BACKGROUNDHigh risk pregnancies poses a threat for fetoplacental vascular supply and are a risk for fetal growth retardation. Umbilical artery Doppler velocimetry is an important test among the invasive tests used for evaluating the fetal well-being. This study was taken to detect any abnormalities in fetoplacental unit and fetal circulation in high risk pregnancies, to identify the hypoxemic fetus and time the delivery before the occurrence of academia and to compare the perinatal outcome with doppler indices. STUDY DESIGN AND RESULTSThirty (30) patients with gestational age at or beyond 32 weeks of gestation who belong to high-risk pregnancies were included in the study and were subjected to clinical examination, biochemical tests, ultrasound and colour Doppler study. They were serially followed up with ultrasound and color Doppler at 34 and 36 weeks respectively. Findings of USG and Doppler studies were correlated with the perinatal outcomes. The uterine artery, umbilical artery and the Middle Cerebral Artery (MCA) Doppler indices for the corresponding gestational age were compared with the reference values. The middle cerebral artery Doppler index was considered abnormal, if the value was below the 5th percentile of previously published values for gestational age. A single cut off value (1.08) was used for Cerebroplacental Ratio (MCA PI/UA PI), above which the cerebro-placental ratio was considered normal and below which it was considered abnormal. CONCLUSIONSThe degree of abnormality in Doppler indicates the degree of fetal compromise. Absent End Diastolic Flow (AEDF) represents the extreme form of altered velocity in the umbilical arteries and it represents the fetus at highest risk of hypoxia. Reverse End Diastolic Flow (REDF) is an ominous sign indicating that the vascular resistance has reached a point where the blood flow is reversed during diastole indicating acidotic fetus. The foetuses with abnormal wave forms suffer from chronic hypoxia and are usually growth retarded. They are at increased risk for hypoxia and acidemia. The present study shows that in the high-risk pregnancies, serial Doppler velocimetry helps the obstetrician to identify fetus at hypoxia and timely delivery preventing acidemia.

Amniotic fluid index (AFI) is one of the indicators of fetal well-being. Fetal umbilical artery Doppler velocimetry is a newer modality in assessing the fetal wellbeing, and thus helps in identifying compromised fetuses. OBJECTIVE: To study the perinatal outcome in ultrasono graphically detected normal and decreased AFI ≥ 34 weeks of gestation and to compare the usefulness of umbilical artery Doppler velocimetry and AFI in predicting the perinatal outcome in oligohydramnios ≥ 34 weeks of gestation. METHODOLOGY: This is a comparative, non-randomized study done over a period of 18 months on 150 pregnant women between gestational ages of 34-42 weeks. Ultrasonography was done for all women and AFI was calculated by four quadrant technique. Umbilical artery Doppler velocimetry was done in cases of AFI ≤ 5 cm. RESULTS: There was increased incidence of intrauterine growth restriction (IUGR), labour induction, and caesarean section for fetal distress and NICU admission in cases with AFI < 5 cm, compared to cases with AFI > 5 cm. Among the cases with oligohydramnios, cases with abnormal umbilical artery Doppler velocimetry had higher incidence of IUGR, LSCS for fetal distress and NICU admissions compared with normal umbilical artery Doppler. CONCLUSION: AFI ≤ 5 cm after 34 weeks of gestation is an indicator of poor perinatal outcome. Umbilical artery Doppler velocimetry in cases with oligohydramnios would help in identifying high risk cases for poor perinatal outcome. Hence, all patients with oligohydramnios, umbilical artery Doppler should be done to recognize the compromised fetus and thus reducing the perinatal morbidity and mortality.

Background: Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. Puberty menorrhagia is excessive bleeding occurring between menarche and 19 years. The leading cause of puberty menorrhagia is hypothalamic pituitary-ovarian axis immaturity followed by bleeding disorders and endocrine disorders. Excessive blood loss leading to anemia has a negative impact over the development and quality of life of the adolescent, requiring immediate attention to these cases. The objective is to evaluate the treatment modalities in the management of cases of puberty menorrhagia admitted in a tertiary care center. Aims and Objectives: The aim of the study was to evaluate the treatment modalities in the management of cases of puberty menorrhagia admitted in a tertiary care center. Materials and Methods: A retrospective and observational study was done on adolescents admitted for management of puberty menorrhagia in Kempegowda Institute of Medical Sciences over a period lasting from January 2017 to October 2021 from hospital records. Results: Among the 35 admitted, 42% belonged to the age group 10–14 years. About 62.8% presented with symptoms lasting <6 months. About 20% presented with hemoglobin <4 g, 51.4% with hemoglobin between 4 g and 6 g, 28.6% with 6 g to 8 g. About 57.2% of patients had anovulatory cycles, 25.7% were PCOS, 11.4% had hypothyroidism, and 5.7% had fibroid uterus. About 42% ultrasonographies showed PCOS, 5.7% had fibroid uterus. The approach to managing these patients depends on the presentation of the patient. Severe anemia is treated with blood transfusion for anemia correction. For the cessation of bleeding anti fibrinolytic tranexemic acid, ethamsylate and hormone therapy with medroxyprogesterone and norethisterone is used. Combined oral contraceptives are also used. In our study, 20% received tranexemic acid and hematinics. About 31.42% received blood, hematinics, and tranexemic acid, 11.42% received hematinics, tranexemic acid, and thyroxine, 17.14% received blood, haematinics, tranexemic acid, and progesterone, 8.57% received hematinics, tranexemic acid, and COCs, 11.42% received hematinics, tranexemic acid, and progesterone. Conclusion: Patients with severe anemia required treatment with packed cells while moderate anemia were corrected with parenteral iron. To control bleeding, tranexemic acid and ethamsylate were sufficient but in 45% of them bleeding was persistent and in them, progestins like medroxyprogesterone and norethisterone were required for cessation of bleeding. In cases where hypothyroidism was diagnosed, thyroxine was started. Medical management was successful in all cases.

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Background: Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional or material quality of life. Puberty menorrhagia is excessive bleeding occurring between menarche and 19 years. Abnormal bleeding amounts to 50% of gynaecological visits in adolescent girls. The leading cause of puberty menorrhagia is hypothalamic pituitary, ovarian axis immaturity followed by bleeding disorders, endocrine disorders. Excessive blood loss leading to anaemia has a negative impact over the development and quality of life of the adolescent, requiring immediate attention to these cases. The objective was to evaluate the incidence, etiology and management of puberty menorrhagia requiring in-patient care.Methods: A retrospective observational study was done on adolescents admitted for management of puberty menorrhagia in Kempegowda Institute of Medical Sciences over a period lasting from January 2017 to October 2021 from hospital records.Results: Amongst the 35 admitted, 42% belonged to the age group 10-14 years. 62.8% presented with symptoms lasting less than 6 months. 20% presented with haemoglobin less than 4 gm, 51.4% with haemoglobin between 4 gm to 6 gm, 28.6% with 6 gm to 8 gm. 57.2% patients had anovulatory cycles, 25.7% were PCOS, 11.4% had hypothyroidism and 5.7% had fibroid uterus. 42% ultrasonographies showed PCOS, 5.7% had fibroid uterus. The approach to managing these patients were with a combination of hormone therapy, hematinics, blood transfusion and anti fibrinolytics like tranexemic acid. 20% received tranexemic acid and hematinics. 31.42% received blood, hematinics and tranexemic acid, 11.42% received hematinics, tranexemic acid and thyroxine, 17.14% received blood, hematinics, tranexemic acid and progesterone, 8.57% received hematinics, tranexemic acid and COCs, 11.42% received hematinics, tranexemic acid and progesterone.Conclusions: In conclusion, the leading cause of puberty menorrhagia was anovulatory cycles, followed by PCOS and then by endocrine dysfunction. Medical management was successful in all cases.