Kairavi Desai ¹, Kiran P. Patole ², Manasi Kathaley ³

Affiliations
1 Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College and Research Centre, Nashik, IN
2 Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, IN
3 Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College and Research Centre, Nashik, IN

Abstract

Introduction: Abnormal Uterine Bleeding (AUB) is an important symptom of both benign and serious gynaecological diseases. Abnormal perimenopausal or postmenopausal bleeding is associated with endometrial carcinoma in approximately 10% of cases. The present study is designed to study the histopathological results of the endometrial biopsy in women with abnormal perimenopausal and postmenopausal uterine bleeding.

Aims and Objectives: To study, the various histopathological patterns of endometrium, in patients with abnormal uterine bleeding, those are in perimenopausal and postmenopausal age group.

Materials and Methods: In all 100 patients were selected for the study after satisfying the specific inclusion and exclusion criteria. They underwent detailed history taking including the pattern of bleeding associated with general, systemic, and pelvic examination. They were subjected to routine laboratory investigations and pelvic ultrasound examination. Endometrial biopsy was done irrespective of endometrial thickness. Endometrial biopsy was done in OPD without anaesthesia. Biopsy was performed using a manual vacuum aspiration syringe, and the material collected was sent for histopathological examination. Endometrium was also obtained from patients undergoing diagnostic or therapeutic dilatation and curettage. Analysis of Histopathology report was done and results were obtained. Results: Most predominant findings of histopathological examination were the … •Proliferative Endometrium in 29% •Simple hyperplasia without atypia 28% •Secretory 20% •Followed by other patterns

Conclusion: Study of endometrial histopathology in perimenopausal and postmenopausal women with abnormal uterine bleeding is helpful to diagnose hyperplasia and carcinoma of endometrium.

Keywords

Postmenopausal Uterine Bleeding, Simple Hyperplasia without Atypia, Secretory

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Padmaja Joshi ¹, Manasi Kathaley ¹, Swapnali Borade ¹, Rucha Dashrathi ¹

Affiliations
1 Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN

Abstract

Background: It was a retrospective observational study to know demographic factors, maternal and perinatal outcome in patients of hypertensive disorders of pregnancy admitted in a medical college and tertiary health care center. Introduction: Hypertensive disorders of pregnancy are one of the important cause of maternal morbidity and mortality in India. Hypertensive Disorders of Pregnancy (HDP) account for nearly 18% of all maternal deaths worldwide. Delivery at early gestational age in patients of HDP is associated with high perinatal morbidity and mortality resulting from prematurity. Method: Total number of 120 cases of hypertensive disorders of pregnancy admitted in our hospital was included in the study after satisfying inclusion and exclusion criteria. We studied demographic factors as well as maternal and perinatal outcome. Results: Majority of the patients i.e. 40% were in the age group of 21-30 yrs. 61% of patients were primi gravida and 25% of patients were second gravida. Maximum number of patients had gestational age ≥ 32 weeks at the time of delivery. 26.6% patients, 73.4% patient’s and 12.5% patients were diagnosed as gestational hypertension, preeclampsia and eclampsia respectively. There was high incidence of HELLP and eclampsia in 12.5% each, DIC in (5%), APH in (4.1%), renal complications in (3.3%) and CNS complication were seen in 0.8%. 67.5% patients were delivered by vaginal route, 32.50% patients required LSCS. Majority of patients i.e., 60% underwent preterm delivery, 34% delivered at term. Maternal mortality occurred in 8 patients (6.67%). HELLP and DIC were the leading causes of death. 70% patients had good perinatal outcome. There were 25.83% still births and 4.17% neonatal deaths. Conclusion: Hypertensive disorders of pregnancy are associated with increased maternal and perinatal morbidity and mortality. Good antenatal care, health education, early diagnosis, early referral to higher center and multidisciplinary approach will reduce morbidity and mortality in mother and baby.

Keywords

Eclampsia, Hypertensive Disorder of Pregnancy, Pre-Eclampsia, Prematurity.

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Rucha Dashrathi ¹, Manasi Kathaley ²

Affiliations
1 Former PG Resident, Department of Obstetrics & Gynaecology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Professor and Head, Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Introduction: There is an uncertain relationship between foetal station and mode of delivery. The rise in the rates of caesarean section in unengaged head in primigravida is due to the reason that high foetal station which is considered as a threat to normal progress of labor and so immediately considered as an indication to early caesarean section. A vigilant attitude and timely intervention can help in decreasing chances of C-section and help such cases deliver vaginally. Aims and Objectives: To study the outcome of unengaged head in full term primigravida in labor. 1. To evaluate the causes of unengaged head and analyse progress of labour. 2. To assess maternal and foetal outcome. Material and Methods: 124 Primigravidae at term with unengaged foetal head in labor were undertaken in the study after they met eligibility criteria. After history taking and clinical examination, course of their labor was monitored partographically to study the maternal and neonatal outcome. Results: Out of 124 patients, 84 (67.74%) patients had vaginal delivery while in 40 (32.26%) Lower Segment Caesarean Section (LSCS) was performed. Out of 84 vaginal deliveries, 64 patients had full term normal deliveries while 20 patients needed assisted instrumental deliveries. Thus, out of 124 deliveries, 64 (51.61%) had normal vaginal deliveries, 20 (16.12%) instrumental deliveries and 40 (32.25%) Caesarean sections. Conclusion: We can imply that primigravida at term with high foetal station with spontaneous onset of labor are not all for immediate caesarean section. Watchful expectancy, vigilant intrapartum partographic monitoring can result into normal vaginal delivery with minimal maternal and foetal complications.

Keywords

Full Term, In Labour, Primigravida, Unengaged Head

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Nikita Damle ¹, Manasi Kathaley ²

Affiliations
1 Former PG Resident, Department of Obstetrics & Gynaecology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - c, Maharashtra, IN
2 Professor and Head, Department of Obstetrics and Gynaecology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Background: Hypertensive conditions are the most widely recognized medical complications during pregnancy. Aims and Objectives: In the current study, an attempt was made to understand the significance of Doppler studies in pregnancy induced hypertension and to correlate with the perinatal outcome and to offer better strategies of prevention and early detection and management. Methods: The study comprised of 138 patients admitted in a tertiary care centre at or beyond 28 weeks of gestation with pregnancy induced hypertension (PIH). To determine and monitor a favorable or worsening fetal wellbeing status, follow up Doppler studies were performed though the results of only last Doppler ultrasound within one week of delivery were used for analysis. Patients were followed up till delivery. The maternal and perinatal outcome was studied thereafter. Results: Umbilical Artery (UA) Doppler findings disclosed 26.8% had abnormal umbilical artery S/D ratio, 31.1% had abnormal umbilical artery Recoiling Index (RI) and 2.90% had abnormal umbilical artery Pulsatality Index (PI). Perinatal mortality in the abnormal umbilical artery PI category was found to be the highest (100%) compared to abnormal umbilical S/D artery ratio (66.7%)to be the highest (100%) compared to abnormal umbilical S/D artery ratio (66.7%) and umbilical artery RI ratio (66.7%). In the estimation of adverse perinatal outcome, the predictive accuracy of the umbilical artery S/D ratio in the prediction of adverse perinatal outcome was found to be 73.91%while that of UA RI ratio was 68.12% and the UA PI was 61.59%.Itwas found that in prediction of adverse perinatal outcome, the Umbilical artery PI had higher specificity (97.65%) than the UA S/D ratio (88.24%) and UA RI (80.00%). Fetal middle cerebral artery Doppler studies revealed that 15.2% patients had abnormal MCA S/D ratio, 13.0% had abnormal MCA RI and 15.21% had abnormal MCA PI of which maximum perinatal mortality was seen in abnormal MCA S/D ratio (66.7%) followed by MCA PI (33.3%). Most specific predictor of adverse perinatal outcome was Cerebroplacental ratio (MCA PI/UA PI be (97.65%) The cerebroplacental index has the highest specificity (97.65%)and positive predictive value (93.55%) in predicting adverse perinatal outcome, compared to that of Umbilical artery pusatility index (97.65% and 1.60%) and MCA Pulsatility Index (91.76 and 84.62%) in the present study. Conclusion: The present study noted the prominance of Doppler ultrasound studies in PIH patients, detecting compromised fetuses in utero and taking fitting action in a timely manner.In the present study, the predictive accuracy of the umbilical artery S/D ratio in predicting adverse perinatal outcome was found to be high relative to UA RI and UA PI. In addition, the umbilical artery PI had the highest specificity compared to other Doppler parameters. Absent end diastolic flow and Reversal of end diastolicflow were associated with significant perinatal.

Keywords

Doppler, Pregnancy Induced Hypertension (PIH), Perinatal Outcome

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