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2017 | July-December | Volume 5 | Issue 2

ORIGINAL ARTICLE

Priyankur Roy, Vineet Mishra, Rohina Aggarwal, Khushali Gandhi, Shaheen Hokabaj

Study of Intravenous Ferric Carboxymaltose in Iron Deficiency Anemia in Women attending Gynecological Clinic: Safety and Efficacy

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:4] [Pages No:71 - 74]

PDF  |  DOI: 10.5005/jp-journals-10032-1110  |  Open Access |  How to cite  | 

Abstract

Introduction

Several intravenous iron preparations are available for the treatment of iron deficiency anemia (IDA). Some of these require multiple small infusions to prevent labile iron reactions, while iron dextran (DEX) is associated with a risk of potentially serious anaphylactic reactions. Ferric carboxymaltose (FCM), a non-DEX intravenous iron, is an effective and a safe option, which can be administered in high single doses without serious adverse effects.

Objective

The objective of the study was to evaluate the efficacy and safety of FCM in the treatment of IDA in gynecological patients.

Materials and methods

It was an open, single-arm study including 442 women of age more than 18 years with definitive diagnosis of IDA and hemoglobin (Hb) between 4 and 11 gm% from December 2013 to November 2016. Out of these, 25 women were lost to follow-up and were excluded from the study. Intravenous FCM (500—1500 mg) was administered and the improvement in Hb levels and iron stores was assessed after 3 weeks of total dose infusion.

Results

Out of the 442 women, 417 women were included in the analysis. Most of the women were in the age group of 30 to 39 years. Most of the women had mild anemia as per the World Health Organization (WHO) guidelines. Mean Hb levels significantly increased over a period of 3 weeks after FCM administration. Other parameters like total iron-binding capacity (TIBC), ferritin, and iron also had a significant improvement after FCM administration. No serious life-threatening adverse events were observed after FCM administration.

Conclusion

Intravenous FCM is an effective and a safe treatment option for IDA and has an advantage of single administration of high doses without serious adverse effects.

How to cite this article

Mishra V, Roy P, Gandhi K, Hokabaj S, Aggarwal R. Study of Intravenous Ferric Carboxymaltose in Iron Deficiency Anemia in Women attending Gynecological Clinic: Safety and Efficacy. J South Asian Feder Menopause Soc 2017;5(2):71-74.

ORIGINAL ARTICLE

Shaikh Zinnat Ara Nasreen, Safinaz Shahreen, Saleheen Huq, Sabereen Huq

Treatment Dilemma of Simple Cyst in Menopausal Women

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:6] [Pages No:75 - 80]

PDF  |  DOI: 10.5005/jp-journals-10032-1111  |  Open Access |  How to cite  | 

Abstract

Objective

Can we offer conservative treatment for the menopausal women who are having simple cysts?

Study design

It is a prospective cross sectional study carried out in ZHSikder medical college & hospital, Medinova and Popular hospital. The study period was from january 2011 to January 2016.

Materials and methods

500 menopausal women with simple cysts were enrolled after counseling and taking written consent. Inclusion criteria was cysts size should not be more than 5 cm, they should be unilocular, without having any solid component or any debris. Exclusion criteria was women with family history of cancer of ovary, breast, or colon or women with HRT therapy. Thorough history taking, clinical examination, and some investigation like CA125, TVS with Color Doppler was carried out for all the women. CT Scan.MRI, and PET Scan were reserved for selected cases. All the patients were followed up every 3 monthly for 3 to 5 years. Surgery was done if the patient developed any symptoms, or increment of sizes of cysts or there was any sonographic changes were evident. MRI1 (malignancy risk index ) was calculated for each patient. Data were analyzed by SPSS where all calculation rate of less than 0.05 was considered significant.

Results

Among 500 cysts, 285 (57%) cysts resolved spontaneously which is highly significant( p = < 0.05), 165 (33%) cysts needed surgery and only 50(10%) cysts remained without significant changes. Histopathology of surgical specimen revealed all were benign except 4 cysts, i.e., < 1% became malignant or malignant potential.

Conclusion

Menopausal women with simple cysts not more than 5cm,which are unilocular, unilateral, without having any solid component and with normal Doppler study are rarely malignant. So if MRI1 is below 200 we may avoid unnecessary surgery and assure the menopausal women for the conservative treatment with regular follow up.

How to cite this article

Nasreen SZA, Shahreen S, Huq S, Huq S. Treatment Dilemma of Simple Cyst in Menopausal Women. J South Asian Feder Menopause Soc 2017;5(2):75-80.

ORIGINAL ARTICLE

Krutika Bhalerao, Anuja V Bhalerao, Richa Garg

To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:6] [Pages No:81 - 86]

PDF  |  DOI: 10.5005/jp-journals-10032-1112  |  Open Access |  How to cite  | 

Abstract

Introduction

Vaginal vault prolapse can be prevented by supporting the vaginal cuff, which is an essential part of hysterectomy, whether done abdominally or vaginally. The American Association of Gynecologic Laparoscopists (AAGL) has recommended for future research, specifically, a randomized trial comparing McCall's culdoplasty (with uterosacral ligament plication) with vaginal high uterosacral ligament suspension (HUSLS) (without plication), since both procedures are accessible to gynecological surgeons without urologic background. Hence, this study was carried out.

Aim

To compare both anatomic and functional outcomes of patients undergoing vaginal HUSLS or McCall's culdoplasty at the time of vaginal hysterectomy.

Materials and methods

This hospital-based prospective comparative study was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining Ethical Committee approval. All women attending gynecological outpatient department having symptom of mass coming out of vagina were subjected to detailed history, examination, and later underwent either HUSLS (43) or McCall's culdoplasty (42), for vault suspension with concomitant hysterectomy. The effectiveness of both the procedures was assessed by preoperative and postoperative pelvic organ prolapse quantification (POP-Q) and both were compared.

Observations

There was statistically significant improvement in all the sites of POP-Q points by HUSLS and McCall's culdoplasty as a method of vault suspension except in total vaginal length (TVL). Vault suspension by HUSLS is better than McCall's culdoplasty. All the points of POP-Q showed better results but the point C was significantly placed at a higher level by HUSLS (p = 0.000) as compared with McCall's culdoplasty. The time required for HUSLS was statistically more as compared with repair by McCall's culdoplasty (81.55/74.53 minutes, T: 1.981, p: 0.05). Complications, such as hemorrhage and ureteric injuries were more in HUSLS (2/43, 4.8%) as compared with McCall's culdoplasty (0/42); this is statistically significant.

Conclusion

High uterosacral ligament suspension provides excellent suspensory support to vaginal vault. Vagina is suspended over the levator ani with normal axis toward sacrum. By doing HUSLS, the vagina is symmetrically supported directed toward the hollow of sacrum. High uterosacral ligament suspension is highly recommended for young women with POP as vaginal length is not altered at all and so is the quality of life.

How to cite this article

Bhalerao AV, Bhalerao K, Garg R. To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):81-86.

ORIGINAL ARTICLE

G Ganitha, PB Premalatha, Iyanar Kannan

A Study of the Age of Menopause and Menopausal Symptoms among Women in a Rural Area of Tamil Nadu, India

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:87 - 91]

PDF  |  DOI: 10.5005/jp-journals-10032-1113  |  Open Access |  How to cite  | 

Abstract

Aim

The aim of this study is to determine the age and symptoms of menopause, and attitude and perception of postmenopausal women toward menopause in a rural area of Tamil Nadu.

Materials and methods

This is a cross-sectional observational study of 500 women in a rural area of Tamil Nadu. Women aged 40 to 55 years who had attained natural menopause and had cessation of menses for at least 1 year were included in the study. Women who had attained surgical menopause or menopause secondary to medical illness were excluded from the study. A self-structured questionnaire was used to collect information.

Results

The mean age of attaining menopause was 45.75 ± 3.83 years; 87% women were symptomatic with at least one symptom. Majority of women (78.2%) had psychosomatic symptoms followed by vasomotor symptoms (55.8%); 68.4% women welcomed menopause with positive attitude; 19.4% women were indifferent and 12.2% women had negative attitude toward menopause. About 24% women felt that the symptoms of menopause were distressing; 23.2% women availed some form of treatment for their symptoms.

Conclusion

Many women are affected by menopausal symptoms. Some women are affected severely by these symptoms. Lack of awareness, economic factors, sociocultural factors, myths, and inaccessibility to health services can negatively affect the attitude of women toward menopause.

Clinical significance

Menopause is an important transitional phase of life in all women. The waning ovarian hormone level causes several symptoms, some of which can be distressing to some women. Age and symptoms of menopause are influenced by several factors. Attitude and perception of women toward menopause reflect the awareness and health care accessibility in the community. Creating awareness of menopausal symptoms can improve utilization of health services and the quality of life of postmenopausal women.

How to cite this article

Ganitha G, Premalatha PB, Kannan I. A Study of the Age of Menopause and Menopausal Symptoms among Women in a Rural Area of Tamil Nadu, India. J South Asian Feder Menopause Soc 2017;5(2):87-91.

ORIGINAL ARTICLE

Krutika Bhalerao, Anuja V Bhalerao, Richa Garg, Amishi Vora

To Compare the Effectiveness of Traditional Anterior Colporrhaphy, Posterior Colpoperineorrhaphy with Site-specific Anterior and Posterior Repair for Pelvic Organ Prolapse

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:7] [Pages No:92 - 98]

PDF  |  DOI: 10.5005/jp-journals-10032-1114  |  Open Access |  How to cite  | 

Abstract

Background

Pelvic organ prolapse (POP) is a common health problem affecting 40% multiparous women above 35 years of age. Lifetime risk of women requiring surgery for recurrence is 10%. The POP is intricious due to complex pelvic anatomy, and difficulty increases due to tissue weakness, lack of evidence-based surgical guidelines, and lack of standardized definition for surgical success, which results in highly variable estimates of success.

Aim

To compare the effectiveness of traditional anteroposterior repair with site-specific repair with concomitant vaginal hysterectomy with respect to anatomical considerations by POP-Q and functional or symptomatic considerations, complications, duration of surgery, and recurrence.

Materials and methods

This hospital-based randomized controlled trial was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining ethical committee approval. All women attending the gynecological outpatient department having symptoms of mass coming out of vagina were subjected to detailed history and examination and 51 women underwent traditional anterior and posterior repair and 44 women underwent site-specific repair with concomitant hysterectomy, with random sampling according to computerized sheet. The effectiveness of both the surgeries was assessed and compared.

Observations

There was statistically significant improvement in all the sites of POP-Q points using traditional repair and site-specific repair. When compared, site-specific repair by POP-Q was better than traditional method.

Conclusion

Site-specific repair of decussated natural tissue has great curative potential, and success is attributable to site-specific repair, rather than nonspecific scar formation by traditional method. Thus, it is important to properly quantify the repair to be done, whether anterior or posterior, and perform site-specific repair.

How to cite this article

Bhalerao AV, Vora A, Bhalerao K, Garg R. To Compare the Effectiveness of Traditional Anterior Colporrhaphy, Posterior Colpoperineorrhaphy with Site-specific Anterior and Posterior Repair for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):92-98.

ORIGINAL ARTICLE

Kshama V Kedar, Radha P Munje, Amar K Karia

Effect of Menopause on Pulmonary Functions: An Analysis!

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:99 - 101]

PDF  |  DOI: 10.5005/jp-journals-10032-1115  |  Open Access |  How to cite  | 

Abstract

Introduction

Sex hormones play an important role in women's health. There is a close relationship between female sex hormones and lung function in postmenopausal women. Deterioration of lung function is observed more after menopause. Estrogen deficiency after menopause accelerates the adverse effects of biological aging on lung mechanics in postmenopausal women. Our study uses a spirometer to analyze and evaluate these effects of menopausal aging.

Objective

To study the effects of menopause on pulmonary function tests in women of perimenopausal age group.

Materials and methods

This study was carried out in the Department of Obstetrics and Gynecology in Indira Gandhi Government Medical College & Hospital (IGGMC) Nagpur, India. Totally 50 women each in premenopausal and menopausal age groups were included in our study. Venous blood was collected under aseptic precautions on 10 to 14 and 18 to 23 days corresponding to follicular and luteal phase of menstrual cycle in premenopausal and postmenopausal women. Serum estrogen and progesterone levels were estimated by microparticle enzyme immunoassay. The pulmonary function of all subjects was measured with digital microspirometer and data collected. The peak expiratory flow rate (PEFR), forced expiratory flow (FEF)25-75, forced expiratory volume (FEV1), and forced vital capacity (FVC) were studied and correlated with symptoms. Data analysis was done using Student's unpaired t-test and chi-squared test.

Results

The mean percentages of predicted values of FEF25-75 and PEFR were lower in postmenopausal women compared with premenopausal women. Mean serum estrogen levels were significantly lower in postmenopausal women as compared with premenopausal women. Progesterone levels were lower in postmenopausal women and in proliferative phase of premenopausal women as compared with luteal phase of menstrual cycle.

Conclusion

As menopause sets in, decrease in hormonal levels leads to decreased lung capacity as evident by pulmonary function tests. Decreased pulmonary function test can be attributed to lower levels of sex hormones estrogen and progesterone in postmenopausal women.

How to cite this article

Karia AK, Kedar KV, Munje RP. Effect of Menopause on Pulmonary Functions: An Analysis! J South Asian Feder Menopause Soc 2017;5(2):99-101.

ORIGINAL ARTICLE

Ferdousi Begum, Setara B Kasem, Shaikh A Razzaque, Raisa Adiba, Selma Anika

Role of Colposcopy in the Evaluation of Visual Inspection of Cervix with Acetic Acid-positive Cases of Unhealthy Cervix

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:102 - 106]

PDF  |  DOI: 10.5005/jp-journals-10032-1116  |  Open Access |  How to cite  | 

Abstract

Introduction

Cervical cancer is the second most common cancer in women worldwide, and it is the principal cancer of women in most developing countries, where 80% of cases occur. This disease is preventable by screening and treatment of preinvasive condition. All sexually active women are at risk of acquiring a human papillomavirus (HPV) infection that may lead to cervical cancer in the future. Cervical cancer is a preventable disease as the different screening, diagnostic, and therapeutic procedures are effective. The screening procedures are visual inspection of cervix with acetic acid (VIA), Pap smear, colposcopy, and HPV deoxyribonucleic acid test. Among them, colposcopy is effective in screening, taking colposcopy-directed biopsy as well as treatment of cervical intraepithelial neoplasia (CIN), such as cold coagulation, cryotherapy, and loop electro-surgical excision procedure. Hence, there is an obvious need to subject the women with VIA-positive report to colposcopy and directed biopsy. This study is done to evaluate the role of colposcopy in evaluation of VIA-positive cases.

Objective

Colposcopic evaluation of VIA-positive cases and detection of precancerous lesion of cervix for early management.

Materials and methods

This was a cross-sectional study done among married female patient aged 22 to 65 years, who had VIA-positive report, and attending the colposcopy clinic in the Department of Obstetrics and Gynecology of Sir Salimullah Medical College and Mitford Hospital from January 2014 to December 2016. Colposcopy-directed punch biopsy was taken from the abnormal colposcopic appearance and specimen sent for histopathological examination.

Results

Out of 97 cases, all had VIA-positive acetowhite areas. But colposcopy revealed that 76.29% had CIN and invasive lesions, while 23.71% had either normal or inflammatory lesions. Colposcopy-directed punch biopsy revealed that 59.79% cases had positive lesions like CIN or invasive carcinoma and 40.21% had neither CIN nor invasive lesions. Among positive lesions, about 34.02% had CIN I, 3.09% had CIN II, 0% had CIN III, and 22.68% had invasive carcinoma. In this study, sensitivity and specificity of colposcopy examination were found 94.83 and 51.28% respectively.

Conclusion

Cervical cancer presents as major cause of morbidity and mortality, especially in developing countries like Bangladesh. In developing countries, the various screening programs are implemented for its early detection and treatment. It is evident that colposcopy plays a very important role in early diagnosis and treatment of preinvasive and early invasive carcinoma of cervix. So wide use of colposcopy in screening program of Bangladesh can reduce many young women's morbidity and mortality.

How to cite this article

Kasem SB, Razzaque SA, Adiba R, Anika S, Begum F. Role of Colposcopy in the Evaluation of Visual Inspection of Cervix with Acetic Acid-positive Cases of Unhealthy Cervix. J South Asian Feder Menopause Soc 2017;5(2):102-106.

RESEARCH ARTICLE

Ritu Sharma, Savita R Singhal

Evaluation of the Role of Ormeloxifene in Abnormal Uterine Bleeding

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:4] [Pages No:107 - 110]

PDF  |  DOI: 10.5005/jp-journals-10032-1117  |  Open Access |  How to cite  | 

Abstract

Aim

This is a prospective study to find the effect of ormeloxifene on menstrual blood loss and its side effects in patients with abnormal uterine bleeding (AUB).

Materials and methods

Fifty women in the age group of 30 to 52 years with AUB were enrolled in the study. After baseline assessment, each patient was given 60 mg of ormeloxifene orally twice a week for first 3 months, then once a week for the next 3 months. The patients were followed up after 1, 3, and 6 months. The effect of ormeloxifene was evaluated by a change in the pictorial blood loss assessment chart (PBAC) score, passage of clots during menstruation, hemoglobin level, endometrial thickness (ET), and dysmenorrhea. Side effects of the drug were also noted at each visit; p-value < 0.05 was taken as significant.

Results

There was statistically significant reduction in median PBAC score from baseline 360 to 113, 73, and 41.5 after 1, 3, and 6 months. There was significant reduction in ET, passage of clots, and dysmenorrhea at each visit. Mean hemoglobin level increased significantly by 1.56 gm% after 6 months treatment. Adverse effects included amenorrhea (28%), ovarian cyst (11.3%), nausea (4.5%), headache (2%), and weight gain (4.5%). There was no major side effect requiring termination of treatment.

Conclusion

Ormeloxifene is a safe and efficacious alternative for medical therapy in the management of AUB.

Clinical significance

Ormeloxifene can be used in women with AUB to avoid the side effects of hormonal treatment and unnecessary hysterectomies.

How to cite this article

Sharma R, Singhal SR. Evaluation of the Role of Ormeloxifene in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2017;5(2):107-110.

RESEARCH ARTICLE

Lineo Matsela, Olakunle Towobola, Ephraim T Mokgokong

Osteoporosis in Black South African Women: Myth or Reality

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:6] [Pages No:111 - 116]

PDF  |  DOI: 10.5005/jp-journals-10032-1118  |  Open Access |  How to cite  | 

Abstract

Aim

The study was conducted to ascertain the severity of the occurrence of osteopenia and osteoporosis among black South African women during their transition from premenopause to postmenopause.

Materials and methods

Sixty-eight black South African women, aged between 32 and 77 years, residents of three districts of Pretoria, South Africa, constituted the participants in the study. Following informed consent, the women were randomly recruited and assessed for age, medical history, and lifestyle data. Each woman was classified as being premenopause, perimenopause, or postmenopause based on her menstrual history within the preceding 12 months to the study. Bone mineral density (BMD) of the L1-L4 vertebrae and the hip vertebrae was measured using dual-energy X-ray absorptiometry (DEXA) method and the results were expressed as T-scores based on World Health Organization (WHO) classifications for osteopenia and osteoporosis.

Results

Osteopenia was found in 2 of the 8 (25%) premenopausal women aged 37 and 38 years. Similarly, 2 perimenopausal women out of the 28 (7.1%), aged 45 and 49 years, also had evidence of osteopenia. Among 32 postmenopausal women, 11 (34.4%) had osteopenia and 8 (25%) were diagnosed with osteoporosis. There was no statistical significant difference (p = 0.0832) for osteopenia between premenopausal and perimenopausal women. However, the incidence of osteopenia became statistically significant between premenopausal and postmenopausal women (p = 0.0137), and between perimenopausal and postmenopausal women (p = 0.0218).

Conclusion

Even from this small cohort study, it is apparent that osteoporosis does afflict postmenopausal black South African women. The need to institute screening strategies and appropriate guidance to prevent osteoporosis in these women is strongly advocated.

Clinical significance

The study draws special attention to the necessity to investigate black South African women for early detection of osteopenia and osteoporosis.

How to cite this article

Matsela L, Towobola O, Mokgokong ET. Osteoporosis in Black South African Women: Myth or Reality. J South Asian Feder Menopause Soc 2017;5(2):111-116.

Source of support

The authors herewith express their gratitude to both MSD (South Africa) and the South African Menopause Society for their financial donations, which enabled the DEXA evaluations of participants in this study.

RESEARCH ARTICLE

Lineo Matsela, Olakunle Towobola, Ephraim T Mokgokong

Knowledge and Attitudes of Black South African Women toward Menopause: Impact of Culture and Traditions

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:6] [Pages No:117 - 122]

PDF  |  DOI: 10.5005/jp-journals-10032-1119  |  Open Access |  How to cite  | 

Abstract

Introduction

Vasomotor symptoms of menopause could affect the quality-of-life of most women. The understanding of menopause by African women and the coping mechanisms of these women are essential factors that may be influenced by culture and traditions. This study has evaluated the psychosomatic and sociodemographic profiles of menopausal black South African women in order to ascertain the role played by their culture and traditions during the menopausal years.

Materials and methods

The study was carried out at three periurban districts close to the city of Pretoria, South Africa. A qualitative, prospective, community-based, cohort study was conducted over a 2-year period. The targeted population included women between 40 and 80 years, and each woman was interviewed using a structured questionnaire. Data on sociodemographic, psychosomatic profiles of the women as well as cultural and traditional beliefs relating to menopause were documented. The data from the study were analyzed by descriptive statistics.

Results

Totally, 450 women were interviewed: 250 (perimenopausal) and 200 (postmenopausal). The ages of the women ranged between 42.5 and 50.8 years (perimenopausal) and between 51.5 and 68.4 years for postmenopausal women. Only 20% of the women interviewed for the study had no formal education and 78% of them were financially independent. The percentage of the women who had an understanding of menopause and expressed cultural explanations for it was 96%. The women explained the impact of support systems on which they relied and by which their attitudes toward menopause were greatly influenced. Knowledge of hormone replacement therapy (HRT) and its importance in the alleviation of vasomotor symptomatology ranged between 80 and 84%, yet the women were reluctant to seek medical remedy for their vasomotor symptoms.

Conclusion

The study provides insight into the impact that traditions and culture of black South African women have on their capacity to cope with menopause.

How to cite this article

Matsela L, Towobola O, Mokgokong ET. Knowledge and Attitudes of Black South African Women toward Menopause: Impact of Culture and Traditions. J South Asian Feder Menopause Soc 2017;5(2):117-122.

RESEARCH ARTICLE

Nikhitha Chandrashekar, Jyothi GS, Prasanna Shetty

Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:6] [Pages No:123 - 128]

PDF  |  DOI: 10.5005/jp-journals-10032-1120  |  Open Access |  How to cite  | 

Abstract

Aim

The objective of this study was to assess the adequacy of the sample aspirated in order to make a definite diagnosis of endometrial disease in abnormal uterine bleeding (AUB) and to draw comparisons between the histopathological findings of Pipelle endometrial aspiration biopsy and dilatation and curettage (D&C).

Materials and methods

Pipelle endometrial biopsy and D&C samples were collected from 100 patients with AUB in the Department of the Obstetrics and Gynecology and sent to the Department of Pathology of a tertiary care hospital for adequacy of the sample and for histopathological analysis.

Results

The Pipelle sample was adequate in 73% of the cases and inadequate in 27% compared with D&C, which showed 85% and 15%, respectively. About 53% of cases were comparable between D&C and Pipelle and 37% were discordant. For endometrial hyperplasia using Pipelle aspirator, the sensitivity was 58.8%, specificity was 91.6%, positive predictive value (PPV) was 58.8%, negative predictive value (NPV) was 91.6%, and concordance was 86%. For detection of endometrial carcinoma using Pipelle, the sensitivity was 50%, specificity was 99%, PPV was 50%, NPV was 99%, and concordance rate was 98%.

Conclusion

It is more convenient and cost-effective for patients to undergo pipelle biopsy to confirm normalcy and rule out endometrial hyperplasia rather than undergoing D&C initially. Out of the 27% of inadequate samples, 14.8% had fibroids and 11.1% had polyps, thus showing that tumors localized to a polyp or a small area of endometrium went undetected with Pipelle.

Clinical significance

Due to the high specificity and NPV and low sensitivity and PPV in diagnosing endometrial lesions and carcinomas, pipelle is suitable for women with a low risk of cancer. In cases where the diagnosis is hyperplasia on Pipelle, the patients are advised to undergo hysteroscopic-guided D&C following pipelle to confirm the diagnosis. This is also applicable for cases of polyps and fibroids.

How to cite this article

Chandrashekar N, Jyothi GS, Shetty P. Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2017;5(2):123-128.

RESEARCH ARTICLE

Disha A Rajput, Shalini M Valecha, Manisha Sarwade, Shrikant Dhumale

Burch Retropubic Urethropexy for Genuine Stress Urinary Incontinence: A Review of Eight Cases

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:4] [Pages No:129 - 132]

PDF  |  DOI: 10.5005/jp-journals-10032-1121  |  Open Access |  How to cite  | 

Abstract

Introduction

Urinary incontinence (UI) is more common than any other chronic disease with the prevalence of approximately 23 and 55%. Among the various forms of UI, stress incontinence (SUI) is the most common (49%), with urgency incontinence (UUI) representing 21% and mixed type (MUI) at 29%. As it affects the quality-of-life of women, the restoration of urinary continence is one of the greatest challenges.

Aim

To review the cases of genuine SUI treated surgically by Burch retropubic urethropexy.

Results

We have managed surgically eight cases of genuine SUI by Burch retropubic urethropexy. On 1-year follow-up, none of the patients had any urinary complaints. All had responded well to surgery and patient's satisfaction index was good.

Conclusion

Since SUI is the commonest among incontinences, it is a challenge to diagnose and treat to improve quality-of-life of patients. Burch retropubic urethropexy is the gold standard treatment for SUI, especially if other indications exist for abdominal surgery. Even in the present era of less invasive vaginal procedures, results are comparable.

How to cite this article

Rajput DA, Valecha SM, Sarwade M, Dhumale S. Burch Retropubic Urethropexy for Genuine Stress Urinary Incontinence: A Review of Eight Cases. J South Asian Feder Menopause Soc 2017;5(2):129-132.

RESEARCH ARTICLE

Anusha Kamath, Pariseema Dave, Meeta Mankad

Evaluation of Incompletely Staged Ovarian Malignancy: A Study in Western India

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:133 - 137]

PDF  |  DOI: 10.5005/jp-journals-10032-1122  |  Open Access |  How to cite  | 

Abstract

Introduction

Incomplete initial surgery complicates subsequent management of ovarian tumors. This study aimed to study demographic and clinical factors associated with incompletely staged ovarian tumor patients.

Materials and methods

Twenty five patients who had undergone incomplete staging surgery for ovarian tumors outside Gujarat Cancer & Research Institute, Ahmedabad, Gujarat, India, were included in this study. Their demographic and clinical features were studied in detail. Patients were either subjected to restaging or were referred for chemotherapy initially.

Results

Mean age of patients was 42 years (23—60 years); 64% of patients had abdominal pain as initial complaint; 64% patients were operated initially using a transverse incision. Only four patients were managed laparoscopically initially, others by laparotomy. Single/part of one ovary was removed in 60% of patients as part of initial surgery. Infundibulopelvic ligament was tied distally in 40% of patients. Omentectomy (Om) and lymphadenectomy were not done in most of the patients. Nineteen patients were found to have malignancy on final histopathological examination; 3 borderline malignancy; 1 granulosa cell tumor; and 2 benign tumors; 52% (n = 13) patients were subjected to chemotherapy; 4% (n = 1) were observed, and rest underwent restaging procedures.

Conclusion

Incompletely staged ovarian tumor patients, especially those with malignant histopathology, should be managed by gynecologic oncologists. The management needs to be individualized and cannot be a blanket therapy.

How to cite this article

Kamath A, Dave P, Mankad M. Evaluation of Incompletely Staged Ovarian Malignancy: A Study in Western India. J South Asian Feder Menopause Soc 2017;5(2):133-137.

CASE REPORT

Ashok S Komaranchath, Sindhu Gopalakrishnan, Shirly John, Pushpa Mahadevan, Lijesh Kumar

Endometrial Metastasis from an Occult Colonic Primary presenting with Massive Ascites

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:4] [Pages No:138 - 141]

PDF  |  DOI: 10.5005/jp-journals-10032-1123  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Komaranchath AS, Gopalakrishnan S, John S, Mahadevan P, Mathew J, Kumar L. Endometrial Metastasis from an Occult Colonic Primary presenting with Massive Ascites. J South Asian Feder Menopause Soc 2017;5(2):138-141.

CASE REPORT

Amrita Singh, Monika Anant, Vandita Y Singh

Papillary Squamotransitional Cell Carcinoma Cervix: A Rare Variant

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:3] [Pages No:142 - 144]

PDF  |  DOI: 10.5005/jp-journals-10032-1124  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Anant M, Singh A, Singh VY. Papillary Squamotransitional Cell Carcinoma Cervix: A Rare Variant. J South Asian Feder Menopause Soc 2017;5(2):142-144.

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