Bhavana Gupta

Abstract

Molar pregnancy is characterized by high level of serum b hcg which can be usually detected by urine pregnancy test as a first screening test. Urine pregnancy test is also used as the first screening test for patients of reproductive age presenting with gynecological problem in order to exclude pregnancy. Rarely large amounts of b human chorionic gonadotrophin (hcg) may cause a false negative result due to over saturation of the assay system, known as, ‘the hook effect’. This can result clinical dilemma in the diagnosis and delay in the management. When there is clinical features of molar pregnancy, the knowledge of “The Hook Effect” will help at arriving at the diagnosis. Keywords: β hCG(serum β -human chorionic gonadotropin, Hook effect, Molar pregnancy, Urine pregnancy test.

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Abstract

Introduction: Uterovaginal prolapse is an abnormal protrusion or herniation of pelvic organs from its normal position in the pelvis, due to failure of anatomical support. The prevalence of uterovaginal prolapse is difficult to be determined because many women are asymptomatic and many are hesitant to discuss with family. It can be considered a silent epidemic. The cause of uterovaginal prolapse is multifactorial. The parity, mode of delivery, postmenopausal status, obesity are some of the factors affecting the severity. The condition is preventive and by counseling and care during antenatal and postnatal period, the prevalence of this condition can be curtailed and quality of life can be improved. Aim: To evaluate the predisposing factors of uterovaginal prolapse in women admitted to the gynaecology ward. Materials and Methods: A retrospective study was done for a period of 2 years from January 2019 to January 2021 at Integral Institute of Medical Sciences and Research, a tertiary care hospital and medical college, Kursi Road, Dasauli, Lucknow. The women admitted in gynaecology ward with symptoms of mass per vagina were included in the study. The data was retrieved from medical records of the department. The case file as per inclusion and exclusion criteria was identified and included in the study. The information of risk factors was collected using patient proforma. The pelvic organ prolapse quantification system (POPQ) approved by international continence society was used for categorizing uterovaginal prolapse. Data was analysed using SPSS version 20. Frequencies, percentage and mean computed to describe the variables of the study. The Chi-square test was used to compare variables. The statistical significance P Result: The period of study was from January 2019 to January 2021. During this period 11256 patients were seen at the gynaecological clinic, out of which 206 patients had uterovaginal prolapse. The prevalence was 1.8%. Conclusion: The multiparity, prolonged and difficult deliveries, delivery by untrained personnel, mismanaged third stage of labour involving injury to sphincters and vaginal tears are determinants of prolapse uterus. Further postmenopausal condition causing hypoestrogenic state causes weaking of ligaments, collagen and aggravates the condition. Hence, preventive measures like institutional delivery, delivery by trained personnel, menopausal clinics may help the target population.   Keywords: Parity, Determinants, Predisposing, Uterovaginal prolapse.

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