Background: Hysterectomy is the commonest major surgical procedure performed in gynecology. It is an effective treatment option for many gynecological conditions. Aim and objective of the study was to analyse the indications, complications of hysterectomies and to see whether preoperative clinical diagnosis was confirmed by histopathology.Methods: Authors present a retrospective study of 198 hysterectomised cases over a period of one year from January 2016 to December 2016. The data regarding patients age, parity, indication for hysterectomy, type of hysterectomy, complications during and after surgery and final histopathological diagnosis were collected from the records and analysed.Results: A total of 198 cases of hysterectomies were studied. Hysterectomies were distributed over a wide age ranging from 32 years to 75 years. Most common age group was 41-50 years. Majority were done through abdominal route 162 cases (81%). Most common indication was abnormal uterine bleeding 56 (28%) and fibroid 41 (21%). One case of accidental bladder injury was noted. Most common postoperative complication was fever (23%). Most common histopathological lesion was fibroid 101 (51%). In three cases preoperative clinical diagnosis did not correlate with final histopathological diagnosis.Conclusions: As any surgical procedure, hysterectomy is also associated with risk of complications. Hence the indication should be carefully evaluated. Reporting of all hysterectomies should be made mandatory and audit results should be used for improvement of quality of health service. Newer and less invasive treatment options should be offered to women with benign pathologies. This will further reduce the incidence of hysterectomy.

Aim:The purpose of the study is to discuss about the presentation and management of adolescent adnexal torsion at ESIC Medical College and PGIMSR. Materials and methods: This is a case series study of adolescents with adnexal torsion, from December 2019 to March 2022 at ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India. Detailed history and clinical examination followed by ultrasonography with Doppler pelvis were done. The type of surgery and the histopathological findings were studied. Written informed consent was taken from all the subjects for publishing the data and images. Results: All patients presented with acute onset of abdominal pain. Eight patients had vomiting. Six patients had right-sided torsion and four patients had left-sided torsion. Laparotomy was done for nine cases. A laparoscopy was done for one case. Only two patients underwent salpingo-oophorectomy due to necrotic changes. The ovary was preserved in eight patients. Two patients had oophoropexy done. One was for recurrent torsion and the other case had undue long ovarian ligament and fallopian tube. Conclusion: Adnexal torsion is a gynecological emergency and requires early surgical intervention. Adnexal torsion in adolescents is usually due to benign functional ovarian cysts and benign teratoma. Malignant ovarian tumors are rare in the adolescent age-group. The goals of surgery are detorsion and preservation of the ovary regardless of its appearance at the time of surgery. Oophorectomy is required only when the ovary is severely necrotic and falls apart. Clinical Significance: Minimally invasive surgical approach with detorsion of adnexa and avoiding oophorectomy will lead to preservation of adnexal structures and their function.

Background: Up to 85% of the women experience some type of mood disturbance in the postnatal period. Postpartum depression affects bonding with infant which may lead to malnutrition and other complications in the infant. This article focuses on the prevalence of depression among postnatal women attending a tertiary care institute in Chennai and to identify the risk factors that affect postpartum depression.Methods: This study was a cross sectional study, performed over a period of three months from January 2019 to March 2019. 200 postnatal mothers were recruited for the study, who were in postpartum period from 1 to 6 weeks after delivery. Specially designed proforma was used to record various determinants to assess the risk factors which could contribute to postpartum depression. The Edinburgh Postnatal Depression Scale was used to detect the depressive symptoms in postnatal mother.Results: A total of 200 cases were studied. Prevalence of postpartum depression was found to be 25%. Primi gravida, history of miscarriage and unplanned pregnancy were associated with increased risk of developing depression in the postnatal period. Fear regarding gender of the child and failure of lactation were not contributing risk factors to postpartum depression. Spacious house and partner support were found to be protective factors to combat depression in postnatal women.Conclusions: Prevalence of postpartum depression was 25%. Significant association was found between primi gravida, history of miscarriage, unplanned pregnancy and postpartum depression. Early screening of the women will reduce the adverse outcomes among both mother and the child.

Background: Pre-eclampsia is a multisystem disorder with two-stage disease pathology where abnormal placentation precedes the endothelial dysfunction which ultimately leads to the systemic inflammatory response. Endothelial dysfunction is one of the hallmark pathologies of preeclampsia, microalbuminuria is the measure of the same and could be used as a marker for predicting pre-eclampsia in early gestation. This study has been carried out to predict pre-eclampsia among low-risk pregnant women with the use of spot urine albumin-creatinine ratio (ACR) and to derive at a definite cut-off value of spot urine ACR. Materials and methods: This prospective study was done in ESIC Medical College & PGIMSR, Chennai, Tamil Nadu, India, for a period of 12 months. Low-risk singleton pregnant women between 16 and 20 weeks of gestational age who satisfied the inclusion criteria were considered. Participants who tested negative for urine albumin by urine dipstick method were subjected to a spot urine ACR test. Urine albumin was measured by the immunoturbidimetric method and urine creatinine by Jaffe's kinetic method. Urine albumin is expressed as mg/dL, urine creatinine as gm/dL, and ACR as mg/gm. All the participants were followed up to delivery. The primary outcome measure was pre-eclampsia, secondary outcome measures were gestational hypertension (GHTN), gestational diabetes mellitus (GDM), intrauterine growth restriction (IUGR), and a cut-off value of urine spot ACR in the prediction of pre-eclampsia was calculated by receiver operative curve (ROC) analysis. Results: Among 164 participants, the proportion of pregnant women affected with pre-eclampsia was 3.04%. The optimum value of ACR in predicting pre-eclampsia obtained was 25.89 mg/gm by applying the ROC curve. It also derived 80% sensitivity and 87% specificity with a positive predictive value (PPV) of 16% and a negative predictive value (NPV) of 99%. Conclusion:The ACR test is widely available with easy interpretation and also convenient for pregnant women. Spot urine ACR value of more than 25.89 mg/gm in asymptomatic pregnant women when measured between 16 and 20 weeks of gestation can predict the development of pre-eclampsia with the sensitivity and specificity of 80 and 87%, respectively. The higher NPV value of 99% of spot urine ACR ratio may help in accurately diagnosing true negatives. However, additional prospective studies with higher sample size and cost-benefit analysis of the test are recommended to confirm these findings before routinely using urine spot ACR as a predictive marker.

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