Sexually transmitted diseases in laboring women: trend over a decade

Background: Center for Disease Control (CDC) recommends routine screening in all pregnant women at first visit for syphilis, HIV, Hepatitis B infection as they have high vertical transmission rate. Syphilis is brought to control by screening and early treatment with penicillin, whereas HIV and Hepatitis B are incurable viral infections till date. Hence prevention is the only way to control the disease in the population. The purpose of the study is to know the burden of sexually transmitted diseases, so that prevention programme is better planned.Methods: This is a retrospective analytical study conducted from January 2005 to December 2014, in Karnataka Institute of Medical Sciences, Hubli, Karnataka. All the patients who delivered in septic ward, who were more than 28 weeks of gestation and who were HIV, HBsAg or VDRL positive were included in the study.Results: Among the total of 79,472 deliveries, the prevalence of HIV, HBsAg and VDRL were 0.90, 1.06 and 0.31 respectively. There were 4 cases of co-infection. The prevalence of HIV was 0.79 in 2005 and reached its peak of 1.33 in 2008 and then showed a steady decrease, reaching a lowest of 0.52 in 2014. The prevalence of HBsAg was 0.70 in 2005 and reached a peak of 1.57 in 2014. The prevalence of VDRL was highest of 0.08 in 2005 and lowest of 0.02 in 2014. Highest operative deliveries were seen in HBsAg positive women. Stillbirths were maximum in VDRL positive women and least in HBsAg positive women. There were 9 maternal deaths in HIV positive women and 3 maternal deaths in HBsAg positive women.Conclusions: In our study HIV prevalence is showing a down trend and syphilis is at the verge of elimination as seen globally. However prevalence of Hepatitis B has shown a rising trend over a decade in our institute, unlike a down trend seen globally. Intensifying the screening of Hepatitis B in pregnancy and Immunisation programme of neonates, reducing overcrowding and providing better living conditions, improving hygiene and health education should be done in order to reduce the prevalence of Hepatitis B infection

Mixed germ cell tumour of ovary presenting as pregnancy: a rare presentation

Malignant mixed germ cell tumour of the ovary containing embryonal carcinoma and choriocarcinoma is a very rare entity. These tumours can present as precocious puberty or menstrual irregularities in adolescent girls. Here we report a case of 22 year old lady who presented as 5 months pregnancy in antenatal clinic. MRI Imaging and tumour markers revealed malignant ovarian tumour. Patient underwent surgicopathological staging and was found to have malignant mixed germ cell tumour stage IIIB, comprising of both choriocarcinoma and embryonal carcinoma components. Patient received one cycle of chemotherapy and was called for follow up. Mixed malignant germ cell tumour of the ovary is a highly aggressive neoplasm that can present in advanced stage.  A high clinical suspicion is needed in patients presenting with pelvic mass associated with menstrual irregularity or amenorrhoea in adolescent and young women

Cause of death and associated conditions of stillbirths

Background: Fetal death is a psychological trauma for the expecting mother and their family. Most of the countries worldwide lack data on stillbirths. Simply counting stillbirths is the first step in analysis and prevention and hence stillbirths need to count. Purpose of the study is to know the incidence, cause of stillbirths and to plan cause specific interventions to reduce stillbirths.Methods: This is a prospective cross-sectional study of patients with stillbirths from September 2014 to August 2015 in Karnataka Institute of Medical Sciences, Karnataka.  All the cases who delivered stillbirths  of  weight more than 1kg, were  grouped into  the following CODAC (causes of death and associated conditions)  simplified classification and were analysed.Results: The total number of births during the study period was 9,863.  Total number of stillbirths in our study period was 563. In the study period, the stillbirth rate was 57.9 per 1000 births, out of which 56.3% were in preterm pregnancy and 43.69% in term pregnancies. The three common causes of stillbirths were hypertensive disorders (34.63%), intrapartum fetal loss (27.17%) and abruptio placenta (11.54%).  In 7.9% of cases the cause of stillbirth was unknown. Nutritional anaemia, teenage pregnancy and intrauterine growth restriction were the most common associated conditions of stillbirths.Conclusions: Anaemia and teenage pregnancy are the two important risk factors associated with stillbirths. Adolescent health education, folic acid and iron supplementation in schools has to be planned as a primary prevention of stillbirth. Early detection and treatment of hypertensive disorders and good intrapartum care, will help us in reducing the stillbirth rate to a large extent, as these are the two important causes of stillbirth

Downstaging of carcinoma cervix: yet to reach the unreached

Background: To know the incidence, presenting symptoms and stages of carcinoma cervix in the patients visiting KIMS, Hubli, Karnataka in the year 2014.Methods: This is a prospective cross-sectional study from January 2014 to December 2014 in Karnataka Institute of Medical Sciences, Karnataka. All patients attending the gynaecological OPD were included in the study. After taking detailed history, patients underwent general physical examination, per speculum and pelvic examination. Patients were divided into 3 groups based on the per speculum and pelvic examination. Group 1 – only PAP smear was taken in women with normal cervix. Group 2 – PAP smear, visual inspection of cervix with acetic acid and biopsy was taken in women with abnormal cervix. Group 3 – only Cervical biopsy was taken and clinical staging was done in women with a suspicious cervix.Results: Total of 8053 patients were screened and examined for carcinoma cervix. A total of 14(0.17%) preinvasive lesions and 85(1.05%) invasive lesions were detected. Out of 85 invasive lesions, the most common pathology was squamous cell carcinomas in 78 (91.76%) patients, adenocarcinomas in 6 (7.05%) patients and adenosquamous carcinoma in 1(1.17%) patient. The most common symptoms of carcinoma cervix were WDPV- 48 (56.4%), Irregular vaginal bleeding- 19 (22.3%), postmenopausal bleeding- 10 (11.7%) and in advanced cases, VVF – 5 (0.05%), RVF- 1 (0.01%) and Uraemia - 2 (0.02%). Most of the patients examined were having disease in stage III -51 (60%) cases, stage IV – 26 (30.58%) cases, stage I -5 (5.8%) cases and stage II – 3 (3.52%) cases.Conclusions: Approximately one in every 100 patients examined in OPD, turned out to be a case of carcinoma cervix, out of which more than 90% patients were diagnosed to be in advanced stage. This huge burden of cases raises the question about screening of carcinoma cervix in rural areas, which needs to be improved. Hence lot has to be done than said, so that screening program of cancer cervix reaches the unreached

Sexually transmitted diseases in laboring women: trend over a decade

Background: Center for Disease Control (CDC) recommends routine screening in all pregnant women at first visit for syphilis, HIV, Hepatitis B infection as they have high vertical transmission rate. Syphilis is brought to control by screening and early treatment with penicillin, whereas HIV and Hepatitis B are incurable viral infections till date. Hence prevention is the only way to control the disease in the population. The purpose of the study is to know the burden of sexually transmitted diseases, so that prevention programme is better planned.Methods: This is a retrospective analytical study conducted from January 2005 to December 2014, in Karnataka Institute of Medical Sciences, Hubli, Karnataka. All the patients who delivered in septic ward, who were more than 28 weeks of gestation and who were HIV, HBsAg or VDRL positive were included in the study.Results: Among the total of 79,472 deliveries, the prevalence of HIV, HBsAg and VDRL were 0.90, 1.06 and 0.31 respectively. There were 4 cases of co-infection. The prevalence of HIV was 0.79 in 2005 and reached its peak of 1.33 in 2008 and then showed a steady decrease, reaching a lowest of 0.52 in 2014. The prevalence of HBsAg was 0.70 in 2005 and reached a peak of 1.57 in 2014. The prevalence of VDRL was highest of 0.08 in 2005 and lowest of 0.02 in 2014. Highest operative deliveries were seen in HBsAg positive women. Stillbirths were maximum in VDRL positive women and least in HBsAg positive women. There were 9 maternal deaths in HIV positive women and 3 maternal deaths in HBsAg positive women.Conclusions: In our study HIV prevalence is showing a down trend and syphilis is at the verge of elimination as seen globally. However prevalence of Hepatitis B has shown a rising trend over a decade in our institute, unlike a down trend seen globally. Intensifying the screening of Hepatitis B in pregnancy and Immunisation programme of neonates, reducing overcrowding and providing better living conditions, improving hygiene and health education should be done in order to reduce the prevalence of Hepatitis B infection

Downstaging of carcinoma cervix: yet to reach the unreached

Background: To know the incidence, presenting symptoms and stages of carcinoma cervix in the patients visiting KIMS, Hubli, Karnataka in the year 2014.Methods: This is a prospective cross-sectional study from January 2014 to December 2014 in Karnataka Institute of Medical Sciences, Karnataka. All patients attending the gynaecological OPD were included in the study. After taking detailed history, patients underwent general physical examination, per speculum and pelvic examination. Patients were divided into 3 groups based on the per speculum and pelvic examination. Group 1 – only PAP smear was taken in women with normal cervix. Group 2 – PAP smear, visual inspection of cervix with acetic acid and biopsy was taken in women with abnormal cervix. Group 3 – only Cervical biopsy was taken and clinical staging was done in women with a suspicious cervix.Results: Total of 8053 patients were screened and examined for carcinoma cervix. A total of 14(0.17%) preinvasive lesions and 85(1.05%) invasive lesions were detected. Out of 85 invasive lesions, the most common pathology was squamous cell carcinomas in 78 (91.76%) patients, adenocarcinomas in 6 (7.05%) patients and adenosquamous carcinoma in 1(1.17%) patient. The most common symptoms of carcinoma cervix were WDPV- 48 (56.4%), Irregular vaginal bleeding- 19 (22.3%), postmenopausal bleeding- 10 (11.7%) and in advanced cases, VVF – 5 (0.05%), RVF- 1 (0.01%) and Uraemia - 2 (0.02%). Most of the patients examined were having disease in stage III -51 (60%) cases, stage IV – 26 (30.58%) cases, stage I -5 (5.8%) cases and stage II – 3 (3.52%) cases.Conclusions: Approximately one in every 100 patients examined in OPD, turned out to be a case of carcinoma cervix, out of which more than 90% patients were diagnosed to be in advanced stage. This huge burden of cases raises the question about screening of carcinoma cervix in rural areas, which needs to be improved. Hence lot has to be done than said, so that screening program of cancer cervix reaches the unreached