37 research outputs found
Primary amenorrhea: a clinical review
No full textPrimary amenorrhoea is a symptom with an extensive list of underlying causes, the majority of which are rare. According to the definition it should present in adolescence, although some conditions are diagnosed in childhood may present with failure of menstruation. Many causes of secondary amenorrhoea can also present with primary amenorrhoea if they arise very early in life. A systematic, compartment based approach will cover the commoner causes of primary amenorrhoea and recommend a pragmatic but cost-effective approach to achieve correct diagnosis. Treatment must be directed at the specific cause but has often wider implications for life long wellbeing like weight management, hormone replacement, sexual health and fertility.</jats:p
Precocious puberty: a clinical review
No full textPrecocious puberty is defined as pubertal development occurring more than 2.5 standard deviations earlier than the average age. It may comprise of central or gonadotropin-dependent precocious puberty and peripheral or gonadotropin-independent precocious puberty. Variants of precocious puberty include premature thelarche, premature pubarche and isolated premature menarche which principally implies onset of menstruation without any other signs of sexual development. Precocious puberty may have long-term consequences including short stature later on in adulthood owing to premature epiphyseal fusion as also psychosocial problems. Evaluation includes a detailed history, physical examination, biochemical tests and imaging directed towards detecting the cause. Gonadotropin Releasing Hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the cause. Isolated variants are usually normal but should be closely monitored. Multi-speciality consultation with involvement of pediatricians and enocrinologists may improve treatment outcomes in these children, who otherwise pose significant challenges to the gynaecologist.</jats:p
Outcomes of Elective Induction of Labor Compared with Expectant Management in Nulliparous Women with Unfavorable Cervix
No full textA clinicopathological evaluation of postmenopausal bleeding and its correlation with risk factors for developing endometrial hyperplasia and cancer: A hospital-based prospective study
No full textSpectral-domain optical coherence tomography measurements of central foveal thickness before and after cataract surgery in children
No full textPurpose To compare macular thickness before and after cataract surgery and intraocular lens (IOL) implantation in pediatric eyes. Design Retrospective cohort study. Setting University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy. Methods The study analyzed spectral-domain optical coherence tomography (SD-OCT) images of the macula in pediatric eyes in which cataract surgery had been performed and that were examined preoperatively and 1, 3, 6, 9, and 12 months postoperatively. Results The mean age of the 11 patients (11 eyes) was 5.8 years ± 2.2 (SD) (range 3 to 14 years). The mean macular thickness at 1 month and 3 months was significantly higher than at baseline (273.7 ± 26.8 μm and 266.0 ± 22.8 μm, respectively, versus 244.8 ± 19.5 μm; P .05 versus baseline). Conclusions Spectral-domain OCT was useful in evaluating the macular changes in the eyes of a cohort of pediatric patients 3 years and older. Cystoid macular edema was not observed during the 12-month follow-up. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned
Combined hysterolaparoscopy as an early option for initial evaluation of female infertility: a retrospective study of 135 patients
No full textBackground: The aim of this study was to find out different causes of female infertility with diagnostic approach using laparoscopy and hysteroscopy.Methods: This retrospective study was done in the Department of Obstetrics and Gynecology of MGMCRI, Puducherry. 135 infertile women aged 19-40 years were enrolled retrospectively for combined laparoscopy and hysteroscopy. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Patient with active genital tract infection and any contraindication to hysterolaparoscopy procedure were excluded. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interventions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized. Data was statistically analyzed using SPSS software version 15; a result of P <0.05 was considered as significant.Results: Out of 135 cases, 65% patients had primary and 34.8% patients had secondary infertility. As a whole pelvic pathology were confirmed in 54.5% and intrauterine pathology in 20.7% patients by hysterolaparoscopy. The most common laparoscopic abnormality detected was tubal pathology 40%, followed by pelvic inflammatory disease 18.5%, ovarian pathology 8.1% pelvic endometriosis 4.4%, and uterine pathology 4.4% in infertile patients. In hysteroscopy, the incidence of uterine anomaly was 9.6% and intrauterine septum is the most common anomaly with a mean incidence of approximately 84% in both the group of infertile patients.Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable abnormalities in pelvis, tubes and the uterus which are usually missed by other imaging modalities.
A case of post-caesarean vesico-uterine fistula: A rare entity becoming common?
No full textVesicouterine fistula (VUF) is rare, with an incidence estimated at 1-4% of all genitourinary fistulas. We report a case of VUF which was referred to our institute on the 6th postoperative day following an emergency repeat lower section caesarean section (LSCS) at 39 weeks, with complaints of hematuria and watery discharge per vaginum for further management. Patient had stable vitals with slight abdominal distension and tenderness and watery discharge per vaginum having an ammoniacal odour. USG examination showed Foley’s bulb inside uterine cavity. CT abdomen confirmed the findings and showed presence of contrast inside uterine cavity. Patient was re-operated on 9th postoperative day in concurrence with urologists. Cystoscopy showed a 2 cm size fistulous opening. Intra-operative findings revealed a fistulous track between posterior wall of bladder and uterine incision. Appropriate reparative surgery was done. Obstetricians need to be aware of this condition particularly while operating on previous caesarean sections.</jats:p
Histomorphological analysis of placental changes of pre-eclampsia patients in a tertiary care hospital of Puducherry, India
No full textBackground: Placenta is a dynamic tissue synthesized physiologically to serve as a nutrient source for developing fetus it is exposed to several changes in reaction to many toxemic conditions associated with pregnancies. Studies had proved that placental changes observed on histomorphology is directly proportional to reaction to hemodynamic compensatory mechanisms, thereby aiding the obstetricians to manage the sequelae of complications. Objective of this study was to study the placental histomorphology in pregnancies associated with pre-eclampsia and to quantitate the observed placental changes.Methods: The study comprised on 101 placental specimens obtained from department of obstetrics and gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry. Toxemia of pregnancies were divided into mild, severe preeclampsia and eclampsia based on blood pressure. The 101 cases were divided as 4 groups: Group 1 (control group); Group 2 (mild preeclampsia); Group 3 (severe preeclampsia); Group 4 (eclampsia).Results: Among the 101 cases, 38 placentas were from uncomplicated full-term deliveries which constitutes the control group. The rest 63 placenta were from toxemia of pregnancies which constitutes the study group.Conclusions: The incidence of toxemic pregnancies and pre-eclamptic cases are on higher margin than assumed. Histomorphology examination of placenta plays a vital role in assessing etiopathogenesis and mechanism of toxemic pregnancies. This aids the obstetrician to further manage subsequent sequelae and fix the complication to significant proportion
Paraurethral leiomyoma in a woman: a case report
No full textParaurethral leiomyomas are rare, benign smooth muscle tumours of the urogenital tract. Most para-urethral tumours occur in the reproductive age group. Its etiology is uncertain and its presentation is variable. Here we present a 45 year old multiparous lady, who approached the out-patient department, with complaints of profuse foul-smelling discharge and a mass per vaginum for 10 days
Clinical study of primary caesarean section in multiparous women in a tertiary care hospital
No full textBackground: The objective of this study was to find the incidence and indications of primary caesarean section in parous women and evaluate the maternal and perinatal outcomes there from.Methods: Prospective study of primary caesarean sections in parous women at our institute from June 2013 to May 2014 was done. Age, indications and the maternal as well as perinatal outcomes were analyzed. Data was expressed as number and percentage.Results: Out of 1124 caesarean deliveries, 68 primary caesareans in parous women were done. The most common age group was 21-30 years. The majority of parous women who underwent primary caesarean section, were para 2. Booked cases constituted the maximum number of such women at 97.1 % (n=66). In parous women undergoing primary caesarean section, the number of spontaneous onset of labour was significantly more than those undergoing induction of labour. The most common indication for caesarean section in this group of patients was fetal distress. There was no neonatal mortality or adverse maternal outcome.Conclusions: Fetal distress was the most common indication for primary caesarean section in the parous woman, although malpresentation also contributed significant numbers. Primary caesarean sections in women with previous vaginal deliveries, were not associated with any significant neonatal or maternal complications
