Womens Health - Suburban Diagnostics

SubUrban Icon Women’s Health

From puberty to menopause, we offer a wide range of tests for women. Hormonal assays, prenatal and antenatal testing, tests for autoimmune disorders, PCOS, infertility, infections, oncology and hematological disorders are some of the key areas of focus in our test range for Women’s Health.

Details of our key offerings in the area of Women’s health are given below:

1. Hormones

LH, FSH
  • FSH (Follicle Stimulating Hormone)
    • Stimulates follicular growth and seminiferous tubules
  • LH (Luteinizing Hormone)
    • Stimulates ovulation, production of estrogen and progesterone
    • Controls the production of testosterone by leydig cells
    • Diagnosis of gonadal, pituitary and hypothalamic disorders
Prolactin
  • Evaluation of menstrual irregularities
  • Predicting ovulation
  • Evaluating infertility
  • Evaluating patients with suspected hypogonadism
  • Evaluating PCOS
  • Evaluating Galactorrhea
TFT (FT3, FT4 and TSH)
  • Free T3, Free T4 and TSH (Thyroid hormones) have profound effects on reproduction and pregnancy
  • Thyroid dysfunction is implicated in a broad spectrum of disorders, ranging from:
    • Abnormal sexual development
    • Menstrual irregularities
    • Infertility
    • Assessing true metabolic status
    • Diagnosing Hyper and Hypothyroidism
    • Autoimmune thyroiditis
ESTRADIOL (E2)
  • Determine the timing of ovulation
  • In males, estradiol helps detect hormonal excess and its cause
  • Is involved in development and maintenance of female phenotype
  • Helps identify:

      In females:

      • Precocious puberty
      • Amenorrhea
      • Infertilty
      • Detection of ovarian failure
      • Monitoring of follicle development in ovary by serial measurements

      In males:

      • Delayed Puberty
      • Infertility
      • Gynaecomastia
      • Signs of feminisation in pubertal boys
Anti Mullerian Hormone (AMH)
  • Evaluating the fertility potential
  • Better response to ovarian stimulation for IVF
  • Assessing polycystic ovarian syndrome
  • Measuring ovarian ageing
  • Predicting onset of menopause
  • Early and delayed puberty guide for contraception
  • Endometriosis diagnosis and prognosis
  • Testicular (Gonadal) function
PROGESTERONE
  • Progesterone levels vary throughout the menstrual cycle
    • Decreases in follicular phase
    • Increases in luteal phase
  • Progesterone is vital in continuation of pregnancy
  • Serial measurements of progesterone are used to determine whether ovulation has occurred, or to monitor the success of induced ovulation
  • Increases in:
    • Ovarian tumors
    • Adrenal Tumors
    • Molar pregnancy
  • Decrease in:
    • Amenorrhea
    • foetal death
    • Gonadal agenesis
TESTOSTERONE
  • Diagnose several conditions in males and females
  • In females the test is prescribed for
    • Infertility
    • Amenorrhea
    • Oligomenorrhea
    • Hirsutism
    • PCOS
  • In males the test is prescribed
    • In case of infertility
    • Decreased sexual drive
    • Lack of secondary sexual characters in males
  • Only 2-3% of circulating testosterone is free
DHT (Dihydrotestosterone)
  • Endogenous potent male sex hormone
  • More potent than testosterone
  • During embryogenesis, DHT has an essential role in the formation of male external genitalia
  • In the adult, DHT acts as the primary androgen in prostate and hair follicles
  • Helps identify:

      In males:

      • Infertility
      • Decreased libido
      • Erectile dysfunction
      • Hypogonadism
Sex Hormone Binding Globulin (SHBG)
  • Increased SHBG levels are seen in hormone replacement therapy (steroids and estrogen), pregnancy, hyperthyroidism
  • Decreased SHBG levels are seen in obesity, PCOS, hypothyroidism
  • Helps identify:
  • In females:

    • Menstrual irregularities
    • Hirsutism
    • Infertility
    • PCOS

    In males:

    • Infertility
    • Decreased libido
    • Erectile dysfunction
    • Hypogonadism

2. PCOS

Polycystic Ovarian Syndrome (PCOS)
  • Apart from the known co-relation between PCOS and an increased risk of type 2 Diabetes, there is increasing evidence of the link between PCOS and thyroid disorders as well
  • Despite the high prevalence of PCOS, the diagnosis and differential diagnosis remains confusing
  • This is partly due to the lack of a specific single diagnostic test for the disorder
  • Tests to detect PCOS:
    • FBS, PPBS
    • DHT
    • HOMA Index
    • Lipid Profile
    • Free testosterone
    • FT3, FT4, TSH
    • FSH, LH, Prolactin
    • SHBG
    • 17-OHP
    • Cortisol
    • Androstenedione
    • AMH
    • DHEAS
    • USG Pelvis
Sonography
  • State-of-the-Art machines from
    • GE Voluson P8
    • Philips HD 15 and HD 11
    • Toshiba Nemio-XG
  • Clinical findings are discussed with the prescribing doctor through telecon
  • Sonography is available across all Suburban radiology centres between 9am to 1pm (Mon-Sat) and at select centres in the evenings
  • Pelvic Sonography
    • Evaluation of pelvic organs such as the uterus and ovaries
    • Evaluate Adnexa
  • Pelvic Doppler
    • Determine vascularity in conditions such as ovarian torsion
  • Follicular study
    • Monitor follicular growth and ovulation

3. AUTOIMMUNE DISORDERS

Bad Obstetric History (BOH)
  • Abortion affects 1-3% of fertile couples
  • Bad Obstetric History (BOH) implies two or more consecutive abortions, early neonatal deaths, stillbirths, intrauterine foetal death
Antinuclear Antibodies (ANA)
  • The Gold Standard technique to detect presence of antibodies
  • Combination of HEp -2010 cells and primate liver cells provides
    • Pattern differentiation which corresponds to a particular disease type (centromere, nuclear dots)
    • Provides additional information for ANA – ve cytoplasmic antibodies (liver disease-endomysium, ANCA)
  • Patterns offer clue as to which autoantibody may be present corresponding to that disease type:
    • Homogenous – SLE
    • Speckled – Sjogrens Syndrome
    • Centromere – Scleroderma
    • Nucleolar – Scleroderma
  • Confirmed by ANA Blot tests or monospecific ELISA
Anti Cardiolipin Antibodies (ACLA)
  • Plays an important role in the blood clotting process
  • When antibodies are formed against cardiolipins, they increase the risk of developing recurrent blood clots in arteries and veins
  • ACLA are found in Antiphospholipid syndrome and SLE
  • Antiphospholipid syndrome is an autoimmune syndrome which presents with venous or arterial thrombosis, thrombocytopenia, recurrent abortions and eclampsia
  • Used for identification of recurrent abortions
Anti Phospholipid Antibodies (APLA)
  • Antiphospholipid antibodies is used to determine the cause of inappropriate blood clot formation (unexplained thrombotic episode, excessive clotting) and recurrent miscarriage
  • APLA are found in Antiphospholipid syndrome and SLE
  • In positive cases, tests needs to be repeated 8 to 10 weeks later to determine whether their presence is persistent or temporary
Lupus Anticoagulant (LA)
  • Test based on guidelines by the International Society of Thrombosis And Hemostasis (ISTH)
  • Helps determine the cause of an unexplained
    • Thrombosis
    • Recurrent Miscarriages
    • Prolonged PTT
  • Test based on two different principles:
    • dRVVT
    • Sensitive aPTT
  • LA is considered positive if at least one of the two tests has positive results. In positive cases, the test needs to be repeated 12 weeks later to determine whether lupus anticoagulant is transient or persistent.

4. Prenatal and Antenatal Testing

Dual Marker Test
Risk interpretation based on MoMs of Indian population developed by screening more than 4 lakh pregnancies over the years
  • All maternal markers analyzed – βhCG, PAPP-A on the AutoDELFIA® platform from PerkinElmer, are CE-marked
  • Gestational age for performing the test
  • Detection rate upto 91%
  • Graphical interpretation of reports with PerkinElmer’s clinically validated LifeCycle™ screening management software
  • Uses FMF (UK) approved PerkinElmer Dried Blood Spot (DBS) technology for first trimester aneuploidy screening
Quadruple Marker
  • Inhibin A with Triple Marker increases detection rate upto 75%
  • Gestational age for performing the test
  • All maternal markers analyzed – βhCG, AFP, Inhibin-A, uE3 on the AutoDELFIA® platform from PerkinElmer, are CE-marked
  • Risk interpretation based on MoMs of Indian population developed by screening more than 4 lakh pregnancies over the years
  • Graphical interpretation of reports with PerkinElmer’s clinically validated LifeCycle™ screening management software
Integrated Test
Dual Marker + Quadruple Marker Test
  • All maternal markers analyzed – βhCG, PAPP-A, AFP, Inhibin-A, uE3 on the AutoDELFIA® platform from PerkinElmer, are CE-marked
  • Detection rate upto 95%
  • Graphical interpretation of reports with PerkinElmer’s clinically validated LifeCycle™ screening management software
Triple Marker Test
Detection rate ~ 65%
  • Risk assessment test in 2nd Trimester to detect Trisomy 18, Trisomy 21 and Neural tube defect
  • Gestational age for performing the test
  • All maternal markers analyzed – βhCG, AFP, uE3 on the AutoDELFIA® platform from PerkinElmer, are CE-marked
  • Risk interpretation based on MoMs of Indian population developed by screening more than 4 lakh pregnancies over the years
  • Graphical interpretation of reports with PerkinElmer’s clinically validated LifeCycle™ screening management software
βhCG
  • Prenatal screening
  • Diagnosis of pregnancy
  • Detection of ectopic pregnancy
  • Gestational Trophoblastic Disease
  • Germ cell tumours
βhCG becomes detectable 3 days post implant
  • Slow increase in HCG indicates ectopic pregnancy in 75% of cases
KaryoLite BoBs (POC)
  • Performed by BACs-on-Beads based molecular karyotyping, covering both p and q arms of all chromosomes 1 – 22 X and Y
  • KaryoLite BoBs offers multiple benefits
    • Rapid aneuploidy detection
    • No requirement of cell culture
    • Chance of failure is less than conventional karyotyping
    • Faster TAT than karyotyping
  • Concordant results with
    • Microarrays and conventional karyotyping for aneuploidies
    • More information than FISH
  • Small amount of DNA sample required (50 ng to 240 ng)
Prenatal BoBs
  • Confirmatory diagnosis for screen positive Trisomy by BACs-on-Beads when 1st and 2nd st and by when 1 or 2 Trimester screening has indicated a high risk of anomaly
  • Detects changes of chromosome 13,18, 21 X and Y and also enables detection of 9 microdeletion syndromes
  • There are no unknown clinical significant results as there is a clear genotype-phenotype correlation for the micro deletion syndromes detected by Prenatal BoBs
  • High sensitivity and specificity (upto 99% detection rate with false positive < 1% and false negative rate of< 2%)
  • Better TAT and additional information regarding the micro deletion
N T Scan (11-13.6 weeks)
  • Assesses risk of having Down’s syndrome and other chromosomal abnormalities
  • The minimum foetal crown–rump length (CRL) should be 45 mm and the maximum 84 mm
  • At Suburban Diagnostics, radiologists are Fetal Medicine Foundation (FMF) UK certified
Anomaly Scan (18-23 weeks)
  • Screen structural and developmental abnormalities
    • Neural Tube Defect (NTD)
    • foetal aneuploidy
Doppler
  • Obstetric Sonography
    • Estimation of:
      • Gestational age
      • foetal growth
      • Foetal well-being
    • Obstetric Doppler
      • Study of foetal hemodynamics
      • Assess utero-placental and feto-placental sufficiency
TORCH testing (Toxoplasmosis, Rubella, Cytomegalovirus and Herpes)

TORCH 8: Toxoplasma IgG, Toxoplasma IgM, Rubella IgG, Rubella IgM, CMV IgG, CMV IgM, Herpes simplex Virus 1 IgG and IgM, Herpes simplex Virus2 igG and IgM

TORCH is for a group of four infectious diseases that may cause illness in pregnant women and birth defects in newborns. The test is a screen for the presence of any of the antibodies to these infections. Confirmation of an active infection may require more specific tests.

Antenatal Panels
  • An essential assessment for every pregnant woman to ensure healthy pregnancy
  • Assist you in predicting the chances of a diabetic baby and ABO-Rh incompatibility
  • Antenatal Panels available:
    • Antenatal Panel 1: CBC, FBS, Blood Group, HIV, HBsAg, VDRL, Urine Routine
    • Antenatal Panel 2: Ante Natal Panel 1 + TSH
    • Antenatal Panel 3: Ante Natal Panel 2 + BUN + Hb Electrophoresis

5. Infections

TB PCR
  • Performed using real time PCR technology
  • Tests can be performed on
    • Pulmonary AFB smear negative
    • Paucibacillary extra pulmonary TB (10-15% of all TB cases)
  • Targets IS6110 gene more prevalent in the Indian population and hence the specificity is higher even in the case of 1 bacillus
Urine Culture
  • Urine culture is the commonest sample received in microbiology laboratory
  • Urinary isolate is identified and susceptibility is done using Vitek 2 Compact
  • The susceptibility towards various groups of antibiotics is deduced using MIC values
  • The interpretation is based on the latest CLSI guidelines
  • We use special containers with boric acid, a urinary preservative, to maintain the colony count of bacteria and avoid over growth
STI SCREENING BY REAL TIME PCR
  • Globally, more than 200 million new cases of STI (Chlamydia and Gonnoehoeae alone) occur every year
  • In India, 30-35 million episodes of STI are reported every year
The most common STIs (excluding HIV) are:
  • Gonorrhoea
  • Chlamydia
  • Syphilis
  • Mycoplasma
  • Trichomoniasis
  • Genital herpes

6. Oncology

Histopathology
  • Gross examination procedure by a dedicated histopathologist
  • Application of stringent diagnostic criteria/protocols for reporting (CAP)
  • Application of special stains and IHC markers whenever necessary
  • Interaction with concerned doctors before reporting critical reports
  • Use of cytospin 4 for fluid cytology
Papsure
  • Screening test to detect cervical cancer and precancerous conditions
  • Cell enrichment process separates and removes blood, mucus and other cells, reducing the risk of misdiagnosis
  • Faster turnaround time
  • Unsatisfactory rates have decreased from 0.98% in conventional smears to 0.24% in Sure Path laboratories. (Multicentre large studies by various laboratories)
  • Same sample can be used for HPV test
HPV DNA Detection and Genotype
  • Detect 40 HPV types involved in causing precancerous lesions and cervical cancer
  • Detects all 14 High Risk (HR) types and other Low Risk (LR) types
  • HR types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 or 68
  • HPV 16/18 is the most carcinogenic HPV genotype and accounts for 75 – 85% of all cervical cancers
  • Approximately 10 other HR HPV genotypes cause the remaining 15 – 25% of cervical cancers
HE4 + CA 125 (ROMA Index)
  • HE4 is used as an aid in monitoring recurrence or progressive disease in patients with invasive epithelia ovarian cancer
  • CA125 is used to detect ovarian cancer and monitor therapeutic response
  • CA125 + HE4 combination (ROMA)
    • Increases sensitivity(75%) and specificity(94.9%) for ovarian cancer detection
    • Accurately stratified 89% of all epithelial ovarian tumor and low malignant potential tumors as high risk and 75% of all benign disease as low risk
BRCA 1 and 2
  • Once in a lifetime test for detection of hereditary breast and ovarian cancer risk
  • BRCA1 mutations confer more than 80% lifetime risk for breast cancer
  • In-depth analysis by NGS and confirmation by Sanger sequencing (Gold Standard Technique)
  • If the patient is positive for mutations, relatives and children can be screened for high risk
  • We provide pre-test and post-test counselling
Mammography
  • The most efficient screening method to detect early breast cancer
  • A mammogram is an X-ray that produces an image of the inner breast tissue on film
  • Complimented by sono-mammography
  • The technique is used to visualize normal and abnormal structures like cysts, calcifications, and tumors within the breasts
  • Mammography can be used to discover a small cancer in a curable stage

7. Blood-Related Disorder

Hb Electrophoresis
  • Performed on automated HPLC technology for accurate reports
  • Helps detection and quantification of hemoglobin fractions
  • Comprehensive test to screen common Hb variants Hb S, C, E and D in addition to beta Thalassemia
  • Estimates Hb A2 and F levels, an important tool in the carrier testing
Anemia
  • Causes of Anemia
    • Physiological anemia
    • Nutritional anemia
    • Hemolysis and hemolytic anemia
    • Hemoglobinopathies

8. GENERAL HEALTH

25-Hydroxy Vitamin D
  • Vit D2 is obtained from dietary sources
  • Vit D3 is obtained from early morning sunlight
  • Both get metabolized in the liver to form 25-OH Vit D
  • Helps in the timely detection and management of osteoporosis
  • Helps in maintaining good bone mineral density which is important to prevent future fractures
Bone Mineral Density (BMD)
  • Bone Mineral Density (BMD) estimates the true mass of bone
  • Helps predict the risk of osteoporosis and future fracture so that a treatment program can be optimized
  • BMD test results are estimated on the basis of:
    • T-Score:
      • The patient’s bone mineral density as compared to the peak bone mass in normal young adult
      • A score of 0 means BMD = norm of a healthy young adult
      • The diagnosis of osteoporosis or low bone mass is based on the T-score
    • Z-Score:
      • The patient’s bone mineral density as compared to the peak bone mass in age-sex matched adult
      • Z-Score is useful for determining whether an underlying disease or condition is causing bone loss

For any further information, please email Dr. Anupa Dixit at dranupa@suburbandiagnostics.com or Dr. Shweta Naik at shweta.naik@suburbandiagnostics.com or Dr. Heena Satam at heena.satam@suburbandiagnostics.com or Dr. Ratika Aggarwal at drratika@suburbandiagnostics.com

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