Menstrual disturbances are common among adolescents with a prevalence rate of 11.3–26.7%. The most frequent menstrual irregularities are oligomenorrhea, menorrhagia, polymenorrhoea, and hypomenorrhea. PCOS (polycystic ovarian syndrome) is now recognized as the most prevalent endocrine disorder among the women of reproductive age. The current study was planned to evaluate socio-demographic factors, endocrine profiles, and ovarian morphology among adolescent girls with menstrual irregularities and compare these parameters in different phenotypes of adolescent PCOS cases. It is a hospital-based cross-sectional study among 248 adolescent girls (10–19 years) with menstrual irregularities. After obtaining informed consent, history and clinical examination findings were recorded on preform proforma. All girls were assessed on day 2/3 of the menstrual cycle for hormonal profile (serum TSH, FSH, LH, prolactin, and serum testosterone) and ovarian morphology (by transabdominal ultrasonography). All participating girls were divided into three groups (groups 1, 2, and 3) corresponding to phenotypes A, B, & D as per the Rotterdam criteria. In the study, oligomenorrhea was the most common menstrual disorder (70.97%). Biochemical hyperandrogenism and thyroid dysfunction were reported in 14.91% and 8.46% of girls, respectively. Our study noted that phenotype D ,i.e., group 3 (MI + PCOM-HA; 49.43%) was the most common phenotype in the study. In a comparative analysis of different groups, significant differences ( p < 0.05 ) in hormonal and metabolic parameters showed highest in group 2, which represents phenotype B of PCOS (hyperandrogenic anovulation). This analysis revealed that adolescent hyperandrogenism (phenotypes A and B) is associated with a more deranged hormonal and metabolic profile than nonandrogenic PCOS (phenotype D). To prevent long-term sequelae, lifestyle changes, early treatment, and close follow-up are recommended in this subset of girls.

The morbidly adherent placenta has evolved into one of the potentially life-threatening conditions in obstetrics. Vaginal bleeding is the most common presentation of placenta percreta. Other symptoms include unusual dull, prolonged lower abdominal pain. Although haematuria is rare, it may be a presentation of the morbidly adherent placenta in early pregnancy. We report a case of placenta percreta with a very uncommon presentation of gross haematuria early in the second trimester managed successfully. It is emphasized that a high index of suspicion, ultrasound, and/or MRI can establish a preoperative diagnosis of the invasive placenta earlier. However, the diagnostic accuracy of cystoscopy is still under debate. With timely diagnosis, preparedness, and multidisciplinary care, it is possible to minimize catastrophic complications.

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A 60-year-old, multiparous, postmenopausal woman presented with abdominal pain and vomiting. She had no history of surgery or malignancy. The abdomen was distended with guarding and rigidity. The patient underwent laparotomy for suspected bowel perforation with peritonitis. Intra-operatively, 1200 mL of purulent fluid was drained from the peritoneal cavity. A 1.5cm £ 1cm perforation, exuding purulent fluid, was found on the anterior aspect of uterus. The area surrounding the perforation was necrotic and gangrenous (Figure 1). On section, the endometrial cavity was found to be replaced by necrotic and gangrenous tissue; the endocervical canal was normal (Figure 2). The purulent drainage was found to be sterile on culture. Histopathological examination revealed chronic cervicitis with lympho-plasmocytic inflammatory infiltrate with no evidence of granuloma or malignancy.Spontaneous rupture of uterus is an extremely rare complication of pyometra 1 ; however more than 40% of cases of spontaneous perforation of pyometra are fatal. Thus, urgent hysterectomy with bilateral salpingo-oophorectomy and thorough peritoneal lavage are warranted. 2