Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240804
Chandni, Nirbhay Kumar Bind
Background: Approximately 22% of gynaecologic cancers are of ovarian origin, but 47% of all gynaecologic cancer deaths occur in women who have ovarian cancer. Ovarian cancer is usually diagnosed at an advanced stage because most of the symptoms are nonspecific, hence, the difficulty in diagnosis at early stages. In general, there is no effective screening test for ovarian cancer. Aim was to evaluate the ability of risk of malignancy index 4 (ROMI 4) to differentiate benign from malignant ovarian tumors. Methods: A prospective observational study was conducted in April 2019 to march 2020. Results: In the present study the ROMI 4 score at cut-off ≥ 450 had sensitivity, specificity, PPV and NPV of 74.3%, 65.3%, 42.6% and 88% respectively for malignant ovarian tumor. Conclusions: Preoperative ROMI 4 score ≥450 will lead to rational basis for further referral to higher centre or gynaecology oncologist timely for appropriate surgical intervention/ management.
{"title":"Risk of malignancy index 4 for differentiating benign from malignant ovarian tumor","authors":"Chandni, Nirbhay Kumar Bind","doi":"10.18203/2320-1770.ijrcog20240804","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240804","url":null,"abstract":"Background: Approximately 22% of gynaecologic cancers are of ovarian origin, but 47% of all gynaecologic cancer deaths occur in women who have ovarian cancer. Ovarian cancer is usually diagnosed at an advanced stage because most of the symptoms are nonspecific, hence, the difficulty in diagnosis at early stages. In general, there is no effective screening test for ovarian cancer. Aim was to evaluate the ability of risk of malignancy index 4 (ROMI 4) to differentiate benign from malignant ovarian tumors.\u0000Methods: A prospective observational study was conducted in April 2019 to march 2020.\u0000Results: In the present study the ROMI 4 score at cut-off ≥ 450 had sensitivity, specificity, PPV and NPV of 74.3%, 65.3%, 42.6% and 88% respectively for malignant ovarian tumor.\u0000Conclusions: Preoperative ROMI 4 score ≥450 will lead to rational basis for further referral to higher centre or gynaecology oncologist timely for appropriate surgical intervention/ management.","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"12 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140373468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240817
S. R. Tauro, Yanglem A. Singh, Basanti Namoijam
Adenocarcinoma of the cervix presenting during pregnancy is an exceedingly rare occurrence, and the optimal management approach remains uncertain due to limited reported cases. Here we are presenting a case of a multiparous lady who presented with complaints of amenorrhoea for 3 months, pain abdomen, spotting per vaginum, mass felt per vaginum. Ultrasonography showed single live intrauterine pregnancy at 11 weeks 4 days of gestational age with an ill-defined hyperechoic lesion measuring 4.36×4.92×4.16 cm in cervix. HPE of cervical biopsy confirmed cervical adenocarcinoma-endocervical type, grade 2. On MRI, a heterogeneous exophytic irregular mass involving the external os, protruding into the upper vaginal cavity was identified with infiltration into the anterior upper vaginal wall, pelvic lymphadenopathy, and sub-centimetric inguinal lymph nodes were observed. The patient underwent radical hysterectomy with bilateral pelvic lymph node dissection. The surgical specimen exhibited stromal invasion exceeding 5mm in depth and width greater than 7mm, involving entire cervical wall with lympho-vascular space invasion. The tumor was ER/PR negative, strongly positive for P16, and HPV studies were also positive. Adjuvant external beam radiotherapy (EBRT) was administered to the pelvis, and the patient is currently in remission.
{"title":"Unveiling the uncommon: invasive adenocarcinoma cervix presenting during pregnancy: a rare case report","authors":"S. R. Tauro, Yanglem A. Singh, Basanti Namoijam","doi":"10.18203/2320-1770.ijrcog20240817","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240817","url":null,"abstract":"Adenocarcinoma of the cervix presenting during pregnancy is an exceedingly rare occurrence, and the optimal management approach remains uncertain due to limited reported cases. Here we are presenting a case of a multiparous lady who presented with complaints of amenorrhoea for 3 months, pain abdomen, spotting per vaginum, mass felt per vaginum. Ultrasonography showed single live intrauterine pregnancy at 11 weeks 4 days of gestational age with an ill-defined hyperechoic lesion measuring 4.36×4.92×4.16 cm in cervix. HPE of cervical biopsy confirmed cervical adenocarcinoma-endocervical type, grade 2. On MRI, a heterogeneous exophytic irregular mass involving the external os, protruding into the upper vaginal cavity was identified with infiltration into the anterior upper vaginal wall, pelvic lymphadenopathy, and sub-centimetric inguinal lymph nodes were observed. The patient underwent radical hysterectomy with bilateral pelvic lymph node dissection. The surgical specimen exhibited stromal invasion exceeding 5mm in depth and width greater than 7mm, involving entire cervical wall with lympho-vascular space invasion. The tumor was ER/PR negative, strongly positive for P16, and HPV studies were also positive. Adjuvant external beam radiotherapy (EBRT) was administered to the pelvis, and the patient is currently in remission.","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"133 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240791
Trupti Ruge, Lathasri A.
Background: Episiotomy is a surgical incision which is made in the perineum to enlarge the vaginal opening for birth, with a purpose to facilitate the completion of the second stage of labour to improve both the maternal and the neonatal outcomes. A significant number of women experience perineal trauma following vaginal deliveries which may result in perineal pain, dyspareunia and faulty healing. The type of suture material which is used, will influence these factors. Objectives were to assess the effect of suture materials (Rapide Vicryl versus catgut) used in episiotomy and evaluate the wound healing characteristics on day 2 and day 7. Methods: All the pregnant women in labour admitted in labour room of Navodaya medical college, 200 patients satisfying the inclusion and exclusion criteria were taken and were assigned in one of the groups for episiotomy and suturing was done using either of the materials-Vicryl Rapide 2-0 or chromic catgut 1-0, followed up the women in the postnatal ward on day 2 and day 7 and look for immediate complications of episiotomy like temperature, severe pain, hematoma induration, wound gapping and discharge. Results: Among a total of 200 cases, at 48 hours, there was no significant difference according to the pain measurement scores, but the median consumption of analgesics was significantly lower with fast-absorbing polyglactin 910. There was no difference in the association with dysparenia at 6 weeks after the delivery between chromic catgut (19%) compared with standard polyglactin 910 group (8%). Conclusions: Fast-absorbing form of polyglactin sutures are preferred over chromic catgut because of their non- allergic properties, increased tensile strength, lesser probability of pain and lower chances of infection.
{"title":"A comparative study of episiotomy suturing using suture material chromic catgut versus Rapide Vicryl and its outcome","authors":"Trupti Ruge, Lathasri A.","doi":"10.18203/2320-1770.ijrcog20240791","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240791","url":null,"abstract":"Background: Episiotomy is a surgical incision which is made in the perineum to enlarge the vaginal opening for birth, with a purpose to facilitate the completion of the second stage of labour to improve both the maternal and the neonatal outcomes. A significant number of women experience perineal trauma following vaginal deliveries which may result in perineal pain, dyspareunia and faulty healing. The type of suture material which is used, will influence these factors. Objectives were to assess the effect of suture materials (Rapide Vicryl versus catgut) used in episiotomy and evaluate the wound healing characteristics on day 2 and day 7.\u0000Methods: All the pregnant women in labour admitted in labour room of Navodaya medical college, 200 patients satisfying the inclusion and exclusion criteria were taken and were assigned in one of the groups for episiotomy and suturing was done using either of the materials-Vicryl Rapide 2-0 or chromic catgut 1-0, followed up the women in the postnatal ward on day 2 and day 7 and look for immediate complications of episiotomy like temperature, severe pain, hematoma induration, wound gapping and discharge.\u0000Results: Among a total of 200 cases, at 48 hours, there was no significant difference according to the pain measurement scores, but the median consumption of analgesics was significantly lower with fast-absorbing polyglactin 910. There was no difference in the association with dysparenia at 6 weeks after the delivery between chromic catgut (19%) compared with standard polyglactin 910 group (8%).\u0000Conclusions: Fast-absorbing form of polyglactin sutures are preferred over chromic catgut because of their non- allergic properties, increased tensile strength, lesser probability of pain and lower chances of infection.","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"68 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140368987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240787
Rushikesh Khadse
Background: The aim of the present study is to investigate the socio-demographic and economic determinants of caesarean (C-) section deliveries in Maharashtra. The paper also focuses to estimate inequalities in C-section deliveries in the state. Methods: The fifth round of the National Family Health Survey (NFHS) 2019-21 was used to accomplish the objective. Univariate, bivariate and logistic regression were used to ascertain the determinants of C-section. Results: The prevalence of C-section delivery in India rose from 2.9% during 1992-93 to 10.6% in 2005-06 and to 21.5% during 2019-21. The proportion of C-section delivery in Maharashtra during 2019-21 is observed to be 25.4%, with 18.3% of the deliveries occurring at public health facility, while 38.9% of the deliveries takes place in private health care settings. Women residing in urban areas, belonging to richer wealth asset index and having higher educational qualification are found to have greater chance of caesarean deliveries. Conclusions: The study reveals that C-sections have increased dramatically in Maharashtra over the previous three decades. The hospital administration is encouraged to take effective actions to reduce the likelihood of needless C-sections while retaining medical justification for C-section births.
{"title":"Analysis of socio-economic factors influencing caesarean section rates in Maharashtra, India","authors":"Rushikesh Khadse","doi":"10.18203/2320-1770.ijrcog20240787","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240787","url":null,"abstract":"Background: The aim of the present study is to investigate the socio-demographic and economic determinants of caesarean (C-) section deliveries in Maharashtra. The paper also focuses to estimate inequalities in C-section deliveries in the state.\u0000Methods: The fifth round of the National Family Health Survey (NFHS) 2019-21 was used to accomplish the objective. Univariate, bivariate and logistic regression were used to ascertain the determinants of C-section.\u0000Results: The prevalence of C-section delivery in India rose from 2.9% during 1992-93 to 10.6% in 2005-06 and to 21.5% during 2019-21. The proportion of C-section delivery in Maharashtra during 2019-21 is observed to be 25.4%, with 18.3% of the deliveries occurring at public health facility, while 38.9% of the deliveries takes place in private health care settings. Women residing in urban areas, belonging to richer wealth asset index and having higher educational qualification are found to have greater chance of caesarean deliveries.\u0000Conclusions: The study reveals that C-sections have increased dramatically in Maharashtra over the previous three decades. The hospital administration is encouraged to take effective actions to reduce the likelihood of needless C-sections while retaining medical justification for C-section births.","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"120 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140370158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240768
Sujjanna A. L. Manuel, David Nunns
Background: This study aimed to assess the consistency of care pathway in patients diagnosed with stage 1A1 cervical cancer in our hospital. Methods: Retrospective analysis of care pathway of patients with stage 1A1 cervical cancer over the last 5years 2017-2022 by accessing their electronic records. Data collected were, information given to patients and their GP of cancer diagnosis, access to clinical nurse specialist, patient information leaflet, Multidisciplinary Team review, discussion of treatment following primary LLETZ and follow up. Results: Total 45 patients were diagnosed with stage 1A1 cervical cancer. All patients and their GPs were sent letters about their diagnosis and plan for further management after multidisciplinary team discussion. Access to clinical nurse specialists noted in 16, and provision of patient information leaflet noted in 9 patient records. Regarding treatment 14 patients had a repeat LLETZ, 7 patients underwent hysterectomy, 5 patients had a second LLETZ procedure followed by hysterectomy and 19 had routine follow up (colposcopy and cervical smear). Follow up of the 33 patients who had LLETZ as definitive treatment, 1patient had recurrence of cancer and 2 patients had low grade dyskaryosis. Histology post hysterectomy, 5 patients had no evidence of CIN, 6 patients showed CIN with complete excision, and no cases of CIN with incomplete excision. All vault smears were negative for malignancy. Conclusions: The clinical standards of management were in par with expectations, however, to improve unmet holistic needs (access to information of support groups, clinical nurse specialists, patient information leaflets).
{"title":"Insight in the consistency of care pathway of patients newly diagnosed with stage 1A1 cervical cancer","authors":"Sujjanna A. L. Manuel, David Nunns","doi":"10.18203/2320-1770.ijrcog20240768","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240768","url":null,"abstract":"Background: This study aimed to assess the consistency of care pathway in patients diagnosed with stage 1A1 cervical cancer in our hospital.\u0000Methods: Retrospective analysis of care pathway of patients with stage 1A1 cervical cancer over the last 5years 2017-2022 by accessing their electronic records. Data collected were, information given to patients and their GP of cancer diagnosis, access to clinical nurse specialist, patient information leaflet, Multidisciplinary Team review, discussion of treatment following primary LLETZ and follow up.\u0000Results: Total 45 patients were diagnosed with stage 1A1 cervical cancer. All patients and their GPs were sent letters about their diagnosis and plan for further management after multidisciplinary team discussion. Access to clinical nurse specialists noted in 16, and provision of patient information leaflet noted in 9 patient records. Regarding treatment 14 patients had a repeat LLETZ, 7 patients underwent hysterectomy, 5 patients had a second LLETZ procedure followed by hysterectomy and 19 had routine follow up (colposcopy and cervical smear). Follow up of the 33 patients who had LLETZ as definitive treatment, 1patient had recurrence of cancer and 2 patients had low grade dyskaryosis. Histology post hysterectomy, 5 patients had no evidence of CIN, 6 patients showed CIN with complete excision, and no cases of CIN with incomplete excision. All vault smears were negative for malignancy.\u0000Conclusions: The clinical standards of management were in par with expectations, however, to improve unmet holistic needs (access to information of support groups, clinical nurse specialists, patient information leaflets).","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"134 39","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240812
Jesmine Banu, Mostafa M. Altarique, Rebeka Sultana, Nastaran Lasker, S. M. Munira, S. A. Anwary, Ariful Islam
The cervical fibroids are rare and large cervical fibroids are rarer. Removing large cervical fibroids when a patient desires future fertility is a surgical challenge because of the risks of significant blood loss, bladder and ureteric injury, and unplanned hysterectomy. For women who desire future fertility, myomectomy can improve the chances of pregnancy by restoring normal anatomy. In this article, we describe a successful pregnancy following the restoration of the normal anatomy of the cervix by a challenging myomectomy in a sub-fertile patient with a large cervical fibroid. A 38-year-old nulliparous lady presented to the reproductive endocrinology and infertility (REI) department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with primary sub-fertility for five and half years, and dysmenorrhea for 2 years. She was a regularly menstruating woman with average flow and duration. Being a resident of Canada, she was diagnosed there as a case of large cervical fibroid (10×9 cm) by TVS extending up to the posterior wall of the uterus, cervix, and upper vagina impacted in the pouch of Douglas during infertility workup. For this reason, she was advised for in vitro fertilization (IVF) keeping the fibroid in situ. However, due to the failure of embryo transfer with this large cervical fibroid, she was advised for embryo transfer following myomectomy. Hysteroscopic myomectomy was tried first (in February 2019 in Canada) but was unable to be removed. Then Laparotomy was tried (in September 2019 in Canada) but failed again. Being a complicated case, she was counselled there for myomectomy by a multidisciplinary approach with the high risk of injury to the urinary bladder, ureter, bowel, and other pelvic structures. But she refused to do a myomectomy there after knowing the dreadful complications with the fear of injury to the pelvic organs. With this problem, she went to different institutions both in the country and abroad but couldn’t get the proper treatment. Finally, she visited the outpatient department (OPD) of the REI department, BSMMU, Dhaka, Bangladesh with the hope of getting the most appropriate treatment for her and she was reassured, counselled, and managed by a challenging myomectomy (in March 2022) through a combined approach of the vagina and abdominal route without any significant intra and post-operative complications. Her whole post-operative period was uneventful, the anatomy of the cervix was restored and detected by TVS, and trial transfer was done before embryo transfer with easy negotiation to the cervix. Finally, she conceived 1 year after myomectomy with easy frozen embryo transfer. Myomectomy in expert hand even for the large cervical fibroid can restore normal anatomy and can achieve successful pregnancy outcomes.
{"title":"Challenging myomectomy of large cervical fibroid - successful fertility outcome: a case report","authors":"Jesmine Banu, Mostafa M. Altarique, Rebeka Sultana, Nastaran Lasker, S. M. Munira, S. A. Anwary, Ariful Islam","doi":"10.18203/2320-1770.ijrcog20240812","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240812","url":null,"abstract":"The cervical fibroids are rare and large cervical fibroids are rarer. Removing large cervical fibroids when a patient desires future fertility is a surgical challenge because of the risks of significant blood loss, bladder and ureteric injury, and unplanned hysterectomy. For women who desire future fertility, myomectomy can improve the chances of pregnancy by restoring normal anatomy. In this article, we describe a successful pregnancy following the restoration of the normal anatomy of the cervix by a challenging myomectomy in a sub-fertile patient with a large cervical fibroid. A 38-year-old nulliparous lady presented to the reproductive endocrinology and infertility (REI) department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with primary sub-fertility for five and half years, and dysmenorrhea for 2 years. She was a regularly menstruating woman with average flow and duration. Being a resident of Canada, she was diagnosed there as a case of large cervical fibroid (10×9 cm) by TVS extending up to the posterior wall of the uterus, cervix, and upper vagina impacted in the pouch of Douglas during infertility workup. For this reason, she was advised for in vitro fertilization (IVF) keeping the fibroid in situ. However, due to the failure of embryo transfer with this large cervical fibroid, she was advised for embryo transfer following myomectomy. Hysteroscopic myomectomy was tried first (in February 2019 in Canada) but was unable to be removed. Then Laparotomy was tried (in September 2019 in Canada) but failed again. Being a complicated case, she was counselled there for myomectomy by a multidisciplinary approach with the high risk of injury to the urinary bladder, ureter, bowel, and other pelvic structures. But she refused to do a myomectomy there after knowing the dreadful complications with the fear of injury to the pelvic organs. With this problem, she went to different institutions both in the country and abroad but couldn’t get the proper treatment. Finally, she visited the outpatient department (OPD) of the REI department, BSMMU, Dhaka, Bangladesh with the hope of getting the most appropriate treatment for her and she was reassured, counselled, and managed by a challenging myomectomy (in March 2022) through a combined approach of the vagina and abdominal route without any significant intra and post-operative complications. Her whole post-operative period was uneventful, the anatomy of the cervix was restored and detected by TVS, and trial transfer was done before embryo transfer with easy negotiation to the cervix. Finally, she conceived 1 year after myomectomy with easy frozen embryo transfer. Myomectomy in expert hand even for the large cervical fibroid can restore normal anatomy and can achieve successful pregnancy outcomes.","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"112 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140370540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240782
Amanpreet Kaur, M. Bedi, Parvinder Singh, Pulkita Lamba, Harbhajan Kaur, Vijay Suri
Background: Aim was to compare histological diagnosis of differently stained endometrial tissue on chromohysteroscopy. Methods: A total of 80 patients diagnosed with AUB and satisfying the study design were included in the study. Hysteroscopy followed by chromohysteroscopy was done using 1% methylene blue. Staining patterns were observed and guided biopsies were taken from differently stained areas and sent for histopathology. Results: On chromohysteroscopy, out of the 80 participants, 53 (66.3%) had focal staining and 27 (33.7%) had diffuse staining. The overall sensitivity, specificity, PPV and NPV of TVS in diagnosing uterine abnormalities was 51.7%, 45.1%, 34.9%, 62.2% respectively. The overall sensitivity, specificity, PPV and NPV for hysteroscopy were 96.6%, 41.2%, 48.3%, 95.5% respectively. The indices for chromohysteroscopy were as follows: sensitivity-69% for focal and 31% for diffuse staining, specificity-49.0% for focal staining and 69.7% for diffuse staining, PPV-43.5% for focal and 33.3% for diffuse staining, NPV-73.5% for focal staining and 62.3% for diffuse staining. Conclusions: The idea of staining of endometrium and taking a guided biopsy is exciting and is undoubtedly, better than a blind sampling. However, subjecting all the patient of AUB to chromohysteroscopy in order to find a major histopathological difference is questionable and needs larger trials to reach to concrete decision.
{"title":"Comparison of chromohysteroscopy findings with histopathological findings in abnormal uterine bleeding","authors":"Amanpreet Kaur, M. Bedi, Parvinder Singh, Pulkita Lamba, Harbhajan Kaur, Vijay Suri","doi":"10.18203/2320-1770.ijrcog20240782","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240782","url":null,"abstract":"Background: Aim was to compare histological diagnosis of differently stained endometrial tissue on chromohysteroscopy.\u0000Methods: A total of 80 patients diagnosed with AUB and satisfying the study design were included in the study. Hysteroscopy followed by chromohysteroscopy was done using 1% methylene blue. Staining patterns were observed and guided biopsies were taken from differently stained areas and sent for histopathology.\u0000Results: On chromohysteroscopy, out of the 80 participants, 53 (66.3%) had focal staining and 27 (33.7%) had diffuse staining. The overall sensitivity, specificity, PPV and NPV of TVS in diagnosing uterine abnormalities was 51.7%, 45.1%, 34.9%, 62.2% respectively. The overall sensitivity, specificity, PPV and NPV for hysteroscopy were 96.6%, 41.2%, 48.3%, 95.5% respectively. The indices for chromohysteroscopy were as follows: sensitivity-69% for focal and 31% for diffuse staining, specificity-49.0% for focal staining and 69.7% for diffuse staining, PPV-43.5% for focal and 33.3% for diffuse staining, NPV-73.5% for focal staining and 62.3% for diffuse staining.\u0000Conclusions: The idea of staining of endometrium and taking a guided biopsy is exciting and is undoubtedly, better than a blind sampling. However, subjecting all the patient of AUB to chromohysteroscopy in order to find a major histopathological difference is questionable and needs larger trials to reach to concrete decision.","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"55 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140371518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240779
Urvashi Miglani, Jasmine K. Kohli, P. Laul, Monika S. Grover, Richa Madan
Background: Approximately 529,000 women die from pregnancy-related causes annually and almost 99% of these occur in developing nations. Even with decline, India still is one of the major contributors to maternal deaths in the world. Hence, the present study was conducted to assess the causes, sociodemographic factors and level of delay influencing maternal mortality. Methods: A retrospective descriptive study based on all maternal deaths within 2.5 years from June 2020 to December 2022 in tertiary care center New Delhi was included. All deaths were assessed for sociodemographic risk factor and processed using descriptive statistics for various variables. Results: During the study 77 deaths were identified. 48 deaths were direct and 29 were indirect maternal deaths. Sepsis and infectious diseases were the leading cause of direct and indirect maternal death respectively. 47% women died at more than 34 weeks’ gestation.12 women died undelivered. 65 women who died in the postpartum period, caesarean section was performed in 32%. Of total deaths 53 women were unbooked and level 1 delay in 78% cases. Conclusions: Education and awareness of importance of antenatal care, diagnosis and management of anemia to be given prime importance. Institutional deliveries to be encouraged. Optimization of comorbid conditions in the preoperative period is quintessential.
{"title":"Maternal mortality in a tertiary hospital of North India- analysis of causes and risk factors","authors":"Urvashi Miglani, Jasmine K. Kohli, P. Laul, Monika S. Grover, Richa Madan","doi":"10.18203/2320-1770.ijrcog20240779","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240779","url":null,"abstract":"Background: Approximately 529,000 women die from pregnancy-related causes annually and almost 99% of these occur in developing nations. Even with decline, India still is one of the major contributors to maternal deaths in the world. Hence, the present study was conducted to assess the causes, sociodemographic factors and level of delay influencing maternal mortality.\u0000Methods: A retrospective descriptive study based on all maternal deaths within 2.5 years from June 2020 to December 2022 in tertiary care center New Delhi was included. All deaths were assessed for sociodemographic risk factor and processed using descriptive statistics for various variables.\u0000Results: During the study 77 deaths were identified. 48 deaths were direct and 29 were indirect maternal deaths. Sepsis and infectious diseases were the leading cause of direct and indirect maternal death respectively. 47% women died at more than 34 weeks’ gestation.12 women died undelivered. 65 women who died in the postpartum period, caesarean section was performed in 32%. Of total deaths 53 women were unbooked and level 1 delay in 78% cases.\u0000Conclusions: Education and awareness of importance of antenatal care, diagnosis and management of anemia to be given prime importance. Institutional deliveries to be encouraged. Optimization of comorbid conditions in the preoperative period is quintessential.","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"61 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140371729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240805
Mounir Moukit, Youssef Bougrini, Mohammed Rahmoune, Ismail Allilou, Abdellah Babahabib
Tuberculosis is one of the leading infectious and contagious diseases, caused by bacteria belonging to the Mycobacterium family. Breast involvement ranks last among the extrapulmonary manifestations of tuberculosis but remains an important clinical condition that may present clinical and radiological similarities with breast cancer, thus requiring a thorough diagnostic approach including histological and/or bacteriological confirmation. This is a retrospective study conducted at the department of Gynecology and Obstetrics of the Military Hospital Moulay Ismail - Meknes, over a period of 4 years. A total of 6 cases of breast tuberculosis were observed, resulting in an incidence rate of 6 cases per 7600 women-years. The mean age of patients was 39 years. Signs of tuberculosis impregnation were found in 33% of cases. The clinical forms encountered, in descending order of frequency, were: diffuse form (50% of cases), nodular form (33% of cases), and sclerotic form (16% of cases). The radiological findings were almost always suggestive of a suspicious lesion. Diagnosis was primarily based on the histopathological study of breast biopsy. All our patients received a standard regimen of anti-tubercular treatment including: 4 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol followed by 2 months of Rifampicin and Isoniazid with favorable outcomes. Only one patient experienced a recurrence due to under dosing of Rifampicin, which was managed with a total of 9 months of treatment. One patient underwent additional surgical drainage. Early and thorough diagnosis of breast tuberculosis is crucial as it helps avoid mutilating surgery in often young women.
{"title":"Breast tuberculosis: a case series","authors":"Mounir Moukit, Youssef Bougrini, Mohammed Rahmoune, Ismail Allilou, Abdellah Babahabib","doi":"10.18203/2320-1770.ijrcog20240805","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240805","url":null,"abstract":"Tuberculosis is one of the leading infectious and contagious diseases, caused by bacteria belonging to the Mycobacterium family. Breast involvement ranks last among the extrapulmonary manifestations of tuberculosis but remains an important clinical condition that may present clinical and radiological similarities with breast cancer, thus requiring a thorough diagnostic approach including histological and/or bacteriological confirmation. This is a retrospective study conducted at the department of Gynecology and Obstetrics of the Military Hospital Moulay Ismail - Meknes, over a period of 4 years. A total of 6 cases of breast tuberculosis were observed, resulting in an incidence rate of 6 cases per 7600 women-years. The mean age of patients was 39 years. Signs of tuberculosis impregnation were found in 33% of cases. The clinical forms encountered, in descending order of frequency, were: diffuse form (50% of cases), nodular form (33% of cases), and sclerotic form (16% of cases). The radiological findings were almost always suggestive of a suspicious lesion. Diagnosis was primarily based on the histopathological study of breast biopsy. All our patients received a standard regimen of anti-tubercular treatment including: 4 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol followed by 2 months of Rifampicin and Isoniazid with favorable outcomes. Only one patient experienced a recurrence due to under dosing of Rifampicin, which was managed with a total of 9 months of treatment. One patient underwent additional surgical drainage. Early and thorough diagnosis of breast tuberculosis is crucial as it helps avoid mutilating surgery in often young women.","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"140 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.18203/2320-1770.ijrcog20240799
Abhilasha Choudhary, Swati, Pahula Verma
Background: The World Health Organization (WHO) has released fresh information showing that the number of caesarean sections performed worldwide has increased and now accounts for more than one in five (21%) deliveries. 89.8% of women experienced significant post-operative discomfort following a caesarean section and 84.2% reported to have moderate to severe pain. This study aimed to compare diclofenac, paracetamol infusion, and a combination of both in patients of post-caesarean for pain management. Methods: The study was a cross-sectional study carried out in the department of obstetrics and gynaecology at a tertiary care hospital in a rural area of Panipat, Haryana. A total number of 102 women who underwent caesarean section were taken for the study. They were divided into 3 groups each having 34 women. The first group was given diclofenac, the second was given paracetamol infusion and the third was given a combination of both for pain management. Results: In our study we have done visual analog score (VAS) scoring at 0, 1, 6, 12, 18 and 24 hours and we found that the mean VAS score in group 3 was highest when compared to other two groups. We also found that on comparing data of VAS score between the three groups the p value came out to significant that is p≤0.001. Conclusions: We found that combination therapy had good results in comparison to individual therapy and had fewer side effects.
背景：世界卫生组织（WHO）发布的最新信息显示，全球剖腹产的数量有所增加，目前每五名产妇中就有一名以上（21%）是剖腹产。89.8%的产妇在剖腹产术后感到明显不适，84.2%的产妇表示有中度至重度疼痛。本研究旨在比较双氯芬酸、扑热息痛输液和两者联合使用对剖腹产后患者的镇痛效果：本研究是一项横断面研究，在哈里亚纳邦帕尼帕特农村地区一家三级医院的妇产科进行。共有 102 名接受剖腹产手术的妇女参与了研究。她们被分为 3 组，每组 34 人。第一组给予双氯芬酸，第二组给予扑热息痛输液，第三组给予这两种止痛药的组合：在研究中，我们在 0、1、6、12、18 和 24 小时进行了视觉模拟评分（VAS），发现与其他两组相比，第三组的平均 VAS 评分最高。我们还发现，比较三组之间的 VAS 评分数据，P 值显著，即 P≤0.001 ：我们发现，与单独疗法相比，联合疗法具有良好的效果，而且副作用较小。
{"title":"Comparative study of diclofenac, paracetamol infusion, or a combination in post-caesarean patients for pain management","authors":"Abhilasha Choudhary, Swati, Pahula Verma","doi":"10.18203/2320-1770.ijrcog20240799","DOIUrl":"https://doi.org/10.18203/2320-1770.ijrcog20240799","url":null,"abstract":"Background: The World Health Organization (WHO) has released fresh information showing that the number of caesarean sections performed worldwide has increased and now accounts for more than one in five (21%) deliveries. 89.8% of women experienced significant post-operative discomfort following a caesarean section and 84.2% reported to have moderate to severe pain. This study aimed to compare diclofenac, paracetamol infusion, and a combination of both in patients of post-caesarean for pain management.\u0000Methods: The study was a cross-sectional study carried out in the department of obstetrics and gynaecology at a tertiary care hospital in a rural area of Panipat, Haryana. A total number of 102 women who underwent caesarean section were taken for the study. They were divided into 3 groups each having 34 women. The first group was given diclofenac, the second was given paracetamol infusion and the third was given a combination of both for pain management.\u0000Results: In our study we have done visual analog score (VAS) scoring at 0, 1, 6, 12, 18 and 24 hours and we found that the mean VAS score in group 3 was highest when compared to other two groups. We also found that on comparing data of VAS score between the three groups the p value came out to significant that is p≤0.001.\u0000Conclusions: We found that combination therapy had good results in comparison to individual therapy and had fewer side effects.","PeriodicalId":14225,"journal":{"name":"International journal of reproduction, contraception, obstetrics and gynecology","volume":"131 49","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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