Study of reproductive health problems in adolescent girls at ESIC PGIMSR, MGM Hospital, Parel, Mumbai: a retrospective study

Background: There are almost 200 million adolescents in India. It is estimated that the adolescent group constitutes about one fifth of India’s population and it is estimated that this age group will grow to over 214 million by 2020. The period of adolescence for a girl is a period of physical and psychological preparation for safe motherhood. Several factors contribute to the adolescents' growth. A vast majority of adolescent girls in India are suffering from menstrual problems, reproductive morbidities and nutritional deficiencies such as dysmenorrhoea, pre-menstrual syndrome, irregular menses, heavy menstrual bleeding, amenorrhoea, white discharge per vagina, UTI, anaemia etc. So, the present study was carried out to assess menstrual problems, reproductive health problems and nutritional status of adolescent girls coming to our hospital.Methods: It is a Retrospective study to find about the menstrual problems, reproductive health problems and nutritional status among the adolescent girls of 10-19 years age group who attended O.P.D. for various health problems. Data was collected retrospectively for two years from December 2015.Results: Mean age of adolescent girls were 14.38 Mean age to attain menarche was 12.93. About 386 (96.34%) adolescent girls were literate. 62.04% and 29.58% of adolescent girls belonged to class IV and Class V respectively. 62.56% of them live in poor housing and environmental status. The source of health information for the majority 123 (32.2%) was from mass media. Frequency and percentages of common menstrual problems like dysmenorrhea, premenstrual syndrome, heavy menstrual bleeding, intermenstrual bleeding and primary amenorrhoea were 29.58%, 26.39%, 16.49%, 24.34 and 1.57% respectively. Other Reproductive health problems white discharge per vagina, itching in private parts, pain in lower abdomen, backache, urinary tract infection, lump in abdomen and others (boils, ulcers, warts etc.) 26.7%, 8.11%, 18.06%, 12.3%, 7.32%, 4.97% and 1.57%. Under weight were 21.98%. Anemia was observed in 57.84% of adolescent girls.Conclusions: Present study concluded that most of the adolescent girls suffer from various types of menstrual problems, reproductive morbidities and nutritional problems. The findings of the present study recommend that awareness should be created among the adolescent girls, so that they will be able to take appropriate decision on medical care and treatment

Knowledge, attitudes, and practices among healthcare providers on cervical cancer, human papilloma virus and it’s vaccine at ESI PGIMSR, MGM Hospital Parel Mumbai, India

Background: Cervical cancer is the second most common cause of cancer in females Worldwide and nearly 85% of the cervical cancer cases are diagnosed in developing countries. The health care providers can play an important role in promoting cervical cancer screening and knowledge about HPV vaccination. So this study was conducted to assess the knowledge, attitude and practices regarding cervical cancer screening and HPV vaccination and to analyze the factors influencing the knowledge about HPV vaccination, among nursing staff.Methods: A cross-sectional study was conducted among 143 nurses and 75nursing students (total 218) at ESIPGIMSR MGM Hospital, Parel Mumbai. Data was collected using Questionnaire, designed based on the study objectives.Results: 73 (33.49%) of the nurses did received education on cervical cancer and HPV in the past. Most of the nurses, 184 (84.4%) considered that they were at no risk of cervical cancer. 143 (65.60%) nurses knew that Pap smear can be done to screen patients. Out of 141 married nurses, only 39 (27.28%) regularly had a gynaecological examination and 105 (74.47%) had never done Pap smear. In addition, 119 (54.59%) participants did not know at what age Pap smear should commence. Only 73 (33.49%) nurses knew about the route of transmission of HPV and 57 (26.15%) knew about HPV vaccine. 215 (98.62%) nurses did not receive an HPV vaccine.Conclusions: The nurses and nursing students did not have prior adequate education on cervical cancer, HPV, and vaccine and the desired level of knowledge on risk factors and signs of cervical cancer and prevention of the disease

The application of 50g oral glucose challenge test in screening for gestational diabetes mellitus in patients attending antenatal care OPD

Background: To screen patients at average risk for Gestational Diabetes using 50g Glucose Challenge test, to ascertain the prevalence of Gestational diabetes through further diagnostic testing and to prevent and manage complications. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Women with GDM are at risk for maternal and foetal complications, so it is important to screen all the pregnant woman.Methods: This study was conducted in 198 patients between 24 and 28 weeks of gestation, attending the Antenatal clinic. 50g oral glucose is administered irrespective of time of the last meal and plasma glucose is measured one hour later. Patients with plasma glucose levels more than 140 mg/dl were subjected to a 100g oral glucose tolerance test, patients with two or more abnormal reading were labelled as GDM and managed accordingly.Results: Prevalence of GDM in our study was 9.59%. Maternal complications like gestational hypertension, vaginal infections and foetal complications were much higher in GDM patients as compare to non GDM group.Conclusions: GDM is a disease which adversely affects both mother as well as foetus. It is concluded that 50 gm glucose challenge test at 24-28 weeks of gestation with a cut-off value of 140 mg/dl is a reliable screening test for GDM. This test offers the best combination of ease and economy of use and reproducibility in screening for gestational diabetes mellitus in average risk patients

Prevalence of thyroid disorders among patients attending the antenatal clinic at tertiary care centre, Parel, Mumbai, India

Background: Pregnancy is associated with major changes in the physiology of the thyroid gland. Undiagnosed thyroid disorders can adversely affect fetal and maternal outcome. This study was done to study the prevalence of thyroid disorder among antenatal women.Methods: This was a prospective study done in the antenatal clinic in the Department of Obstetrics and Gynaecology, ESI PGIMSRMGM Hospital, Parel, Mumbai, India.Results: In present study, fifty out of three hundred and fifty pregnant women screened had thyroid disorder. The prevalence of thyroid disorder in this study was 14.2%. The prevalence of subclinical hypothyroidism was 7.7% (n= 27), overt hypothyroidism was 4% (n=14), subclinical hyperthyroidism was 1.7% (n=6) and overt hyperthyroidism was 0.8% (n=3).Conclusions: Thyroid disorders in pregnancy are associated with adverse fetomaternal outcome. Its prevalence is high in Indian women. Thus thyroid screening should be included in the routine antenatal investigations

Pre-operative diagnosis of ovarian ectopic pregnancy: a challenge to practicing clinician

The first case of primary ovarian ectopic pregnancy was reported by St. Maurice in 1689. Primary ovarian ectopic pregnancy is rare entity, with incidence of around 3% of all ectopic pregnancies. The aim of present case report is to study the role of different modalities like clinical findings, biochemistry, sonography, surgery and histopathology in diagnosis of primary ovarian ectopic pregnancy. Authors present a case of a 24 years old female with history of 2 months amenorrhoea, per vaginal spotting and mild intermittent abdominal pain in RIF. Examination was unremarkable and serum βHCG was 2007.5IU/ml. An ultrasound scan showed an ectopic mass in the right adnexa suggestive of a tubal ectopic pregnancy and she underwent surgical management at our institute.  At laparoscopy, both fallopian tubes were noted to be normal with an ectopic mass attached to the right ovary with a pedicle. With these unusual laparoscopic findings, possibilities of tubal miscarriage, ovarian pregnancy, or abdominal pregnancy were suspected. Ectopic mass was coagulated and cut through the pedicle with bipolar cautery and specimen was sent for HPE. Our patient made an uneventful recovery and no further medical management was indicated. The diagnosis of right ovarian ectopic pregnancy was finally confirmed by histopathological evidence of the presence of chorionic villi in a background of ovarian stromal tissue, in consideration with Spigelberg’s criteria. Present case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on ultrasound scan. Pre-operative diagnosis of ovarian ectopic pregnancy still remains a challenge in spite of current medical advances. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be made at surgery. However, histopathological examination is confirmatory and always mandatory