ABSTRACT
Background: Abnormal uterine bleeding (AUB) is debilitating condition affecting 14-25% of women of reproductive age. It has significant impact on women’s personal, social, physical and quality of life. Present study is planned to study causes, investigation along with management of structural causes of abnormal uterine bleeding in reproductive age group.Methods: Consecutive type of non-probability sampling was used for selection of study subjects. A total of 100 gynaecology OPD women diagnosed with menorrhagia of 15-45 years age group were enrolled in study.Results: Mean age of the study subjects was between 26-35 years (47%). 67% were from low socio-economic class while 33% were from middle class. Maximum number of women (66%) had symptoms for less than 6 months. 47% presented with Menorrhagia. 89% were Multiparous, and 11% were Nulliparous. Most common structural causes of AUB was leiomyoma (41%) followed by polyps (23%), adenomyosis (17%), endometrial hyperplasia (15%) and endometrial carcinoma (4%). Prevalence of anemia was 73% in present study. Maximum leiomyoma were treated medically while higher percentage of polyps and hyperplasia was treated surgically. Most commonly performed surgery was polypectomy (20%) followed by dilatation and curettage (17%) and myomectomy (15%). Total abdominal hysterectomy was done in 8% cases while radical hysterectomy was done in 2% cases.Conclusions: Benign lesions of endometrium account for majority of cases presenting with AUB in reproductive age group. Other premalignant and malignant causes should also be considered. High prevalence of anemia was observed in these cases. A comparative clinicopathological study will help in arriving at the cause and correct diagnosis. Histopathological examination is one of the major tools in evaluation of abnormal uterine bleeding and helps us in proper management and treatment of cases.
ABSTRACT
Background: Abruptio placenta or accidental haemorrhage is one of the obstetrical emergencies and is truly accidental with few warning signs. Present study is planned to study the maternal and fetal outcome in patients of abruption placenta in a tertiary care referral hospital in a rural set up which is helpful to plan management strategies and to decrease mortality and morbidity.Methods: A prospective observational study was conducted at Department of Obstetrics and Gynaecology at tertiary care centre during September 2015 to August 2019. A total of 270 cases of abruptio placenta coming to the labor ward and delivered were included in the study. The information collected regarding maternal and fetal parameters were recorded in a master chart in Microsoft Excel 2010 and analyzed using the statistical package for the social sciences software (SPSS) version 20.0.Results: In the present study there were a total of 29887 deliveries with 270 cases of abruptio placenta, incidence being 0.9%. Bleeding per vagina is the most common presentation (85.6%) followed by pain abdomen (70.7%). Common risk factors for accidental hemorrhage were: Pre-eclampsia (39.6%) and anaemia (32.2%). Rate of cesarean section was 40.7% (n-110) while rate of forceps delivery was 4.8% (n-13). Associated maternal complications include: post-partum hemorrhage (18.9%), DIC (10%), acute renal failure (4.1%) and puerperal sepsis (1.9%) while maternal mortality rate was 1.9%. Low birth weight (<2.5kg) was observed in 74.8% cases while still birth and neonatal mortality rate was 35.2% and 12.6% respectively.Conclusions: Abruptio placenta or accidental hemorrhage is major risk factor for maternal and perinatal morbidity and mortality, thus efforts should be taken to reduce risk factor for abruptio placenta. Strengthening of antenatal care, anticipation and evaluation of associated high-risk factor and prompt management of complication can improve maternal and perinatal outcome in these cases. Abruptio placenta should be managed in centers where there is advanced maternal and neonatal health care facilities are available.
ABSTRACT
Background: Mullerian anomalies occur in approximately 3-4% of fertile and infertile women, 5–10% of women with recurrent early pregnancy loss, and up to 25% of women with late first or second-trimester pregnancy loss or preterm delivery. However, due to low prevalence rate and asymptomatic course of the anomalies, Mullerian anomalies remain underdiagnosed and often overlooked as a possible cause of recurrent pregnancy failures, preterm deliveries, IUGR and low birth weight.Methods: Total of 30 cases of Mullerian anomalies with pregnancy, prior diagnosed or incidental during LSCS, were studied for complications during pregnancy, history of gynecological complaints and rate of diagnosis with routine imaging technique.Results: Septate uterus was the most common anomaly seen in this study (36.6%).56.6% were diagnosed incidentally during LSCS despite the fact 26.6% of cases had history of 2 or more abortions and 30% had some or other gynecological complaints previously. 10% of pregnancies ended in abortions, 20% had preterm delivery, 36.6% had malpresentations and there was case of rupture uterus (03.3%).Conclusions: Mullerian anomalies are often asymptomatic or have subtle gynecological symptoms which are often missed by both patient and gynecologists. It is observed that due to the asymptomatic course of Mullerian anomalies, invasive nature of HSG and lack of 1.5 Tesla MRI at many institutes leads to low rate of diagnosis of Mullerian anomalies. Pregnancy with Mullerian anomalies often have preterm delivery, IUGR and malpresentation, so, require proper counselling and close monitoring during antenatal period.