called the Swede score has a high specificity and can omit the need of biopsy. Objective: The objective of this study is to evaluate the diagnostic efficacy of colposcopy using Swede score in unhealthy cervix and to determine the degree of correlation between colposcopy scores and histopathological findings. Materials and Methods: The study was conducted in the Department of Obstetrics and Gynecology, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India, from January 1, 2020, to June 30, 2021. Ninety-eight patients fulfilling the inclusion and exclusion criteria were selected for the study. Results: It was evident that colposcopy using a Swede score of >5 and even more of >7 is definitely more sensitive and accurate in the screening of unhealthy-looking suspicious cervix in the Indian population and can be considered to use for performing a direct excisional procedure or cryotherapy as a “see and treat” method at this cutoff point, avoiding the need for cervical biopsy for histopathological confirmation. Conclusion: Swede score performed well in this hospital-based study on a selected population coming to gynecology OPD with complaints of lower abdominal pain, discharge per vaginum, dyspareunia, abnormal uterine etc. referred to the colposcopy clinic in view of unhealthy- looking suspicious cervix.

Comparative Evaluation for the Efficacy of Collecting Sample by using Vaginal Atrophy Screening Combistick (VAS Combistick) as against the Traditional Method of Collecting Sample for Screening of Vaginal Atrophy in Perimenopausal Women

Background: Genitals and sexuality is an essential element of healthy and happily aging perimenopausal women with their partners. Vaginal atrophy (VA) of menopause is a condition associated to physiological, histological and anatomical changes noticed in the genital and urinary tracts in peri and postmenopausal women. Vaginal atrophy is the sequel of the decrease levels of estrogens in plasma, which are symptoms of menopause.
 Objectives: 1. To evaluate the baseline data for vaginal maturation index (VMI) & pH in perimenopausal women. 2. To evaluate and compare the method of collecting sample by using VAS combistick & traditional method. 3. To evaluate and compare the accuracy of VMI score & pH using VAS combistick & traditional method. 4. To evaluate and compare the feasibility & acceptability using survey based analysis in VAS combistick method and traditional method.
 Methodology: This will be an interventional-cross sectional comparative study. This study will include women who will come to Acharya Vinobha Bhave Rural Hospital (Obstetric and Gynaecology) OPD with at least one symptoms of vaginal atrophy. These women will take self sampling by using VAS combistick will be included in ‘sampling A’ (self sampling group) while, samples of the same group of patients taken by the traditional method will be included in ‘sampling B’ (clinician sampling group).
 Results: In this study we have hypothesized that vaginal sampling by vaginal atrophy screening (VAS) combistick may be better when compared to traditional method of sampling for screening of vaginal atrophy in terms of adequacy, feasibility and acceptability.
 Conclusion: VAS combistick may be considered as an alternative and better examining strategy which may give a reproducible and equivalent result to screening of vaginal atrophy in comparison to that of traditional sampling methods.

Correlation of Vitamin D Levels with Polycystic Ovary Syndrome: A Cross-sectional Study

Objective: To compare vitamin D status in, women with PCOS & fertile women without PCOS and its subsequent evaluation.
 Introduction: PCOS is an endocrine disorder of women in reproductive age, characterised by obesity, hyperandrogenaemia and insulin resistance. Women with PCOS tend to be overweight and have increased risk of development of Type II Diabetes and cardiovascular disease. Exact Etiology of PCOS still remain an enigmatic dilemma however various studies conducted till date include diet and lifestyle modification as the key factor to promote health, BMI, reduced hyperinsulinemia and reduce the risk of development of PCOS.
 Main aim of our study was to compare vitamin D status in women having PCOS, with fertile women in a tertiary care hospital in Uttarakhand.
 Methodology: The conducted study was cross sectional, involving the enrolment of 100 women comprising of 50 women with PCOS and 50 fertile women without PCOS. Participants were selected from gynaecological OPD at Shri Mahant Indiresh Hospital, associated with Shri Guru Ram Rai Institute of Medical Sciences, Dehradun from July 2019 to January 2020. The diagnostic criteria of PCOS used was the Rotterdam criteria. The serum 25-hydroxy vitamin D and other metabolic markers were measured. Vitamin D deficiency was defined as serum 25 (OH) D concentrations less than 20 ng/ml measured on an instrument named as miniVidas (BioMerieux, Germany) based on ELFA (enzyme linked fluorescent assay).
 Results: Serum 25-hydroxyvitamin D was significantly lower in women with PCOS compared to fertile controls (p< 0.0001), and the prevalence rates of 25(OH) D deficiency and insufficiency were higher in women with PCOS than in fertile women (p < 0.0001). The study results showed that the prevalence of 25 (OH) D deficiencies in PCOS women was significantly high. Serum 25 (OH) D concentrations were significantly negatively correlated with body mass index (BMI), waist-to-hip ratio (WHR), fasting insulin, total cholesterol and low-density lipoprotein cholesterol (LDL-C), (P < 0.05). In comparison, serum 25 (OH) D concentrations were significantly positively correlated with high-density lipoprotein cholesterol (HDL-C) (P < 0.05). Increased BMI and WHR, high levels of fasting insulin, total cholesterol and LDL-C were regarded as risk factors, but high level of HDL-C was considered to be protective factor of vitamin D deficiency in PCOS women.
 Conclusion: The study demonstrated that women with PCOS have a significantly lower 25(OH) D compared to fertile controls. A compromised vitamin D status in PCOS women is associated with a higher prevalence and metabolic risk of PCOS in women.

Effectiveness of Progressive Muscle Relaxation Technique among the Antenatal Mothers above 32 Weeks of Gestation on the Reactivity and Time Consumption of Non Stress Test: A Randomized Controlled Trial

Background: Non Stress Test is a simple, inexpensive and non-invasive method to assess the wellbeing of the fetus by observing the FHR with its acceleration in response to the movement of the fetus. Objective: To assess the effectiveness of progressive muscle relaxation technique among the antenatal mothers above 32 weeks of gestation on reactivity and time consumption of Non Stress Test Design: Randomized controlled trial Setting: Obstetrics and Gynaecology OPD, PGIMER, Chandigarh Participant: 120 Antenatal mothers ³32 weeks of gestation Methods: 120 pregnant mothers i.e sixty each in Experimental and Control group willing to participate and available at the time of data collection were enrolled through a random sampling technique. Progressive muscle relaxation technique was demonstrated and was performed simultaneously by the antenatal mothers 15 to 20 minutes prior to NST who were enrolled under the Experimental group. Routine care was given to Control group. Data were collected by using an interview schedule in the month of October to December 2020. Non stress test was done as per schedule of antenatal visit and interpretation of NST graph in relation to the reactivity, time consumption and baseline fetal heart rate were compared in both the group. Results: It revealed that all the antenatal mothers in the Exp. group and 90% of mothers in the Control group showed reactivity of Non stress test. In relation to time consumption of Non stress test, all mothers in the Experimental group took normal time i.e 20 minutes. Out of the 90% of antenatal mothers who were reactive in the Control group, 5% took more than 20 minutes. A statistical significant difference was found in relation to reactivity by applying Chi Square (p<0.05). The finding also showed a significant difference in between the Experimental and Control group in relation to the reactivity of Non stress test as shown by Mann Whitney U test, baseline fetal heart rate during NST, all the antenatal mothers had normal BHR between 110 to 160 bpm in both groups. Conclusion: It can be concluded that Progressive muscle relaxation technique performed prior to Non stress test can be used for improving the Non stress test results, time-saving, evokes positive feeling and satisfaction among the antenatal mothers. Keywords: Non Stress Test, Progressive Muscle Relaxation Technique, Reactivity.

Frequency of Backache and its Management in Pregnant Women Attending IUH OPD

Objective: Frequency of backache and its treatment among pregnant women attending Isra University Hospital (IUH) OPD. Material and methods: This cross-sectional study was conducted at Out patient’s department of obstetrics\Gynaecology Isra hospital Hyderabad from February 2019 to Augusts 2019. A total of 80 pregnant women irrespective of their age, marital and literary status, visiting out-patient department of Isra University were included. All the females were assessed regarding backache and its treatment at gynaecological OPD. All the information was recorded via study proforma. Data was analyzed via SPSS version 20. Results: A total of 180 pregnant women were studied, and most of the women 40% were in age group of 31-40 years. Out of all, 22.2% women were primigravida, 40.6% were multigravidas and 36.7% women were grand multigravidas. The history of backache before pregnancy was among 20% of the females and 62.2% of women had developed backache during pregnancy, while 12.8% women had no complaint of backache. Out of 121 females who had backache during pregnancy, 28.30% had an onset of pain during 1st trimester, in 23.30% during 2nd trimester and in 48.30% during 3rd trimester of pregnancy. Out of all 32.20% women got relieved by taking rest, 63.90% women took analgesics as a treatment measure and 3.3% women took some other treatment options. Conclusion: It was observed that the more than 60% of all pregnant women experienced backache and mostly during 3rd trimester. Most of the females took treatment in the form of analgesics and some women got relieved by taking rest. Keywords: Pregnancy, backache, Management

LEIOMYOMA TYPES, INCIDENCE AND CLINICAL PRESENTATION - A STUDY AT A TERTIARY CARE HOSPITAL

A cross sectional studywas conducted over a period of 15 months from 1st Jan 2020 to 31st March 2021 at Malla Reddy Hospital,a tertiary care hospital. To study the incidence of fibroids according to FIGO categorization and their clinical presentation. 38 confirmed cases of fibroid uterus in the age group 20 – 60 attending gynecology OPD were interviewed and subjected to regular gynecological examination, PAP smear, dilatation and curettage procedures. Based on the studies, 60% of these patients were subjected to total abdominal hysterectomy as a part of treatment and the intra operative findings of the specimens were noted. The leiomyomas were classified according to the histopathological and ultrasonographic findings based on FIGO categorization. Highest incidence was seen 41 to 45 years age (52.6%). Incidence of Leiomyoma types according to FIGO subclassification system were found to be Type0=5%, Type1=5%, Type2=5%, Type3=13%, Type4=30%, Type5=13%, Type6=18.6%, Type7=3.3% and Type8=5%. Multiple fibroids were more common than single fibroids. Posterior location fibroids were more common than anterior. Most common symptom was menorrhagia (73.6%) followed by spasmodic dysmenorrhea (47.3%) and metrorrhagia (26.3%), infertility and symptoms of anemia. Most common sign was pallor (58%) followed by mass per abdomen (18.4%). Incidence of associated pathology of adenomyosis (18%) ovarian cysts (8%), endometrial polyps (8%), myxoid degeneration (2.6%). The results of our study matched the existing studies.

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.

Quality of Life in Patients with Urinary Incontinence: A Cross Sectional Study

Background: Urinary incontinence in women severely affects the physical, social and psychological aspects of life. Objectives: To find out the Quality of Life in female patients with urinary incontinence in a tertiary care hospital. Materials and Methods: A cross-sectional, observational study was conducted in the Gynecology out-patient department. All non-pregnant women ≥21 years of age, attending the Gynecology OPD of tertiary care hospital for various complaints were included in the study. After obtaining written informed consent, demographics, relevant medical and surgical history was noted, and they were then administered two validated questionnaire 'Incontinence Quality of Life Questionnaire' (IQOL) and SF-36. Result: The overall incidence of incontinence in this population was 17.0%, with a steadily rising incidence by age. The incidence was more in postmenopausal than premenopausal women. Menopausal women compared to non-menopausal women also had significantly higher incontinence QOL scores (median of 5 vs. 3; p=0.001). Avoidance and limiting behavior (ALB), Psychosocial impact (PSI) and social embarrassment (SE) scores were studied improved after 24 weeks. Items determining ALB had high correlation coefficient with total ALB and all of them were statistically significant. Items determining PSI had statistically significant correlation with mean PSI with all the items except two items. But among the items

A COMPARATIVE STUDY OF CENTCHROMAN AND DANAZOL IN MANAGEMENT OF MASTALGIA.

Mastalgia is one of the most common presenting symptom in female attending surgical and gynaecological OPD. In majority of patients it can be managed with reassurance and simple medication. But in 10-20 % of patient severe pain affects quality of life and causes severe anxiety. Aim was to compare the effectiveness of Centchroman and Danazol in mastalgia by using visual analogue scale (VAS), Fifty-two patients were taken in study & randomized into two groups with all women presenting with mastalgia with VAS score ≥3 between ages of 20-40 years. Centchroman (30mg OD for 3 months) in group 1 and Danazol (50 mg bid for 3 months) to group 2 was given and were monitored for VAS for pain and we found that centchroman is more effective than danazol and there was signicant difference in parameters in both the groups as Age, VAS th score, duration of menstrual cycle, No. of cases with cyclical, non-cyclical mastalgia. Relative risk (RR) of 1.256 at 12 week, 2.280 at th 24 week were noted, P value was found to be signicant. It can be concluded that Centchroman therapy is a safe, equally effective, and less costly alternative to Danazol for the treatment of mastalgia.

RETROSPECTIVE STUDY OF UTERINE FIBROID PATIENTS AT TERTIARY LEVEL HOSPITAL

Background: Fibroids are the most common benign tumours of the uterus. They can be asymptomatic or might present with different symptoms varied from heavy menstrual bleeding, dyspareunia, abdominal distension, or pressure-related bladder symptoms etc. Present study was done with the aim to assess the clinical features of uterine broids.Material &methods:It was a retrospective Hospital based study conducted over a period of six months in which 131 women who attended Gynecology OPD of a tertiary care teaching hospital in Rajasthan from January to June 2019 with complaints of menstrual disorders with anemia or abdomino-pelvic mass with pain and feeling heaviness in the abdomen were included.Results: Out of 131 women, 37 (28.2%) women presented to Gynecology OPD with abdomino-pelvic mass without any menstrual abnormality while 94 (71.8%) women were symptomatic. 53.4% women presented with Heavy menstrual bleeding while Dysmenorrhea (n=65; 49.6%), Fullness/heaviness in abdomen (n=61; 46.6%), Irregular period (n=57; 43.5%), Prolonged duration of menstrual bleeding (n=42; 32.0%), Constipation/bloating/diarrhoea (n=41; 31.3%) and non-menstrual pelvic pain/cramping (n=39; 29.8%) were other symptoms seen in women with broids. Conclusion : Uterine broids cause abnormal uterine bleeding and other symptoms which have negative impact on women's quality of life, affecting their sexual, social and professional life. Early diagnosis and treatment reduces morbidity and improves quality of life.

Perception of patients About Medical care at Gynecology OPD in I.T.H.S :Observational Study

Background: Hospitals are the most important organizations of health care system. Globally 80% patients are attended at OPD. Aim: To find the perception of patients regarding care provision at Gynecological OPD in Islam Teaching Hospital, Sialkot Study Design: Observational study. Methodology: Hundred patients were included in present study. All information was collected via Questionnaire and was kept in secret. Data analyzed by SPSS 20.0v. Results: Quality of information provided by receptionist was satisfied 84(84%), partially satisfied 10(10%) and unsatisfied 6(6%). Promptness with which patients was checked by the doctor was Poor 2(2%), Fair 6(6%) and good 92(92%). Behaviour of doctor towards patients was Satisfied 80(80%), partially satisfied 16(16%) and unsatisfied 4(4%). Time given by the doctor to the patients was Satisfied 80(80%), partially satisfied 20(20%). Conclusion: This study concluded that satisfaction of patients of Gynecological OPD was overall good. However, many of the existing shortages can be improved by presenting an organized program. Keywords: Perception, patients and Gynaecology OPD.

Effectiveness of cryotherapy in VIA positive women

Introduction: In this study we studied the effectiveness of Cryotherapy in cases with abnormal squamous intraepithelial lesions detected only by VIA.
 Method: In our study, 64 patients in reproductive age group attending gynecology OPD, with complaints of discharge per vaginum, lower abdominal pain, and post coital bleeding were screened with VIA and positive women had cryotherapy and they were followed up by same after six months.
 Result: A total of 64 VIA positive women had cryotherapy. Most of the women were of age group 31-40 years (40.6%). Majority of the women were of parity 2 or more (89.1%). The most common complaint was discharge (46.9%) followed by pelvic pain (32.8%). VIA was negative among most of the women (87.5%) after cryotherapy. The outcome of cryotherapy was not associated with age and parity rather presence of symptoms was statistically associated (p=0.034).
 Conclusion: We concluded that in low resource settings, simple and safe diagnostic test VIA and therapeutic procedure cryotherapy are safe and effective method to combat the killer disease of cervical cancer.
 Keywords: Cryotherapy, Visual inspection with acetic acid (VIA), cervix

Role of Transabdominal Ultrasound in Characterization of the Ovarian Mass

The use of grey-scale ultrasound morphology to characterize a pelvic mass may also be called ‘pattern recognition’. The grey-scale ultrasound image provides as much information as that obtained by the surgeon or pathologist when they cut a surgical specimen to see what it looks like inside. Aim of our study is to characterize the ovarian mass by ultrasound. The study was conducted in Department of Radiology and Imaging, College of Medical Sciences, Bharatpur. Patients with suspected ovarian mass in Gynecology OPD were included in our study. A prospective cross-sectional study was conducted on 60 patients in college of medical science, Bharatpur, over the period of one year (from November 2019 to October 2020). Present study showed benign ovarian (90.0%) pathology are the most commonly encountered ovarian mass. Ovarian mass is most common in adult female of age 15-30 years and malignant ovarian mass was most common among the age group of 30-60 years. Among benign pathology of ovary simple follicular cysts are most common (39.0%), followed by hemorrhagic cyst (31.0%), dermoid cyst (17.0%), chocolate cyst (9.0%) and ectopic pregnancy (4.0%). Among the malignant ovarian mass serous cystadenocarcinoma and mucinous cystadenocarcinoma showed similar frequency (33.0% each) and followed by immature teratoma and krukenberg tumor (17.0% each). Ultrasound parameters like size, septal thickness, solid component and spectral doppler (RI ans PI) are very helpful for determination of malignant pathology. In this study the sensitivity and specificity of size parameter is least (40.3% and 60.2%) and highest in solid component and spectral Doppler parameter (PI) being (82.0% and 92.0%). Combined study of grey scaleand spectral Doppler study plays crucial role in characterization of ovarian mass to differentiate between benign and malignant pathology.

AN AUDIT OF MENOPAUSAL SYMPTOMS AND ITS MANAGEMENT IN A TERTIARY CARE CENTRE OF CENTRAL INDIA – A PROSPECTIVE STUDY

Background : Menopause marks a major physical and psychological change in every woman's life with a spectrum of symptoms that affect her daily routine. However, these menopausal symptoms present as an iceberg phenomena in the clinical setting. In order to overcome this, the MENQOL questionnaire has been developed as a validated research tool to measure the various symptoms of menopause and to assess post treatment improvement felt by patient .[1] Objectives: Ÿ To observe the distribution of menopausal symptoms with the help of a validated questionnaire Ÿ Assessment of improvement in symptoms after 4 weeks of management. Methodology: A Prospective observational study was conducted in a tertiary care centre of central India, over a period of 6 months from January 2019 to June 2019. All menopausal women who presented to the gynaecological OPD were subjected to Standard and validated MENQOL questionaire and were asked for rating of menopausal symptoms and assessment in improvement of symptoms done with the same questionare after 4 weeks therapy. Women with severe osteoporosis, severe mood disorders or depression and MENQOL Rating score <3 were excluded from the study. Results: Total 256 menopausal women presented to the outpatient department over the periods of 6 months, Among them 238 women were included in the study who were fullling the inclusion criteria .The results concluded that the mean age of our study population was 47±3years ,with maximum women falling in the category of 44 -52years. Majority of women (72%) experienced vasomotor symptoms followed by sleep disturbances (55%) ,genitourinary symptoms (44%),low energy (32%), sexual dysfunction (26%), mood disorders (21%), and body image changes (18%). Most of the women had an overlapping of these symptoms. Treatment was mainly symptom oriented & signicant improvement was seen in vasomotor symptoms (P=0.00059) ,sexual dysfunctions (P = 0.0077), low energy (P=0.0042), genitourinary symptoms (P=0.003234), and in sleep disturbances (P=0.049) . Conclusion: MENQOL can be used as a simple diagnostic tool in clinical journey of menopause for detection of symptoms and evaluation of treatment success , but further research is needed before recommending the routine use of MENQOL in clinical settings.

TO EVALUATE THE SENSITIVITY OF TVS IN PREDICTING ENDOMETRIAL PATHOLOGY

Background: To evaluated the sensitivity of TVS in predicting endometrial pathology Methods: This is a descriptive type of observational study conducted among women with Postmenopausal Bleeding who attended the Gynaecology OPD SMS Medical College Jaipur. 60 Postmenopausal patients were included in this study. After fulfilling the inclusion crtieria a detailed history and clinical examination was done as per Proforma, followed by investigations. Results: In majority of patients histopathlogy is found as atrophic endometrium i.e. 23 cases, out of which majority of patients had endometrial thickness 4 mm i.e. 11 cases but 3 cases of endometrial hyperplasia had ET 6 mm on TVS. Conclusion: Transvaginal sonography is safe, simple, non invasive and cost effective in the diagnosis of endometrial disease. Keywords: TVS, Endometrial, Hyperplasia.

Cytological versus Histopathological Examination in Lesions of Cervix, taking histopathology as a Gold Standard

Background: Malignancy of cervix is the major health burden in South Asia including Pakistan. PAP smear is the screening test for its early detection. To find out the specificity and sensitivity of the system called as Bethesda system, the correlation of cytological findings with histopathology,with histopathological examination as the golden standard. Aim: To find out the cytological utility in diagnosing different pathologies of cervix, to assess and infer the epithelial lesions cases and to correlate cytology findings with its consequent follow-up biopsies. Methods: This study was carried out taking 150 PAP smears of women coming to gynecological OPD ofShaikh Zayed Hospital Lahore from September 2020 to February 2021. There correlation with subsequent follow-up histology sections by using 2001 revised Bethesda System.Different factors analysis which were causing inconsistencies was done. Results:The overall sensitivity of PAP smear is 86.94%, specificity 57.14%, positive predictive value 86.94 %, negative predictive value 57.14 % and accuracy 80% in detecting low/high grade lesions and malignancy. Keywords: Bethesda system,Cervix cytology findings; Histopathological findings.

Bacterial Vaginosis and its Relation with Sociodemographic Determinants in married reproductive age females

Aim: To determine the frequency of Bacterial vaginosis by pap smear cytology and find its association with its sociodemographic determinants. Study design: Cross sectional analytical study Place and duration of study: Department of Histopathology, Shaikh Zayed Hospital, Lahore from 1st January 2016 to 31st October 2016. Methodology: Two hundred and sixty pap smears of married women of reproductive age group with vaginal discharge who attended Gynecology OPD were included. Proper history regarding age, socioeconomic status, age of marriage, literacy level, smoking, and nutritional status was taken. Results: Disease prevalence was found to be 19.2%(50)in this sample of 260 while 9.1% had Candidiasis, 47%, 17.2% ,3.7%, 4.1% had Mild nonspecific inflammation, Moderate nonspecific inflammation, Moderate to severe nonspecific inflammation, and negative smears respectively. Bacterial vaginosis was associated with age, monthly income, illiteracy, early age at marriage, history of abortion and nutritional status with significant p-value ≤ 0.05. However no association was found between the disease and marital status, smoking and pallor. Conclusion: Low socioeconomic status, literacy, age >35, nutritional status is strongly related to occurrence of bacterial vaginosis in women of reproductive age group with vaginal discharge. Key Words: Bacterial vaginosis, Pap smear, Sociodemographic determinants