A Dream of Horses & Other Stories by Aashish Kaul

By Aashish Kaul

The tales during this assortment draw variously at the subject matters of affection and loss, Taoist metaphors, socio-political issues, and the writer's position and function on this planet. Literary and intricate but obtainable and fast moving, every one tale differs extensively standard, motivation, philosophy, and denouement from all of the others. the gathering encompasses topographies and locations from China to France, and eire to India.

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Possible causes of physiological vaginal discharge are: • • • • Vestibular gland secretions. Vaginal transudate. Cervical mucus. Residual menstrual fluid. Don’t forget to reassure the patient that vaginal discharge might simply be physiological, related to the menstrual cycle or to pregnancy. Pathological causes need to be excluded. The differential diagnoses of pathological vaginal discharge are shown in Fig. 1. The most common group is the infections. History to focus on the differential diagnosis of vaginal discharge The patient should be asked about the nature of the discharge.

2 refer to miscarriage. The term ‘miscarriage’ is used in preference to ‘abortion’ which many women will equate with a termination. History for Bleeding/Pain in Early Pregnancy Last menstrual period The first day of the last menstrual period (LMP) will allow you to calculate the gestation. This becomes important when interpreting early pregnancy scans. While an empty uterus on a scan at 7 weeks might indicate an ectopic pregnancy, a small gestation sac with no fetal pole is common at 5 weeks. However, it is important to establish whether the woman is sure of her dates and whether her cycle is regular; if not, the estimated gestation may be wrong.

Inflammation. Ulceration. Foreign bodies. Local tumours. Bimanual pelvic examination will reveal pelvic tumours. It might also elicit tenderness and cervical excitation, suggesting PID. 2 Investigations for vaginal discharge Investigation Cause of discharge • Microbiological swabs (vulval/high vaginal/ endocervical/urethral). • MSU specimen. • Cervical cytology/biopsy. • Endometrial sampling/hysteroscopy. • Pelvic ultrasound scan. • Laparoscopy. 2 shows the relevant investigations for vaginal discharge.

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