Power Doppler sonography – A supplement to hysteroscopy in abnormal uterine bleeding: Redefining diagnostic strategies

Background: Abnormal Uterine Bleeding (AUB) is a very frequent cause of gynecological visits in women of all age groups. Ultrasound pelvis with or without endometrial sampling have been conventionally used to make diagnosis. Power Doppler is a comparatively recent modality which can be used to screen patients who will need endometrial biopsy/ curretage. We hereby conducted a study to compare the diagnostic accuracy of power Doppler sonography and hysteroscopy with histopathology associated with abnormal uterine bleeding. We also calculated the incidence of uterine pathology in AUB by power Doppler ultrasound and hysteroscopy and compared it with histopathology. Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University. After excluding 42 women, a total of 100 women fulfilling the inclusion criteria contributed to our study. Selected women underwent power Doppler ultrasound and hysteroscopy with guided biopsy. Results were compared with histopathology as per the gold standard. Evaluation of sensitivity, specificity, positive and negative predictive values were performed for each modality. All statistical analyses were performed using the SPSS 11.0 statistical package. P value ?0.05 was considered statistically significant for all tests used. Results: Sensitivity and specificity of power Doppler are 75% and 100% for carcinoma endometrium, 72.72% and 98.9% for endometrial hyperplasia, and 81.81% and 100% for endometrial polyp, respectively. Conclusion: Power Doppler sonography can be used to screen outpatients who do not need an endometrial biopsy for abnormal uterine bleeding. This will avoid unnecessary hysteroscopy in definitive benign cases, and watchful hysteroscopy in suspected premalignant and malignant cases. Irregular branching vessels and color splashes were found to be the best parameters for diagnosing endometrial carcinoma. Power Doppler should be done along with transvaginal sonography in all cases of abnormal uterine bleeding

Causes of Domestic Violence in Married Women with psychotic and Nonpsychotic Illness.

Background: Women are integral to all aspects of society. They are worshipped, but when it comes to dealing with them, much still remains. Women bear the burden of responsibility associated with being wives, mothers and carers of others. There is a dearth of casecontrol studies. Domestic violence in women with psychiatric morbidity has not received sufficient attention. Domestic violence can often lead to victims developing mental health problems, and people with mental health problems are more likely to experience domestic violence. People diagnosed with mental illness are more likely than others to be victims of domestic violence. Psychiatric morbidity as a determinant of domestic violence has received little attention. Indian culture is unique and there is limited work on domestic violence from Eastern Uttar Pradesh. Objective: To assess the magnitude and compare the cause of domestic violence in married women with psychotic and nonpsychotic illness. Materials and methods: Sixty-five women attending psychiatry outpatient department (OPD) of SSL Hospital with 35 women with psychotic illness and 30 nonpsychotic illness were studied for the magnitude of domestic violence by their husband. Domestic violence questionnaire was used. Women diagnosed as suffering from Axis-I disorder as per DSM IV TR. Results: Significantly more women in psychotic illness than nonpsychotic illness reported domestic violence (total/ psychological and physical) by their husbands in past year (women with psychotic illness: 80% total/psychological violence; 65.7% physical violence and nonpsychotic illness: 50% total/ psychological violence; 43.3% physical violence). Total domestic violence with psychiatric morbidity was observed in 66.2%. Conclusion: Women with psychotic illness have a higher reporting of domestic violence by their husbands during the past years. Women with mental disorders are likely to be victims of violence. Mental disorder may increase vulnerability to domestic violence by increasing the likelihood of women being in unsafe relationships and environments and increase their vulnerability to violent victimization.

Spectrum of anemia in pregnant Indian women and importance of antenatal screening.

Anemia is a common health problem but control of anemia in pregnant women is less well studied. The purpose was to study prevalence of anemia in young pregnant women, correlate with indices and study significance of identification of hemoglobinopathies. Of the 120 pregnant women, Hb was less than 8 g% in 58 (44.2%). Seventy-eight (65%) had iron deficiency, 22 (18.3%) had dimorphic anemia, and 14 (11.6%) had hemolytic anemia. Megaloblastic anemia was present in 6 (5%). Of hemolytic anemia, 50% were thalassemia trait. MCV< 76 fl was observed in 88 (73.3 %) cases. MCV<76 fl and MCH < 27 pg had 100 % sensitivity and 28.7 % specificity for screening of beta-thalassemia trait. NESTROFT had comparable sensitivity but lower specificity (14.9%). Sixty-three percent (60/78) of IDA had increased RDW whereas 78 % (11/14) of hemolytic anemia had RDW value in normal range (p value< 0.05). MCV/RBC of <14 was more specific parameter (96.8%) for beta-thalassemia trait. Four high-risk couples were identified. Thus, moderate to severe anemia was observed in most pregnant women. Hemoglobinopathies should be screened in antenatal clinics to identify the couples that would need a prenatal test. A lower MCV/RBC with RDWin the normal range may be useful in screening for thalassemia trait in pregnant women.