A prospective observational to study sociodemographic profile, clinical profile and pattern of gynecological malignancies in a tertiary care center in Himachal Pradesh

Background: Cancer is the second leading cause of death globally and is estimated to account for 9.6 million deaths in 2018. Due to the lack of cancer awareness, variable pathology, and dearth of proper screening facilities in developing countries such as India, most women report at advanced stages, adversely affecting the prognosis and clinical outcomes. The aim of the study was to study the sociodemographic profile, clinical profile, pattern of gynaecology malignancies and their histopathological findings of all gynaecological malignancy patients attending gynaecological OPD.Methods: A prospective observational study was conducted in the Department of OBG, KNH Shimla from June 2019 to May 2020 where 241 gynaecological malignancy patients were recruited. Detailed history, general physical examination, systemic, gynaecological examination and required investigation was done and the data was analysed.Results: The most commonly occurring gynaecological malignancy was cervical cancer. 82.2% of the patients belonged to the age group 40-69 years. Majority of the patients were multiparous, belonged to rural background, belonged to Hindu community. 69.3% were menopausal. Among the 132 women who gave history of age at first coitus as less than 18 years, 60.6% of them had cervical cancer. Most common presenting complaints was post-menopausal bleeding. In cervical cancer 43.6% of patients diagnosed at stage III and were managed by radiation therapy.Conclusions: According to this study, cervical cancer is the most common gynaecological malignancy followed by ovarian cancer. Most of these patients seeked medical attention in advanced stage

Ectopic pregnancy and unsupervised abortion pills: the hidden truth

Background: Aim of the study was the indiscriminate use of self-consumption of abortion pills and its association with complication like ectopic pregnancy reporting to a tertiary care center.Methods: The study was a prospective observational study conducted in the department of obstetrics and gynecology, Kamla Nehru State hospital for mother and child, Indira Gandhi medical college Shimla w.e.f. 1st July 2018 to 30th June 2019. A total of 27 women reported to the hospital who were diagnosed of having ectopic pregnancy after intake of abortion pills.Results: A total of 27 cases presented to the hospital who were diagnosed to have ectopic pregnancy. Maximum 18 (67%) cases were in 21-30 years of age group. Married women constituted 21 (77%) cases. The 14 (52%) belonged to rural area while 13 (48%) belonged to urban area. The chemist was found to be source of procurement in 19 (70%) cases, private practitioner in 6 (22%) cases and only two consumed pills after consultation with registered doctor.Conclusions: This study shows urgent need for legislation and restriction of drugs used for medical termination of pregnancy. Drugs should be made available via health care facilities under supervision to reduce maternal mortality and morbidity due to indiscriminate use of these pills.

Study of risk factors for preterm deliveries in a tertiary hospital

Background: Preterm labour and preterm deliveries are very challenging obstetric complications. Early identification of risk factors may help identify women at risk for preterm deliveries.Methods: A one-year observational study was conducted in the department of obstetrics and gynecology, IGMC Shimla, Himachal Pradesh from 1st August 2017 to 31st July 2018. All mothers who delivered between 24 to 37 weeks were subjected to a detailed history with respect to age, parity, previous pregnancy outcomes and to identify the presence of any risk factors. A thorough obstetric and systemic examination was done. Parametric and non-parametric test of significance were used to find the association between different quantitative and qualitative variable.Results: Incidence of preterm deliveries was 11.4%. Maximum cases were of age group 25-30 years. 71.7% belonged to lower socio-economic status. 54% cases were seen in multigravida. History of previous abortion was seen in 18.4% and 9.7% had history of preterm deliveries. 12% cases had history of 1st trimester bleeding.  Spontaneous onset of preterm labour was seen in 55.1%. The significant risk factors associated were PIH and genitourinary infections.Conclusions: The risk factors of preterm birth to a large extent can be identified in antenatal period. Adolescent health education including good nutrition, good hygiene, counselling for contraception to reduce unintended pregnancies and birth spacing can lower the preterm birth rate. Better prenatal care, early identification of risk factors and complicated cases, regular follow up and proper management can help us in reducing preterm births