Journal of Obstetrics and Gynecology of India最新文献

The effect of cancer in women has varied effects. Overall malignancies of the breast, cervix, and ovary account for over 43% of all cancer cases in India. Globally, cervical cancer is fourth cancer in terms of incidence among women, following breast, lung, and colorectal cancer. However, this illness primarily affects women in India, where it is the second most frequent malignancy after breast cancer. HPV-related cervical cancer is a serious public health issue that has a solution. In 2020, the World Health Organization (WHO) launched a global initiative to eliminate cervical cancer which set targets for three important strategies: HPV vaccination, cervical cancer screening, and treatment. The WHO's "Best Buys" recommendations for cancer sub-set place vaccination of females between the ages of 9 and 14 at the top of the list. In India, efforts are underway to increase the number of teenage girls receiving the human papillomavirus (HPV) vaccine. The nation granted licenses for bivalent and quadrivalent HPV vaccinations in 2008, and in 2018, a nonavalent vaccine was approved. It is important to keep in mind that the cervical carcinoma vaccination is not a quick fix; thus, screening for the disease should continue. Any nation can potentially significantly lower the incidence of cervical cancer by carefully combining economical, high-coverage vaccinations with well-organized screening programs. Since 9-14 years is the ideal age range before sexual debut in today's world, this is the key vaccine age range. Estimates of vaccine effectiveness for younger adolescents, those between the ages of 9 and 14 years, varied from roughly 74 to 93%. Let us envision an India of the future where girls grow up with one fewer cancer threatening their life and a place where cervical cancer has been eradicated.

Introduction: Residual or recurrent cervical cancer post-CCRT is a challenging clinical issue, even though there has been much effort in recent decades to increase patient survival after radiation. There is a paucity of literature regarding the role of hysterectomy in recurrent/residual disease after radiation in LACC patients. Such a procedure is controversial and not routinely performed because of difficulties in obtaining tumor-free margins and the high rate of associated morbidity.

Aims and objectives: Evaluate outcomes and morbidities in patients who had undergone hysterectomy for residual or recurrent disease after radiation in LACC patients.

Material and methods: This is a prospective observational study on radiotherapy-treated LACC patients (IIB-III) with residual disease or recurrent disease who have undergone adjuvant hysterectomy. This study has been conducted at AHPGIC, Cuttack, with a sample size of 30 patients.

Results: 18/30 patients underwent extrafascial hysterectomy, and rest 12 patients had radical hysterectomy. No significant difference in complications, achieving tumor free margins or recurrences post adjuvant hysterectomy based on the radicality of surgery was observed. 5 cases of recurrences post-adjuvant hysterectomy were detected. Some of the factors which had significant association with recurrences post adjuvant hysterectomy were non squamous histology, no preoperative brachytherapy, deep stromal invasion and positive surgical margins. Median follow-up time was 14 months (12-27 months).

Conclusion: This study shows that adjuvant hysterectomy is feasible with good outcome and acceptable morbidity after chemoradiotherapy in cervical cancer patients "If selection of patients for adjuvant hysterectomy is appropriate."

Cervical Cancer prevention is a relatively new concept in Medicine. Since mid-twentieth century, diagnosis of Precancerous phase became possible thus outcome of invasive cervical cancer could be avoided. The dawn of this new era began with the research on HPV infection, being the causative factor. Clinical use of vaccines made it possible to start primary prevention by the year 2006. There has been a paradigm shift in this field and some of the important shifts will be discussed. The 1st paradigm is to better understand "Cancer Prevention". Cytology or the "Pap Smear" as it is commonly known is a simple low cost, low technology test. Combining it with biomarker test gives it more validity. Angiogenesis of cervical neoplasia was based on colposcopy. Angiogenesis inhibitor was discovered on this concept which improved treatment results. Incidence and mortality of cervical cancer shows a global disparity. For this, we have to study the social determinants. Some of the causes leading to high mortality are delay in diagnosis and reaching healthcare facility. UN's SD goal has suggested 30% reduction to be achieved. HPV is the cause of many other cancers apart from cervical cancer which may lead to suffering and mortality. The most deadly genotypes of HPV are 9 which form the NONAVALENT Vaccine. Introduction of vaccine made in India may be a game changer. A new "Ray of Hope" was the introduction of therapeutic vaccines in 2020. It will reduce human suffering and prolong life. As research advances, many more new Paradigms will evolve.

Cervical cancer elimination is a global health priority with the ambitious 90:70:90 target set by the WHO. This initiative aims for 90% of girls to be vaccinated against HPV, 70% of women to be screened with a high-performance test, and 90% of those who test positive to receive appropriate treatment by 2030. This editorial reflects on the journey from the initial declaration in 2018 to the present, highlighting the progress, challenges, and future directions in the fight against cervical cancer. With significant contributions from organizations like FIGO and FOGSI, the introduction of cost-effective vaccines and advanced screening methods, we are on a path towards achieving our targets. However, persistent efforts and global collaboration are essential to overcome the remaining hurdles.

Postpartum hemorrhage (PPH) remains a significant contributor to maternal morbidity and mortality worldwide. In India, PPH affects approximately 12% of women. The prevention and management of PPH are the significant challenges in obstetrics, with accurate assessment of blood loss and timely intervention being critical. Active Management of the Third Stage of Labor is a gold standard strategy for prevention. Recent advancements in PPH management include the use of recombinant activated factor VIIa, which has shown promise in decreasing the need for invasive procedures and second-line therapies. Additionally, surgical and radiological interventions have been effective in cases of refractory PPH. Overall, ongoing research and advancements in PPH management continue to enhance the quality of care and maternal outcomes experiencing this potentially life-threatening complication of childbirth. This editorial explores prevention and management of Atonic PPH with encompassing medical and surgical strategies, to enhance understanding and optimize clinical care for mothers at risk of this obstetric emergency.

There is an interest in menopause that demands answers and solutions. Menopause affects each women differently and hence it is unique and needs to be talked about. This focus has led to improvement in women's health bringing about better outcome in physical and mental health. Increase in life expectancy has led to menopausal health care, an important issue. Menopause is not disease but causes symptoms that can differ individually. Occasionally, surgery, radiation, and medications can cause menopause. Menopause hormone therapy (MHT), nonhormonal therapy, and lifestyle modifications under supervision can improve menopausal outcome. It also gives window of opportunity to evaluate and reduce risk of cardiovascular, bone, and urogenital health. Menopausal women should be provided with all options that are suitable and feasible for improvement in their life.

Introduction: Depot medroxy progesterone acetate (DMPA) is an injectable contraceptive with well-proven effectiveness and excellent safety profile. It is marketed as Antara in India as a part of the government's family planning programme.

Purpose: This study aimed to assess the experiences of women using Antara (DMPA) at a tertiary care hospital of Eastern India.

Materials and methods: An institution-based retrospective cross-sectional study was carried out in the family planning unit of the study institution from April 2021 to October 2022 among 200 women of reproductive age. Each of the mothers was administered a researcher-administered questionnaire containing questions pertaining to their sociodemographic characteristics and Antara use experience.

Results: The mean age of the study participants was 26.4 ± 5.9 years. Most of the participants were Hindus (55.0%), homemakers by their occupation (86.0%), and from lower socio-economic status. A significant proportion of the women had no formal education (14.0%) or had below primary education (14.5%). The most common reason provided by the participants for the discontinuation of Antara was the incidence of various side effects such as irregular menstruation, amenorrhea and apprehension. Lower educational status (p value < 0.001), poorer socio-economic status (p value < 0.001), and interval period starting of Antara (p value < 0.001) were statistically significantly associated with the discontinuation of the contraceptive.

Conclusions: Most women who started taking DMPA (Antara) discontinued due to the fear of side effects. Therefore, the focus should be to educate women regarding the benefits and side effects of DMPA through proper counselling.

The focus of the life and work of an obstetrics and gynaecological specialist is improving women's health, hence it is imperative that this issue be addressed in the Journal of Obstetrics and Gynaecology of India while we are still fresh with our memories of the "International women's day" celebration. The multidimensional impact of health and well-being of women has now been realised not only in the medical field but also in the realms of socioeconomic development. Governments all over the world are now paying special attention towards improving infrastructure, policymaking and implementation strategies to uplift the quality of healthcare for women and children, which  are now also important components of the Sustainable Development Goals. It is heartening to see worldwide interdisciplinary collaboration and coordination to achieve this vital goal and include every aspect of women's healthcare through the "lifecycle" approach and "holistic care" protocols.