Metrorrhagia Research Articles

Short-term Menstrual Distributions After COVID-19 Infection: Does Vaccine Administration Matter?

Background: COVID-19 infection may be associated with potential sequels on the hormonal system, which can substantially alter menstrual cycles in women. Objectives: This study aimed to evaluate short-term menstrual distributions after COVID-19 infection and determine whether vaccination and type of vaccine could alter menstrual cycles. Methods: This study was carried out using an online survey to record any menstrual distributions such as any changes in duration, volume, and time of menstruation, intermenstrual bleeding (IMB) and dysmenorrhea as well as exacerbation of premenstrual syndrome (PMS) on 268 women aged 18 to 45 who were infected by COVID-19. The participants were followed at least for three months after their COVID-19 infection. The history of vaccine administration before infection was also recorded, and the results were compared regarding various vaccine types. Results: Short-term menstrual distributions after infection were common. in this regard46.7% had IMB, 66.1% experienced exacerbation in PMS, 67.7% had increased volume of bleeding, 62.9% had dysmenorrhea or exacerbation in dysmenorrhea. Also, 27.4% and 35.4% experienced a shorter or longer duration of menstrual cycles, respectively. All distributions returned to normal after a maximum of two cycles. However, there was a substantial difference (P = 0.024) between women who received the AstraZeneca (recombinant) and Sinopharm (inactivated) vaccines, as the number of patients who experienced changes in menstrual cycles was relatively lower in the recombinant group. Conclusions: Menstrual distributions are common but temporary in the short term following COVID-19 infection. Although, the recombinant vaccine (AstraZeneca) was associated with lower menstrual disturbance rates compared to Sinopharm or Sputnik vaccines.

Development and Validation of a UPLC-MS/MS Method for the Quantification of Components in the Ancient Classical Chinese Medicine Formula of Guyinjian

Guyinjian (GYJ) is an ancient classic formula of traditional Chinese medicine used for the treatment of liver and kidney yin deficiency; it was derived from the book "Jing Yue Quan Shu" in the Ming Dynasty. Modern clinical observation experiments have shown that GYJ has a definite therapeutic effect on the treatment of gynecological diseases such as kidney deficiency type oligomenorrhea, climacteric syndrome, intermenstrual bleeding, pubertal metrorrhagia, etc. However, the lack of GYJ quality control studies has greatly limited the development of its wider clinical application. In this study, a validated UPLC-MS/MS method was developed successfully for the first time and used to quantify fourteen compounds in GYJ samples with good specificity, linearity (r = 0.9960-0.9999), precision (RSD% ≤ 3.18%), stability (RSD% ≤ 2.22%) and accuracy (recovery test within 88.64-107.43%, RSD% at 2.82-6.22%). Simultaneously, the determination results of 15 batches of GYJ samples were analyzed by multivariate statistical methods, and it was found that the compounds have a greater influence on batch-to-batch stability, mainly Rehmannioside D, Loganin, Morroniside, Ginsenoside Re, and 3',6-Disinapoylsucrose. The proposed new method has the advantages of high sensitivity, high selectivity, and rapid analysis, which provides a reference for the GYJ quality control study.

Cesarean scar niche: An evolving concern in clinical practice.

Increasing cesarean section rates have led to an increased awareness of associated complications such as the formation of cesarean scar niche, defined as an indentation at the site of the cesarean scar with a depth of at least 2 mm, diagnosed by ultrasound or magnetic resonance imaging. The precise prevalence of cesarean scar niche is unclear. The cause of a cesarean scar niche appears to be multifactorial and likely a combination of technical factors (low incision location), anatomical factors (uterine retroflexion), and patient factors, which might impair healing (body mass index, smoking, maternal age). Most patients with cesarean scar niche are asymptomatic; however, women can present with postmenstrual bleeding, pelvic pain, and subfertility. In pregnancy, cesarean scar niches have been associated with placenta accreta spectrum disorder and uterine rupture. Treatment should be reserved for symptomatic women. Hormonal treatment using either the combined oral contraceptive pill or a progesterone-containing intrauterine device may address irregular vaginal bleeding. Surgical management should be reserved for those in whom hormonal manipulation has failed or is contraindicated. The aim of this review was to summarize current literature pertaining to the cause, prevalence, diagnosis, and symptoms of cesarean scar niche and to make recommendations for managing this relatively new condition.

A novel approach using vaginal natural orifice transluminal endoscopic surgery to repair a symptomatic uterine isthmocele

To describe the first case of using a vaginal natural orifice transluminal endoscopic surgery approach to repair a uterine isthmocele. Stepwise explanation of the surgical technique using original video footage. This study was exempted from requiring hospital Institutional Review Board approval. Hospital. A 30-year-old (gravida 2, para 2) patient presented with symptoms of intermenstrual bleeding and secondary subfertility following 2 uncomplicated cesarean section deliveries (elective for breech and repeat). The patient had a transvaginal ultrasound (US) demonstrating an isthmocele with a defect of 8.1 × 7.0 mm with a myometrial thickness of 2 mm over the defect and proceeded to undergo surgery because of persistent symptoms. An anterior vaginal incision is made on the cervix from the 3 o'clock to 9 o'clock position after local anesthetic and adrenaline infiltration of the tissue. The vaginal epithelium was carefully dissected cephalad, although an attempt was made to maintain the uterovesical space and fold. A small (7 cm) V-path gel port was inserted into this uterovesical space and the gel port was affixed with a port connected to an insufflation stabilization bag to minimize the pressure fluctuations within the confines of a small operative space and help maintain visualization throughout. Under endoscopic view, the site of the isthmocele was identified using an endoscopic US probe and confirmed on 2 dimensional imaging. A monopolar hook with an inbuilt aspirator and suction function was used to incise over the isthmocele with a grasper used to dissect into this space. A Hegar dilator was used to delineate the cervical canal. Once the isthmocele was excised, the defect was reinforced and obliterated with a barbed suture whereas the Hegar dilator was in place to prevent inadvertent canal occlusion during suturing. Continuous suturing took place from the cephalad to the caudal directions in 2 layers. Once hemostasis was confirmed, the gel port was removed, and the vaginal epithelium was closed with interrupted sutures using a braided absorbable suture. The perioperative course and care were uneventful with the Foley catheter being removed 3 hours after surgery. The patient was discharged within 24 hours. A follow-up organized 6 weeks after surgery demonstrated obliteration and repair of the previously detected uterine isthmocele on the pelvic US scan. The patient also reported a resolution of symptoms at this postoperative visit. N/A. N/A. Uterine-conserving surgical approaches to an isthmocele have been described, including vaginal, hysteroscopic, and laparoscopic (with and without robotic assistance) approches and laparotomy, with no single approach deemed to be superior to the others. The existing evidence is limited by the lack of uniformity in the definition and diagnosis of uterine isthmocele, consistency in indication for surgery, and small case numbers in published surgical series. Vaginal natural orifice transluminal endoscopic surgery provides a novel approach to this type of surgery, which may be potentially less invasive as the procedure is conducted outside the peritoneal cavity and combines the best vaginal approach to the surgical site with endoscopic magnification and capacity for microscopic dissection. This approach should be considered new and only in a clinically appropriate and carefully counseled patient.

CRYOTHERAPY AS A METHOD OF TREATMENT FOR CERVICAL ECTOPY

Introduction: Cervical erosion is a common physiological process seen in almost all women of reproductive age group. Cervical erosion/ ectopy is histologically dened as a condition in which the squamous covering of the ectocervix is replaced by single-layer columnar epithelium which is continuous with the lining of the endocervix. This retrospective study was carried out at gynaecology clinic in district Shi Material And Method: vpuri M.P. From December 2017 to April 2022. 69 patients were included in the study. A detailed history including name, age, residence, socioeconomic status, parity, and any inammatory condition in past was taken. Per-speculum & per-vaginal examination was done. After counselling and written consent, all patients with cervical erosion (cytologically negative for intraepithelial lesions) were treated in an outpatient Colposcopy clinic by cryotherapy. After treatment, all patients were asked to come for follow-up th th th after 4 , 8 and 12 weeks. In our study most common age group was 25-40 years (5 Results: 0.72%), most of them were of low socioeconomic status (52.17%) and were from rural areas (79.71%) most of them were para 2 (42.02%). The most common presenting complaint was excessive vaginal discharge (68.11%), followed by intermenstrual bleeding (15.94%) and vaginal itching (4.34%). The most common problem experienced after cryotherapy by patients was Hydrorrhoea (Watery discharge) 81.15% which lasts for 2-4 weeks. In our study, symptomatic cure was found in 85.50% patient. On clinical examination, healing of the cervix [clinical cure (ectopy completely disappeared in maximum patients after 8-12 weeks)]. was found in 89.85% of the patient after 12 weeks of cryotherapy. we concluded that cryotherapy is a safe and effectiv Conclusion: e and acceptable method to treat symptomatic ectopy of the uterine cervix. It is cost effective, as fast acting, easy to acquire therapy and can be practiced by health personnel, and can be used in lowor middle income countries.

Primary lymphoma of the uterine cervix: a clinicopathologic study of 13 cases with review of additional 54 cases in the literature.

Primary lymphoma of the uterine cervix (LUCX) is extremely rare, and its diagnosis is challenging. However, its clinicopathological features have not been well characterized. Thirteen primary LUCX patients were retrospectively studied, and 54 patients from the literature were reviewed. Primary LUCX was identified in 0.22% (13/6000) of patients with uterine cervical malignancies in our institution. The patients' median age was 51years (range: 22-85years). All patients had a bulk of neoplasms in the uterine cervix. The median tumour diameter was 6cm (range: 1.5-10cm). Approximately 78.0% (39/50) of the patients initially presented with irregular vaginal bleeding or discharge. Moreover, 86.7% (39/45) had Ann Arbor stage I or II. Diffuse large B-cell lymphoma, not otherwise specified, was the most common type, accounting for 85.0% (57/67) of primary LUCX cases. Follicular lymphoma (7.5%, 5/67), extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (4.5%, 3/67), mantle cell lymphoma (MCL), blastoid variant (1.5%, 1/67), and peripheral T-cell lymphoma (1.5%, 1/67) were occasionally observed. Three patients (7.1%, 3/42) with DLBCL, NOS died from the disease during the follow-up period. Their 5-year overall survival (OS) rate was 93.5%. The patient with MCL, blastoid variant in our present cohort died of the disease 33months after diagnosis. Primary LUCX is an extremely rare condition. The clinical symptoms are non-specific. DLBCL, NOS is the most common histologic type, showing a favourable outcome with accurate diagnosis and timely and optimal treatment.

Levonorgestrel-releasing intrauterine system vs. systemic medication or blank control for women with dysmenorrhea: Systematic review and meta-analysis of randomized controlled trials.

To compare efficacy and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) with systemic medication or blank control in the treatment of dysmenorrhea. PubMed, EMBASE, the China National Knowledge Infrastructure (CNKI) and Wanfang Data were searched to collect randomized controlled trials (RCTs) comparing LNG-IUS with systemic medication or blank control among women diagnosed with primary dysmenorrhea or secondary dysmenorrhea (adenomyosis or endometriosis) from inception to 2020.04. Der Simonian-Laird random-effect model was used to pool data. Seventy-one RCTs (6551 patients) were included. Overall bias risk was medium. Sixty-two articles enrolled patients with adenomyosis; LNG-IUS significantly reduced the visual analogue scale (VAS) score compared with the systemic medication group among adenomyosis women at 3 months (standardized mean difference (SMD) = -0.81, 95% confidence interval (CI) -1.22 to -0.40); 6 months (SMD = -1.25, 95%CI: -1.58 to -0.92); 9 months (SMD = -1.23, 95%CI: -1.63 to -0.83); 12 months (SMD = -1.66, 95%CI: -2.14 to -1.18). No difference was found in the incidence of irregular vaginal bleeding (16 RCTs; RR = 0.91, 95%CI: 0.62-1.33, P = 0.63, I 2 = 4%) and other adverse outcomes. Sensitivity analysis regarding randomization methods was robust. Nine RCTs enrolled endometriosis women. Pooling results showed no significant difference between LNG-IUS and systemic medication treatment in terms of VAS at 6 months (SMD = -0.27, 95% CI: -0.97-0.43). Moreover, LNG-IUS was associated with higher risk of irregular vaginal bleeding (26.8% vs. 0). LNG-IUS was associated with a reduced severity of dysmenorrhea compared with systemic medication; it was also beneficial for better control of menstrual blood loss and fewer adverse outcomes. Owing to small sample sizes, further well-designed RCTs are warranted to confirm these findings and long-term effects of LNG-IUS in the treatment of dysmenorrhea. https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.

7986 Laparoscopic Left Adnexal Cystectomy in a Pediatric Patient with Infected Ohvira

<h3>Study Objective</h3> Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) is an abnormality of Mullerian development typically diagnosed after menarche with painful menses due to the obstructed outflow of one hemivagina. Microperforations may occur in the vaginal septum which can lead to infected hematometrocolpos, intermenstrual bleeding, and abnormal discharge. <h3>Design</h3> We present a video demonstrating the case of a twelve-year-old girl with history of renal anomaly and painful menses with intermenstrual bleeding and persistent discharge. Preoperative imaging suggested OHVIRA with an eight-centimeter adnexal cyst on preoperative imaging. Differential diagnosis of the adnexal cyst included tubo-ovarian abscess, ovarian or paratubal cyst, and ectopic ureter leading to a fluid collection. <h3>Setting</h3> Concurrent laparoscopic and vaginal surgery at an academic children's hospital medical center. <h3>Patients or Participants</h3> Twelve-year-old girl with history of renal anomaly and gynecologic symptoms. <h3>Interventions</h3> The vaginal septum was removed in the operating room, revealing purulent hematocolpos consistent with infection. Laparoscopy allowed for diagnosis of paratubal cyst with adnexal inflammation and concurrent cystectomy, in addition to permitting confirmation of uterine anatomy for future guidance. <h3>Measurements and Main Results</h3> Postoperatively, the patient healed well from laparoscopy. Her vaginas were unified, and she was counseled that she has two cervices and hemi-uteri for future gynecologic planning. <h3>Conclusion</h3> While a majority of cases of OHVIRA may be surgically corrected with vaginal surgery alone, the addition of laparoscopy allowed for diagnosis and treatment of the concurrent paratubal cyst at the time of vaginal septum resection.

PSAT276 A Case of Malignant Struma Ovarii: Management After Surgery

Abstract Background Struma ovarii is a highly specialized and extremely rare monodermal ovarian teratoma that comprises 0.3 to 1% of all ovarian tumors. It consists of greater than 50% of mature thyroid tissue that is usually benign, but malignancy has been reported in up to 5- 23% of the cases. Even after surgery, recurrence rates of malignant struma ovarii can be as high as 35%. [1] Adjuvant thyroid targeting therapies such as radioiodine ablation after total thyroidectomy and TSH suppression therapy have been shown to reduce the risk of tumor recurrence similar to that of primary thyroid cancer. Case Description A 46-year-old healthy lady presented with a 3-month history of non-specific lower abdominal pain and inter-menstrual bleeding. An extensive review of systems was otherwise unremarkable. Ultrasound of the pelvis showed a 4 cm left adnexal mass. An MRI of the pelvis revealed a 2.2×3.6×2.4 cm solid, enhancing mass within the left ovary with an adjacent cystic component. Tumor markers including CEA, CA 19-9, and CA 125 were unremarkable. Due to suspicion for malignancy, she underwent laparoscopic left salpingo-oophorectomy and resection of the mass. Histopathology revealed papillary thyroid carcinoma approximately 1 cm in size with a background of struma ovarii. Immunohistochemistry staining showed positivity for thyroglobulin and Thyroid Transcription Factor-1 (TTF-1). BRAF mutation analysis was negative. An ultrasound of the thyroid gland disclosed two low-risk nodules. TSH was 1.070 mcIU/ml (0.450-4.500), and thyroglobulin level was 6.8ng/ml (1.5-38.5). We performed an Iodine-123 whole-body scan which was negative for abnormal radioiodine uptake. Based on these results, we classified this patients’ recurrence risk as low to intermediate. We initiated TSH suppression therapy with thyroid hormone to maintain TSH in the low normal range. We deferred total thyroidectomy and radioiodine ablation given the low recurrence risk. She will be monitored for recurrence with TSH and thyroglobulin panel at 6 and 12 months in the first year and then annually for at least the next ten years. Discussion Given the rarity of malignant struma ovarii, there are no consensus guidelines for identifying patients with a high recurrence risk who would benefit from thyroid targeting therapy. While some authors recommend total thyroidectomy and radioiodine ablation for all patients, a recent review [2] recommended an algorithm based on imaging, laboratory, and pathologic characteristics of the tumor to risk-stratify patients and treat them depending on their recurrence risk. Improved strategies for risk-stratification and follow-up are essential to provide optimal treatment for malignant struma ovarii patients without over-treating them.

“COLPOSCOPY IN THE DIAGNOSIS OF PREMALIGNANT INTRAEPITHELIAL LESIONS OF THE CERVIX”

Introduction Cervical malignancy is the fourth most common cancer in women. By 2030, cervical cancer is expected to kill over 474,000 women per year and 95 % of these deaths are expected to be in low- and middle-income countries. Colposcopy is a simple non-invasive procedure to study benign and premalignant lesions of the cervix. It also determines the location, size, and extent of abnormal cervical lesions and guides to detecting the site for biopsies. Material and method This retrospective study was carried out at a colposcopy clinic in district Shivpuri M.P. From 1 April 2019 to 31 July 2022. About a total of 59 patients were selected for this study. After counseling and written consent, the colposcopy was carried out in screened-positive patients. All results were noted and documented. In the patient with a positive nding suspicious of the premalignant lesion, a biopsy was taken from the suspicious area and sent for histopathological examination. Result The most common age group nding in this study was between 31-40 (44.06%), Most of the patients were of low socioeconomic group (50.84%), most common age at marriage was 18-20 years (54.23%) most of them were multipara (76.27%) and most of them were belong to rural area (61.01%). The most common presenting symptom was excessive vaginal discharge (61.01%) followed by post-coital bleeding (11.86%) and abnormal intermenstrual bleeding (11.86%). Out of 59 patients, with Swede score on Colposcopic examination LSILcases were 54.23% and HSILcases were 18.64%. On a colposcopy-directed biopsy, among a total of 59 patients, histopathology examination results showed Chronic cervicitis in (18.64%) patients, CIN I in (40.67%), CIN II (28.81%), and CIN III (11.86%). Conclusion Colposcopy is an important triaging investigation between a screen-positive woman and the histopathological diagnosis and thus represents an important component of cervical cancer screening.

Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women’s Health Study

Use of menstrual tracking data to understand abnormal bleeding patterns has been limited because of lack of incorporation of key demographic and health characteristics and confirmation of menstrual tracking accuracy. This study aimed to identify abnormal uterine bleeding patterns and their prevalence and confirm existing and expected associations between abnormal uterine bleeding patterns, demographics, and medical conditions. Apple Women's Health Study participants from November 2019 through July 2021 who contributed menstrual tracking data and did not report pregnancy, lactation, use of hormones, or menopause were included in the analysis. Four abnormal uterine bleeding patterns were evaluated: irregular menses, infrequent menses, prolonged menses, and irregular intermenstrual bleeding (spotting). Monthly tracking confirmation using survey responses was used to exclude inaccurate or incomplete digital records. We investigated the prevalence of abnormal uterine bleeding stratified by demographic characteristics and used logistic regression to evaluate the relationship of abnormal uterine bleeding to a number of self-reported medical conditions. There were 18,875 participants who met inclusion criteria, with a mean age of 33 (standard deviation, 8.2) years, mean body mass index of 29.3 (standard deviation, 8.0), and with 68.9% (95% confidence interval, 68.2-69.5) identifying as White, non-Hispanic. Abnormal uterine bleeding was found in 16.4% of participants (n=3103; 95% confidence interval, 15.9-17.0) after accurate tracking was confirmed; 2.9% had irregular menses (95% confidence interval, 2.7-3.1), 8.4% had infrequent menses (95% confidence interval, 8.0-8.8), 2.3% had prolonged menses (95% confidence interval, 2.1-2.5), and 6.1% had spotting (95% confidence interval, 5.7-6.4). Black participants had 33% higher prevalence (prevalence ratio, 1.33; 95% confidence interval, 1.09-1.61) of infrequent menses compared with White, non-Hispanic participants after controlling for age and body mass index. The prevalence of infrequent menses was increased in class 1, 2, and 3 obesity (class 1: body mass index, 30-34.9; prevalence ratio, 1.31; 95% confidence interval, 1.13-1.52; class 2: body mass index, 35-39.9; prevalence ratio, 1.25; 95% confidence interval, 1.05-1.49; class 3: body mass index, >40; prevalence ratio, 1.51; 95% confidence interval, 1.21-1.88) after controlling for age and race/ethnicity. Those with class 3 obesity had 18% higher prevalence of abnormal uterine bleeding compared with healthy-weight participants (prevalence ratio, 1.18; 95% confidence interval, 1.02-1.38). Participants with polycystic ovary syndrome had 19% higher prevalence of abnormal uterine bleeding compared with participants without this condition (prevalence ratio, 1.19; 95% confidence interval, 1.08-1.31). Participants with hyperthyroidism (prevalence ratio, 1.34; 95% confidence interval, 1.13-1.59) and hypothyroidism (prevalence ratio, 1.17; 95% confidence interval, 1.05-1.31) had a higher prevalence of abnormal uterine bleeding, as did those reporting endometriosis (prevalence ratio, 1.28; 95% confidence interval, 1.12-1.45), cervical dysplasia (prevalence ratio, 1.20; 95% confidence interval, 1.03-1.39), and fibroids (prevalence ratio, 1.14; 95% confidence interval, 1.00-1.30). In this cohort, abnormal uterine bleeding was present in 16.4% of those with confirmed menstrual tracking. Black or obese participants had increased prevalence of abnormal uterine bleeding. Participants reporting conditions such as polycystic ovary syndrome, thyroid disease, endometriosis, and cervical dysplasia had a higher prevalence of abnormal uterine bleeding.

The Prevalence of Dietary Supplements That Claim Estrogen-like Effects in Japanese Women.

Recently, adverse events, such as irregular vaginal bleeding and menstrual disorders, associated with the use of dietary supplements containing Pueraria mirifica, have been reported in Japan. P. mirifica contains phytoestrogens, such as deoxymiroestrol and miroestrol. Therefore, we investigated the use of supplements that claim to have estrogen-like effects (i.e., estrogen-like supplements) in Japanese women aged from 15 to 69 years old in an online survey. The prevalence of estrogen-like supplement use was 5%, accounting for approximately 15% of the sample, including ex-users. The majority of the users were in their 40s and 50s, mainly using these supplements for the treatment of menopausal symptoms. In contrast, the younger generation mainly used them for beauty purposes, such as weight loss, mastogenic effects, and skin care. Many of them visited a clinic or took medicines for menstrual-related troubles. In all age groups, soybeans/isoflavones were the most commonly used, followed by equol and placenta. Participants in their teens and 20s also used P. mirifica. Among them, 16.2% had experienced adverse events, including irregular vaginal bleeding, breast swelling and pain, and heavy menstruation. In conclusion, estrogen-like supplement use is associated with adverse events; thus, it is necessary to pay attention to the use of these supplement. Furthermore, because the purpose of use differs depending on generation, caution according to each generation is necessary.

Abdominal Hysterectomy for Benign Gynecological Diseases

OBJECTIVES This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions. METHODOLOGY After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report. RESULTS Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample. CONCLUSION The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear.

ROLE OF PAP SMEAR TEST: FROM SCREENING TO CURE IN TERTIARY CARE HOSPITAL

OBJECTIVE This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions. METHODOLOGY After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report. RESULTS Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p-value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample. CONCLUSION The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear.

Idiopathic retroperitoneal fibrosis with endometrial cancer: a case report and literature review

BackgroundRetroperitoneal fibrosis is a rare disease characterized by chronic nonspecific inflammation, which leads to clinical compression manifestations of retroperitoneal organs especially ureter. Approximately 70 percent of retroperitoneal fibrosis cases are idiopathic which has no clear etiology. This study reported a rare case of a 48-year-old woman presented with idiopathic retroperitoneal fibrosis and endometrial cancer.Case presentationA 48-year-old woman presented with irregular vaginal bleeding without abdominal pain, bloating or discomfort. The patient was diagnosed iRPF after splenectomy 13 years ago. Then she took prednisone for 2 years and took tamoxifen for about 11 years. She stopped taking the medication from October 2019 to May 2020 and then started taking tamoxifen again until November 2020. Two weeks after she stopped taking tamoxifen, she presented with irregular vaginal bleeding. Gynecological ultrasound revealed a thick endometrium with uneven echo enhancement and blood flow signals. Then diagnostic curettage was performed with pathological examination showed endometroid carcinoma. Later, the patient was admitted to Peking University Third Hospital for surgery. Preoperative imaging examinations, including CT, MRI, and PET/CT, all showed pelvic enlarged lymph nodes and they were highly suspected to have lymph node metastasis. The patient underwent laparoscopic surgical staging and enlarged lymph nodes in the pelvic and aortic regions were removed. Finally, the pathology confirmed that endometrioid adenocarcinoma and fibrosis, but there was no tumor infiltration in these enlarged lymph nodes. The patient is now in good condition.ConclusionThis case report stressed the difficulty to distinguish between lymph node metastasis and inflammatory hyperplasia by common imaging methods. Due to increased surgical difficulty among retroperitoneal patients, lymphadenectomy should be carefully evaluated to avoid additional surgical complications and over-treatment.

RETROSPECTIVE ANALYSIS OF CHANGING TRENDS IN PRESENTATION AND MANAGEMENT OF ADENOMYOSIS

Background Adenomyosis is a challenging clinical condition, usually diagnosed between 35 to 50 years of age, with prevalence among hysterectomy ranged from 8.8% to 61.5%. Women with adenomyosis have a prole of symptoms which includes abnormal uterine bleeding, dysmenorrhea, dyspareunia, chronic pelvic pain and subfertility. The condition was diagnosed pathologically in hysterectomy specimens by microscopy but now preoperative diagnosis is done by magnetic resonance imaging (MRI) and transvaginal sonography (TVS) and medical or surgical treatments are proposed as per the diagnosis. The diagnosis of adenomyosis as such becomes difcult due to the coexistence with other conditions like endometrial hyperplasia and uterine leiomyomas. Methods This is a retrospective, cross-sectional study done among 100 women admitted in the Gynaecology ward in Chettinad Hospital and Research Institute, Kelambakkam during the period of August 2019 to August 2020. Women with complaints of abnormal uterine bleeding and had hysterectomy were included. The patient's data were retrieved from the subject's case sheets obtained from Medical Records Department. The histopathological examination reports were retrieved from the Department of Pathology. The data collected were listed in Microsoft Excel v365 and interpreted using statistical software SPSS v21. Results Among the subjects, 35% were found to have adenomyosis in the histopathological diagnosis. Out of those, 6% had only adenomyosis followed by 11% with leiomyoma, 13% with endometrial hyperplasia and 5% with both leiomyoma and endometrial hyperplasia. 71.4% of adenomyosis were in 41 -50 years age group and 80% were multiparous. The most common presenting symptom in adenomyosis subjects were Menorrhagia (74.3%) followed by Dysmenorrhoea and Intermenstrual Bleeding with almost 50%. Conclusion Over the few years, a dramatic change has been attained in presentation and management of adenomyosis. It has turned into a clinical diagnosis rather than a histological entity and can be appreciated through imaging techniques, even though a common denition and classication are still in paucity. This will be of maximum concern in the forthcoming years as the disease needs to have a enduring treatment and so it has to be diagnosed earlier to provide better medical or surgical therapies and to avoid hysterectomy.

Analysis on Action of Rakthasthambhaka Dravya’s in Asrigdhara with special reference to Abnormal Uterine Bleeding

Rakta is the main constituent in the human body as it is considered as vital. Sthambhana means to prevent mobility or block, is one among the Shadvidopakrama and can be well-thought-out as a part of Chaturvidha Chikitsa. Raktasthambhana means to stop excess flow of Rakta because Atyaadhika Raktasrava (excessive menstrual bleeding) may be life threatening so haemostatic measures should be adopted. Asrigdhara defined as excessive and prolonged bleeding during menstruation with or without intermenstrual bleeding. The Nidana’s leading to vitiation of Tridosha’s in Garbhashaya Gata Siras and Artavavaha srotas leading to Artava Atipravrutti. Abnormal uterine bleeding is a common gynaecological complaint with various aetiologies and varied pathophysiological origins. Excessive bleeding during menstruation can restrict with her daily activities, disturb her wellbeing and reducing their efficiency in society. Excessive flow of blood during menstrual and intermenstrual period creates a condition of anaemia in the patient. The Raktasthambhaka Dravya’s are not only helpful for stopping excessive and prolonged bleeding during menstruation but also regularizes menstrual cycle and acts on improving the quality of Rakta Dhatu were discussed in detail in the present paper with their clinical researches.

The effect of SARS-CoV-2 BNT162b2 vaccine on the symptoms of women with endometriosis.

PurposeAs the use of the messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) Coronavirus disease 2019 vaccine has grown, reports on menstrual changes have arisen. We aimed to examine menstrual bleeding patterns and endometriosis-associated symptoms after receiving the mRNA BNT162b2 SARS-CoV-2 vaccine in women with endometriosis, as compared to the control group.MethodsThis is a questionnaire-based cross-sectional study including a total of 174 women. The study group included 86 women with a confirmed diagnosis of endometriosis and the control group included 88 women with no diagnosis or suspected diagnosis of endometriosis. Each woman completed a questionnaire on menstrual bleeding patterns and endometriosis-associated symptoms before and after receiving two doses of the BNT162b2 vaccine. Primary outcomes were changes in amount or length of menstrual bleeding, rates of intermenstrual bleeding and worsening in dysmenorrhea in the endometriosis patient group, as compared to the control group. Secondary outcomes included changes in all endometriosis-associated symptoms.ResultsIn our cohort, women with endometriosis were more likely to experience changes in bleeding patterns (women with endometriosis: 39.5%, control group: 31.0%, p = 0.02), and a significant worsening in endometriosis-associated symptoms with an almost 4.3-fold worsening in dysmenorrhea [95% CI 1.9–9.9, p < 0.01] and 5.5-fold odds for any worsening in symptoms in endometriosis patients, as compared to the control group [95% CI 2.7–11.1, p < 0.01].ConclusionIn our cohort, endometriosis was shown to be a significant risk factor for worsening of menstrual symptoms, after receiving the SARS-CoV-2 BNT162b2 mRNA vaccine. Further research is needed to confirm these findings.

Misdiagnosis of epithelioid trophoblastic tumors: a case report and literature review

Background: The most common clinical types of gestational trophoblastic neoplasia are invasive hydatidiform mole and choriocarcinoma, which can be diagnosed without pathology, and be cured by chemotherapy. Epithelial trophoblastic tumor, a rare type of gestational trophoblastic neoplasia, does not exhibit precise clinical manifestations upon auxiliary examinations. Therefore, since epithelial trophoblastic tumors are prone to misdiagnoses and missed diagnoses, their diagnosis have to be confirmed through pathology and immunohistochemistry. Case: We describe a case of a 37-year-old woman that had been misdiagnosed at a local hospital after she had presented with irregular vaginal bleeding and elevated human chorionic gonadotropin. The initial diagnosis was ectopic pregnancy and she was subjected to left salpingectomy, however, after treatment, there was no significant drop in human chorionic gonadotropin. Later, she was diagnosed with gestational trophoblastic neoplasia and was treated with multiple chemotherapy and hysterectomy. However, after treatment, her human chorionic gonadotropin was found to repeatedly fluctuate. Eventually, pathological examination of a resected lung lesion confirmed the presence of epithelial trophoblastic tumors. Conclusions: Epithelial trophoblastic tumor is an intermediate trophoblastic tumor that is not sensitive to conventional chemotherapy. Surgical resection is the recommended therapeutic option. Gestational trophoblastic neoplasia patients presenting with persistently low levels of human chorionic gonadotropin and resistance to conventional chemotherapy should, therefore, be considered for early surgical resection, or tissue biopsy to pathologically confirm the diagnosis and inform treatment options.

A Rare Case of Large Cervical Polyp in Pregnancy Removed through a Minimally Invasive Polypectomy Procedure

A 28-year-old gravida 1, para 0 woman at 13 weeks of gestation presented to the emergency room complaining of irregular vaginal bleeding lasting over 10 days. The patient did not undergo any examination before the pregnancy, and the existence of the cervical polyps was unclear. Examination revealed no uterine contraction, and vital signs were normal. There was a large polyp-like mass in the vagina, approximately 10 cm in diameter (Fig. 1). Continuous vaginal bleeding was observed. Vaginal examination revealed that the mass protrudes from the posterior wall of the cervical canal, although the internal cervical canal was closed.