Search

Background The most common pathological cause of abnormal vaginal discharge in reproductive-aged women is bacterial vaginosis (BV). Amsel’s criteria and Nugent scoring systems are commonly employed approaches for the diagnosis of BV. Despite the Nugent scoring system being the gold standard method for diagnosing BV, Amsel’s criteria are generally preferred in clinical setup owing to the fact Nugent scoring requires considerable time and expert microscopist. This study was conducted to determine the diagnostic value of Amsel’s criteria by comparing it with the Nugent scoring system. Methods This was a descriptive cross-sectional study conducted at Tribhuvan University Teaching Hospital, Nepal from October 2016 to September 2017. Vaginal specimens were collected from a total of 141 women presenting with abnormal vaginal discharge. The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were calculated, and each component of Amsel’s criteria was compared to the Nugent scoring system. Results The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were 50%, 98.2%, 87.5%, and 88.8% respectively. The clue cells showed 100% specificity and vaginal discharge with pH > 4.5 had 89.3% sensitivity while compared with Nugent’s scoring system. Conclusions Amsel’s criteria can be used as an adjunct method to Nugent scoring for the diagnosis of BV in the hands of skilled manpower in resources limited countries. The presence of clue cell and positive whiff test of Amsel’s criteria shows good match with Nugent’s score.

Gestational trophoblastic neoplasia is extremely rare entity accounting 1% of all gynecological malignancies. Invasive mole is a form of Gestational trophoblastic neoplasia which is locally invasive with propensity of metastasis. Association of partial mole with invasive mole and/or theca lutein cysts is a rare occurrence. Large cysts may present with complications. A case with these rare combinations presented at 15+3 weeks period of gestation as acute abdomen due to torsion of bilateral theca lutein cysts is reported. Right salpingo-ophorectomy with untwisting of left cyst was done. Six cycles of chemotherapy was given with regular βhCG monitoring. First trimester dating scan would have helped in early diagnosis, treatment and prevention of complications. Keywords: Invasive mole; theca lutein cysts; torsion.

Aim: To study laparotomy as second intervention for hemoperitoneum following primary surgery in obstetric and gynecology. Method: Eleven years retrospective study going back from Dec 2006 embracing all the cases of re/laparotomy for intraperitoneal bleeding were carried out in TUTH, Nepal. Results: Of the 24 cases complicated by intraperitoneal hemorrhage for which relaparotomy had been done 12 each were formed by gynaecologic and obstetric cases: 11 were caesareans (CS) and a laparotomy following vaginal birth after caesarean (VBAC). In gynecology the preceding surgeries undertaken were [diagnostic laparoscopy (1), laparotomy (3), hysterectomies 8 (3 being vaginal)] Massive hemoperitoneum occurred in ¼ cases; extensive hematoma in a third having altogether with associated risks factor in 9(37.5%).Source of bleeding were disligated/abraded infundibulopelvic vessel (3), cuff bleeding (4), cardinal ligaments (1), uterine cornua (1), uterine angles (6), vagina (1) and placental bed (1) which were duly managed by 5 obstetrics hysterectomy. Laparotomy >2 times were repeated 4: obstetric 2 [(1) for vault bleeding following hysterectomy done for scar rupture after VBAC and other for slippage of ovarian vessel following hysterectomy and internal iliac ligation] and same number in Gynecology 2 [(1) after vaginal hysterectomy first for laceration of infundibulopelvic vessel and then for generalized ooze and hematoma]. Next was following a diagnostic laparoscopy, complicated by unexplainable intraperitoneal bleeding first devised by internal iliac ligation, then finally by hysterectomy that died. Conclusions: Careful tying of the blood vessel, choosing right technique and appropriate ligature in the first place is as important as proper closure of all the surgical incision/ inflicted cut taking note of the rise in the pulse rate and fall in the blood pressure in overall postoperative cases such that related morbidity and mortality from late diagnosis leading to delayed second surgical intervention can be obviated or minimized. Key Words: Intraperitoneal bleeding, hemoperitoneum, relaparotomy doi:10.3126/njog.v2i2.1458 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 63 - 68

During the interval period, she almost collapsed from heavy vaginal bleeding and therefore admitted and investigated. Complete blood count showed features of pancytopenia (low hemoglobin estimation reported as 5 gm%, low WBC, RBC and also platelets). For this she was transfused with 3 units of packed cell. In oral hormone therapy, medroxy progesterone acetate was substituted by norethisterone acetate and as usual, was sent home with a decision to operate later once there was subsidence of body edema and return in the tissue perfusion. This was also because on the unavailability of attending doctor.