Abnormal uterine bleedingTransvaginal sonography Hysteroscopy Endometrial polyp Submucous fibroid a b s t r a c t Background: Abnormal uterine bleeding (AUB) accounts for 33% of female patients referred to gynaecologists. Common causes of AUB include endometrial polyps, endometrial hyperplasia, submucous fibroids and anovulation. Accurate diagnosis of the cause of AUB can reduce the frequency of hysterectomy. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation. Methods: 100 female patients with AUB were enrolled in the study. Each patient was subjected to TVS where uterine cavity was studied in detail and hysteroscopy under anaesthesia using saline as distension medium. Sensitivity, specificity and predictive value of TVS as compared to hysteroscopy were calculated. Subgroup analysis within each group was also performed. Results: Menorrhagia was the commonest presenting symptom in the study population (n ¼ 58) followed by metrorrhagia, menometrorrhagia and continuous bleeding >21 days. 74 female patients had normal size uterus. In 57 patients, the uterine cavity was normal on TVS. Thickened endometrium, endometrial polyp and submucous fibroids were seen in 19, 16 and 6 patients respectively. Hysteroscopy showed normal cavity in 59 female patients and polypoidal endometrium, polyps or submucous fibroids in 41. TVS was found to have high sensitivity and specificity (95.23 and 94.82 respectively) and high positive and negative predictive value. Strength of agreement between TVS and hysteroscopy was high (kappa value 0.898). Conclusion: TVS is recommended as first line investigation in AUB. If TVS shows normal cavity, further evaluation can be omitted and patient started directly on medical treatment for her symptoms.© 2014, Armed Forces Medical Services (AFMS). All rights reserved. m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 1 ( 2 0 1 5 ) 1 2 0 e1 2 5http://dx

No abstract

Positron emission tomography combined with CT in the evaluation of operable cervical cancer can help in the optimal selection of patients for surgery such that multimodality treatment with its attendant increase in morbidity is avoided.

Aim Obstetric patients presenting to the intensive care units (ICU) with or without underlying medical or surgical comorbidities can be a challenge to both the treating obstetrician and the intensivist. They occasionally present with near-miss events which if left untreated, can result in death. Objectives To study the prevalence, indications of ICU admissions, near-miss events, and their effect on mortality in obstetric and puerperal patients . Material & methods We conducted a retrospective analysis of the health records of all the obstetric and puerperal patients (pregnant and until 6 weeks postpartum) admitted to our tertiary care hospital from January 2019 to December 2020. Patient demographic characteristics, obstetric, surgical, and medical conditions, acute physiology, and chronic health evaluation (APACHE) II scores, organ failures, treatment, ICU and hospital length of stay, and mortality outcomes were studied. Results A total of 22 obstetric patients were admitted to the ICU during the above study period. Mean age was 28.7 ± 6.24 years, mean gestation was 34.4 ± 6.61 weeks, mean APACHE II score was 12.68 ± 5.67, median ICU length of stay was 5 days, and median duration of hospital length of stay was 10 days. The antepartum risk factors such as severe preeclampsia (27%), antepartum bleeding (14%), and postpartum complications like postpartum haemorrhage (33%), sepsis with multiorgan failure (25%) are the commonest indications that resulted in ICU admission. Conclusion Higher APACHE II scores at the time of ICU admission, prolonged ICU, and hospital length of stay may be associated with high maternal mortality.

Background: Hypertensive disorders and intrauterine growth restriction are common complications encountered during pregnancy. This study was conducted to observe the usefulness of systolic/ diastolic (S/D) ratio in umbilical artery as compared with non-stress test (NST) to predict perinatal outcome in pregnancies complicated with hypertensive disorders and intrauterine growth restriction (IUGR). Methods: It was a prospective observational which was conducted on patients undergoing antenatal visits at the department of obstetrics and gynaecology, Army hospital research and referral, New Delhi from May 2017 to April 2019. NST was started at 32 weeks twice weekly in all patients. All patients were subjected to umbilical artery Doppler velocimetry waveform on weekly basis or every third day in cases of nonreactive NST. Results: Out of 140 patients, 53 patients (37.9%) had PIH and 44 (31.4%) had IUGR. 43 cases (30.7%) had both PIH and IUGR. Among the 140 patients, 40 patients (28.6%) had non-reactive NST and 60 patients (42.9%) of the patients had abnormal doppler. Abnormal doppler and non-reactive NST were associated with APGAR score of less than 7 at 5 minutes in the newborn. Abnormal perinatal outcome was more in abnormal doppler than normal doppler and the finding was statistically significant (p<0.05). Conclusions: Overall sensitivity and diagnostic accuracy of Doppler is better as compared to that of NST in terms of detecting adverse perinatal outcomes.

We thank the reader for showing interest in our work. Saline Infusion Sonography (SIS) is a well known diagnostic technique for evaluation of intracavitary lesions of the uterus. In case an intracavitary lesion is found on SIS, the patient will require hysteroscopic surgery for its definitive management. In our study, we used only TVS for the initial triage of patients with AUB. In case, the endometrial cavity appeared normal, we concluded that we could dispense with any further testing and proceed with treatment based on the clinical profile of the patient. On the other hand, if we found some intracavitary lesion, which could be distinguished as polyp, fibroid or thickened endometrium with a good degree of accuracy on TVS itself, it would merit definitive treatment at hysteroscopy. Therefore, we recommended in our study that these cases be taken directly to hysteroscopy, that will clearly establish the diagnosis and provide the opportunity for definitive therapy simultaneously by interposing SIS between TVS and hysteroscopy in a patient found to have an intracavitary lesion, we would not be gaining any advantage. The time, effort and cost of adding SIS to the investigative work-up of AUB cases was thus avoided.

Background: Mifepristone has been used for cervical priming and labour induction for long with modest success. This double-blind study compares mifepristone with placebo in causing cervical ripening and inducing spontaneous labour in women past their expected date of delivery.Methods: 200 women at 40 weeks gestation received mifepristone or placebo after Bishop score was assessed. 48 hours later, cervical score was rechecked. Improvement in Bishop score was noted as primary outcome measure. Incidence of spontaneous labour, cesarean delivery and meconium staining of liquor during labour was also monitored.Results: 16 women went into labour before 48 hours and 184 were evaluable. Improvement in Bishop score was noted in significantly more women in mifepristone group (82/94 versus 42/90, p<0.0001). Mean change in Bishop score was 3.22 in mifepristone group and 1.61 in placebo group. This advantage in cervical ripening with mifepristone did not translate into better obstetric outcome. The incidence of spontaneous labour (64/94 mifepristone versus 60/90 placebo), cesarean section (4/94 versus 12/90) and MSL (8/94 versus 10/90) was comparable in the two groups and did not reach statistical significance.Conclusions: Mifepristone has a beneficial effect on cervical ripening in term pregnancies but does not offer obstetric advantage in terms of higher rates of spontaneous labour or vaginal delivery.

No abstract