Pelvic Organ Prolapse in Perimenopausal and Menopausal Women.

Background: Pelvic organ prolapse (pop) is a chronic disorder, often asymptomatic. There are several factors involved in the aetio-pathogenesis of POP. Perimenopausal women bear most of the burden of pop. Vaginal delivery is an established risk factor and clinical presentation may take years when women are symptomatic in menopausal age. Method: A cross-sectional study was done for one year in a rural teaching hospital, where 150 pop women were included. Variables associated with both asymptomatic & symptomatic pop were analyzed. The mean, proportion, & simple logistic regression were used to analyze the data and p value < 0.05 was considered significant. Results: The prevalence of pop was 4.8%. Associated socio-economic & obstetrical variables were age group of 41-50 years (82.7%), housewives (84%), multiparty (93.33%), lower economic conditions (86.7%), home deliveries (74.71%), and early resumption of work after delivery (61.3%). Bulging in the vagina (p < 0.001), & difficulties in micturition (p = 0.001) were significant symptoms. Among asymptomatic & symptomatic pop, difference in BMI (p = 0.042), education level (p = 0.001), menstrual history (p = 0.001) & place of delivery (p = 0.037) were significant. Different stages of pop were significantly associated with differences in age groups (p < 0.001), menstrual history (p < 0.001) & place of delivery (p = 0.039). Differences in the proportion of constipation were significant with anterior compartment defects (p < 0.001), whereas the association of chronic lung diseases was found significant (p = 0.028) in the case of apical compartment prolapse. Simple logistic regression of co-variants shows age can predict the severity of pop stages (OR 7.25; 95% CI 1.95-26.99). Conclusion: All stages of pop were present mostly in the age group of 41-50 years rather than in the over 50 years age group. Menopause is associated with the severity of prolapse and is mostly symptomatic. Age can predict the severity of pop.

Prediction of pre-eclampsia: comparative analysis of two screening tests.

Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality. Unfortunately, in spite of extensive research worldwide, still we lack an effective screening test for pre-eclampsia. The aim of the current study is to assess the importance of micro-albuminuria and uterine artery Doppler resistance index as a screening test for pre-eclampsia during antenatal period. The study is a prospective audit. The study population consisted of 160 antenatal mothers attending the outpatient department. Test for micro-albuminuria was done at 14 weeks, 18 weeks, 28 weeks and 34 weeks of gestation. Uterine artery Doppler resistance index (0.58 taken as cut-off) was recorded at 18 weeks of gestation. The subjects were followed up till delivery for development of pre-eclampsia. Sensitivity, specificity, positive and negative predictive value (along with confidence interval and diagnostic odd's ratio) of the tests were calculated. Sensitivity, specificity, positive and negative predictive value of micro-albuminuria was recorded as 66.67%, 93.24%, 44.44% and 97.18% respectively. Those of uterine artery Doppler resistance index were 33.33%, 95.96%, 40% and 94.67% respectively. Diagnostic odd's ratio of micro-albuminuria and uterine artery Doppler resistance index were 27.600 and 11.833 respectively. Confidence interval and diagnostic odd's ratios show that uterine artery Doppler study is a better screening test amongst the two. Both the tests being non-invasive in nature and having high specificity and high negative predictive value can be utilised in community-based antenatal care for identifying women who need intensive vigilance.

Ultrasound assessment of endometrial cavity in perimenopausal women on oral progesterone for abnormal uterine bleeding: comparison of diagnostic accuracy of imaging with hysteroscopy-guided biopsy.

AIM: To investigate the effect of oral progesterone on the accuracy of imaging studies performed to detect endometrial pathology in comparison to hysteroscopy-guided biopsy in perimenopausal women on progesterone treatment for abnormal uterine bleeding. METHODS: The study population comprised of women aged 40-55 years with complaints of abnormal uterine bleeding who were also undergoing oral progesterone therapy. Women with a uterus ≥ 12 weeks' gestation size, previous abnormal endometrial biopsy, cervical lesion on speculum examination, abnormal Pap smear, active pelvic infection, adnexal mass on clinical examination or during ultrasound scan and a positive pregnancy test were excluded. A transvaginal ultrasound followed by saline infusion sonography were done. On the following day, a hysteroscopy followed by a guided biopsy of the endometrium or any endometrial lesion was performed. Comparison between the results of the imaging study with the hysteroscopy and guided biopsy was done. RESULTS: The final analysis included 83 patients. For detection of overall pathology, polyp and fibroid transvaginal ultrasound had a positive likelihood ratio of 1.65, 5.45 and 5.4, respectively, and a negative likelihood ratio of 0.47, 0.6 and 0.43, respectively. For detection of overall pathology, polyp and fibroid saline infusion sonography had a positive likelihood ratio of 4.4, 5.35 and 11.8, respectively, and a negative likelihood ratio of 0.3, 0.2 and 0.15, respectively. CONCLUSION: In perimenopausal women on oral progesterone therapy for abnormal uterine bleeding, imaging studies cannot be considered as an accurate method for diagnosing endometrial pathology when compared to hysteroscopy and guided biopsy.

Pre-operative assessment of benign and malignant ovarian tumours using colour Doppler ultrasonography.

Ultrasonography of 56 women with adenexal masses who were admitted for laparotomy were done mainly by transvaginal route. Though Gray scale morphologic evaluations of masses were done routinely, only colour Doppler imaging criteria were taken into consideration in this study. These are pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), timed average maximal velocity (TAMXV), vessels localisation and dicrotic notch. Histopathological examination was done and considered as gold standard. In 83.78% cases of benign tumour PI is equal or greater than 1, whereas it was less than 1 in 84.21% in malignant ovarian tumour. The sensitivity, specificity, PPV and NPV were respectively 84.21%, 83.78%, 72.72% and 91.11%. RI in benign tumours were equal to or more than 0.4 in 81.08% and less than 0.4 in 68.42% in case of malignant tumours. The sensitivity, specificity, PPV and NPV were respectively 68.42%, 81.08%, 65% and 83.33%. Considering the TAMXV>12 cm/second as a criterion for malignancy the sensitivity, specificity, PPV and NPV were respectively 89.45%, 89.19%, 80.95% and 94.28%, and also considering septal/central localisation of vessels as a criterion for malignancy, it was found the sensitivity, specificity, PPV and NPV were 89.47%, 62.16%, 54.84% and 92% respectively. Considering absence of dicrotic notch for malignant tumours we found sensitivity, specificity, PPV and NPV were 89.47%, 81.08%, 70.83% and 93.75% respectively. The above findings of the PI, TAMXV and dicrotic notch evaluation show most useful was colour Doppler parameters for pre-operative screening for ovarian malignancy in this study.