Knowledge and attitude regarding obstetric ultrasound among pregnant women: a cross sectional study

Background: Ultrasound examination forms an integral part of antenatal care both in high risk and normal pregnancies. Even though it acts as a source of reassurance about the well-being of her baby and also a source of connecting with her baby in the antenatal period, for many pregnant mothers in India it is still only a tool for sex determination and its other major uses remain in the background. Fear regarding its safety and doubts about its necessity are also prevalent among pregnant women. The purpose of this study is to assess the knowledge of antenatal mothers regarding the uses of ultrasound during pregnancy and also to assess their attitude towards ultrasound.Methods: This is a descriptive cross sectional study carried out in Sri Manakula Vinayagar medical college and hospital, Puducherry, India between the periods of April 2014 to July 2014. 300 pregnant women were selected by simple random sampling among patients attending the antenatal clinic for routine checkup irrespective of their parity. After obtaining informed consent, these women were given a predesigned, self-administered questionnaire in local language that had questions on socio demographic data, knowledge regarding use of ultrasound in pregnancy, attitude towards ultrasound, source of information about ultrasound and awareness regarding PNDT act. The data was entered in SPSS and analyzed using descriptive statistics.Results: Although awareness regarding the indications for USG during pregnancy was found to be fairly good among the participants , 36 % of the them assumed determination of sex in utero as an indication for ultrasound.88% of them considered ultrasound as safe and 98% considered it essential. 26% of the pregnant women considered that sex determination was permissible by law. Most of them obtained information regarding ultrasound from health providers and the role of media was negligible.Conclusions: Awareness regarding the uses of USG during pregnancy and attitude towards ultrasound was good but knowledge about recommendations of PNDT act was lacking in pregnant women and so every possible route particularly extensive media coverage can be used to create awareness regarding the recommendations of the PNDT act to the public

Role of transvaginal sonography and hysteroscopy in abnormal uterine bleeding: does the diagnostic yield increase by combining transvaginal sonography, hysteroscopy and biopsy?

Background: Abnormal uterine bleeding is the most common complaint of perimenopausal and postmenopausal women. The aim of this study was 1) To evaluate the causes of abnormal uterine bleeding using transvaginal sonography, hysteroscopy and endometrial curettage to achieve the greatest diagnostic accuracy. 2) To determine the sensitivity and specificity of TVS and hysteroscopy in the detection of various uterine pathologies.Methods: This was a descriptive cross sectional study between January 2013 to June2014 in Sri Manakula Vinayagar medical college and hospital. After obtaining ethics committee approval, 100 consecutive patients with abnormal uterine bleeding between the age group of 35 and 55 years, who consented to participate in the study, were subjected to transvaginal sonography followed by diagnostic hysteroscopy combined with a directed biopsy. TVS and hysteroscopy was performed by two different investigators. The endometrial curettings and any intracavitary lesion were subjected to histopathological examination. Results tabulated and analysed using MS EXCEL and cross tabulation using Epi-info. Sensitivity, specificity, PPV, NPV for each pathology by TVS and hysteroscopy with HPE as the gold standard was calculated. Also the pathology causing abnormal uterine bleeding was computed by taking into account the endometrial characteristics and the associated lesions diagnosed by TVS, hysteroscopy and histopathological examination report.Results: 61 patients had only single lesions in the form of normal endometrium, atrophic endometrium, endometrial hyperplasia, endometrial polyp, malignancy and IU synechiae whereas 39 patients had lesions like intramural fibroids, adenomyosis, submucus myoma and polyps associated with different types of endometrium. The diagnostic accuracy of TVS and hysteroscopy were comparable for normal endometrium whereas hysteroscopy was found to be more accurate for endometrial polyps, endometrial hyperplasia and atrophic endometrium.Conclusions: The combination of transvaginal sonography, hysteroscopy and directed biopsy was found to increase the diagnostic yield in patients with abnormal uterine bleeding. As the diagnostic accuracy increased by combining the three modalities, an effective and appropriate management can be planned.

Attitude to counseling and testing for HIV and knowledge about prevention of mother to child transmission of HIV in men accompanying antenatal attendees at a tertiary care hospital in South India

Background: Parent to child transmission is the second most common route of transmission of HIV in India contributing to 5% of new infections. This is due to underutilization of the components of PPTCT among  pregnant  women . As male partners remain the main decision makers in the family and influence their wife’s behaviour, poor awareness and negative attitude of men towards testing and treatment of HIV is a hindering factor in the successful implementation of the program. Therefore this study was carried out to study the awareness of men regarding HIV and PPTCT and also to assess their attitude towards testing and treatment in an antenatal clinic setting.Methods: This is a cross sectional descriptive institution based study conducted in Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. The study participants were men who accompanied their pregnant wife to the antenatal clinic. A pretested, predesigned questionnaire was used as the survey tool to assess the knowledge of these men about PPTCT services and also to assess their attitude towards HIV testing during pregnancy. The collected data was entered in SPSS and analyzed using descriptive statistics.Results: Among participants only 68% were aware that a HIV positive mother could transmit infection to her baby and more than half of the participants were not aware that breast feeding could cause vertical transmission. Nearly 39% of the participants were not aware that mother to child transmission can be curtailed by giving ART during pregnancy. Acceptance for HIV testing was fairly good even before pretest counseling to the extent of 88.6% of the participants. Among the participants who did not want to get tested for  HIV, 52.9% assumed that their HIV status will be the same as that of their wife whereas 29.4% said that they were not comfortable undergoing the test along with their wife.Conclusions: The present study shows that men lacked awareness about the concept of vertical transmission of HIV and also the various aspects of prevention of maternal to child transmission of the infection. Their attitude towards testing was positive even though they were not aware of its implications. Media should be used to create awareness and couple counseling and testing should be promoted in all PPTCT centers thereby increasing the male participation in the PPTCT program

Scar endometriosis following hysterotomy: a case report

Scar endometriosis is a rare entity mostly following obstetrical and gynecological surgeries and difficult to diagnose. It is often misdiagnosed as abscess, suture granuloma or lipoma. We report a case of scar endometriosis following hysterotomy - because of its rarity

Why women seek abortion? a qualitative study on perspectives of rural women on abortion and contraception

Background:Induced abortions have been a sensitive issue throughout the world and the reasons for which women seek abortion is diverse and depends on many social and economical factors. In India, most of the rural women are still not aware of their rights and needs regarding abortion and consider abortion as illegal. Exploring the perspectives of rural women regarding induced abortions using qualitative methodology would help us to understand their attitude towards abortion and guide us towards educating women to adopt a favorable attitude towards safe abortion and contraception. The aim of this study was to explore the rural woman’s perspective of their rights and needs in relation to abortion and attitudes and beliefs regarding contraception Methods: A descriptive qualitative study done in Sri Manakula Vinayagar Medical College & Hospital. Nine, purposively selected rural women attending family welfare clinic for seeking termination of pregnancy after having experienced at least one or more previous abortions were subjected to in-depth interview. The participants of the study were duly counseled and informed consent was taken prior to the in-depth interview. Semi-structured guideline was used for data collection, which included background characteristics, the reasons for seeking multiple abortions and perception of their rights and needs regarding abortion and their beliefs and attitude regarding contraception. In-depth interview was carried out in Tamil and translated to English by the authors The evolving themes were summarized and manual content analysis was done.Results:The age group of our respondents was between 22-30 years and eight respondents were multiparous whereas one respondent was a nullipara. Among the 9 respondents, 4 had a previous history of unsupervised medical abortion. The most common reason cited for repeated abortions was unwanted pregnancy due to completion of the family followed by other reasons like lack of spacing, health, financial and social reasons. In majority of the respondents both the husband and wife were involved in the decision making process but husband had the final authority. Women experienced a lot of emotional turmoil during the abortion process and feeling of guilt and pain was quite common. Most of the respondents used natural methods of contraception and many misconceptions prevailed regarding the use of contraceptives. Awareness of the legal status of abortion, the time limit and indications for legal abortions was almost negligible in these women.Conclusion:  These findings highlight the need to improve rural women’s knowledge of fertility and contraception. Media and service providers should use every possible opportunity to educate women regarding the legal status of abortion and to promote contraceptive usage by creating awareness regarding safety and free availability of various contraceptives thereby clearing misconceptions regarding contraception. There is a need to educate rural women that use of a regular contraceptive method is better than undergoing repeated abortions

Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Summary Background Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development