Journal of Obstetrics and Gynecology of India最新文献

Purpose: Age at menarche is believed to be an important indicator of reproductive maturity in women and hence a mirror to the health status of the population. Polycystic ovarian syndrome (PCOS) is a common endocrine disorder that affects reproductive-age women. Girls with early menarche are more likely to develop PCOS-like features. The paper explores the associations of age at menarche with PCOS and other health outcomes especially in relation to the presence of PCOS, related reproductive and metabolic abnormalities.

Methods: This is a secondary analysis of data collected from analytical cross-sectional study, conducted at ten centres in the six zones of India, as a part of ICMR task force project. The participants (n = 10,109) who were enrolled for the study comprised of women aged 18-40 years.

Results: The mean age of menarche was 13.15 ± SD. The age of menarche reduced at a rate of 0.018 (P value = years per unit increase in years). Those with late onset of menarche had 1.45 times more odds of developing PCOS when compared to those who had a normal age of onset of menarche. What about early onset of menarche?

Conclusion: A receding age at menarche among younger girls as compared to older women which may be due to a trend of reducing age at menstrual onset. While, there was an association of PCOS diagnosis with extremes of age at menarche, more marked in case of late onset of menarche, more studies are necessary to establish the relationship.

Background: Cervical cancer is the one of the most constantly diagnosed and leading cause of cancer death in women, with an estimated 604,000 new cases and 342,000 deaths worldwide. One woman dies of cervical cancer every 9 min in India. Despite its high incidence, the knowledge and awareness regarding cervical cancer and its screening is limited. This study aims to estimate the proportion of preinvasive lesions of cervix among healthy and immunocompromised individuals.

Methods: An observative cross-sectional study done in a tertiary care centre from January 2021 to June 2022 among 250 normal and 250 immunocompromised individual's attending tertiary care centre. Coloscopy guided biopsy was taken for histopathological examination after informed and written consent.

Results: The proportion of preinvasive lesion of cervix among 500 individuals is 8.2% (41). The proportion of preinvasive lesion among normal individuals is 5.2% (13) and among immunocompromised individual is 11.2% (28). Most of the positive cases, 46% (19) were seen in women with more than two children. 75% (31) of positive cases were seen in women who had their first coitus at age less than 21 yrs. 87.8% of positive cases were seen in women not using any method of contraception.

Conclusion: Preinvasive lesions are more common in immune compromised and it is precisely clear that all women must undergo cervical cancer screening as cervical cancer is the most common among women. "Prevention is better than cure"-Screening and early treatment of preinvasive lesion is cost-effective way to prevent cancer cervix.

Abdomen is the second most common site of Tuberculosis. The diagnostic challenge of abdominal tuberculosis (TB) masquerading as endometriosis arises due to overlapping symptoms and the non-specific nature of both conditions. Abdominal TB can affect various organs, including the peritoneum, leading to symptoms such as abdominal pain, pelvic pain, and menstrual irregularities-symptoms that are also associated with endometriosis. The presentation is therefore vague and non specific ,making its diagnosis difficult. Abdominal tuberculosis at any age can always present as endometriosis or peritoneal carcinomatosis or ovarian malignancy, ileocecal c and other conditions with elevated CA125 levels and hence poses a diagnostic challenge. Presenting an interesting case of a 23 year old ,married female who presented to the ER with acute abdomen. Patient gives history of treatment for endometriosis for the past three months, in light of her symptoms and investigations that she presented with. Patient was posted for diagnostic laparoscopy and was diagnosed as intra abdominal TB with tissue diagnosis. Patient then received ATT and underwent infertility evaluation. Hence Diagnostic laparoscopy with tissue diagnosis is gold standard for timely diagnosis and treatment of Abdominal TB. Hence such cases must be approached with caution and with all the differentials in mind for prompt treatment.

Currently, there is a growing concern for human health with the rise of environmental pollution. Water contamination and health problems had been understood. Sanitation-related health issues have been overcome in the greater part of the world. Progressive industrialization has caused a number of new pollutants in water and in the atmosphere. It is a growing concern for the human health, especially upon the reproductive health. Current researchers provide a strong association between the rising concentrations of ambient pollutants and the adverse health impact. Furthermore, the pollutants have the adverse effects upon reproductive health as well. Major concern is for the health of a pregnant woman and her baby. Maternal-fetal inflammatory response due to the pollutants affects the pregnancy outcome adversely. Preterm labor, fetal growth restriction, intrauterine fetal death, and stillbirths have been observed. Varieties of pathological processes including inflammation, endocrine dysfunction, epigenetic changes, oxidative and nitrosative stress, and placental dysfunction have been explained as the biological plausibility. Prospective studies (systematic review and meta-analysis) have established that exposure to particulate matters (PM) and the nanoparticles (NP) leads to excessive oxidative changes to cause DNA mutations, lipid peroxidation and protein oxidation. Progressive industrialization and emergence of heavy metals, micro- (MP) and nanoparticles (NP) in the atmosphere and in water are the cause for concern. However, most of the information is based on studies from industrialized countries. India needs its own country-based study to have the exact idea and to develop the mechanistic pathways for the control.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy, affecting women, from adolescence to postmenopause. For two decades; PCOS has been defined in reproductive age group by the presence of two of three criteria according to Rotterdam criteria.The aim of this document is to highlight the pitfalls and drawbacks of Rotterdam criteria for diagnosis of PCOS after 20 years of application in clinical practice and to propose a novel evidence-based practical modification of these criteria.

Conclusion: After two decades of Rotterdam consensus, the diagnostic criteria of PCOS could be modified and revised based on evidence-based guidance into three groups: reproductive age, adolescent, and postmenopausal group. The spectrum of PCOS should start from isolated polycystic ovarian morphology, i.e., without hyperandrogenism (HA) and ovulatory dysfunction (OD) to full-blown phenotype (PCOM + HA + OD). Furthermore, each group could be subclassified into obese or lean with presence of IR or not.

Background: Global infertility affects over 186 million women, posing significant health and societal challenges. Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder among reproductive-aged women, often characterized by inflammatory dysregulation. Dietary factors exacerbate insulin resistance and ovulatory dysfunction in PCOS through heightened inflammation. Improving diet quality may mitigate hyperinsulinemia, hyperandrogenism, and inflammation, thereby reducing complications such as infertility. This study examines diet quality using the healthy eating index (HEI) and the dietary inflammatory index (DII) in women with PCOS experiencing infertility.

Methods: This case-control study enrolled 80 infertile patients diagnosed with PCOS, alongside 80 healthy individuals without PCOS. Dietary inflammatory Index (DII) and healthy eating index (HEI) scores were computed using a 168-item food frequency questionnaire. Spearman's correlation test was employed to assess variable relationships, and logistic regression was conducted to identify factors influencing PCOS risk.

Results: PCOS patients exhibited higher mean DII scores compared to controls (- 2.24 ± 0.80 vs. - 2.57 ± 0.93) and lower HEI scores (55.74 ± 4.89 vs. 58.64 ± 7.16). Adjusted analyses revealed significant inverse relationships between dietary inflammatory and health indices and PCOS risk. Comparison with CRP levels showed significant associations (P < 0.001), but not with other biochemical markers or insulin resistance (TYG index) (P > 0.05).

Conclusion: This study highlights the significant associations between DII, HEI, and the risk of infertility and PCOS. Improving diet quality may mitigate inflammation and associated PCOS complications, offering potential avenues for intervention and prevention strategies.

Transfusion management in patients with rare blood group phenotypes is a special challenge, especially in surgical cases. We report here the case of a 51-year-old female patient presenting with a huge pseudo-broad ligament fibroid and rare blood group phenotype. Initial serological testing during preoperative workup of the said case revealed BG discrepancies characterized by the O group on cell typing with an extra reaction with pooled 'O' cells on serum typing. A pan-agglutination pattern in antibody screening coupled with a negative direct antiglobulin test and auto-control indicated a Bombay or para-Bombay phenotype. Use of anti-H lectin, saliva secretor study, and antibody screening with cord O cells (Oi) aided in identifying para-Bombay phenotype. Transfusion support in this patient was challenging due to the presence of an anti-IH antibody acting at 37°. One of the major challenges to perioperative care was the unavailability of compatible donor blood units. An autologous transfusion approach was therefore adopted. After the uneventful surgical excision of the fibroid with minimal intraoperative blood loss, one unit of autologous blood was transfused to the patient. This case exemplifies the importance of comprehensive pre-transfusion testing and meticulous planning for patients with rare blood group phenotypes in order to minimize the risk of transfusion reactions and optimize surgical outcomes. Because the rare phenotype of the para-Bombay and transfusion are often problematic, rare donor registries and a heightened degree of clinical awareness will serve to improve patient safety in these instances.

Background: There is trend towards increased caesarean deliveries in the modern era. One of the most common negative effects of caesarean births is post-operative infectious morbidity. In addition to antibiotic prophylaxis, it has long been advised to prepare the surgical site with povidone-iodine to reduce presence of bacterial and fungal organisms near the skin or vagina. We thus concentrated on researching use of 1% povidone iodine vaginally preoperatively to prevent post-caesarean section endometritis in our hospital.

Methods: This was a prospective, observational, case-control study. All pregnant women undergoing LSCS fulfilling the inclusion criterion were recruited and divided into two groups. All characteristics were recorded in specially designed Case Report Form, and patients were reviewed for 6 weeks for outcome measures. The data were analysed using Excel sheets, and Chi-square test and independent sample t-test were applied to analyse the statistical significance.

Results: The cases were found to have undergone significantly greater mean number of pelvic examinations than the controls (p value < 0.0001). Greater proportion of controls developed endometritis and fever than the cases, and this value was statistically significant (p < 0.05). Wound infection and post-LSCS CRP levels were greater among controls as compared to cases, but this was not statistically significant.

Conclusion: Incidence of post-caesarean endometritis and fever was significantly lower among cases as compared to controls. Application of povidone iodine is a simple and cost-effective method which can be implemented on a larger scale in order to reduce caesarean related morbidity.