A Randomized Prospective Study Of Menstrual Irregularities In Relation To Obesity In Terms Of Body Mass Index

Introduction: Obesity in women is worldwide problem. Obesity may lead to hyper androgenism resulting in increased extra glandular aromatization by adipocytes leading to anovulation and menstrual irregularities. Aims and Objectives: To establish relation between obesity and menstrual irregularities in women and also to study the effect of weight reduction on menstrual pattern. Materials and Methods – It is a randomized prospective study of one year duration in the Dept. of Obstetrics and Gynecology, Calcutta National Medical College, Kolkata. Out of 198 obese females, 62 were presented with menstrual irregularities. Body mass index was calculated to detect obesity. Following investigations were done – serum FSH, LH, Prolactin, T , T , TSH, testosterone and USG of uterus and adnexa, diagnostic 3 4 laparoscopy and endometrial biopsy. Result and Analysis: 31.3% of obese women had menstrual irregularities in our study. After reduction of 7-8 kgs, 80% of the women who had reduced weight also had menstrual improvement. Conclusion: One third of the obese female patients presented with menstrual irregularities. Weight reduction by exercise and balanced diet 6 reduced hyperandogenemia leading to ovulation which ultimately improved menstruation .

Unilateral lower limb oedema in pregnancy.

A 21 years old lady was admitted with severe pain and swelling of left lower limb in a pregnancy of 34 weeks of period of gestation. On examination there was pitting oedema of the whole left lower limb with extreme tenderness. Doppler USG of left femoral vein showed a thrombus in the process of recanalisation and no significant flow was demonstrated inside the lumen and USG for foetoplacental profile showed a single live foetus of gestational age 34 weeks. The case was diagnosed as deep venous thrombosis in pregnancy. She was treated with heparin injection 5000 unit subcutaneously twice daily throughout pregnancy along with antibiotics. In spite of proper management she developed extensive ulceration in left lower limb. She delivered normally a healty male child after induction with oxytocin dirp. The postpartum period was uneventful. Throughout this period heparin was continued and she was referred to surgery department for skin grafting.

A study of prophylactic use of 15-methyl prostalglandin F2alpha in the active management of third stage of labour.

To compare active management of third stage of labour with 15-methyl prostaglandin F2alpha (PGF2alpha) and conventional management with methylergometrine as prophylaxis for postpartum hemorrhage, a randomised comparative study was carried out at Calcutta National Medical College and Hospital, Kolkata on 100 women. They were randomly allotted to one of the two groups. Group A included 50 women who received 15-methyl PGF2alpha (125 microg) intramusculary at the time of delivery of the anterior shoulder and group B included 50 women who underwent conventional management of the third stage of labour where methylergometrine 0.2 mg was given after delivery of placenta. Main outcome measured were duration of third stage, amount of bleeding and side-effects. The present study showed that there were significent reduction of the duration of third stage as well as reduction of amount of bleeding particularly when 125 microg of 15-methyl PGF2alpha was given intramuscularly at the time of delivery of the anterior shoulder in comparison to coventional method of management of third stage of labour with methylergometrine. Placental expulsion occurred within 4 minutes in group A and 16.5 minutes in group B. The amount of bleeding following delivery was 95.6 ml in average in group A and 249.6 ml in average in group B. 15-methyl PGF2alpha (125 microg) is certainly effective in prevention of postpartum haemorrhage particularly in developing country like India where this complication contributes a major factor for maternal mortality.

Genital fistula--our experience.

Genital fistulas cause immense physical and psychosocial problem in women's life. The present study was conducted to note the varieties of genital fistula as well as their causative factors and the results of the operative corrections. Altogether 42 patients with different varieties of genital fistula were enrolled in the study. The causative factors of the genital fistulas, specially, that of vesicovaginal fistulas were thoroughly enquired. After confirming the diagnosis, the operative corrections were undertaken. Among the varieties of genital fistula, 76.19% were vesicovaginal fistula, 11.90% were rectovaginal fistula and 4.76%, 4.76% and 2.38% cases of ureterovaginal, urethrovaginal and vesicocervical fistulas respectively. The primipara women were the major sufferers of genital fistulas due to obstetric grounds. Regarding aetiologies of vesicovaginal fistulas, 71.87% patients had obstetric reasons, after prolonged labour, instrumental delivery and after caesarean section due to obstructed labour. Abdominal hysterectomy (44.44%) topped the list of the gynaecological causes of vesicovaginal fistulas. The cases of ureterovaginal fistulas were after abdominal hysterectomy. One case of urethrovaginal fistula was due to some chemical application for correction of genital prolapses. The rectovaginal fistulas were mostly due to obstetric reasons. The success rate after the first attempt of repair of vesicovaginal fistula was 82.75% and overall failure was 10.34%. The other varieties of fistulas were repaired with 100% success rate. The incidence of genital fistulas can be reduced by vigilant obstetric care and meticulous surgery.