Evaluation of endometrial thickness with transvaginal ultrasonography in perimenopausal women presenting with abnormal uterine bleeding and correlation with its histopathological findings

Background: Abnormal uterine bleeding is the most common presenting menstrual complaint in women of perimenopausal age group. Most frequently used diagnostics tests to investigate the causes of abnormal bleeding are Transvaginal ultrasonography (TVS) and endometrial biopsy. Uterine curettage is an invasive procedure and is performed with anaesthesia. TVS is a non-invasive method that has been used to evaluate the endometrium and uterine cavity. The objectives of this study were to measure and evaluate the role and accuracy of endometrial thickness by transvaginal ultrasonography study to detect endometrial pathology in perimenopausal women presenting with Abnormal Uterine Bleeding. To correlate the transvaginal sonographic results with the Histopathological findings to discriminate normal from pathological endometrium.Methods: Prospective study including 150 perimenopausal women with abnormal uterine bleeding. Endometrial thickness was measured by TVS and then D and C was performed for all the patients.Results: Out of 150 women, 128 (85.3%) had normal and 22 (15%) had an abnormal endometrium. 43.3% were of 41-45 years and 65.3% patients presented with complaint of heavy menstrual bleeding. Majority of the patients in the study group were para 2 or more. Fibroid uterus (24%) was the commonest uterine pathology detected on TVS. 53.3% of patients had endometrial thickness in the range 10-14.9 mm. Most common finding on HPE was secretory endometrium (44.6%). Endometrial carcinoma was found in 3%. Endometrial thickness <14mm was associated with least abnormal endometrial pathology.Conclusions: Endometrial thickness of less than 14 mm need not be indicated for D and C in perimenopausal abnormal uterine bleeding. In perimenopausal women with AUB, TVS should be the investigation of choice due to its convenience, accuracy and non- invasiveness.

A Study of Factors Associated with Low Birth Weight in a Tertiary Care Centre in Rural South India

Low birth weight (LBW) is a significant indicator of child survival and future morbidity in any community all over the world. It has reduced considerably in developing countries due to improved living conditions and better care of women and adolescent girls. However, in developing countries, it is still an important cause of child mortality and morbidity. LBW is typically multifactorial at different levels such as maternal, fetal, and environmental factors. Objectives: The objectives are as follows: (1) To assess the prevalence of LBW in a tertiary care setting in a rural area and (2) to determine various sociodemographic factors associated with LBW and degree of association of each. Materials and Methods: A record based study was conducted at Adichunchanagiri Hospital and Research Centre, wherein all singleton live births data for 1 year (January 1, 2016–December 31, 2016) were accessed from the MRD section of AH and RC. All available data were analyzed using percentages, odds ratio, and Multivariate analysis. Results: Overall, the prevalence of LBW was 15.89% (194 LBW out of 1221 live births). Female babies (17.12%), Teenage mothers (19.37%), Rural residence (15.94%), Maternal Hypertension (21%), and Shorter spacing between pregnancies (17.47%), and Preterm (62%) were some associated factors with LBW. Of all the above risk factors, teenage mothers, spacing, and gestational age were found to be statistically significantly associated with LBW. Conclusions: Although declining in most communities, LBW still remains unacceptably high in many undeveloped regions. It requires a multi-pronged approach by a team of dedicated professionals to reduce this problem afflicting mankind.

Cervical and vaginal agenesis report.

Cervical agenesis is a very rare condition often associated with atresia of vagina. Clinical diagnosis is usually difficult before surgery. Transverse vaginal septum or vaginal agenesis is also a rare condition that results from incomplete fusion between vaginal components of the mullerian ducts and urogenital sinus. Here we presented case of 16 years old girl who presented with primary amenorrhea and cyclical lower abdominal pain for 6 months. Abdomino-pelvic scan showed hematometra with bilateral hematosalpinx with mild free fluid in pouch of Douglas with collapsed vagina and cervix. MRI pelvis confirmed USG findings giving differential diagnosis of high vaginal septum or cervical agenesis. She was operated for cervical recanalization and vaginosplasty.

Couvelaire uterus – A case report.

“Couvelaire uterus” or “Utero-placental apoplexy” is a rare complication of severe forms of placental abruption. It occurs when vascular damage within the placenta causes hemorrhage that progresses to and infiltrates the wall of the uterus. We presented here rare case of 23 years old female with Couvelaire uterus.