Background: Heavy menstrual bleeding (HMB) is defined as prolonged (>7 days) or excessive menstrual blood loss greater than or equal to 80 ml per menstrual cycle. The objective of the study was to assess the efficacy, acceptability and side effects of LUS IUS in women with heavy menstrual bleeding.Methods: 42 women with heavy menstrual bleeding with or without associated dysmenorrhoea or chronic pelvic pain and had no contraindication to IUS insertion were included in the study. Patients having active genital tract infection, suspicion of pregnancy, uterine fibroids >2.5 cm in size or sub mucosal distorting the uterine cavity, uterine size >12 weeks, atypical endometrial hyperplasia or malignancy, abnormal cervical cytology, coagulopathy or liver disease were excluded from the study. Preliminary endometrial biopsy was done to rule out malignancy and LNG IUS was inserted under anaesthesia. Women were followed for 3,6,12 and 24 months post insertion.Results: In first 3 months, 20% patients achieved normal menstrual cycle, and at 6 months 44.44% had scanty menstrual flow and after 1 year of use 81.5% achieved amenorrhoea. In initial 3 months 37.5% patients had irregular heavy bleeding, which reduced to 13.89% at 6 months and 0% at 1 year follow up. Irregular spotting was second most complaint in 32.5% patients in initial 3 months that persisted in 7.4% patients at 1year follow up. In 5.0% patients, there was spontaneous expulsion of the device in first 3 menstrual cycles. After 3 months of use 57.5% patients were satisfied with the device and at the end of 1 year 92.5% were satisfied.Conclusions: LNG IUS is highly effective in controlling blood loss, well tolerated and better alternative for hysterectomy with higher user satisfaction in all age group of women.

The perimenarcheal onset of polycystic ovarian syndrome (PCOS) has long been recognized, through both its pathophysiology and the frequent onset of hirsutism and menstrual irregularities in this age group. However, there is often a delay in diagnosing PCOS in adolescence because menstrual irregularity is frequently thought to be normal in the first 2 or 3 years after menarche, particularly if clinical signs of hyperandrogenism such as hirsutism or acne are mild or absent. This was a Cross-sectional Study consisting of 102 adolescent girls, aged 12 to 19 years, selected from patients attending the Gynecology Outpatient Clinic. In present study, level of insulin resistance along with markers of PCOS was assessed and compared in adolescent women with (cases) or without (controls) menstrual irregularities, a hall mark of PCOS. 18(35.29%) cases versus 01(1.96%) controls the Rotterdam criteria of PCOS. Clinical manifestations of hyper androgenism were not yet present in all cases who met Rotterdam criteria of PCOS, suggesting menstrual irregularity, especially oligomenorrhoea (83.3% of all PCOS (cases), as the most precocious marker of PCOS. CONCLUSIONS: Adolescents with persistent menstrual irregularities 2 years after menarche frequently have PCOS and elevated HOMA-IR values than controls, indicating a high probability of developing insulin resistance and metabolic syndrome later in life.

Introduction Vaginal discharge is the most frequent complaint during pregnancy, leading to numerous complications in both the mother and fetus. Aim The goal of this study was to determine the prevalence of vaginal discharge, investigate its common infectious causes and associated symptoms during pregnancy. Methods This hospital-based cross-sectional study performed over one year evaluated 200 expectant mothers with vaginal discharge at any trimester in the Department of Obstetrics and Gynecology, in cooperation with the Microbiology section, of Indira Gandhi Institute of Medical Science, Patna. Results The mean age of the mothers was 26.84±5.51 years (range 19-42 years). Most of the patients (47.5%) were in the age group of 26-35 years, belonged to the lower socioeconomic class (67.5%), gravida 3 or more (43.5%), and presented in the third trimester. The prevalence of pathological discharge in pregnancy was 148/308 (48.05%). A positive culture was obtained in 105 (52.5%), and negative culture was obtained in 95 (47.5%). Vaginal candidiasis was diagnosed in most cases (37.5%), followed by aerobic vaginitis (15%), trichomoniasis (13.0%), and bacterial vaginosis (8.5%). The non-pathological discharge was diagnosed in 26.0%. Dysuria was the most common symptom (32.5%), followed by itching (27.5%) and urinary tract infection (UTI; 10.0%). The following variables were significantly associated (P<0.05) with discharge: age (in years), age group, gravida, culture, organism isolated on culture, UTI as a symptom, and diagnosis. Conclusion Expectant mothers presenting with vaginal discharge need to be evaluated to identify the etiology and allow timely treatment, which might be helpful in preventing complications.

Background: Obstetric emergencies can occur suddenly and unexpectedly. Obstetrics is unique in that there are two patients to consider and care for, a mother and a baby or fetus. Identification and referral of high risk pregnancies are an integral part of maternal and child health services. Timeliness and appropriateness can reduce the incidence of obstetric emergencies. Present study was carried out to know the incidence, nature and outcome of obstetric emergencies.Methods: Retrospective study of obstetric emergencies admitted to Obstetrics and Gynaecology department of Indira Gandhi Institute of Medical science, Patna from March 2015 to September 2017.Results: The common clinical presentation was Ectopic Pregnancy (19.64%), Heart Disease (16.64%), Abortion (13.69%), Severe Anaemia (16.66%), Purpureal Sepsis (9.52%), Sever pregnancy induced hypertension (3.57%), Eclampsia/ HELLP Syndrome (2.38%), Multiple Pregnancy (1.19%) Malignancy Disorder with Pregnancy (2.97%) and HIV in pregnancy (0.59%). Intervention done include Dilation and evacuation (13.69%), Caesarean section (28.57%), Vaginal delivery (22.62%), Caesarean Hysterectomy (2.38%), Exploratory Laparotomy (20.83%) and conservative management in (11.90%) of patients. Maternal outcome include shock due to rupture ectopic and post-partum (16.68%), Blood Transfusion done in (27.99%), Septicaemia (15.48%), ICU admission (8.92%), HDU (12.5%), Pulmonary oedema (6.54%), DIC (4.16%), CCF (3.57%), Ventilatory Support (1.78%) and Maternal Mortality (2.38%). Fatal outcome includes live birth (58.8%), NICU Admission (27.45%), Ventilatory Support (7.84%) and Neonatal mortality (5.88%).Conclusions: High risk pregnancy identification and proper antenatal, intranatal and postnatal care will reduce the incidence of obstetrical emergencies. Peripheral health care system need to be strengthen and early referral need to be implemented for better maternal and fetal outcome.

Introduction: Pregnancy-related acute kidney injury (AKI) is a common occurrence and is associated with substantial maternal morbidity and mortality in developing countries. It may comprise up to 25% of the referrals to dialysis centers in developing countries. Acute kidney injury in pregnancy bears a high risk of bilateral renal cortical necrosis and consequently chronic renal failure. Study aimed to evaluate the contributing factors responsible for pregnancy-related Acute kidney injury and to assess the outcome of patients with pregnancy-related Acute kidney injury. Material and methods: The present study is a prospective study of patients with obstetric complications leading to Acute kidney injury admitted in Obs and Gynae Deptt and nephrology deptt of IGIMS for a period of one year. Pregnant women who are included in the study are those who were healthy previously and had developed Acute kidney injury-oliguria (Urine output <400 ml/d) and azotemia (Serum creatinine >2 mg%) due to pregnancy related complications. Results: Pregnancy related complications was present in 38 patients admitted in our hospital with acute kidney injury in one year period. Out of these 37% (14) of patients were in early stage of pregnancy while 63% (24) were in later stage of pregnancy and puerperium. Causes of AKI was post abortal sepsis in 23.6%, puerperal sepsis in 26.3%, haemorrhagic shock in 23.6%, eclampsia/pre-eclampsia/HELLP syndrome in 21%, IUD in 2 nd trimester with sepsis in 2.6% and acute fatty liver of pregnancy in 2.6% of cases. Sepsis was the major cause accounting upto 52.6% of cases. Approximately 52.6% (20) of patients improved on treatment and dialysis, 21% did not improve (8), 13.15% (5) died and 13.15% (5) left against medical advice. Cause of death in 80% (4 out of 5) of patients was sepsis. Renal biopsy was performed on 62.5% of patients who did not improve (5 out of 8 patients). Renal transplant was done in 1 patients. Conclusion: Obstetric AKI is still a critical situation in developing countries and rare entity in developed countries. Maternal mortality has decreased but sepsis still accounts for majority of cases. Therefore early diagnosis and treatment is the need of the hour.