Awareness of post partum intra uterine contraceptive device and reasons for its low acceptance in an urban Indian population

Background: The safety and efficacy of the Post-Partum Intra Uterine Contraceptive Device (PPIUCD) has been documented worldwide. With increasing institutional deliveries and greater sensitization, the aim is to increase PPIUCD insertions. Many areas still report poor acceptance.  Objectives of this study to determine the proportion of antenatal women willing to accept PPIUCD insertion and the reasons behind refusal to accept this method.Methods: A prospective questionnaire study was done between January 2019 to June 2019 of 200 women. Inclusion criteria were antenatal women in the 2nd/3rd trimester. Exclusion criteria were those opting for a permanent method of contraception and those with a contra-indication.Results: Eighty-four women (42%) had never used any method of contraception. Earlier Intrauterine device (IUD) use (including both interval and PPIUCD) was in only 18.9% of all contraceptive users. Only 2 women in the group had ever used PPIUCD. 79% of women were aware of IUDs. Those unaware were mainly nulliparous. Amongst those aware of an IUD, 88 (56%) were aware it could be inserted postpartum. Only 18% were aware it could be inserted intra-cesarean. All women who participated were offered the option for a PPIUCD. Fifty-nine (29.5%) of all women expressed their willingness but on follow up till delivery only 18 of these women got a PPIUCD inserted.  Amongst those not willing for the PPIUCD insertion the commonest reason was general apprehension (39%) followed by partner refusal (33%) and fear of complications (31%). Six women (4.2%) gave history of complications following earlier use and were unwilling for its repeat use. Conclusion: The large unmet need for contraception in India can be solved through repeated counselling and discussions with the woman during her antenatal visits. Alleviating apprehension and addressing concerns of the couple will increase PPIUCD acceptance

Pap smear in antenatal women: a valuable opportunity for screening and awareness

Background: Pregnancy creates an important opportunity to screen the cervix for neoplastic and infectious diseases and to spread awareness. A pap smear is simple, cost effective and safe in pregnancy. In low resource countries, this may be the only opportunity when the woman visits a health centre.  It also helps identify and treat infections that could hamper the pregnancy outcome. Objective of the study is to determine the awareness of pap smear as a cervical cancer screening test in antenatal women; to determine the incidence of cervical neoplasia and premalignant lesions of the cervix in antenatal women.Methods: A cross-sectional study was carried out between November 2018 to April 2019. Inclusion criteria were pregnant women in the first trimester. Exclusion criteria were pregnancy greater than 12 weeks, symptoms of vaginal infection, history of sexual intercourse or vaginal medication or bleeding in the last 48 hours or a normal pap smear in the last 3 years. The reporting was done as per Bethesda 2014.Results: 308 women underwent a pap smear in their 1st trimester. 94% were satisfactory smears and 3(0.9%) an abnormal smear (2 LSIL and 1 ASCUS). 31.2% had inflammatory smears. Only 15 women were aware of pap smear as a test for cancer cervix screening and all these women were graduates and above. No women had ever had a pap smear test in the past. One fifth of women studied had 1 or more risk factor the commonest being early age at first intercourse.Conclusions: The antenatal period should be utilized as an opportunity to screen women for cancer cervix

Small-Cell Neuroendocrine Carcinoma of the Cervix Masquerading as a Cervical Fibroid: Report of a rare entity

Primary neuroendocrine tumours of the cervix are extremely rare, with an incidence of only 0.5–1%; as such, these entities can present a clinical and diagnostic challenge. Small-cell neuroendocrine carcinomas of the cervix are highly aggressive tumours that have a tendency to metastasise. We report a 44-year-old woman who presented to the Gynaecology Clinic of the Employees State Insurance Corporation Medical College & Hospital, Faridabad, India, in 2016 with menorrhagia. Based on a clinical examination, she was provisionally diagnosed with a cervical fibroid. However, a biopsy revealed features of a small-cell neuroendocrine carcinoma of the cervix which was subsequently confirmed via immunohistochemistry. An accurate diagnosis of a neuroendocrine carcinoma is vital as it forms the basis for treatment decisions as well as informing predictions for long-term survival

Scar endometriosis with rudimentary horn: An unusual and elucidative report of a case diagnosed on histopathology and immunohistochemistry

Endometriosis is defined as the presence of functioning endometrial tissue outside the endometrial cavity. Scar endometriosis, also known as spontaneous abdominal wall endometriosis, is an unusual clinical presentation which often goes unnoticed. It usually develops after pelvic operations. The incidence has been estimated to be only 0.03%–0.15% of all cases of endometriosis. It can be either asymptomatic or present as abdominal wall pain at the site of surgical incision. It is most commonly diagnosed clinically or on ultrasonography. The treatment of choice predominantly remains surgical excision. We present a case of a 24-year-old female (known case of bicornuate uterus) who presented with chief complaints of abdominal pain for 1 month and 6 months after metroplasty. The patient was clinically diagnosed as a case of scar endometriosis with rudimentary horn and fistulous tract and taken up for surgery. Both the scar tissue and fistulous tract were removed and histopathology revealed only endometrial glands without stroma or hemosiderin-laden macrophages. Diagnosis of scar endometriosis was established on positive immunohistochemistry for estrogen and progesterone receptor in endometrial glands. Timely diagnosis and surgical excision of scar endometriosis along with close follow-up are necessary to prevent complications and recurrence

Xanthogranulomatous change in a leiomyoma: First report of an extremely rare variant/degenerative change

Xanthogranulomatous inflammation, a specific form of chronic inflammation, is marked by parenchymal destruction, proliferative fibrosis, and infiltration of typical foamy histiocytes admixed with hemosiderin-laden macrophages and foreign-body giant cells. Myometrial xanthomatosis, a term designated for nodular or diffuse histiocytic hyperplasia of the myometrium, has been reported in association with pregnancy-related procedures. Moreover, a 2–3-fold increase in histiocytic counts has been observed in leiomyomatous areas than in adjacent normal myometrium. The first evidence of collections of lipid-laden macrophages was documented in the form of yellowish degeneration of uterine leiomyomas. We report a case of xanthogranulomatous change in a leiomyoma in a 47-year-old female who presented with abnormal uterine bleeding. To the best of our knowledge, this is the first report of xanthogranulomatous variant/degenerative change in a leiomyoma. This case highlights a new variant of leiomyoma which both gynecologists and pathologists should be aware of as it may pose a diagnostic challenge both clinically as well as pathologically