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Showing posts with the label Obs and Gynae

Menopause - Definition, symptoms and hormone replacement therapy

 Menopause   refers to a point in time that follows 1 year after the permanent cessation of menstrual periods that occurs naturally or is induced by surgery, chemotherapy or radiation. On average, natural menopause occurs between 50 and 51 years (range 45–59) and is part of the process of normal ageing. It has been noted that smoking advances the age of menopause by approximately 2 years. The diagnosis can only be made retrospectively and it is usually preceded by months or years of irregular cycles, that is not associated with some other physiological or pathological causes. If the cessation of menses occurs before the age of 40, then it is referred to as the "Premature ovarian failure". The older terms perimenopause or climacteric generally refer to the time period in the late reproductive years, usually late 40s to early 50s. Characteristically, it begins with menstrual cycle irregularity and extends to 1 year after permanent cessation of menses. The more correct t

Hyperemesis gravidarum - definition, epidemiology, pathophysiology, complications, management

Definition: Mild to moderate nausea and vomiting are seen commonly until approximately 16 weeks in most pregnant ladies. Although nausea and vomiting tend to be worse in the morning, thus erroneously termed morning sickness, they frequently continue throughout the day. In some cases, however, it is severe and unresponsive to simple dietary modification and antiemetics. Hyperemesis gravidarum is defined as vomiting sufficiently severe to produce weight loss, dehydration, alkalosis from loss of hydrochloric acid and hypokalemia. Rarely, acidosis from partial starvation and transient hepatic dysfunction develop. Modified PUQE scoring index  (Pregnancy-Unique Quantification of Emesis and Nausea) can be used to quantify the severity of nausea and vomiting.  Epidemiology: There appears to be an ethnic or familial predilection. The hospitalization rate for hyperemesis is around 0.5 to 0.8%. Hospitalization is less common in obese women. In women hospitalized in a previous pregnan

Mittelschmerz's syndrome

Definition: It refers to pain at the time of ovulation. It is not that frequently encountered. Clinical features: Patient will complain of pain in either the suprapubic region or right/left iliac fossa. It usually starts around the mid cycle. The pain does not shift and is not associated with nausea or vomiting. It is there for less than 12 hours. Patient may have slight vaginal bleeding or leucorrhea. Relief of pain occurs spontaneously. Severity varies from patients and usually range from 3 to 5 on a scale of 10. Mechanism: The most probable causes are: 1) increased tension of the growing Graafian follicle just prior to rupture, 2) irritation of the peritoneum by the released follicular fluid following ovulation. Treatment: Non opiod analgesics and assurance do good in this condition. In difficult cases, we may look into a possibility to render the cycle anovular with contraceptive pills.


Definition: It is strictly defined as an excessive normal vaginal discharge and it should fulfill the following criteria: 1) the excess secretion is evident from persistent moistness of the vulva or staining of the undergarments, 2) it is non-purulent, 3) since it is non-irritant, it never causes pruritus. Mechanism: Normal vaginal secretion depends on the estrogen level. So a rise in the level of estrogen eventually causes increased secretion. This rise is seen during puberty, around ovulation and pregnancy. Some cervical causes of leucorrhea include erosions, chronic cervicitis, polyp and ectropion. Treatment: 1) Local hygiene is very important. 2) Use of cotton undergarments is recommended. 3) Anxiety of the patient must be relieved through counselling. 4) Treat the possible cause of the leucorrhea.

Abnormal Uterine Bleeding (AUB) - PALM-COEIN classification

This is a new classification for abnormal bleeding in a non pregnant woman of reproductive age group. It stands for : P - Polyp A- Adenomyosis L- Leiomyoma M- Malignancy/ Hyperplasia C- Coagulopathy O- Ovulatory dysfunction E- Endometrial causes I- Iatrogenic N- Not classified causes. The classification is as such since the first 4 ones i.e. PALM can be diagnosed and measured directly by inspection or imaging techniques. The other ones need investigations other than imaging in most cases to reach a diagnosis.

HPV vaccination

Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts.  Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years old, who did not get any or all of the three recommended doses when they were younger. These vaccines can also be given to girls beginning at age 9. It is recommended that females get the same vaccine brand for all three doses, whenever possible. One available vaccine (Gardasil) protects males against most genital warts. This vaccine is available for boys and men, 9 through 26 years of age. The best way a person can be sure to get the most benefit from HPV vaccination is to complete all three doses before beginning sexual activity. Quadrivalent human papillomavirus (HPV) vaccine may prevent infection with HPV types 6, 11, 16, and 18. The cost for this vaccination is around 90 eur