Demographic parameters of women with uterine fibroids presenting as abnormal uterine bleeding

Background: Uterine fibroids are commonest benign uterine tumors. Only about 25% women with fibroids are symptomatic. Around 70-80% are discovered incidentally during routine pelvic examination. Using ultrasonography screening, some authors have estimated a cumulative incidence of 70% in all women by age 50. Symptoms attributable to fibroids are mainly abnormal uterine bleeding (AUB), pelvic pressure, pain, and reproductive dysfunction. Heavy and/or prolonged menses is the typical bleeding pattern with myomas. Uterine fibroids are a leading cause of hysterectomy in perimenopausal women, thus, this study was done to find out its prevalence and demography in women presenting with AUB. The objectives of the present investigation were to find out the prevalence of uterine fibroid in women with AUB and to find out the various demographic features of womenMethods: The study was done for 2 years in the Dept of Obstetrics and Gynecology of a rural tertiary institute after taking clearance from institutional ethical committee. All the women presenting with AUB were included in the study. History and demographic features was enquired and entered in a predesigned proforma. All women were clinically examined after consent. Women with suspicion of fibroid were subjected to diagnostic modalities and the reports were followed and correlated.Results: Total 11,841 patients came to Gynaeological OPD during the study period. Out of these 3,878 (32.75%) presented with AUB, 2,126 were diagnosed as having fibroids after examination and investigations. Hence, the prevalence of fibroids amongst the women with AUB was 54.82% and 17.95% amongst all gynaecological patients. Maximum women were between 31-40 years, (64.78% rural and 62.73% urban). Majority were having parity between 1-2 (40.73% in urban, 38.96% in rural).Conclusions: Uterine fibroids are the commonest reason of AUB in reproductive age group with the prevalence of 54.82%. The trends in age incidence have remained the same over the years, commonly affecting women in third decade. There is no difference in incidence of fibroids amongst various socioeconomic classes.

Study of sociodemographic factors of women undergoing caesarean section in tertiary care centre of rural area of central India

Background: Many studies have attempted to examine and evaluate the changes in population characteristics that may have contributed to the observed increase in CS rate. The aim of this study was to determine the caesarean section rate and demographic characteristics of women undergoing caesarean section in our rural tertiary health centre of central India.Methods: This prospective study was conducted in department of obstetrics and gynecology. The study instrument comprised a pre-structured data collection proforma which had various sections; social demographic characteristics, obstetric history and gestation details.Results: The overall caesarean section rate (CSR) was 36.88%. Maximum women (39.62%) who underwent Caesarean section were of age group 25-29 years. 58.05% from rural while 41.95% from urban area. CS was more in women of lower middle (22.80%) and upper lower (20.80%) class. Majority of women who had caesarean section were educated till higher school (31.87%) or were graduate (22.61%), 5.85% were illiterate. Majority of women (56.40%) were housewives. CSR was 70.83% in referred and 28.31% in booked. 52.86% women were nulliparous. Caesarean section was maximum (83%) in term, 16.92% preterm women and 0.08% post term women. 38.69% were referred from other health facilities. Maximum referrals 43.21% were from the district hospital.Conclusions: It was noted that the preference for caesarean section is more in women of 25-29 years, lower middle and upper middle class, rural women, educated upto high school and housewives at our centre. This hospital also serves as referral centre from surrounding health facilities increasing the caesarean section rate of the institute

A clinical audit and confidential enquiry of caesarean section indications at rural tertiary health care centre

Background: Worldwide CSR has been steadily increasing beyond recommended level of 15 %by WHO. High CSR have been reported in developed and developing countries. Reasons for increase in CSR are not obvious and somewhat complex. Thus, present study was undertaken to analyze various indications for CS performed at rural tertiary health care centre Sewagram, M.S.Methods: This was prospective study included all women who underwent CS from 1st January 2015 till 30th June 2016. Data was entered in MS excel sheet analyzed with percentage and chi square test using SPSS ver.17.Results: CSR was 36 .88% in present study. As per NICE guidelines CS were classified in four categories based on urgency, women were distributed in each category. Category I had 22.62%, category II -38.61%, category III - 28.37% and Category IV - 10.40% women. In CAT I common indication was foetal bradycardia (71.53%). In CAT II CS, common indication was non reassuring foetal status (38.82%).  Breech presentation (14.74%) and previous scar with doubtfull scar integrity (14.33) were next common indications. In CAT III (43.43%), IV (41.13%) previous LSCS with inadequate pelvis was the common indication. Confidential enquiry revealed that 26.17% (28/107), 20.3% (40/197), 23.17%, (35/151) and 8.3 % (5/60) of CAT I, II, III and IV CS had questionable indications.Conclusions: In this study, CSR was higher than WHO standard. Common indications in primipara was foetal distress while in multiparas primary indication previous LSC

Impact of Round-the-Clock, Rapid Oral Fluid HIV Testing of Women in Labor in Rural India

Nitika Pant Pai and colleagues report the results of offering a round-the-clock rapid HIV testing program in a rural labor ward setting in India

Rationale & design of the PROMISES study:A prospective assessment and validation study of salivary progesterone as a test for preterm birth in pregnant women from rural India

Abstract Background In India, 3.6 million pregnancies are affected by preterm birth annually, with many infants dying or surviving with disability. Currently, there is no simple test available for screening all women at risk of spontaneous PTB in low income setting, although high resource settings routinely use cervical length measurement and cervico-vaginal fluid fetal fibronectin for identification and care of women at risk due to clinical history. In rural India, where the public health system has limited infrastructure, trained staff and equipment, there is a greater need to develop a low-cost screening approach for providing early referral, treatment and remedial support for pregnant women at risk of preterm birth. There is interest in the use of a salivary progesterone test as a screening tool preliminary evidence from India, Egypt and UK has shown promise for this type of test. The test requires further validation in a low resource community setting. Methods The Promises study aims to validate and test the feasibility of introducing a low-cost salivary progesterone preterm birth prediction test in two rural districts in India with high rates of prematurity. It is a prospective study of 2000 pregnant women recruited from Panna and Satna in Madhya Pradesh over approximately 24 months. Demographic and pregnancy outcome data will be collected, and pregnancies will be dated by ultrasound sonography. Saliva progesterone will be measured by ELISA in samples obtained between 24–28 weeks of gestation. The association between salivary progesterone and preterm birth will be determined and the utility of salivary progesterone to predict preterm birth < 34, as well as < 30 and < 37 weeks assessed. Additional qualitative data will be obtained in terms of acceptability and feasibility of saliva progesterone testing and knowledge of PTB. Discussion A validated cost-effective saliva test, which has potential for further adaptation to a ‘point of care’ setting will allow early identification of pregnant women at risk of preterm birth, who can be linked to an effective pathway of care and support to reduce preterm birth and associated adverse consequences. This will reduce both economic and emotional burden on the affected women and their families

Impact of round-the-clock, rapid oral fluid HIV testing of women in labor in rural India.

BackgroundTesting pregnant women for HIV at the time of labor and delivery is the last opportunity for prevention of mother-to-child HIV transmission (PMTCT) measures, particularly in settings where women do not receive adequate antenatal care. However, HIV testing and counseling of pregnant women in labor is a challenge, especially in resource-constrained settings. In India, many rural women present for delivery without any prior antenatal care. Those who do get antenatal care are not always tested for HIV, because of deficiencies in the provision of HIV testing and counseling services. In this context, we investigated the impact of introducing round-the-clock, rapid, point-of-care HIV testing and counseling in a busy labor ward at a tertiary care hospital in rural India.Methods and findingsAfter they provided written informed consent, women admitted to the labor ward of a rural teaching hospital in India were offered two rapid tests on oral fluid and finger-stick specimens (OraQuick Rapid HIV-1/HIV-2 tests, OraSure Technologies). Simultaneously, venous blood was drawn for conventional HIV ELISA testing. Western blot tests were performed for confirmatory testing if women were positive by both rapid tests and dual ELISA, or where test results were discordant. Round-the-clock (24 h, 7 d/wk) abbreviated prepartum and extended postpartum counseling sessions were offered as part of the testing strategy. HIV-positive women were administered PMTCT interventions. Of 1,252 eligible women (age range 18 y to 38 y) approached for consent over a 9 mo period in 2006, 1,222 (98%) accepted HIV testing in the labor ward. Of these, 1,003 (82%) women presented with either no reports or incomplete reports of prior HIV testing results at the time of admission to the labor ward. Of 1,222 women, 15 were diagnosed as HIV-positive (on the basis of two rapid tests, dual ELISA and Western blot), yielding a seroprevalence of 1.23% (95% confidence interval [CI] 0.61%-1.8%). Of the 15 HIV test-positive women, four (27%) had presented with reported HIV status, and 11 (73%) new cases of HIV infection were detected due to rapid testing in the labor room. Thus, 11 HIV-positive women received PMTCT interventions on account of round-the-clock rapid HIV testing and counseling in the labor room. While both OraQuick tests (oral and finger-stick) were 100% specific, one false-negative result was documented (with both oral fluid and finger-stick specimens). Of the 15 HIV-infected women who delivered, 13 infants were HIV seronegative at birth and at 1 and 4 mo after delivery; two HIV-positive infants died within a month of delivery.ConclusionsIn a busy rural labor ward setting in India, we demonstrated that it is feasible to introduce a program of round-the-clock rapid HIV testing, including prepartum and extended postpartum counseling sessions. Our data suggest that the availability of round-the-clock rapid HIV testing resulted in successful documentation of HIV serostatus in a large proportion (82%) of rural women who were unaware of their HIV status when admitted to the labor room. In addition, 11 (73%) of a total of 15 HIV-positive women received PMTCT interventions because of round-the-clock rapid testing in the labor ward. These findings are relevant for PMTCT programs in developing countries