A literature search was done using PubMed. The age at natural menopause (ANM) depends on various factors like genetic, environmental, socioeconomic, reproductive, dietary, and lifestyle of which some like nulliparity, vegetarian diet, smoking, high fat intake, cholesterol, and caffeine accelerates; while others like parity, prior use of oral contraceptive pills, and Japanese ethnicity delays the ANM. ANM is an important risk factor for long-term morbidity and mortality; and hence, the need to identify the modifiable risk factors like diet and lifestyle changes. Delayed menopause is associated with increased risk of endometrial and breast cancer, while early ANM enhances the risk for cardiovascular diseases and osteoporosis. The correlation between diet and ANM has not been extensively studied; however, whatever studies have been done till now point towards role of high intake of total calories, fruits, and proteins in delaying the ANM, while high polyunsaturated fat intake accelerates it. The role of dietary soy, total fat, saturated fat, red meat, and dietary fiber in determining the ANM has been controversial and needs further studies to substantiate it. The lifestyle factors like current smoking and vigorous exercise have been significantly associated with early menopause, while moderate alcohol consumption delays the ANM. Large prospective studies are needed to study the association of ANM and other modifiable factors like passive smoking fish consumption, soy, and various types of tea. The knowledge of modifiable determinants of ANM can help in setting up menopausal clinics and initiating health programs specially in developing countries.
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Background: Anaemia in pregnancy is the commonest medical disorder in developing countries like India. It has multifactorial etiology and is associated with increased maternal and perinatal morbidity and mortality. The study aimed at analyzing the socio-demographic variables and also the maternal and perinatal outcome of pregnant women admitted to labour room with severe anaemia (Hb <7 gm%) late in pregnancy. Methods: This is a retrospective observational study done at a tertiary care rural medical college in Gujarat over a 3 year period from January 2014 to December 2016. Results: Results of the study were analyzed. Out of 3963 deliveries during the study period 225 (5.6%) patients were severely anaemic. There were 177 (78.6%) unbooked patients and 169 (75.1%) were multigravidas. Majority of patients belonged to under 24 yr age group. Maternal complications were in form of preterm labour (44%), preeclampsia-ecclampsia (24.8%), cardiac failure (2.2%), PPH (2.2%) maternal death (0.4%). Neonatal outcome was analyzed in terms of prematurity (44%), LBW (24.8%), NICU admission (15.1%), still birth (4.4%), neonatal death (11.5%). Conclusions: Severe anaemia during pregnancy is associated with adverse maternal and perinatal outcome. It is also one of the preventable indirect cause of maternal mortality. Imparting health education to adolescent girls, regular antenatal check-ups, early diagnosis and treatment along with active participation of ASHA workers at grass-root level might help in bringing down the prevalence. A more focused approach is warranted towards pregnant women in rural and underdeveloped areas of India.
Dissection of the aorta which is very rare in pregnancy usually occurs in the third trimester when blood volume and cardiac output rise to a maximum. We present here, a case of a 38-year-old pregnant woman with acute aortic dissection Type B. Management was conservative and after stabilization of vitals, obstetric hysterotomy was performed.
Aim: Successful management of acute liver failure in a case of dengue infection in postpartum patient by a multidisciplinary approach. Background: Dengue fever is a viral infection transmitted by the bite of Aedes aegypti mosquito. It is a major public health problem in developing countries like India. Symptomatology of dengue ranges from mild self-limiting illness to fulminant liver failure. Hepatic dysfunction is a known complication in dengue fever that ranges from mild to moderate elevation of serum transaminases to catastrophic fulminant liver failure. Acute liver failure is a rare complication of dengue infection with high mortality rate. Case description: We report here a case of 19-year-old female who was referred to our center for management of primary postpartum hemorrhage with acute febrile illness. Laboratory investigations revealed anemia, thrombocytopenia, and positive dengue NS1 antigen test. The patient was managed in the critical care unit for pulmonary edema, acute kidney injury, and deranged coagulation profile secondary to hepatic dysfunction. Postpartum hemorrhage was another challenge tackled conservatively. The spectrum of liver involvement varied from a modest rise in transaminases in the early phase and culminating finally in acute hepatic failure by the end of 2 weeks. Multiple blood and blood products were transfused during her 1 month stay in intensive care. There was no perinatal transmission. A multidisciplinary approach involving obstetricians, intensivists, and gastroenterologists resulted in successful recovery of the patient from acute liver failure. Conclusion:Clinicians should have a high index of suspicion for dengue fever in endemic areas in a case of acute febrile illness with/without the classical signs and symptoms of dengue fever. Pregnancy poses a special challenge for the obstetrician as delivery during this period can have devastating complications. A multidisciplinary approach with cautious fluid management is advisable in patients with severe dengue infection. Postpartum hemorrhage can be one of the life-threatening complications due to thrombocytopenia and deranged coagulation profile. Acute liver failure is a rare complication but can develop in patients with severe hepatitis. Clinical significance: Dengue infection in pregnancy can mimic other causes of thrombocytopenia like HELLP syndrome, megaloblastic anemia, and gestational thrombocytopenia; hence, a detailed evaluation is warranted in pregnant women presenting with acute febrile illness with thrombocytopenia. Liver involvement in dengue infection can have devastating consequences leading to severe hepatitis and acute liver failure.
Adenomyosis is the presence of ectopic endometrial glands and stroma in the myometrium. It traditionally presents with pelvic pain, menorrhagia and dysmenorrhea in the fourth or fifth decade of life. Here, we present a case of adenomyosis presenting with severe menorrhagia at the age of 23 years. Traditionally, adenomyosis is diagnosed in histopathologically, in hysterectomy specimens or myometrial biopsies. Noninvasive modalities, such as transvaginal ultrasound and magnetic resonance imaging aid in diagnosis in the office before treatment is undertaken. Office hysteroscopy is an established tool in the diagnosis of abnormal uterine bleeding and infertility.While hysteroscopy does not have pathognomonic features of adenomyosis, certain patterns have been described in association with adenomyosis, including endometrial defects, abnormal vascularization and cystic hemorrhagic lesions. In this case of adenomyosis, typical appearance of circumscribed endometrial defects on hysteroscopy was seen. This appearance has been described in literature but is the first report from India. Hysteroscopy has the potential to be an important additional procedure for the evaluation of uterine pathology, even in the case of adenomyosis, because it offers the main advantage of direct visualization of the uterine cavity and the possibility of obtaining histological specimens under visual control. With shifting focus toward conservative and fertility preserving management of adenomyosis, office hysteroscopy is likely to emerge as an important tool in the diagnostic armamentarium for adenomyosis.
Pulmonary tuberculosis (TB) is one of the top 10 leading causes of death in the world. Multi-drug resistant TB can lead to short-term and long-term sequelae causing clinical, psychosocial, and financial burden on the diseased. Pregnancy in a woman with compromised pulmonary function is a challenge for the treating obstetrician. A multidisciplinary approach involving a respiratory physician, pre-conceptional counseling, and delivery at a tertiary care center can reduce maternal morbidity and mortality. Compliance with antitubercular treatment with regular follow-up can minimize the long term effects of pulmonary TB. We report a case of unilateral lung collapse due to multidrug-resistant pulmonary TB in pregnancy with good maternal and fetal outcomes.
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