Analysis of indications and route of hysterectomy for benign conditions

Background: Hysterectomy is the most common operation performed by gynecologist, next to caesarean section. The primary focus of this study was to review the indications and surgical technique of hysterectomy.Methods: This retrospective study was performed in the department of Obstetrics and gynecology, in collaboration with Department of Pathology.  All women in the reproductive age group and post-menopausal age who underwent hysterectomy with or without salpingo-oophorectomy were included in this study.Results: In our study, out of 100 patients, clinical indication was fibroid in 45 (45%) patients, menorrhagia in 15 (15%) patients, adenomyosis in 25 (25%) patients, uterovaginal prolapse in 5 (5%) patients, endometrial polyp in 5 (5%) patients and ovarian tumor in 5 (5%) patients. Histo-pathological diagnosis was leiomyoma in 55 (55%), adenomyosis in 30 (30%), endometrial polyp in 5 (5%), endometrial hyperplasia in 5 (5%) and serous cystadenoma of ovary in 5 (5%). Abdominal hysterectomy was performed in 46 (46%) patients, vaginal hysterectomy in 44 (44.33%) patients while laparoscopic hysterectomy was performed in 5 (6.66%) patients.Conclusions: In this study, most common indication for hysterectomy was fibroid uterus and it was correlated well with histopathology. Abdominal & vaginal hysterectomies were performed in almost equal number

Preventive gynaecology: awareness, attitude and practices of gynecologists

Background: Gynecologists are aware of screening tests of all gynecological malignancies. However, attitude and practices do not match with this. Present study was conducted in 214 gynecologists to evaluate awareness, attitude and practices of preventive gynecology.Methods: A survey was conducted among 214 gynecologists of Nagpur, using a questionnaire. This evaluated implementation of screening and preventive measures used by them for self-protection as well as for the women seeking their services. Their attitude regarding HPV vaccine as a preventive measure was also noted.Results: In present study, 160 (74.76%) gynecologists routinely advice pap smear to the patients, 54 (25.23%) gynecologists advice pap smear to the patients only if it is indicated. 102 (47.66%) gynecologists and spouses have got their own pap smear done. 192 (89.71%) were doing their self breast examination regularly and 66 (30.84%) had done their mammography. 168 (78.50%) had their ultrasound done and 98 (45.79%) had their P/V done. 132 (61.68%) are advising HPV vaccination to the patients routinely and 48 (22.42%) gynecologists had given HPV vaccination to their daughters.Conclusions: Proper and effective utilization of available facilities would depend on creating better understanding and change in their outlook. Stepping up and strengthening of preventive health care services is essential

Antenatal screening for aneuploidy

Background: It is uncertain how best to screen pregnant women for the presence of fetal Down's syndrome and other aneuploides, whether to perform first-trimester screening or to perform second-trimester screening or both.Methods: Women with singleton and multiple pregnancies underwent first-trimester combined screening (measurement of nuchal translucency, pregnancy-associated plasma protein A [PAPP-A], and the free beta subunit of human chorionic gonadotropin at 10 weeks 3 days through 13 weeks 6 days of gestation). Also, second-trimester quadruple screening (measurement of alpha-fetoprotein, total human chorionic gonadotropin, unconjugated estriol, and inhibin A) and triple marker test was done from 15 to 18 weeks of gestation.Results: 12 (5%) patients had positive screening test for combined screening in first trimester, 6 (10.9%) patients had positive screening for quadruple test while 1 (2.85%) patients had positive screening for triple test. Out of 19 positive screening, 16 (84.21%) had their amniocentesis done for confirmation of diagnosis. In all 16 patients, chromosomal analysis was normal. Not a single patient turned out to have a baby with Down syndrome or any other aneuploidy. False positive rate for combined screening in first trimester was 5%, false positive rate for quadruple test in second trimester was 10.9%, false positive rate for triple marker test in second trimester was 2.85%.Conclusions: First-trimester combined screening is better than second-trimester quadruple test or triple marker test for syndrome or any other aneuploidy