Preferences of eligible women from an Indian medical college hospital for adapting contraceptives

Background: Indian women prefer to avoid unwanted pregnancy, but do not practice contraception adequately. After completing their family size, they are more concerned about terminating their fertility, rather than spacing the births. The main aim and objective of the study is to find out preferences for (a) Regularity if any, of barrier contraceptive usage (b) Use of any contraception at zero gravidity (c) The prevalence of temporary & permanent contraception (d) Prior practice of any temporary contraception before opting for tubectomy (e) Acceptance of male sterilization.Methods: The study was conducted at Obstetrics & Gynaecology department, Chirayu Medical College and Hospital, Bhopal, India. Women in reproductive age group, whether tubectomized or not & postmenopausal women, attending OPD, admitted or those working at the hospital were included. They were given a prestructured, pretested questionnaire. Sociodemographic details, reproductive & contraception details recorded. Analyzed as per the demands of the study objectives.Results: From total 267 study subjects, 81 % were practicing contraception. 103  temporary and  113 had sterilization done. Only 42 % were using barrier contraceptive effectively.46% of the temporary contraceptive users discontinued. There was no significant difference between temporary and permanent method users. 97% did not use any contraception at zero gravidity. 69% of the sterilized population never used any contraception before they underwent sterilization. There was only one vasectomy in 267 study subjects.Conclusions: The contraceptive methods are poorly practiced. The users do not use any temporary contraception effectively & adequately. A negligible percentage of eligible women practice contraception before first pregnancy. Very few women practice temporary methods any time before they get sterilization done. Overall, the concept of spacing is lacking. Women are more inclined towards permanent methods. Male sterilization is very rarely chosen by the couples

Broad ligament myoma at 75 causing clinical, ultrasonic and intraoperative diagnostic dilemma

This case is reported because of the diagnostic dilemma it caused. This is a report of a 75 years postmenopausal female with epigastric pain & old USG report of 4 cms mass in right adnexa, ? neoplastic, done 1 year back. Clinically uterus was atrophic with 4 cms mass in right fornix, mobile, nontender, separate from uterus. CA 125=19.7 U/L. USG showed right adnexal mass of about 4 cms, anechoic,  right ovary was not seen separately, suggestive of right ovarian mass, left ovary normal. Laparotomy was done with provisional diagnosis of persistent postmenopausal ovarian mass. During the procedure the same mass was seen attached to right cornu of uterus. Right ovary was not seen separately. TAH with BSO was done. On dissecting the specimen, the mass & right ovary were found entrapped together in leaves of broad ligament. The ovary & the mass were in close proximity of each other appearing as one; pedicle of the mass was seen attached to right cornu of uterus with a peduncle; quite separate from right ovarian ligament but in its close proximity, both appearing as one. Histopathology report suggested it to be leiomyoma

An overview of women with post-partum haemorrhage in a tertiary care centre at capital of Madhya Pradesh, India

Background: Death due to pregnancy remains an important cause of premature mortality of women worldwide. Post-Partum hemorrhage (PPH) is still most common cause of maternal morbidity and mortality. Attention needs to be paid to the prevention of PPH with organization of continuous in-service training for all the health workers to emphasize early identification of the patient’s at risk, anticipation and corresponding readiness to manage PPH cum active management of third stage of labour. Our institute is a tertiary care centre receiving moribund patients with late referral affecting the outcome adversely. This area needs to be explored methodically. The main objective is to Study the pattern of referred & in-house PPH cases, To re-emphasize the importance of antenatal supervision & anticipating, identifying and managing the complications at the earliest as well as prophylactic management of PPH, enhancing the awareness in this regard. Also to find out if there are situations where early referral to the tertiary care centre could have changed the outcomeMethods: The study was conducted at Chirayu Medical College & Hospital, Bhopal, India.  Retrospective data of all the cases of postpartum haemorrhage from November 2010 – October 2015, whether referred or in-house in the study period was recorded. (n= 37; 2.66%).  Patients’ antenatal delivery & PPH details, management received & maternal outcome were recorded. The data was compiled & analyzed statistically in view of the aims & objectives.Results: 84 % were unbooked, 65% delivered at tertiary centre. 70% had atonic PPH, 46% PPH due to coagulopathy. 65% had severe anemia, ARF in 27%, ARDS in 19%.  65% recovered completely, 16% recovered from PPH & had some persistent morbidity, mortality 19%.Conclusions: The importance of antenatal supervised care under expert’s guidance cannot be overemphasized. Identifying the complications at the earliest can prevent many complications. Timely referral of the obstetric patients to a tertiary centre can save many lives

Gut in the Womb

Dilatation and curettage is one of the common minor procedures with minimal complications but it can cause major complications like perforation of uterus, which is a surgical emergency and the delay in diagnosis and treatment has deleterious consequences for the mother. We are reporting this case of intestinal evisceration & its strangulation in puerpera after surgical evacuation for retained product of conception. This case is reported as evacuation is a commonly done procedure in puerperium for management of secondary PPH, hence want to emphasize that delay in the diagnosis of complications and management can lead to grave prognosis of the mother

Advanced cervical leiomyosarcoma with severe comorbidities: a clinical conundrum for optimal management

Leiomyosarcoma of uterine cervix constitute a very rare but aggressive group of neoplasms of the cervix with poor prognosis. Although recognised as a distinct entity, treatment algorithms and overall management strategies rely on suggestions from uterine counterparts as robust data on management of the cervical leiomyosarcoma, especially when advanced, is scarce. Present case was a 51-year-old perimenopausal woman with acyclic vaginal bleeding and dyspnoea on ordinary physical activity. On examining, a firm hypogastric mass of 14 weeks was found abdominally and a pedunculated, polypoidal hard mass of 5X5 cm with a 2 cm thick peduncle coming out of endocervical canal (confirmed on CT) was noted hanging outside vagina. Histopathology suggested cervical leiomyosarcoma. Triple vessel disease and severe cardiac dysfunction (LVEF=30%) with large left ventricular thrombus rendered the patient at very high risk for mortality during surgery. Systematic comorbidity assessment with due consideration to risk-benefit ratio of all treatment options was undertaken and neoadjuvant chemotherapy was started after multidisciplinary recommendation. Patient tolerated the first cycle of chemotherapy well but died of a sudden cardiac arrest after one week. Advanced age and stage are poor predictors for survival in patients with aggressive cervical leiomyosarcomas, even more so, in those with severe comorbidities. Meticulous clinical evaluation and systematic incorporation of comorbidity indices in decision-making for tailored cancer treatment is imperative in arriving at a justified plan of action for this rare and aggressive entity

Audit of peripartum hysterectomies at an Indian tertiary care centre: a 12-year review

Peripartum hysterectomy is performed in critical conditions like major obstetric haemorrhage, abnormally-invasive placenta, rupture uterus. In developing countries incidence is 0.2–5/1000 deliveries. It can also be done as non-emergent surgeries for suspected cases by pre-planning. If high-risk patients are identified, timely intervention done, yields better outcome. Data of peripartum hysterectomy patients during last 12 years collected. Demographic details, menstrual-obstetric history, high-risk factors, previous and current delivery details, postpartum haemorrhage, indication, operative details of peripartum-hysterectomy, maternal-perinatal outcome, blood loss, anaesthesia records, length of ICU and hospital stay quantity of blood and products transfused analysed. 18 cases of peripartum hysterectomy with incidence of 2.76 per 1000 deliveries     noted. 14-emergency, 4-electively done.  In current pregnancy 13 had caesarean deliveries, 5 had vaginal deliveries, all required emergency hysterectomy. Majority were 26-30 years, 83% multiparous. 11 required emergency hysterectomy. 27.77% were due to atonic PPH and 22.22% placenta accreta spectrum. Mean anaesthesia duration, ICU stay, mean blood loss, units of blood and products was more in emergency group. Maternal and perinatal outcomes were favourable in elective group. Keeping high index of suspicion for accrete, identifying risk factors for atonic PPH, managing proactively, results in favourable maternal-perinatal outcome

Descriptive analytical study looking for agreement between colposcopic cervical findings and cervical exfoliative cytology

Background: To see whether cervical findings on colposcopy & reports of exfoliative cytology agree with each other according to grade of severity.Methods: This study included 306 cases. Data of PAP’s smear reports & colposcopic examination findings collected. Reports of colposcopically directed s cervical biopsy colleected wherever it was done (28). The colposcopic findings were graded according to Reid’s coloscopic index, reports of PAP’s smear classified according to Bethesda system. Data was analysed to find out any agreement.Results: The findings of colposcopy & PAP’S smear reports (n=306) showed significant agreement (p=0.0037). The findings of colposcopy & colposcopically directed cervical biopsy (n=28) were in agreement with each other. The reports of PAP’S smear & colposcopically directed cervical biopsy (n=28) showed agreement with each other.Conclusion: In India, cancer cervix is prevalent. Hence screening & early diagnosis of preinvasive lesions is very important. Colposcopic findings & pap’s smear reports have an agreement with each other. Pap’s is cheap, easily available, not needing specific training, but low sensitivity. Colposcopy is highly sensitive, costly, not available everywhere. Since they have significant agreement pap’s can be given an equivalent place, especially for screening. Its sensitivity can be increased by repeating the smear. It can be combined with colposcopy, where it is available to increase diagnostic yield

Level of acceptance of IUCD insertion in Indian women - a cross-sectional mixed research from central India

Background: In India, knowledge & awareness of IUCD is inadequate. Many misconceptions are present in the society. Health care providers promote sterilization more than temporary methods or IUCD. The objective was to study the acceptance level of IUCD insertion in Indian women.Methods: We conducted a cross sectional study in the dept. of Obstertrics & Gynaecology, Chirayu Medical College & Hospital, Bhopal on 267 women, interviewing them whether they had accepted IUD in past, if yes continued how long. If no, then causes of non-acceptance found out. They were counseled for IUCD insertion at present. IUCD insertion done for those who were willing. Causes of refusal noted for those who did not accept it. Statistcal analysis of results done.Results: 113 women were users of temporary contraception, in general they used it for 178 spacings. IUCD was used for 19.10% of spacings. Out of 267, 11.98% accepted IUCD, 10.48% in past & 1.49% at present; 88% did not accept, p=0.001. Continuation was done by 2.62%. Menstrual problem was the commonest reason for discontinuation. From the total, 231 women eligible for IUCD did not accept IUCD in past. 160 eligible women refused IUCD insertion at present.The difference between temporary & permanent contraceptives was not statistically significant, p=0.82. In the acceptor group, significant difference was found in housewives & working women, p=0.02 & that between BPL card holders & nonholders, p=0.0009.Conclusion: IUCD acceptance was very poor in our study. People consult their relatives/friends more than the healthcare providers in this regard, who tend to spread misconceptions. Healthcare providers need to look into the matter seriously. Promotional activities need to be focused on IUCD

Evaluation of intrauterine pathologies by hysteroscopy in abnormal uterine bleeding

Background: Hysteroscopy is the gold standard for uterine cavity evaluation because it allows direct visualization of the uterine cavity, mitigate characteristics of lesions such as nature, size, shape, location and vascular pattern. Methods: This was a prospective observational study conducted in department of obstetrics and gynecology at Chirayu Medical College and Hospital, Bhopal (MP). Patients presenting to general gyne OPD with abnormal uterine bleeding at Chirayu Medical College and Hospital between January 2021 to May 2022 were studied. All patients selected for study had a thorough evaluation with detailed history, clinical examination, lab tests and sonography followed by hysteroscopy and endometrial biopsy. Results: Mean age of patients in our study was 44 years with majority of patients in 41-50 years age group. Predominant complaint reported was heavy menstrual bleeding (HMB) (47.50%) followed by HMB with frequent cycle (11.25%). Hysteroscopy detected intrauterine abnormality in 42.50% cases. Most common finding on hysteroscopy in our study was hyperplastic endometrium in 17.50% patients followed by endometrial polyp in 15% of patients. Atrophic endometrium was seen in 2.5% and 2.5% had submucous fibroid. Conclusions: Hysteroscopy allows diagnosis or exclusion of intracavitary pathologies, which are underdiagnosed on routine pelvic sonography. It also enables treatment in the same sitting with accurate tissue biopsy from the representative areas and facilitates planning of further management. When combined with endometrial biopsy and pelvic ultrasonography, it can establish an accurate diagnosis in a majority of patients thereby reducing the burden of hysterectomy

Acute abdomen in pregnancy, not to forget twisted ovarian cyst: a case report

Aim of the study was to present a case of acute abdomen in pregnancy with twisted ovarian cyst which is a rare entity. A primigravida with period of gestation 25 weeks presented to casualty with acute abdomen. Her USG Doppler revealed findings of ovarian mass of around 9 by 6 cm which underwent torsion. Patient was taken up for emergency laparatomy. Per operatively right sided tubo-ovarian mass-9×8×5 cm, dumbell shaped, fleshy, hemorrhagic and necrosed with one twist over the pedicle seen separate from the uterus. Left side tubes and ovaries seen normal, uterus-26-week size. Frozen section revealed benign pathology. Postoperatively patient was done well and delivered a healthy baby at term via cesarean section. High index of suspicion, regular antenatal follow up and analysis of related risk factors, early and prompt diagnosis and timely intervention in cases of ovarian torsion in pregnancy can change feto-maternal outcome. Meticulous planning and timely intervention under multidisciplinary care team at a tertiary care centre reduces feto-maternal morbidity and mortality